Life Competence: the Diabetes example

Many of us, since beginning the journey towards AIDS Competence, have come to realize that this process is applicable to other health and social issues. The Roll Back Malaria programme has spearheaded this new development by adapting the AIDS Competence Process to Malaria in November 2005.

For some months, the Constellation for AIDS Competence has been working with Handicap International on the adaptation of the AIDS Competence Process to the prevention and care of Diabetes at the local level. The initiative started in April 2006 in Manila (Philippines) where Dr Jean-Louis Lamboray presented the approach during a large meeting mainly attended by representatives and partners of Handicap International from various countries.

The International NGO decided to be involved in the prevention of diabetes at the local level based on the fact that the impact of diabetes on communities in developing countries is beginning to be felt all around the world and WHO estimates the prevalence of disabilities among people with diabetes to be between 20% and 30%.

After the Manila meeting, 3 countries decided to carry the approach forward and, with the support of the Constellation for AIDS Competence, to adapt the AIDS self-assessment tool to diabetes. The Handicap International offices in Burundi, India and Nicaragua have utilized a first version of the tool with the various actors in their respective countries. The Constellation provided coaching for facilitation either directly (by providing their own Coaches) or indirectly through telephone coaching.

During a recent workshop in Lyon (21 - 23 November 2006), representatives of the diabetes response in these three countries met to exchange their experiences and know-how on the utilization of the diabetes self-assessment tool. The objectives of the workshop were to refine this tool for further use, expose actors to the related methodologies of the process, brief them on the principles and importance of the Human Capacity Development approach and finally decide on next steps.

During the workshop, facilitated by a Constellation Coach, the various 10 practices were extensively discussed and refined. This was also an opportunity to exchange good practice, experience and concerns through Peer Assists and development of the first Knowledge Assets for diabetes. The participants, coming from both the field and HQ, learned from each other how to implement the approach at the local level and through these interactions, they gained a greater understanding of the approach and methodology. While the main purpose of the workshop was "methodological", participants appreciated this opportunity to learn what is being done in other countries within similar projects. At the end of the workshop, the three country delegations agreed to continue utilizing the Diabetes Competence Process in their project: but, as the tool was refined, these projects will now target group/community exchanges and local learning with various partners. The purpose of this next phase will now be to enhance the diabetes response at the local level, to increase ownership and to share and learn good practices.

Handicap International HQ is committed, with the support of Sanofi-Aventis, to expand the number of countries which will use the Diabetes Competence Process. It is therefore envisaged to have a first Knowledge Fair for Diabetes at the end of 2007 or beginning of 2008. To accompany this process, the support of the Constellation needs to be discussed.

What are the main lessons?

(1) More than ever, we can consider that the Life Competence Process is perfectly applicable to other Health and Social issues;

(2) The adaptation of the process can only be effectively carried forward by partners who already believe in the strength of communities and in the local response;

(3) The participating delegations at the Lyon workshop included a perfect mix of actors: 1 from HI, 1 from a patient association (diabetic patient) and 1 from the medical sector. Hence the various perspectives and sensitiveness which emerged during the discussions;

(4) With regard to the Constellation, there is a need to clarify how we can continue to support this Handicap International initiative.

Handicap International will present a poster on the development of the diabetes competence tool during the upcoming International Diabetes Conference in Capetown (South Africa, 3 - 8 December 2006). We have mobilized our Coach in South Africa to help on the poster presentation.