Diabetes describes a group of metabolic diseases which cause high blood sugar levels. In recent years, diabetes has become one of the leading causes of deaths worldwide. According to the World Health Organization, around 1.6 million people worldwide died due to diabetes in 2015. In 2017, an estimated 8.8 percent of the adult population worldwide had diabetes.
Diabetes in the UAE is rising at one of the fastest rates in the world. Rapid economic growth, lifestyles and unhealthy diets have contributed to increasing the risk factors, also, an increasing population and a greater understanding of the condition have also contributed to the increase in patients diagnosed with diabetes. According to a 2017 survey, 15.2% of Dubai’s population are diabetic and 15.8% pre-diabetic (people at risk of becoming diabetic due to their high blood sugar levels) with the UAE as a whole having the 10th highest rates in the world.
The Dubai Health Authority (DHA) is one of the government entities that participated in the 2nd cycle of Dubai We Learn initiative, a one year programme consisting of a range of knowledge sharing and organisational learning activities designed to fast-track organisational improvement and stimulate innovation. A key part of this initiative has been the mentoring of benchmarking projects by DGEP’s partner the Centre for Organisational Excellence Research, New Zealand. Project teams used the TRADE Best Practice Benchmarking Methodology – a rigorous 5-stage approach that involves searching for and implementing leading-edge practices.
Terms of Reference Stage:
The Terms of Reference (TOR) is the first stage of the TRADE Benchmarking methodology. This is where the team developed a clear aim of what they wanted to achieve, specified the resources required, and what was expected in terms of financial and non-financial benefits.
The Dubai Health Authority’s (DHA) project aim:
To develop & start implementing a Dubai Diabetes prevention framework based on worldwide best practices within one-year (2017); to reduce the Pre-Diabetic population, (356,460.48) adults by at least 10% by 2021.
The target of reducing the pre-diabetic population by at least 10% by 2021 was ambitious considering the adverse trends in some of the risk factors such as obesity, unhealthy diet, smoking and lack of exercise.
The main task of the Review stage is to study and understand the current status of the area of focus. The DHA team used several methods and techniques, such as literature review, community needs analysis questionnaire, brainstorming sessions, fishbone diagrams, and SWOT analysis. DHA recognised that it would not be able to have a significant impact on diabetes on its own and therefore needed to work closely with other stakeholders that could influence or play a role in reducing diabetes. For example, during the brainstorming sessions, DHA invited Dubai Municipality (to explore issues such as how public parks are used and the monitoring of the food offered by food outlets)) and the Dubai Sports Council (to understand how government sports clubs and initiatives can help to prevent diabetes).
Some key findings from the Review stage:
- The most important factors to prevent diabetes are weight loss through healthy eating, and at least 150 minutes per week of regular physical activity. This can reduce the risk of type 2 diabetes by 58% in individuals at high risk.
- An important gap to be bridged is the lack of coordination between the different parties responsible for activities that lead to the prevention and control of non-communicable diseases.
- A screening and early detection programme for people who are most susceptible to diabetes and determine pre-diabetic cases, will allow reducing complications of diabetes as well as the burden of the disease.
After setting the plan for the whole project and studying the current state, it was time to start looking for solutions or best practices to bridge the gap between the current and the desired state. The team set criteria for selecting benchmarking partners which were: organisations who have developed similar strategic initiatives that serves Dubai vision 2021, who have used public health innovations in the area of prevention, who have implemented prevention programs, who have lifestyle modification initiatives, who have achieved high success rates in terms of implementation, and who have the best health outcomes related to non-communicable diseases. DHA identified 17 potential partners which were reduced to 9 partners for site visits and internet conferencing.
The benchmarking partners were from different fields, which enabled DHA to learn a wide variety of practices. This was besides an extensive desktop research conducted on: Health Promotion & Campaigns, Screening & Early Detection, Innovative Initiatives, Policy, Research, and Applications. In total, DHA were able to record more than 50 improvement ideas for potential implementation. For example, the best practice of Bharat Petroleum Corporation Ltd (BPCL), the winner of the 5th International Best Practice Competition Award was considered for implementation. In BPCL, all employees undergo an annual health check and receive a Wellness Index Score (WIS). The WIS of all employees are then averaged to obtain a company WIS. Initiatives such as Yoga, meditation, counselling by dieticians and health talks are provided to address the most common health challenges faced by employees. As a result, the company’s WIS has improved each year and the number of staff at risk of diabetes has dramatically reduced.
In the Deploy stage, the team translated the ideas and best practices found in the Acquire stage into actions. The team developed and refined the actions through holding a number of meetings and brainstorming sessions with its stakeholders.
By April 2018 the team was able to implement 30 improvement ideas, the three most important were:
1- Developing a Dubai diabetes prevention framework and gaining acceptance of this within DHA and the wider stakeholder group. Previously, there was no diabetes prevention program for Dubai; there were scattered efforts, which were not systematic or collaborative
For each sub-element of the Dubai diabetes prevention framework, an action plan outlines what needs to be done in co-operation with each stakeholder, it also assigns the responsibilities for each task and timeframe for implementation until 2021.
2- Implementation of Diabetes Screening: The screening program was developed in primary health care for early detection of diabetes and the risk factors through adapting the National Periodic Assessment and Diabetes Risk Assessment tool (Finnish Diabetic Risk Assessment Score).
3- Developing and implementing a pilot Happiness Prescription Programme. This programme was adapted from the Social Prescribing Programme from NHS (UK). The pilot phase of the Happiness Prescribing Program involved a total of 43 participants. It consisted of a comprehensive health survey, nutrition and health education and support, and various fitness classes.
The main task of the Evaluate stage is to evaluate if the project aim has been achieved and to measure the financial and non-financial benefits. Although, the main aim of the DHA project was targeted for completion in 2021, there were other objectives to be achieved within the one-year time frame of Dubai We Learn. For example, developing the Dubai diabetes prevention framework and getting all the stakeholders to approve it and be part of it within one year was a huge achievement.
Other achievements included increasing awareness of diabetes. From 2017 till 2018, DHA held more than 460 awareness campaigns which covered more than 47,000 participants with a satisfaction rate of 98.1%. The campaigns were held in different locations such as public parks, government departments, and private sector companies. Also, to target a wider audience base, the DHA worked with the public media to conduct awareness campaigns using the social media, radio, TV, and newspapers. In total, DHA estimated they reached 560,000 people.
Another important achievement was the successful pilot phase of the “Happiness Prescribing programme”. The 43 participants achieved good rates of weight loss ranging from 7 to 11 kg in six months. In addition to 13% risk reduction from severe to intermediate risk and 7% risk reduction from intermediate to low risk in the women’s group. For the men’s group, there was 7% risk reduction from high to moderate risk.
DHA’s project achieves 7 stars ★ ★ ★ ★ ★ ★ ★
Each project team of Dubai We Learn initiative gave a 15-minute presentation and submitted a benchmarking report which was assessed by an expert panel. The projects were evaluated based on the TRADE Benchmarking Certification Scheme. Three of the teams achieved 7 Stars, four teams 5-6 Stars, and four teams 3-4 Stars. These were exceptional results as even to achieve 3-4 Stars and reach TRADE Benchmarking Proficiency is challenging within a one-year timeframe. Dubai Health Authority project was evaluated as 7 Stars project, which means the project is considered as a role model in the approach and deployment of the TRADE Benchmarking methodology.
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