Oman Findings: Big Need, Bigger Opportunity

Oman has one of the highest prevalence rates for diabetes of any country globally. Although a country of only 2.8M, an estimated 12-16% of the entire population is affected with even higher prevalence rates for hypertension and CVD. The need for diabetes and chronic disease interventions is unquestionable. I met with Dr. Mohammed Lamki, head of the Oman Diabetes Society in Muscat and was amazed and impressed by the awareness of this need and current efforts to strategically address the population across the spectrum of prevention, early detection, treatment, and compliance.

Much of this has to do with the fact that diabetes has been on the radar for Oman since 1991. Almost 20 years ago a survey was published in Diabetes Medicine that revealed a 9.8% prevalence rate among a sample size of patients in Oman. At that time, these rates were not tracked in this region and provided an awakening around the unusually high hereditary propensity for diabetes.

A Hopeful System:

Currently the majority of diabetes patients are detected in Oman when they develop complications such as loss of vision, foot numbness, and kidney problems (it is estimated that 50% of patients on dialysis have diabetes). This indicates that these patients’ conditions have already progressed to a point of no return, but there is still hope that they can slow down the progression of the disease. This is fairly common among most of the countries I have visited, with only a few select communities that have succeeded in pushing patients into the diagnosis / treatment process before complications appear. What does this mean? HUGE opportunities for early detection and prevention for the onset of diabetes.

What is even hopeful to me, is the healthcare system itself. Oman covers all healthcare for patients through the government system, including insulin, glucose monitors and oral medications for diabetes, such as metformin. This relieves a large barrier of affordability present in most countries. Patients can, of course, pay out of pocket for more expensive brands or products such as fast-acting insulin or insulin pumps. In addition, the average GDP per capita is much higher than a number of other countries I’ve visited to date reducing the barriers for more expensive therapies.

Training a Diabetes-Ready Healthcare Workforce:

Dr. Lamki’s vision is to prepare Oman for high-quality, large-scale diabetes care. Formally launching his diabetes educator program and website this week (June 22^nd) he has been working to build a state-of-the-art Diabetes Institute in the Royal Hospital in Muscat as a comprehensive care and teaching facility for the country.

His approach is similar to that of some of Project HOPE’s programs in India and China. With a focus on building capacity within the nursing community as diabetes educators, the new training program will enhance the access and quality of care in secondary and primary care centers in both urban and rural areas. What was very apparent was his strong belief in the role nurses (not physicians) play in diabetes treatment. “I believe in nurses, not doctors.”

Working with a educationalist in the MOH, John Kelly, they developed a curriculum for an 8 week diabetes education program: 2 weeks of instruction, 6 weeks of practical experience. The need for “practical” education was a high priority as well. Diabetes is a complicated disease – it can’t just be taught theoretically – this program gives nurses the opportunity to train under experienced nurses to see how it’s done: learn, see, do. The goal is to standardize some of the tools available to health facilities around the country as well and provide easy access to experts through a national center of excellence.

I spoke with the Director of Nursing Programs in Oman’s MOH later to discuss his perspective on the program. With areas like foot care as a large need (there is a huge shortage of podiatrists in the region), he expressed the ministry’s interest in expanding homecare efforts where inpatient capacity is constrained. I also learned that they have a post-graduate training for nurses and GPs to provide chronic care in the community. The 1.5 year educational program includes instruction and practical experience (similar to the diabetes model) focusing on a multidisciplinary approach to treating multiple risk factors. These are all noteworthy initiatives to help patients with diabetes (and other chronic diseases) in the region.

How can Project HOPE Help?

Going through the actual diabetes training curriculum with Mr. Kelly, we discussed several opportunities for how Project HOPE could bring its expertise and experience to benefit the current efforts in country. I had limited previous knowledge of an educationalist’s role in healthcare, but Mr. Kelly explained his “patient journey” or care path approach to designing educational programs for a variety of health programs. The training structure is planned by starting with the capabilities required of the healthcare worker - what skills are needed from the moment the patient enters a health facility.

What I noticed is that the proposed curriculum is very similar to Project HOPE’s current training programs in India and China related to diabetes. Although Oman’s MOH has developed the curriculum, they have yet to fund and develop the actual content to deliver the course. This could be an opportunity for Project HOPE to partner with Oman’s Diabetes Society to leverage its strengths and experiences in other regions to reduce the time and resources needed to execute Oman’s goals for the training institute.

Additionally, Dr. Lamki expressed an interest in learning more from Project HOPE about actually running a diabetes education program on a day-to-day basis. Technical expertise and management experience could greatly benefit Oman as they start-up and refine their program over time. Outcomes could also be a promising sub-focus within the project management. As Project HOPE has started conducting outcomes research on patients who benefit from diabetes education – outcomes research could be implemented to evaluate success within Oman’s Diabetes Institute. Good results could also set the stage for an exemplary model and standards of outcomes for the region.

Project HOPE also worked with the International Diabetes Federation in India to acknowledge the diabetes educator program as compliant with global standards. This process could be facilitated in Oman with Project HOPE’s experience and understanding of IDF’s requirements and program goals.

Integrated Chronic Care for the Long-Term:

Educating GPs and patients may be a long-term strategy for chronic care in Oman. Because the disease prevalence is integrated across chronic conditions, chronic care educators may be the future model to address multiple risk factors, early detection, treatment, lifestyle change, and patient empowerment across the continuum of care. With nurses as the soldiers of healthcare fueling the educational systems in health, it is difficult to pull patients into the system without increasing awareness among the primary healthcare system and patient communities.

That being said, you have to start somewhere! I applaud Oman’s current efforts and look forward to seeing the impact over the coming years. Whether in an advisory role or implementer of programs, Project HOPE has an opportunity to assist and contribute to success throughout the journey…