Design of a District-level Pilot Project Model for Prevention of Chronic Wounds & Lymphedema in Settings With Limited Resources
- Tue, 3/16/10 - 12:25pm
- 0 Comments
- 2589 reads
Abstract: Chronic wounds and lymphedema are often secondary complications of chronic diseases. Chronic wounds and lymphedema cut across diseases, settings, and borders especially in settings with limited resources, and present an opportunity to implement an integrated approach to prevention and care. The following article describes key elements in the design and development of pilot projects based on the principles of the World Health Organization’s (WHO) Innovative Care for Chronic Conditions model. The pilot projects will advance the efforts of World Alliance for Wound and Lymphedema Care (WAWLC) to aid health systems in building capacity for effective wound and lymphedema care.
Address correspondence to:
Erik Post, MD
Royal Tropical Institute
Wibautstraat 137-k
1097 DN Amsterdam
The Netherlands
Email: e.post@kit.nl
Background
In 2007 the first meeting was held for what is now called the World Alliance for Wound and Lymphedema Care (WAWLC). Several organizations were part of this initiative, notably the Association for the Advancement of Wound Care (AAWC), Health Volunteers Overseas (HVO), the Canadian Association for Wound Care (CAWC), the Buruli Ulcer Initiative, Handicap International, Medecins Sans Frontieres, Netherlands Leprosy Relief, The University Hospital of Geneva, World Health Organization (WHO) representatives from the Buruli Ulcer and Filariasis Programs, and some persons on individual title.
A White Paper was commissioned (finalized in 2009) on current best practice in wound care with a perspective on wound care in settings with limited resources. The anticipated publication date for this document is sometime in 2010. Since the inception of WAWLC, several field visits were made to Ghana, Uganda, Sierra Leone, and Cameroon to document current practices at the field level, to network, and to transfer knowledge (see the Treadwell & Keast article in this issue).
Since 2007 several other societies and professional organizations have joined the initiative. During the most recent WAWLC meeting in October 2009, more than 40 participants from WHO and various countries were present, including 11 medical societies, 2 industry observers, and several non-governmental organizations (NGOs). This group defined the mission of the WAWLC as “Working in partnership with communities worldwide to advance sustainable prevention and care of wounds and lymphedema in settings with limited resources.”
In 2009, the WAWLC decided that in order to promote this mission further it would be useful to facilitate pilot projects, which would be based on best practices outlined in the White Paper while focusing on the five principles for wound care (see the Macdonald & Asiedu article in this issue) and the application of minimum standards. This manuscript outlines the basic process that must be undertaken in order to design and implement an effective and sustainable program using an integrated approach at the district level. Examples of similar global initiatives and links to the evidence for their effectiveness may be found at www.filariasis.org, www.pmnch.org, as well as www.who.int/en.
Pilot Project Design and Essential Elements for Implementation
The long-term goal of the pilot project is to design and develop a model for healthcare systems in settings with limited resources that organize appropriate and low-cost interventions and technology at all levels of the health system for the prevention and care of chronic wounds and lymphedema. The specific objective is to design and develop a model at the district level within a 2-year timeframe.
1. World Health Organization. Innovative care for chronic conditions: building blocks for action: global report. Geneva, Switzerland; 2002:1–99.
2. Smith WC, Zhang G, Zheng T, Watson JM, Lehman LF, Lever P. Prevention of impairment in leprosy; results from a collaborative project in China. Int J Lepr OtherMycobact Dis. 1995;63(4):507–517.
3. Benbow C, Tamiru T. The experience of self-care groups with people affected by leprosy: ALERT, Ethiopia. Lepr Rev. 2001;72(3):311–321.
4. Cross H, Newcombe L. An intensive self care training programme reduces admissions for the treatment of plantar ulcers. Lepr Rev. 2001;72(3):276–284.
5. World Health Organization. Innovative care for chronic conditions (ICCC) framework. 2006.
6. Cross H, Choudhary R. Self care: a catalyst for community development. Asia Pacific Disabil Rehabil J. 2005;16(2):1–17.
7. Cross H, Choudhary R. STEP: an intervention to address the issue of stigma related to leprosy in Southern Nepal. Lepr Rev. 2005;76(4):316–324.
8. Flowchart of Steps to Conduct a Health Facility Assessment. International Health Facility Assessment Network. 2008.
9. Varvasovszky Z, Brugha R. How to do (or not do) a stakeholder analysis. Health Policy Plan. 2000;15(3):338–345.
10. World Health Organization. Handbook on monitoring and evaluation of human resources for health with special applications for low and middle-income countries. 2009.
11. Mistra V, Ramasankar P. Andhra Pradesh, India: Improving health services through community score cards. World Bank; 2007.
12. van Dijk M. The quality of leprosy services from the client's perspective. Netherlands Leprosy Relief: 2007.
13. van den Broek J, van der Kwaak A, Sixma H, et al. Measuring the quality of TB services: the patient's perspective. Tuberculosis Coalition for Technical Assistance; 2007.
