How to improve access to affordable and quality diabetic services

In Summary

• Diabetic patients have been given a wide berth to shoulder individually the encumbrance of medical cost especially in this pandemic period

• Studies have shown that approximately 20 per cent of persons hospitalised as a result of Covid-19 have diabetes comorbidity.

A blood test is carried out during a past even to mark the World Diabetes Day.
A blood test is carried out during a past even to mark the World Diabetes Day.

Diabetes, which is one of the Non-Communicable Diseases (NCDs) has been known to exert a more pervasive and catholic global burden on humanity and society even before the declaration of the Covid-19 pandemic.

As the world limbers up to commemorate World Diabetes Day (WDD) on November 14th, it will be prudent for everyone to be incognizant that diabetic patients have been perversely on the receiving end of Covid-19 ire.

Astonishingly, just like any other NCD, diabetic patients have been given a wide berth to shoulder individually the encumbrance of medical cost, especially in this pandemic period.

The parochial view that diabetes is associated with elite groups should be demystified in the context of the report released by Lancet journals in 2017 focusing on Sub-Saharan Africa (SSA) where the poverty rate stands at 41 per cent.

Sadly, low and middle-income countries are projected to experience the steepest increase of diabetes as they transition to lower-middle- and upper-income status. Individuals with diabetes are at increased risk of developing diabetes-related complications as a result of the Covid-19-related conundrum.

Studies have shown that approximately 20 per cent of persons hospitalized as a result of Covid-19 have diabetes comorbidity and approximately 26per cent of individuals who die from Covid-19 have diabetes.

Diabetes burden is further exacerbated by figures shown through a review done by Mercer et al., in 2019 which indicated that more than two-thirds of individuals in SSA with diabetes are undiagnosed.

This vividly forewarns that there is expansion of diabetic epidemic that is likely to devastate health and economic consequences for the region unless quick and decisive action is taken to turn the tide.

The government recently launched a biometric registration for universal health coverage (UHC) scheme beneficiaries in Mombasa County.

During the momentous occasion, the president extolled the success story of UHC (one of the ‘Big Four Agenda’) implementation from the four piloted counties, lessons learnt propelled him to categorically scale up the implementation of UHC delineated to five major pillars.

On the fourth pillar, he emphasized that the ‘implementation plan has adopted the Essential Health Benefits Package which will cover non-communicable disease management among others at a low cost of 6,000 Kenya shillings per household per annum.’

This call will augment the national strategy for the prevention and control of non-communicable diseases 2015-2020.

However, we should be vigilant on how we reify the words of the president since Kenya is renowned to put down edifying policies but dismally develop implementation slough.

As the theme suggests, “nurses make the difference”, it is imperative for all the stakeholders to synergize their efforts geared towards making a difference to both the caregivers and patients.

All of us must cogitate about how the increasing prevalence of diabetes can be delayed, prevented, and hopefully reversed.

The national strategic plan envisioned a framework of prevention and control which is anchored in three domains that include: Disease prevention and health promotion, early diagnosis and control of NCDs through health system strengthening and monitoring, surveillance, and research.

All three domains are intertwined to ascertain that we have identified people who are not yet diagnosed and those at high risk so that the medical community can intervene early before they are left needing treatment for diabetes complications when it is already too late.

Additionally, the domains will make sure the already diagnosed are receiving quality care services and moreover, zero increase of diabetes/obesity as per global 2025 NCD targets.

It is my clarion call for the national government and county governments to be deontic and consider duly implementation of the policies and strategic plans for NCD.

This can be done through the allocation of budget and resources to avert out-of-pocket expenditure on NCD, which has impoverished over one million Kenyans due to high health expenditures as alluded by the president during the launch of biometric registration for universal health coverage scheme beneficiaries in Mombasa.

Diabetes Commodity Security and Cost

One of the challenges that flawed the implementation of the UHC in the four piloted counties was commodity security or rather health products and technologies.

Inconsistent and irrational supply chain marred the realization of UHC.

The national and county governments should consider to reduce the cost and assure common ‘mwananchi’ of the availability and access of quality drugs (i.e. Insulin etc.) and diagnostic technologies.

Prevention is better and cheaper than cure, it is our civic responsibility to strive and support improved lifestyle like physical activity and dietary choices to avert type 2 diabetes which is steadily flying under the radar with warning signs and symptoms not obvious.

As the governments play their role, families also have their critical role to play in supporting any family with diabetes to help that individual to manage their condition.

In conclusion, due to the vulnerability of the diabetes patients, epistemically, the only humane way to celebrate this day is to break the adage of quid pro quo and don your mask appropriately covering your mouth and nose in order to save a diabetic patient from contracting Covid-19. 


James Marcomic Maragia - Turkana County Medical Laboratory Coordinator.