Primary Care Practitioners Training on Diabetes Management

Venue: Studio 6

Date: 1st November 2014

1.  Salutations
2.  Thanks

Thank you for the invitation to be here, and I want you to know that, not only am I glad to be here today, but I am also thankful that you all have made time to be part of this event.

I know that we have a diverse group of experts this afternoon, and that  this is the 2nd training for this year on Diabetes Management. Its good to see you all here this afternoon…..all the facilitators and the participants.

During the past few weeks that I have been at the Ministry, I have been visiting the different heath facilities in the Central Division—the hospitals, the health centres , the nursing stations, the various offices, Mataika house and so forth.

It has given me a better understanding of what is being done in the public sector on Health.  I have seen the pressures faced by our health workers.

I have seen the cramped offices, consultation rooms, recorder rooms and pharmacies in which they work.. I have seen the lack of storage space.

I have heard of the difficulties that zone nurses have to face in trying to get to they communities that that they serve.. and they walk, take the public transport, use their own cars, or hitch rides just to get there.

I have heard first hand.

I  have seen with my own eyes the haggard faces of doctors who see up to 90 patients a day and of nurses who work alone in nursing stations seeing up to 90 people a day…

I have become aware of  the constraints that have to be contended with, and the mountains that have to be climbed.

So I want you to know that since I have become Minister of Health and Medicine in late September, my respect for Health professionals has grown in leaps and bounds.

I applaud you all, and I hope that this program adds impetus to what we are all trying to achieve.

However, everyday there is a clamour across this nation for better service in the health sector, for more efficient service, for more effective and more caring service.

There is a clamour for more effective approaches ,for more effective service.

There are rising expectations of what is expected and what is desired from the Health sector.

We have to contend with all of these issues and we must raise the ante… service delivery levels will have to be improved. What we have achieved in the past will have to be surpassed. The status quo is not good enough anymore.

Over the past two days in the Ministry we have been formulating our Annual Corporate Plan for 2015…setting out what we aim to achieve in all the areas that we cover..and the list is extensive.

We have also addressed the important issue of creating a stronger culture in the Ministry that is focussed on building a workforce that is caring and compassionate, and focussed on delivering this through our service levels.

We have focussed also on strengthening the  deployment of the systems that we have established for improving data collection, conversion of this into information and knowledge so that the whole sector can be improved ..so that we can deliver better services.

We have taken note of the importance of continuing with longer term efforts to revolutionise systems…of deploying systems, or monitoring and evaluating systems to make sure that they work..and at the same time address the everyday complaints in the sector.

I know that the ultimate way of addressing issues in this vast sector is by system changes, by process changes and by changing mindsets…that is a mammoth task , but it must be done, and I will give my very best to make it happen.

I have always believed that people who understand problems best, are those who face those problems everyday..those who work there..the workers themselves.

I believe that if you give them exposure to new ideas and concepts that it will be those very workers who will themselves be best able to identify what the root cause of problems are, to develop solutions and to fix those problems.

I have believed this for many years..and it has been at the heart of my management and leadership philosophy. This is  why I am a great believer in the concepts of Quality Circles, Cross- functional Quality Improvement teams and the like.

I am also a great believer in the  importance of leadership…and if leadership is doing the right things…if leadership has the rights values.. and if you can see those values coming through in the behaviour of leaders..that this will have an impact on the people who work under them and who work with them…and in this way attitudes and culture in any organisation can change.

This is something that I will work on in the Ministry together with the everyone in the Ministry…..to bring about the enhancement of service delivery. To make a difference.

However, I know also that we cannot make a great improvement to Health just by focussing on actions within my Ministry.

Heath issues require a whole of government, whole of health sector and whole of nation approach. That must be our focus . It requires everyone working towards the ultimate vision of a healthier population.

Developing a healthy population may require looking at legislations in areas other than just health—it will require looking also at trade issues, taxation issues, education issues and so forth.

It requires also a stronger partnership between the public and private sector…so this program  being an example of that public private partnership…is exactly what I am talking about.

3. Diabetes Management

Since assuming this position I have come to learn a lot about the rate of diabetes, and have learnt that the rate of diabetes in the Pacific and in Fiji is among the highest in the world. That is not a record of which we are proud. It is something that needs to be addressed.

This month is an important month for NCDs—first of all November is NCD month. And second, World Diabetes day falls on 14th of November.

The data provided to me shows that the rate of diabetes jumped from 19.6 % (STEPs survey of 2002) to 29.6% (STEPs Survey 2011)

The occurrence of diabetes related amputation has been recorded as 1 in every 12.6 hours

80% of the surgical wards in our divisional hospitals are occupied by Diabetes patients.

The Diabetes centre  has conducted foot care trainings to nurses, provided foot kits, developed the foot care manual and now through the help of the World Diabetes Foundation, two surgeons will be coming to train our surgeons on lower limb saving techniques.

Diabetes complications encompass more than just health complications.

The Ministry of Health & Medical services has a wide variety of programs focussing on addressing premature deaths and disabilities related to NCDS through screening and SNAP(Smoking, Nutrition, Alcohol and Physical Activity) intervention….advocating for healthy lifestyle through the Wellness concept to improve the service deliverables

The Government has set its target to reduce the gap in health and health equities.

We recognise the burden of NCDs on individuals, families and health systems and recognise the need to work in collaborations with other stakeholders to discuss the way forward for the health of our people

This is an approach to be used for Diabetes Management, and it is an approach to be used in looking at other aspects of health. This is why we intend to  organise a Forum on Health in which we will invite stakeholders to come forth and give us their feedbacks and to come up with suggestions on the way forward to improve the Health sector in Fiji. This Forum will be organised in November of this year.

Coming back to diabetes, Government is committed through its manifesto to ensuring NCD medications are available and that pharmacy hours are extended.

A big vinaka vakalevu to Diabetes Fiji …our main sponsor for this training and the team at Diabetes Centre in Suva for bringing together the very people that look after our peoples health.

I take my hat off to Diabetes Fiji for the work that it is doing.. and I applaud the initiatives that it has put in place

We need more focussed forums like this that brings together Private Practitioners and doctors based at government health facilities to tackle other issues such as cancer, cardiovascular diseases and emerging new diseases.

The sharing of learning, the passing on of learning …it all creates a strong base upon which to make improvements. Creating knowledge is a strong and important step in taking up the fight on diabetes.

4. Our Aim as Government

Our aim as a Government is to improve the lot of everyone in this country.. and in the health sector we want to improve the health of everyone here in Fiji.

In battling NCDs and Diabetes we do face an uphill battle. We must fight.. we cannot just lay back and let others decide our fate. Change will always come..it can be change for the better or change for the worse. We need to be people who do something about such changes…. Who do not just recognise that the change is taking place and do nothing about it.  No, we must choose to do something.

The prevention of NCDs is a massive challenge, and is something that will require a whole of government, and indeed a whole of society approach.

The management of Diabetes is obviously something that we have to take a whole of sector approach…the Health sector that is approach.

We need to work together across the different boundaries and silos that we put ourselves in…to share ideas, to share concerns, to learn together…so that together we can enhance peoples lives.

I have no doubt that this program will give all over you new knowledge…that you will learn a lot .

I hope this program will not only expand your learning but that it will also do a number of other things.. that it will act as a catalyst for other things…that you will become more productive in preventing and controlling diabetes…that you will build strong networks that can then continue this work.. that you will build a strong network here that will continue this work…and that we will all together move Fiji closer to where we want to be in terms of diabetes management.

That is the bottom line.

I wish you a great teaching, sharing and learning experience.