Peer educator networks for diabetes and hypertension
in Cambodia
Health literacy, ICT & empowerment
If there are access-to-chronic-care problems such as…
• costly distance• unreliable drug
supply• unresponsive
services• long waiting
times• over-loaded medical
staff
• exclusion
• lack of certain services
• lack of referral to other specialisations
• over-pricing (cf. reference)
• unnecessary services
• inappropriate information
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….this opens a market for involvement of chronic patients
“Unmet needs” create opportunities… Chronic patients meet at the
home of the community-based Peer Educator
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Tasks of a Diabetic Peer Educator PE core tasks: 1. Organize screening Diabetes, High Blood Pressure & CKD & DBR +++2. Counsel, assess new patient, register: create a record (=EMR)3. Train patients in self-management4. Be intermediary: Make appointments on behalf of patient with Dr5. Follow-up by outreach to patient’s home if necessary;6. Set up Village HBP Groups in each village, maintain monthly visits7. Report monthly to ODPM (OD Peer Network Manager (salaried);
Selected PE extra tasks:1. Some help organize 2x/yr the blood collection for lab service (at Public HC)2. Some help in Medical Consultation sessions (OPD only at Public Hospital)3. Some help supervise & run Revolving Drug Fund (Public + Private)4. Some join in Primary prevention activities
Distribute voucher to the poor patients for 70% discount on medicines (Revolving Drug Fund)
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From 2005 until October 2013: 15,539 members
11 sub-networks in 13 health districts (OD’s)AREAS:
o Phnom Penh (3 OD’s) : 5 poor areas (1 OPD)
o Takeo province: all 5 OD (6 OPD’s)o Banteay Meanchey : 1 OD (1 OPD)o Kompong Speu : 2 OD‘s (2 OPD’s)o Kompong Thom : 2 OD’s (2 OPD’s)SERVICE INFRASTRUCTURE:o 22 Contracted pharmacies (4 public)o 12 OPD’s in Public Referral Hospitalso 129 Peer Educator (129 HC areas)o 553 Village HBP Groups BENEFICIARIES per October 2013:o 537,883 adults self-screened (UG
strip)o 8,369 DM patients registered
338 DM self-injecting Insulino 7,170 HBP patients (non-diabetic)
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Health Literacy in Outputs & Outcome Re-assessments + Rewards (yearly..?)
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1. Physical Outcomes (15)
2. Patient Book filled (3)3. Nutrition habits (7)4. Physical activity (4)5. Medical care (6)6. Knowledge of disease
(3)7. Feeling well (5) Total = 43 indicators
ICT for empowerment of: 1. Groups & 2. Individual Patients
•
Database
“internet”
Registration data (1st
assessment by PE) createsE.M.R.
Laboratory
Profiles
Medical Consultation + Prescribed Medication Retail
Pharmacy invoice
data
Self -Management data (via PE follow-
up)
Integration TYPES of data: 1. Clinical + 2: Self-Management + 3. Medicine Supply + 4. Use
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Use Database as a tool… :• Calculate supply needs Revolving
Drug Fund • Measure % adherence to prescribed
medication• Measure performance by main
actors by area– Patients themselves– PE’s (degree of patients under control) – Doctors’ prescribing– Pharmacists dispensing
• Determine financial rewards for the main actors
• Long term cohort records• Measure use of special
subsidies/discounts
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Example 1: ICT for group power
Generates data for financial reward : (A + B)/2 * C A) % of Satisfaction among patients who used public pharmacy at least 2 times (PE-routine-survey);
B) % of Adherence to prescribed medication over past 12 months
C) multiplied by 15% of the value of dispensed medication to chronic patients over the same period;
Reward was SHARED as Payment for Performance among:Provincial Health Department, 1%Operational District Office, 3%User Fees of the Public Hospital, 36% Pharmacist of the Public Hospital 60%
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Example 2: ICT for individual power
Laboratory profile :
• In Khmer Language• Result Trend over
time• PE trained to
explain and counsel• Lab profile offered
at 30% of market prices
• External Quality Assurance System11
final slide ! Sustainability & AcceptabilityActivity 4 new
market(s)Policy Status
ICT-role
Peer Educator Networks
Financially sustainable from RDF-mark up. Alternative via local governments ?
National MoH Policy (07.11.2013)
Database holds it all together ; barcodes;*PE Smartphone
Revolving Drug Fund (RDF)
Financially sustainable. Below market prices.It can also handle complementary Gvt supply
T. B. D.No alternative that works well.
Transparent system;POS-Automation Software applicationsInternet
Public Hospital OPD’s
Financially sustainable, perhaps under-minable;
T.B.D. Not yet tried
Laboratory Service
Financially sustainable. At 30% of market price, no competitor is interested…
Continue as not-for-profit provider
DatabasePotential for more*PE smartphone
Re-assessments & Rewards
Financial sustainable but depends on RDF (ideal?)
TBD How adaptable is our database?
Supervision by local Gvts
Interested and open to take on a new role
OD is supervisor of Peer Educator Netw.
Database to be installed at OD
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