10 September 2020
Honduras’ National Health Code (Decreto Numero 65-91, El Congreso Nacional) establishes the right of citizens to the assistance and care necessary for the promotion, conservation, recovery and rehabilitation of their health. Yet, access to this care remains an ongoing challenge, with more than four in ten of the country’s 9.2 million people living in rural areas.
Noncommunicable diseases (NCDs) are an enormous challenge to Honduras’s health systems. In 2016, NCDs represented more than two-thirds of all deaths in Honduras, and more than seven-in-ten premature deaths. Diabetes is a particular challenge, with more than half the population estimated to be living either without a diagnosis, or an appropriate treatment plan.
Despite the considerable health risks of diabetes, data on national prevalence and management remain extremely poor. Honduras does not have an updated population prevalence of diabetes nationally, with WHO estimating 7.2% of the population were living with diabetes in 2016.
Fact: More than 650,000 people live with diabetes in Honduras, but the majority have either not been diagnosed, or do not have an adequate treatment plan.
Why it matters: A lack of information about diabetes treatment, glycaemic control and complications undermines the effective management of diabetes in the Honduran health system.
In practice: The project created a two-year National Plan and Monitoring Framework, agreed among key Honduran government institutions, to improve diabetes information systems in Honduras, and delivered new equipment to improve monitoring and surveillance.
We estimate more than 650,000 Hondurans are living with diabetes. But the majority of them either have not been diagnosed, or do not have an adequate treatment plan. Strong surveillance and NCD registries are vital to change this.”
Concerningly, a partial population-based survey of diabetes, hypertension, and NCD risk factors conducted in the cities of Tegucigalpa and Comayagüela in 2009 found half of all people living with diabetes did not have an established diagnosis and treatment plan. In addition, the inconsistent data collection that does occur mainly addresses consultations or patient registration, without being able to determine that patient’s pathway.
Timely health information, efficient system management and appropriate resourcing are all needed to enable decision-makers to assess the burden of NCDs in Honduras, and assign government resources accordingly. In this context, collecting, analysing and interpreting data on NCDs and their risk factors is vital.
However, to date Honduras has not had adequate systems to gather information on diabetes care. The information system used to collect diabetes data is inadequate to comply with the standards needed to inform decision-making by authorities and clinicians. Information systems are highly-fragmented, with few data-sharing processes in place.
As three examples:
Until 2018, we did not have a statistical or epidemiological surveillance unit. Since then we have been working to obtain data and information, but our resources are still very weak".
"It is vital to have an integrated information system that gives us information anywhere, anytime. This can permit us to make decisions for such important issues as human resources, medications, and actions. It also allows us to monitor and follow up on clinical management for the benefit of patients.”
A recent project, funded by the Government of Denmark, was granted to a coalition project led by the PAHO/WHO Country Office in Honduras, working with the Ministry of Health (Secretaría de Salud, SESAL) and INADI, and supported by other government institutions.
This coalition had a primary aim to create and agree a national plan for the improvement of the health information systems. To support this improvement, secondary aims of improving diagnostics and monitoring frameworks were also considered vital.
As a first step, activities were carried out to evaluate the available information related to diabetes in the healthcare system, and to improve the capacity and quality of information systems to assist clinical management.
This evaluation shone a light on several areas of need. In response, a framework for the effective surveillance and monitoring of diabetes and its complications was developed and validated by the working-group. This framework contains 21 indicators and 5 annexes, capturing data on aspects such as health outcomes, service productivity and performance, and quality of healthcare delivery.
This framework is important because it allows us to advance a delay: we can now have standardized information from all health facilities as a first step to integrating these systems together.”
To progress this framework, a national plan for the improvement of health information on diabetes care for 2020-2024 was prepared. The plan set out ways to integrate NCD monitoring and surveillance into the existing health system.
It also finds key areas to improve. With technological strengthening as a particular area of concern, a procurement process was undertaken nationally to secure glucometers, biometric identification systems and computer equipment for health facilities.
The national plan to improve health information for diabetes care will help reach people living with diabetes not previously diagnosed, improve patient care, and identify where equipment is needed. Credit: National Institute of Diabetics (Instituto Nacional del Diabético, INADI).
Despite only beginning in April 2020, the project has allowed Honduras to lay the foundations for future action.
Most importantly, a National Plan has been created to develop information systems for diabetes and its complications. This roadmap includes milestones for development, such as strengthening dialysis registries, developing diabetic patient registries at central and regional levels.
While conducted in a very short time-scale, the National Plan will serve as a primer for larger structural developments across the country and rapidly improving diagnosis and monitoring capacity. It is hoped this work will create tangible improvements in both universal health coverage, and give diabetes patients the quality of care they deserve.
Importantly, grant funding has also enabled partners to achieve a technical agreement for the surveillance and follow-up of people living with diabetes, through a National Monitoring Framework.
As Dr. Karla Pavón, director of the Health Surveillance Unit (UVS), Ministry of Health summarises, this technical agreement ultimately means better care for people living with NCDs:
By generating unique information we can support decision-makers in a timely manner. Working with the health networks, we can move forward to detect the NCDs that are taking place all over the country."
Part of this technical agreement has included boosting the capacity for dialysis surveillance. The capacity of the national Dialysis Register is being doubled, through access to ten new biometric facilities that register a patient’s pathway. Ten new computers have also been placed in decentralised clinics, with software that enables data collection in a central database.
What’s more, people living with diabetes are also supported with 270 new glucometers, distributed to primary care and INADI health services to enable point-of-care glycaemic control.
… this project makes a great contribution, and will respond to patients’ needs while ensuring the optimal use of resources that the State invests in diabetes care”.
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