Challenges of diabetes screening and prevention program in a worksite setup in Nepal
Non-communicable diseases (NCDs), such as diabetes, are a growing global problem. They are the leading cause of death in the world and their increasing prevalence disproportionately affects low-income countries, such as Nepal. Complications from diabetes, such as coronary artery and peripheral vascular disease, stroke, diabetic neuropathy, amputations, renal failure and blindness results in disability, reduced life expectancy and enormous health costs. The diabetes country profile released by World Health Organization (WH0) in 2016 showed that 9.1 %of the Nepali population are living with diabetes.
Given the rise in diabetes among working populations and the amount of time most people spend at work, the workplace has considerable potential to influence the way in which employees manage their diabetes. We aimed to set up a diabetes screening and prevention program in a steel manufacturing factory in Nepal. Total of 350 permanent employees were recruited. Among them 52% were staffs and 48% were workers. The staffs and workers were deployed in different sections in factory as per job structure. The salaries of workers was<100 dollars/month and the salaries of staff varied from 50 dollars to 2000 dollars/month.
We faced three major challenges during screening. First, we detected that 14% of the workers had diabetes and were not aware of it. There was a low level of health literacy among workers related to diabetes knowledge, self-efficacy and self-care behaviors, and glycemic control.Although the government of Nepal provides biguanides drug (metformin)free of cost at primary health center, many of the workers were unaware of this and were untreated. They expected the research team to provide them free medication and consultation. Second, the average daily income of the workers is less than 4 dollars. Their priority is food and shelter rather than health. So, merely counselling them to seek health care is not sufficient. Third, there was a misconception that health workers take their blood samples, accumulate the samples, and sell them in the market.
It’s high time that the Government of Nepal take concrete steps to promote health literacy among industrial workers. The wages of workers should be increased every two years as per the labor act. The government of Nepal has a health insurance program. However, it is only limited to 15 districts among 77 districts in Nepal and the coverage remains low. We recommend that low income workers needed to be targeted for better coverage. The insurance will reduce out of pocket expenditures and incentivize workers to seek health care.
Finally, a multi-sectorial collaborative policy and program intervention are needed from government position to ensure equitable access to essential medicine for glucose control along with various preventive and promotive programs.
-(Writer : Prajjwal Pyakurel, M.D. in Community Medicine and Tropical Diseases, B.P.Koirala Institute of Health Sciences, Dharan, Nepal)