The Africa Diabetes Leadership Forum: Johannesburg Sept 30-Oct 1, 2010

At the referral of several of my interviewees, Novo Nordisk and the World Diabetes Foundation graciously invited me to their Africa Diabetes Leadership Forum hosted in Johannesburg this September. The goal of the event was to bring light to critical needs and best practices on diabetes programs and policies in Africa. In addition, nearly every health Minister of Health of the African region was present to recognize the importance of diabetes in their national priorities and agenda.

 

One of the first speakers was the First Lady of the Republic of South Africa, Bongi Ngema. She first began with a personal story talking about lifestyle change. Cooking oil must be used in moderation. Gardens must be planted. People must change their behavior. She then continued to address her dedication to women with diabetes in their families and gestational diabetes as a priority for the country and region.

Professor Pierre Lefébvre later conducted a very moving speech that simplified many of the concepts and difficulties I had seen throughout my research. He compared diabetes to a tsunami. What we are seeing now is the very splashes of a wave that is going to rupture the health of our communities. He presented a model for thinking about success as it pertains to diabetes programs. E= MC² or Excellence = Money/Manpower X Committment². Commitment is critical to using the resources available to us to achieve our goal.

Lise Kingo, the Executive VP and Chief of Staff of Novo Nordisk went on to describe the corporate involvement in addressing diabetes needs through the World Diabetes Foundation (WDF). Novo Nordisk’s extensive work in diabetes since 1923 has proven that diabetes “hits the poorest countries the hardest.” It prevents children from going to school, disables parents and grandparents, and kills friends and neighbors through lack of detection and availability of treatment. Ms. Kingo described Novo Nordisk’s “triple bottom line” that measures overall company performance along three axes: financials, social responsibility, and environmental responsibility. Their programs through the WDF are funding a substantial portion of all diabetes programs globally addressing affordability, health system strengthening, the most vulnerable of patients, and advocacy/awareness campaigns at the country level.

The goal for the forum and outcome is to establish sustainable and LOCALLY owned programs and policies. The WDF has helped countries all over the world with leadership forums (NY, Moscow, Beijing, Johannesburg, Dubai) identify a holistic approach with partnerships and metrics to execute on a vision. She ended with a lovely African proverb, “if you want to walk fast, walk alone; if you want to walk far, walk together.”

Prof. Jean Claude Mbanya, President of the IDF, continued with some additional points specific to Africa. In his perspective, the young working population is the most vulnerable and likely to develop Type 2 at rates never before seen in Africa. The second are children with Type 1 diabetes – for them this is a death sentence without resources, education, and affordability. Jean Claude also described diabetes as an inherent threat to many current infectious disease efforts. This was an interesting take and was built on later by Knut Lönnroth and Frank Mwangemi who discussed TB at the World Health Organization and HIV/noncommunicable disease integration respectively. We also went through a detailed “lessons learned” from HIV in the region from Miriam Rabkin.

George Alleyne of PAHO (Pan American Health Organization) discussed “knocking on an open political door” and described what are traditionally referred to as noncommunicable diseases (NCDs) as the neglected chronic diseases (NCD) since they were originally neglected from the Millennium Development Goals. This “dual disease burden” of infectious disease and chronic disease must be addressed through scoped 1. Programs, 2. Funding, and 3. Impact (public health, financial, reach, etc.). Incentives MUST align to accomplish long-term goals. George reinforced the need to generate Activity with IMPACT vs. Activity with intention… a route which has been pursued by many who have fought to get the resources and programs on foot to date.

From what I could discern, each country would have to develop at a minimum (1) a public health and financial business case for diabetes and NCDs, (2) agreement and alignment of public-private incentives and goals, and (3) definitive goals and metrics to which success would be evaluated. Ideally, each country would also start with a clear baseline of data indicating the size, location, and areas of greatest need.

A pleasant surprise during the day was Derek Yach, the Director of Global Health Policy at Pepsi. A South African native having spent the majority of his career at the WHO, Derek is committed to reshaping Pepsi as a sign of hope for the future of humanity vs. a threat to humanity. “Every 30 seconds a limb is lost to diabetes,” he describes. His team is working with the company’s R&D to cut billions of calories in Pepsi’s food portfolio. The food industry has enormous power to shape how and what we eat – and this will benefit millions of people globally if they are able to successfully make healthy foods that people want to eat. Even starting with Pepsi Max in developing countries might help – diet sodas in general are very difficult to find and at times more expensive as the demand is low.

In the evening Tshepo Musese, a South African musician and actor with Type 1 diabetes, shared a moving performance that highlighted some of his experiences including: weight loss, fear of needles, family challenges, affordability. 

The second day of the forum was dedicated to best practices sharing which included a number of my previous interviewees including Dr. Eva Njenga, Atieno Jalango, Dr. Maina, Mrs. Eva Muchemi, Dr. Francois Bonnici, and Professor Rheeder. Segments included examples of programs or policies across the following:

• General awareness education
• Exercise
• Nutrition
• Training healthcare workers
• Early detection / screening
• Treatment protocol / coordination
• Patient empowerment / compliance
• Quality of resources / data
• Complications prevention and management

At the end of the forum the general consensus was that the event was enormously successful. Africa is on its way to developing national and a larger regional strategy for diabetes and other NCDs (both noncommunicable diseases and previously neglected chronic diseases).

IDF has published a Summary Report for the forum online.