Success story of Bangladesh should be an eye opener for countries with limited resources

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 Ibrahim Model of sustainable healthcare, Prevention and Management of Diabetes

Success story of Bangladesh should be an eye
opener for countries with limited resources

With proper planning and dedicated leadership, it is possible
to create healthcare for diabetes and other chronic
disease even in poor countries

Diabetic Association of Bangladesh has shown that NGOs can
do a lot and it is futile to expect the Government to do everything

KARACHI:  Developing countries like India, Pakistan, Bangladesh with limited resources are faced with the lack of care for life long chronic diseases like diabetes, hypertension. These diseases have now become an epidemic but this epidemic is rising faster in the developing countries. Bangladesh Diabetic Association has created a sustainable model of healthcare which is known as Ibrahim Model in Bangladesh.  Through this model, Bangladesh Diabetic Association is at present looking after over 35% of people with diabetes and hope to increase this coverage to 50% by 2020. This was stated by Prof. A. K. Azad Khan, President of Diabetic Association of Bangladesh. He was making a presentation in the first plenary session  on “Diabetic Care development in  Resource constraint Region” at the recently held International Conference  of Diabetes and Endocrinology (IDEC 2016) organized by Baqai Institute of Diabetes and Endocrinology (BIDE) in collaboration with some other institutions  held here from August 19-21st 2016.

Prof. Azad Khan

Prof. Azad Khan gave a historical background to the development of this service in Bangladesh under the devoted leadership of late Prof. Mohammad Ibrahim and the facts and figures which he presented along with the services being provided must have come as an eye opener for all the delegates from different countries attending the conference particularly those with limited resources.  Usually people and professionals in these country expect and demand the Government to do this thing and that thing but Diabetic Association of Bangladesh has shown that the NGOs working under the honest, sincere, devoted leadership can do a lot and it was futile to expect and ask the government to do everything.

Prof. Azad Khan pointed out that rapid urbanization, change in life style, increase in population and increase in life expectancy have all increased the prevalence of diseases like diabetes in these countries.  Hence, a different health system is required to prevent and manage diabetes. Bangladesh Diabetic Association through BIRDEM was the largest diabetic care provider in the world today which has affiliates in sixty one districts and seven sub-affiliates. 

 

Clinical Practice Guidelines for Diabetes being discussed during one of the 
sessions at the IDEC 2016 organized by BIDE at Karachi from 
August 19-21st 2016.

Giving details of the Ibrahim Model, Prof. Azad Khan mentioned organizational set-up with democratically elected leadership interested in social development and healthcare ensuring community ownership, Decentralization of the association set up, healthcare and educational institutions and financial sustainability.  Diabetic Association of Bangladesh at present owns one hundred nine institutions, 3672-Bed Hospital providing primary, secondary, tertiary care in all disciplines including organ transplantation, cardiac surgery including interventional cardiology procedures like angioplasty and stenting. It has developed capital with government assistance and with the help of philanthropists. Running cost of these institutions is met through cross financing from surplus generated from rich patients, non-diabetic patients as well as diagnostic services. In order to create manpower, it has established three medical colleges, developed eighteen postgraduate programmes, courses on allied health sciences at its own university. It also runs a certificate course for graduate doctors in diabetes and so far over ten thousand doctors have been trained. It has prepared a National Policy on prevention of diabetes. The decentralized model is a success. The leadership works voluntary and do not draw any benefits from the Association.

Explaining the functioning of these associations at the District level,  Prof. Azad Khan said, they are  independent and run by local leadership which is provided help and technical advice, assistance from the Center. These associations generate their own funds. BIRDEM has over 4,500 patients who visit its OPD daily. The association has also developed Rehabilitation and Vocational Training Centers for young diabetics. BIRDEM is also working as a WHO Collaborating Center. In the extended diabetic care, we plan to have one accredited diabetes specialist in every city. It has e learning programmes for those who have qualified diabetes course and for other disciplines. Diabetes Educator, Prof. Azad Khan emphasized was the most important member of the diabetes care team. Doctors are too busy and cannot do patient education. We have also made it mandatory that every diabetic center in order to be recognized by us must have a Diabetes Educator. He also referred to Health Insurance scheme for Garment workers which is funded by the Government of Switzerland.

We make use of the latest technology, hence we have managed to provide healthcare through mobile phones and call centers connecting the care to the newly created doctor’s network of certified physicians. We have combined distance learning with distance clinical care. Ibrahim Model,  Prof. Azad Khan further stated has shown that with proper planning and dedicated leadership, it is possible to create healthcare for diabetes and other chronic disease even in poor countries.