20 February 2019
The Hoshangabad project, which aimed to field test and develop operational guidelines for the new national Indian gestational diabetes (GDM) diagnosis and management guidelines in Madhya Pradesh, came to an end by the end of 2017. The project, which was implemented by Jhpiego, integrated GDM testing and management into the antenatal care programme in 175 health facilities and in 975 villages (through community outreach services).
By 31 December 2017 the project had achieved the following:
• Facilitator’s guide, reference manuals and job aids developed for capacity building of community health workers (ASHAs), Auxiliary Nurse Midwives (ANMs), Staff Nurses and Medical Officers.
• Availability of essential supplies to measure blood sugar in pregnant women ensured throughout the maternal health structures.
• GDM capacity building of a range of health service providers: 52 Medical Officers, 98 Staff nurses, 216 ANMs and supervisors, 30 lab technicians, 10 nutrition counsellors, and 1,168 community health workers.
• 24,052 women tested for GDM of which 2,178 women (9%) were diagnosed with GDM.
Key learnings from the project include:
• A single contact service delivery approach is key
• Effective counselling of the women requires training of health staff at all levels, including outreach and community health workers.
• Extensive counselling is needed if the women is to succeed with the nutrition therapy
• It is difficult to make the woman wait the required two hours for the result of her Oral Glucose Tolerance Test (OGTT) – using the time for counselling has shown useful
• Maternal health and the NCD department coordination is critical for supplies and logistics support.
In March 2017, the learnings from the project were presented on two occasions: first at the 9th International Symposium on Diabetes, Hypertension, Metabolic Syndrome and Pregnancy (DIP2017) 8-12 March in Barcelona, and later as a part of a side-event to the 61st session of the Commission on the Status of Women (CSW61) at the UN HQ titled ‘Healthy Women, Healthy Livelihoods: Delivering an integrated NCD response for all’. The event was co-hosted by the Government of Denmark, NCD Alliance, Women Deliver, MSH and Novo Nordisk.
In July 2017 the project was showcased as a best-practice at the ‘4th National Summit on Good and Replicable Practices and Innovations in Public Healthcare Systems in India’ hosted by the Ministry of Health and Family Welfare (MoHFW) of India.
The Ministry of Health and Family Welfare has updated its national GDM guidelines based on learnings from the Hoshangabad project. In February 2018, the Ministry showcased the project and the revised guidelines on a national orientation workshop for maternal health officers from all states, with a means to roll-out universal GDM screening and management in all states of India. Paying attention to the blood sugar of pregnant women is now seen as a way of improving maternal and newborn health, as well as a means of preventing non-communicable diseases (NCDs).
In 2017, Novo Nordisk furthermore expanded its support to FIGO’s work in the field of Hyperglycaemia in Pregnancy (HIP) with an additional grant to support the work of the newly created FIGO NCD Committee.
Novo Nordisk builds on its previous commitment to Every Woman Every Child that targets non-communicable diseases (NCDs) including diabetes as a leading cause of death and disability in the world today. Novo Nordisk believes in taking a life-course approach to preventing NCDs worldwide and has committed, in 2014, to implementing a USD $400,000 project focusing on gestational diabetes mellitus in a state in India. The project will focus on capacity building, screening of pregnant women and awareness-raising. The two-year project will take place in coordination with Novo Nordisk India and in close collaboration with local state health authorities. The project will directly support the order issued by the Government of India in 2007 to make universal screening for glucose intolerance during pregnancy mandatory.
In 2015 Novo Nordisk is committing an additional USD $330,000 to create awareness of the link between gestational diabetes and maternal and newborn health through engaging in advocacy work through global partners such as the International Federation of Gynecology and Obstetrics (FIGO), Women Deliver and Management Sciences for Health.
Creating a model for gestational diabetes (GDM) testing and management in India – a project rolled out in Hoshangabad, Madhya Pradesh ( India) developed:
- Manuals for training of medical officers, staff nurses, Auxiliary Nurse Midwives (ANMs) and community health workers (ASHAs)
- Flipbooks on GDM testing and management for service providers and community health workers (ASHAs)
- Awareness and treatment posters for clinics and village health centres
- Client booklet for nutritional counselling and lifestyle modification
- Food compendium and sample diet charts customized to local eating habits
- Calorie calculation chart Capacity building and GDM testing: 6,948 pregnant women have been tested for GDM as per the national guidelines. 694 (10%) women have been diagnosed with GDM, and managed through lifestyle modifications.
- Training of 52 medical officers, 97 staff nurses, 216 ANMs and supervisors, 30 lab technicians, 9 nutrition counsellors and 1,168 community health workers.
- GDM testing and management initiated in all 175 facilities and in 975 villages through community outreach services.
The 2014 WHO study published in the Lancet finds that more than 1 in 4 maternal deaths globally are caused by pre-existing medical conditions such as diabetes, HIV, malaria, obesity, and the health impacts of these can be aggravated by pregnancy. Novo Nordisk convened an event entitled ‘Reaching the Last 25 Percent: Saving lives of women and newborns through a life cycle approach’ on 19 January 2016 in Washington DC, co-hosted with Management Sciences for Health. This meeting aimed at giving examples of and discuss how governments, civil society, and the private sector in low and middle income countries are looking at NCDs, with a focus on gestational diabetes, to address maternal mortality and morbidity
*Progress data as of March 2017.
Non-Communicable Diseases (NCDs) including diabetes are the leading cause of death and disability in the world today.1 Novo Nordisk believes in taking a life-course approach to preventing NCDs worldwide. We take this into action by addressing the health of the Next Generation through an updated Every Woman Every Child commitment of USD 400,000 to a project focusing on gestational diabetes mellitus (GDM) in a state in India. The project will focus on capacity building, screening of pregnant women and awareness raising. The two-year project will take place in coordination with Novo Nordisk India and in close collaboration with local state health authorities.
GDM poses an increased risk of developing type 2 diabetes for mother and offspring. By strengthening capacity within GDM Novo Nordisk will support the work to prevent the development of diabetes in mother and child.
The International Diabetes Federation (IDF) estimates that hyperglycaemia in pregnancy occurs in 1 out of 5 pregnancies (equalling 6 million) annually in India. Of these, 90% are due to GDM.
The project will directly support the Order issued by the Government of India in 2007 to make universal screening for glucose intolerance during pregnancy mandatory.
The Early Origins of Health Initiative continues under the name Changing Future Health. Novo Nordisk commits USD 1.5 million to the Changing Future Health initiative which will advance the prevention of diabetes with a focus on improving maternal, newborn and child health.
The aim of the Changing Future Health initiative is to give a healthy start to life by supporting the wellbeing of women and their partners prior to pregnancy. As a public private partnership between Novo Nordisk and the Malaysian Ministry of Health, the initiative will design and demonstrate efficacious community based interventions that improve health outcomes for the mother and unborn child.
The initiative is grounded in the Developmental Origins of Health and Disease science, showing that the risk of obesity and type 2 diabetes in the child can be influenced during fetal development. The initiative advocates for a life course approach to prevention and aims to demonstrate this approach as an underexplored opportunity to halt the rise in type 2 and gestational diabetes. The initiative supports the development of new evidence and platforms for action by addressing critical research gaps. In 2015, the initiative will begin enrolling young newly married couples into its first pilot, Jom Mama, in Malaysia.
Novo Nordisk commits to Every Woman Every Child through the Early Origins of Health Initiative, which is committed to advancing the prevention of non-communicable diseases (NCDs) with a focus on improving maternal, newborn and child health. The overarching aim is to give a healthy start to life by supporting pregnant women and their children during the ‘first 1000 days’ – the nine months of pregnancy and up to the first two years of childhood. The Early Origins of Health Initiative will design and demonstrate efficacious interventions that will improve health outcomes for the mother and unborn child, and explore solutions that can potentially spur new approaches to preventing non-communicable diseases. The Early Origins of Health Initiative will prototype an intervention in South Africa during 2012-2013. The Early Origins of Health Initiative brings together private sector partners with core competencies in areas such as of nutrition, diabetes, healthcare and hygiene.
Novo Nordisk commits to continue to work towards improving the health of women and children with a specific focus on screening, treatment and care for gestational diabetes and will develop a partnership-based programme, as part of a long-term commitment to sustainable improvement in health, through which the company will campaign for universal screening for gestational diabetes; support the development of new evidence and platforms for action by addressing critical research gaps; mobilise key stakeholders at national and global levels to promote change with a positive health impact for women and the next generation; engage key partners in exploring and co-creating innovative solutions targeting women, diabetes and pregnancy.
 WHO, Global Action Plan for the Prevention and Control of NCDs 2013-2020.
Untreated GDM has serious consequences for maternal and newborn health, and increases the risk of developing diabetes and other non-communicable diseases (NCDs) later in life.2 Timely diagnosis and treatment of diabetes in pregnancy offers an important window of opportunity—a chance to reduce short- and long-term health risks for women and children. Unfortunately, GDM has received relatively little attention as a public health priority. Learn more.
Lessons can be learned from a locally-managed GDM project in Barranquilla, Colombia called “Vida Nueva” or “New Life.” The project’s holistic NCD-awareness and capacity-building approach has unlocked vast resources, demonstrating that relatively small investments to integrate GDM care into existing prenatal services can significantly improve standards of care. To learn more click here.