The International Working Group on the Diabetic Foot together with the Diabetic Foot Society of India (DFSI) and the Muhimbili University College Of Health Sciences Dar es Salaam, Tanzania (MUCHS), have initiated a foot care project called “Step by Step, improving diabetic foot care in the developing world” in 2003. The World Diabetes Foundation (WDF) financially made this possible.
Among others successful projects,a programmes in the Caribbean region were financed by Rotary Clubs in several countries (lead by the Rotary Club of Ledbury, UK), Rotary International and IDF.
The Step-by-Step programme (SbS) is a two-year project. Teams consisting of a doctor and a nurse or paramedic, are invited to attend a basic and an advanced course. During the two years data collection is mandatory. The goal is to improve educational skills and the management of diabetic foot problems. By doing so this has created a cascade effect and sustainability in the region/country. An experienced national and international faculty is responsible for teaching and the practical sessions. Medical equipment and educational materials are provided to all participants. Very successfully pilot programmes and studies were held in India and Tanzania in 2004 and 2005 . More recent publication(s) have shown that well executed SbS programmes have a significant reduction in amputation rate. (more info...)
Pictures founding of the Step-by-Step project
Train-the-Foot-Trainer ( TtFT) Program: “How to set up a Step-by-Step Project”
From Step-by-Step programmes to Train-the-Foot Trainer Courses
How to set up a Step-by-Step program
The spin-off effect of the Step-by-Step (SbS) courses is significant. This programme was successfully first introduced in 2004 and per December 2012 in over a dozen other countries implemented since. Because of its success there is a rapidly and increasing demand for these programmes in countries throughout the world. As a result it was felt that in order to sustain this good initiative a new model had to be adopted, which was robust both financial and in manpower terms.
For this reason the Step-by-Step Development and Research Group (SSDRG) of the IWGFD initiated at the end of 2010 the idea of developing the Train-the-Foot-Trainer program; How to set up a Step-by-Step project, aimed to reach more regions in a shorter period and to respond in an efficient way the demands.
The first pilot project was held as TtFT course in the SACA (South and Central America) region in Brasilia, Brazil, from 5-8 December 2012.
Train-the-Foot-Trainer program, how to set up a Step-by-Step project
Brasilia, Brazil 5-8 12 2012
First TtFT course: participants, faculty, sponsors and observers
Given the enormous success in the past decade of the Step-by-Step programs (SbS), the Step-by-Step Development and Research Group (SSDRG) of the IWGFD initiated at the end of 2010 the idea of developing a Train-the-Foot-Trainer program, how to set up a Step-by-Step project, aimed to reach more regions in a shorter period and to respond in an efficient way the demands. As a result the first Train-the-Foot-Trainer (TtFT) course was held in Brasilia, Brazil 5-8 December 2012. This was the first of a series planned to be executed in several regions around the world.
Content of the course
The course consisted of 4 major parts:
- General considerations as history, background, overview of the significant success of the SbS projects to reduce the number of amputations throughout the world, aspects of attitude and motivation.
- Content and procedures, how to install the basic course of the SbS program in ones own country.
- Content and procedures, how to install the advanced course of the SbS program.
- How to successfully implement the SbS program, to create sustainability, how to proceed with data collection, regional networking, publicity and create further awareness. Special information on funding of these programs was given.
IWGDF, IDF DFP, SACA region, SBD (Brazilian Diabetes Association), FAP (Fundaςão de Apoio a Pesquisa-Foot Acquisition Program-) and ADB (Associãςao dos Diabético do Brasil)
-Dr Hermelinda Pedrosa, (local chair), Brazil
-Dr Daniel Braver, (chair GLEPED), Argentina
-Dr Nalini Campillo, Dominica
-Dr Geisa Macedo, Brazil
-Dr Yamile Jubiz, Columbia
-Dr Kristien van Acker, (international chair), Belgium
-Professor Vilma Urbančič, Slovenia
-Dr Stephan Morbach, Germany
-Pod Mr Neil Baker, UK
-Dr ZG Abbas, Tanzania
-Pod Ms Simone McConnie, Barbados
-Mr John Greedy (Rot Club of Ledbury),UK
Dr Manuel Vera Gonzalez, (chair IDF SACA region), Cuba
Dr Karel Bakker, (chair IWGDF/IDF DFP), the Netherlands
59 people (of which 15 observers) from 14 countries of the SACA region participated in the course. The course was given in English, Spanish and Portuguese.
This first TtFT course was a great success. It was a truly interactive program, the workshops in smaller groups were very well received, and the teaching lectures by the so experienced faculty members performed were very much appreciated. To all participants tools were given to install SbS programs in their own countries as well as guidelines for implementation and data collection to create sustainability. Educational materials (books, videos for patients and health care workers, poster materials and IWGDF Diabetic Foot guidelines 2011) were presented to all country representatives.
The participants felt inspired by the course and grateful to receive enough motivation, to try to install programs in their own countries to improve the management and prevention of diabetic foot.
Tentatively the time schedule for implementation was defined as follows: feedback report on implementation plans to be delivered in june 2013. To be followed by a basic course in their countries before June 2014. Subsequently data collection will be started to be followed again by the advanced course before the end of June 2015. International and Local Faculty members will help to guide and monitor this process.
This course was financially made possible by unrestricted grants from the IDF, the SBD, ADB, FAP and the following industrial sponsors: Woerwag, Podartis, Molnlycke, Sanofi-Aventis, Servier and Medical Monofilament Mfg.
The organizers are grateful to the Brazilian Diabetes Associations (SBD and ADB) and the local faculty for hosting the course in Brasilia.
Dr Kristien Van Acker, Belgium: firstname.lastname@example.org
Dr Karel Bakker, the Neteherlands: email@example.com
Diabetic Foot Care Education Programme
Training of certified Diabetic Foot Care Assistants (DFCAss)
The IDF DFP / International Working Group on the Diabetic Foot (IWGDF) offers proposals for foot care training courses to educate certified Diabetic Foot Care Assistants (DFCAss).
It is felt that there is a great need for diabetic foot education to be available in every country. It is therefore recognized that in countries where podiatry does not exist, interested health professionals should be offered a standardized form of diabetic foot care education to implement in their healthcare setting as an adjunct to their professional responsibilities. In the absence of podiatry the need for affordable and practical diabetic foot care education below the level of podiatry has to be recognized by designing suitable programmes to improve care.
The courses are not designed to be offered either to podiatrists or be run in countries where podiatrists practice. The exceptions to this are where podiatrists who wish to become Course Leaders will undertake the courses themselves. However it is envisaged that there may be a demand for courses where the few podiatrists there are in practice cannot cope with the number of diabetic foot patients.
Successful courses to address local diabetic foot care issues are already in practice in a few countries but with the DFCAss courses offered by the IWGDF working group on Diabetic Foot Care Education (DFCE) the aim is not to detract from courses already in place but offer a standardized international course that any country with no podiatry services can apply to undertake, rather than have to set-up their own individual courses.
Please find the full Diabetic Foot Care Education Programme – For the training of certified Diabetic Foot Care Assisants in this download.
Launched September 2008
Both in the Czech Republic in 2009 (Prof Alexandra Jirkovska) and in Slovenia in 2011 (Prof Vilma Urbančič) the DFCAss curriculum has been introduced already.
DFCAss course in Prague, 03-12-2009, Prof. Alexandra Jirkovska introduces the course.
Sue Tulley, Abu Dhabi, UAE: firstname.lastname@example.org
Margreet van Putten, the Netherlands: email@example.com
Vilma Urbančič-Rovan, Slovenia: firstname.lastname@example.org
Karel Bakker, the Netherlands: email@example.com
- Tulley S, Foster A, van Putten M, Urbancic-Rovan V, Bakker K (2009)
Diabetic foot care training in developing countries: Addressing the skills shortage. The Diabetic Foot Journal 12(1): 14–22