MoPoTsyo Patient Information Centre

Our mission is to improve access to reliable information and self-management skills for Cambodian diabetics and high blood pressure patients, especially those who are poor. We want to make living with diabetes and other chronic diseases more affordable and feasible for Cambodians including for those who are poor. Based on our experience in Cambodia since 2005, this can best be done by involving people who have the chronic disease themselves. With engagement and training passive diabetes patients can recover from their disease and become active people able to manage their disease and share their knowledge and skills with others. We want to help more chronic patients and this means that w...

MoPoTsyo Patient Information Centre
262, Street 138
Tik Laak 2, Khan Tuol Kork
Phnom Penh, Phnom Penh 1000
Cambodia
85512800322
http://www.mopotsyo.org

Project Leaders

Maurits van Pelt

Mission

Our mission is to improve access to reliable information and self-management skills for Cambodian diabetics and high blood pressure patients, especially those who are poor. We want to make living with diabetes and other chronic diseases more affordable and feasible for Cambodians including for those who are poor. Based on our experience in Cambodia since 2005, this can best be done by involving people who have the chronic disease themselves. With engagement and training passive diabetes patients can recover from their disease and become active people able to manage their disease and share their knowledge and skills with others. We want to help more chronic patients and this means that we need to grow in terms of geographical areas that the networks cover and in terms of "associated disorders" that we cover, for example early diagnosis of Chronic Kidney Disease, Retinopathy etc. MoPoTsyo patient information centre 12 Work principles 1 Creating opportunities for poor people to get their disease diagnosed, creating access to treatment and getting patients organized and involved 2 Developing disease modules with as much participation of the users as possible 3 Increasing awareness of the risks of disease complications, strengthening capacity to self-manage, stimulating people's sense of responsibility to slow disease progress 4 Working towards a care model which keeps the costs to patients as low as possible 5 Coaching and teaching by trained peer educators living in the community 6 Decentralizing skills and services to organized patient communities 7 Mobilizing and supporting volunteers among patients 8 Making the essentials affordable, enabling the poorest to pay, exceptionally and temporarily providing financial assistance (like an "equity fund for diabetes") but without removing individual responsibility 9 Demystifying the medical business around the disease but without reductionism of the disease's real mysteries while strengthening recognition of medical competency 10 Strengthening the basis for trust between patients and qualified health service providers 11 Creating an "informed demand for health services by appropriate health service providers" by planting "informed seeds" inside communities who are capable, credible, active and ready to share 12 Applying a holistic "people centred" approach, in which medical interests have their appropriate place. Charter: MoPoTsyo patient information centre Charter 1 MoPoTsyo aims to provide reliable information to patients living with chronic diseases, especially the poor who are not aware of their diagnosis. 2 MoPoTsyo is an independent non governmental not for profit Cambodian organisation. 3 MoPoTsyo is based on volunteer networks at grass root community levels in deprived areas; 4 MoPoTsyo organises courses for chronic patients given by chronic patients suffering from the same disease, adapted to an participating audience of poor people; 5 MoPoTsyo advocates for more and better policies, more and better use of resources, more and better laws and regulations to protect patients with chronic diseases; 6 MoPoTsyo is a transparently managed organisation that is regularly held accountable by the board and the members for the use of its resources and the performance; 7 MoPoTsyo does not discriminate on the basis of sex, religion, race, nationality and gives priority to the most vulnerable;

Programs

In Cambodia, diabetes is a devastating disease. Expensive clinical care is accessible only to the urban rich, while the average person in rural areas (let alone the poor!) remains untreated and die very prematurely depending on the severity of their disease. The Cambodian organisation, MoPoTsyo, has created an innovative solution that has already saved thousands of lives but many areas are not yet covered. In the early nineties, Cambodia's public health system started to be rebuilt after decades of war. Health experts and international donor agencies designed a system in which most resources went to combat communicable diseases. Non- communicable diseases, many of which are chronic conditions, were largely ignored. A prevalence survey carried out in 2010 showed that as many as 2.3% of rural Cambodians aged between 25 and 60 had diabetes and that 10% had hypertension. While the prevalence of these conditions is not particularly high in comparison with other countries, what is worrying is that a comparatively high number of lean Cambodians suffer from diabetes and hypertension. The reasons are unknown, but experts attribute it to a genetic predisposition combined with environmental factors. Cambodia's post-war public health system is not fit for purpose in that it does not know how to deal with patients suffering from chronic diseases such as diabetes. Health reform is needed urgently as the society rapidly modernises and lifestyles change. Diabetes is one of Cambodia's silent killers - the great majority of patients go undiagnosed. The average reported history of diabetes in a group of more than 500 patients who registered at Kossamak National Hospital was just four years. Only one in ten patients reported a history of more than ten years. This suggests that most people with the disease live for only a short time after contracting the condition. As well as killing otherwise healthy adults in the prime of their productive lives, the fallout of diabetes drains households of their assets. Parents are forced to take their children out of school to work and supplement the family's income. Livestock and even land are sold to pay for treatment, leaving debts that can never be repaid. There is little protection against such costs. High-risk debtors - which poor people typically are in the eyes of their creditors - pay the highest interest rates: 2% per day is not unusual. And when interest rates are high, poorer patients lose any assets they might have. Losing land is a growing problem for the rural people. Landlessness rose from 13% in 1997 to 20% in 2004, and experts speculate that this has already risen to 30%. According to a much-quoted survey, half the rural poor who have lost their land blame it on health care costs. Treatment for diabetes is based on medication and monitoring by clinic-based professionals. But in Cambodia, only well-off city dwellers can afford regular medication - insulin in the private sector costs US$16 for 10 ml, without the syringes. The MoPoTsyo solution Cambodian non-governmental organisation, MoPoTsyo, came up with an alternative to expensive clinic-based support. They started involving 'experienced' diabetes patients in the early diagnosis, treatment and education of new patients. This experimental programme started in 2005 in two slum areas in the capital, Phnom Penh. It gradually expanded into five slum areas and by June 2007, the first rural project had begun in Takeo province, about 100 kilometres south of Phnom Penh. At the start of 2012 there were expanding Peer Educator Networks in 8 districts in 4 provinces with more than 8,000 registered chronic patients who have diabetes, high blood pressure or both. They can all learn how to self manage from the trained peer educator in their own community. The proximity makes that they do not have to travel far to get the support and basic care that they need. The core of the programme consists of community-based peer educators who have diabetes themselves, but who are managing their own symptoms well. They receive a six- week training course, after which they take an examination. These trained patients form Peer Educator Networks (PENs), and their homes become weekly meeting points for diabetes patients living in the community. The peer educators visit people at home and help to increase awareness of the disease. For early diagnosis, they hand out urine glucose test strips, and do blood glucose tests. This screening helps to identify who is diabetic. Anyone whose blood glucose levels show diabetes can register with the patient information centre. Membership is free and there are more than 70 peer educators running patient information centres from their homes, with a total membership of 4,000 diabetics. The income needed to run the programme is generated by providing services to registered patients. MoPoTsyo acts as an importer and wholesaler of routine medication, which is sold to the pharmacies in the communities where the peer educators are active. These contracted pharmacies sell the prescription medicines to the registered members and peer educators at the lowest possible price. The payment scheme for peer educators is innovative too. Peer Educators receive small incentive payments based on their reported activities through a monthly money transfer by mobile phone. Peer educators whose patients have the best health outcomes - in terms of knowledge and understanding, blood pressure, blood sugar and weight control - receive higher rewards. Twice a year, peer educators from another province evaluate the work of their colleagues by assessing random samples of patients. Peer educators also help patients navigate through Cambodia's largely unregulated health system. They help new patients to find the health service provider that gives best value for money. This can be a provider trained by and paid by the PEN, or a recommended affiliated provider. Once detected with diabetes, patients are coached so that they will know how and where to get what they need from the health service. Peer educators try to protect vulnerable diabetes patients against buying services from untrustworthy health care providers. Patients outside the system continue to pay too much for very poor quality care. But informed patients who are members do not just save money, they are healthier, more confident and better equipped to voice their concerns and improve their situation. The financial advantages of being registered with a PEN help to keep patient retention at about 90% annually. According to a study carried out by Chean Men, a senior researcher at the Center for Advanced Study in Phnom Penh and a member of MoPoTsyo's board, the average monthly spend on routine medication for PEN members is US$4 - before registration, they would have been spending about US$12. Peer educators run courses to help patients learn about their condition, but for many patients, the personal contact between them and their trusted peer educator is just as important, especially in the early stages. Patients build up a practical understanding of how they can control the disease and slow its progress. Courses given by the peer educator consists of six sessions: 1. An explanation of basic human biology 2. How diabetes affects the body's mechanisms 3. How to restore and keep the blood-glucose balance (physical activity, food intake and medicines) 4. The various types of medicine and their roles 5. Nutrition and healthy eating for Cambodians with diabetes 6. How to self-test, set targets, self-measure and record progress The courses emphasise the importance of lifestyle changes. Most Cambodian diabetics do not realise that white rice, particularly Cambodian rice, is highly glycemic, meaning that the large quantities of glucose in the rice are very quickly released into the blood stream. Cambodians take more than 80% of their daily energy from white rice. MoPoTsyo's food pyramid is a great help for the patients too. Every registered patient receives a poster showing where commonly eaten food items are on the glycemic index: highly glycemic foods are shown in red at the top of the pyramid, and foods with a low glycemic index rating are shown in the green layer at the bottom. The pyramid helps hyperglycemic (type 2 diabetes) patients to bring their glucose levels down by encouraging them to replace white rice with healthier sources of energy. In rural Takeo province, over 70% of people diagnosed with diabetes had been unaware of their condition until they were detected by the peer educator. Early diagnosis is a key step in the prevention of complications, especially because the screening activity is combined with access to affordable care. Independent assessments based on random samples of registered patients show a relatively consistent pattern of health improvements. Despite low levels of literacy, PEN members have a better understanding of their condition and of how to improve their health and lifestyle. Taken together in all random assessments, average blood glucose and blood pressure levels improve significantly after registration. The vast majority report that they are more physically active and are eating less white rice than before. Studies show that there are also fewer episodes of hospitalisation after registration with a PEN. Health expenditure is reduced by a factor of three. The PEN approach challenges the widespread notions that diabetic patient populations can only be reached effectively through professional health services, and that any strategy aiming to deliver secondary prevention requires investment in clinic- based care and the strengthening of the capacity of professional health service providers. The results achieved by the PENs provide a strong case for attempting to scale up this initiative.

Statistics on MoPoTsyo Patient Information Centre