Abstract

Effective control of chronic diseases in developing countries remains a major challenge in developing countries of the world where low levels of literacy, conflicting notions of disease etiology and low belief in self-efficacy operate jointly to render populations at risk of diseases like non-insulin dependent diabetes mellitus (NIDDM) hopeless. Even as declared by the WHO, the public health challenges of NIDDM have become a serious priority that the organized health care systems of many countries lack the capacity to address the problem effectively without seeking innovative ways beyond what is currently practiced. A paradigm for community participation in population-based non-insulin- dependent diabetes mellitus (NIDDM) control program being used in rural south-eastern Nigeria is presented. The paradigm features the use of area primary health care district health committees as community-based diabetes control implementation committees (CDCICs). It also calls for the deployment of village health workers/volunteers as community-based diabetes control workers (CDCWs) with responsibility for suspect case search, community mobilization, blood-sugar monitoring and referral, and health education. The model integrates population-based NIDDM into area primary health care system. It also aligns control activities with traditional authority hierarchies and political processes of rural communities. Experience from the implementation of the paradigm in five communities in South-eastern Nigeria is presented.  Implications for achieving long-term sustenance, relating diabetes control to prevailing socio-cultural norms and practices as well as for demystification of diabetes control are discussed.

Key words: Non-insulin dependent diabetes mellitus (NIDDM), community participation, community-based diabetes control workers, community-based diabetes control implementation committees, diabetes control, primary health care.