Problem: Rising prevalence of type 2 diabetes and associated health care costs; limited availability of diabetes-related health promotion and disease prevention services.
Solution highlights: The Ministry of Health convened a working group to develop a national diabetes strategy. After several years of deliberation among working-group members, the finalized National Diabetes Strategy was approved by the government in 2010; an active patient association supported patient engagement and involvement throughout the initiative’s planning and implementation process; meaningful stakeholder engagement across professions and institutions helped develop a common vision for the initiative; building trust between stakeholders took time, but was necessary to allow functional teamwork and effective plan development; oversight from the Ministry of Health fostered important linkages across activities, ensuring that changes to service delivery under the initiative aligned with and complemented other parallel reforms.
Description of practice
In 2007, approximately 125 000 patients in Slovenia (6% of the total population) were living with diabetes. Type 2 diabetes accounted for 95% of all diabetes cases, many of which could have been prevented or treated through dietary and lifestyle changes. With diabetes prevalence projected to rise to 8% of the total population by 2025, diabetes was a growing public health concern and economic burden for Slovenia.
In 1989, the St Vincent Declaration signalled a widespread recognition of the growing burden of type 2 diabetes in Europe and highlighted the need for a national diabetes plan in Slovenia. When type 2 diabetes came to the forefront of the EU agenda again in 2006, national advocacy efforts pushing for a comprehensive diabetes strategy increased in Slovenia. In response to international recommendations and national advocacy efforts, the Ministry of Health for Slovenia convened a working group to develop a national diabetes plan. After several years of planning, the working group finalized a patient-centred, transparent working document for diabetes in 2009. Later that same year, the National Health Insurance Institute joined the working group in support of the proposal in what was termed “the winning moment” for the National Diabetes Strategy. The Ministry of Health formally approved the Strategy in 2010. The Strategy complements and builds on several independent health care reforms that occurred in Slovenia during the late 2000s and is designed to strengthen diabetes prevention and care services already in place. Currently midway through implementation, the initiative will run until 2020. Standardizing the quality of prevention and treatment, better integrating care, and responding to the needs of vulnerable populations are the main challenges for the future. Strengthening primary care, further involving patients, implementing monitoring systems and introducing e-health are key priorities.
Implementation of practice
What stage is the practice currently in?
Who was/is responsible for the implementation of the practice?
Strong advocacy by the national diabetes association succeeded in securing necessary government support, leading the Ministry of Health to form a multidisciplinary working group to design the national diabetes plan. As participation in the working group was unpaid and voluntary, it was composed of highly-motivated individuals: “If you have zero-cost activities then you get different types of people who get involved. When money is the driver, you get completely different types of people.” Later support from the National Health Insurance Institute was seen as the “winning moment for the national diabetes plan”. The Ministry of Health formally adopted the proposed strategy and set up a coordinating committee to oversee its implementation. Two-year action plans break the 10-year National Diabetes Strategy into more tangible goals. The coordinating committee convenes annually to review progress in relation to the two-year action plans, strategize improvements and resolve any issues.
The main goals of the initiative are: to prevent or delay type 2 diabetes in at-risk individuals, to increase early detection of diabetes, and to decrease diabetes-related health complications. Although a system to evaluate the initiative is not currently in effect, a study conducted to assess the burden of diabetes will serve as a benchmark for improvements. A national clinical register for diabetes is also being developed.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
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- Dr. Vesna Kerstin Petric
- Ministry of Health