Evaluation of a diabetes decentralization program in rural Madagascar using the RE-AIM framework

Area of Science:

• Global Health
• Public Health Interventions
• Diabetes Management

Background:

• Diabetes poses a significant health burden in Africa, causing substantial mortality and disability.
• Madagascar faces challenges in diabetes care, particularly in rural areas due to health system limitations.

Purpose of the Study:

• To evaluate a multifaceted diabetes decentralization program in rural Madagascar using the RE-AIM framework.
• To assess the implementation, effectiveness, and sustainability of a joint NGO-Ministry of Public Health initiative.

Main Methods:

• Mixed methods study design evaluating program implementation at primary health centers (PHCs) over 18 months.
• Utilized the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.
• Included mass screenings, healthcare worker training, and patient support groups.

Main Results:

• 2.1% of screened individuals tested positive for diabetes; 59.3% entered care at PHCs.
• High rates of fasting blood glucose checks (93.2%) and moderate medication stock-outs (1.35 days/month).
• Diabetes control reached 48.0% of patients, improving over time from 33.3% to 57.8%.

Conclusions:

• NGO support is vital for extending diabetes services to remote populations.
• A multi-layered approach is necessary for effective diabetes diagnosis and treatment implementation.
• Patient adherence to dietary recommendations remains a key challenge.