the call to action on diabetes by the international diabetes federation was based on a clear message that  diabetes is everyone 's business.(1 ) we see tremendous efforts in this space both from the government , as well as from non - governmental organizations , researchers , academicians , and corporate sector .
the ministry of health and family welfare , government of india , launched the national program on prevention and control of diabetes , cardiovascular diseases and stroke ( npdcs ) in 2008.(2 ) the non - communicable diseases ( ncd ) cell of government of india supervises and monitors the implementation of the program at various levels .
mcgm is dedicated to ncd program in mumbai providing facilities for diagnosis , treatment , follow - up and referrals in 55 dispensaries , 18 peripheral hospitals and three teaching institutes .
mcgm has complemented the ncd program with innovative initiatives for educating , screening , and tracking , such as patient database & tracking system , school program , workplace intervention survey , community camps , extensive iec and public - private partnerships . in a city like mumbai , which hosts over 1.1 million people with diabetes,(3 )
the way forward is an integrated care model that can harness the expertise of different sectors like the government , private sector and community . in this communication
, we describe the successful implementation of one such integrated public - private partnership model .
mcgm public health department has a specific cell working on ncd , with a strong diabetes component .
mcgm has 55 diabetes clinics with facilities of testing , consultation , treatment and diet counseling .
the primary health care system is well - linked to the secondary and tertiary system for referrals .
2013 saw the opening of a new chapter in the ncd program , when mcgm partnered with the private sector in a transparent and positive way to fight this problem . through this partnership , eli lilly , a us - headquartered pharmaceutical company , brought to the table its expertise in patient education .
this partnership aims to strengthen the capacity of diabetes clinics of mcgm across the city and special diabetes outpatient department clinics in peripheral and major hospitals .
eli lilly supported mcgm to build the capacity of primary workforce by transferring skills and tools for better management of diabetes .
this was done through an educational tool called diabetes conversation map ( dcm ) , created by healthy interactions , in collaboration with international diabetes federation , and sponsored by eli lilly .
this tool uses interactive group participation to empower people with diabetes to become actively involved in managing their ailment.(4 ) this group learning experience is facilitated by trained diabetes educators , who have the necessary skill and expertise to co - ordinate education among a group of health workers , caregivers or patients as the case may be using different types of dcms .
fifty - five medical officers of mcgm diabetes dispensaries were sensitized and 28 amos located at health posts of mcgm were trained in partnership with eli lilly , in use of dcm .
capacity building training on dcm by certified master trainer was preceded by training on clinical spectrum and management protocol by experts from medical colleges in mumbai . following the training ,
a systematic implementation plan was chalked out for conducting the dcm sessions in the dispensaries . trained amos under the supervision of medical officers took sessions in diabetes dispensaries . during initial sessions
altogether , amos from these 28 health posts conducted 168 sessions in attached 25 dispensaries ( some dispensaries were attached to more than one health post ) and 1616 beneficiaries availed the sessions over just six months ( july - dec 2013 ) . although , no quantitative measurement of impact was done during implementation of this model , general feedback obtained on a regular basis from health providers is that dcm helps clear misconceptions among patients in an interactive way and helps improve compliance of patients .
it helps save time of medical officers , who can effectively educate multiple patients in a single session regarding the basics of the disease , its outcome , complications and importance of lifestyle modification and treatment adherence .
the dcm sessions also act as a forum for patients to interact with other individuals facing similar problems and they learn through mutual interaction , eventually making life easier for them .
these sessions bring out the faiths , beliefs , and cultural influences of patients and their relatives , which otherwise are unknown to the concerned health provider , and may act as hindrances .
the health care provider can tailor his / her health care delivery accordingly for better treatment outcomes .
patients who are educated through dcms tend to accept lifestyle modification better than one - way health talks , as this is a more visual and interactive medium . with this encouraging feedback ,
26 additional amos located at health posts attached to remaining diabetes clinics , have been trained on dcm , who will now roll it out to the patients and their care givers .
fifty - five medical officers of mcgm diabetes dispensaries were sensitized and 28 amos located at health posts of mcgm were trained in partnership with eli lilly , in use of dcm .
capacity building training on dcm by certified master trainer was preceded by training on clinical spectrum and management protocol by experts from medical colleges in mumbai . following the training ,
a systematic implementation plan was chalked out for conducting the dcm sessions in the dispensaries . trained amos under the supervision of medical officers took sessions in diabetes dispensaries . during initial sessions
altogether , amos from these 28 health posts conducted 168 sessions in attached 25 dispensaries ( some dispensaries were attached to more than one health post ) and 1616 beneficiaries availed the sessions over just six months ( july - dec 2013 ) . although , no quantitative measurement of impact was done during implementation of this model , general feedback obtained on a regular basis from health providers is that dcm helps clear misconceptions among patients in an interactive way and helps improve compliance of patients .
it helps save time of medical officers , who can effectively educate multiple patients in a single session regarding the basics of the disease , its outcome , complications and importance of lifestyle modification and treatment adherence .
the dcm sessions also act as a forum for patients to interact with other individuals facing similar problems and they learn through mutual interaction , eventually making life easier for them .
these sessions bring out the faiths , beliefs , and cultural influences of patients and their relatives , which otherwise are unknown to the concerned health provider , and may act as hindrances .
the health care provider can tailor his / her health care delivery accordingly for better treatment outcomes .
patients who are educated through dcms tend to accept lifestyle modification better than one - way health talks , as this is a more visual and interactive medium . with this encouraging feedback ,
26 additional amos located at health posts attached to remaining diabetes clinics , have been trained on dcm , who will now roll it out to the patients and their care givers .
there is enough evidence to show how education of patients positively impacts the disease outcomes.(56 ) physicians strive to help patients embrace their treatment plan .
however , the burden of patients in a routine outpatient department hardly leaves physicians with sufficient time to engage in individual discussion around education and counseling .
thus , many queries of these patients remain unanswered either due to lack of time or their hesitation to ask questions to the doctor .
moreover , the patients decisions are often driven by other sources of information , including friends , relatives and advocates of alternative remedies .
thus , it is necessary to empower them to take their own decisions and of course , right decisions , when medical help is not around .
although overcoming these tensions in the patient journey is a mammoth task , dcm does help to some extent by engaging people in a meaningful conversation about diabetes . through dcm
, information is delivered in an engaging atmosphere through peer - to - peer discussions , and patients find it easier to apply this knowledge to real - life situations , thus taking small , meaningful steps towards managing their condition better .
the success of this program was possible due to an effective collaboration of a public organization that were rightly committed for improving the situation of diabetes patients and a private organization who had the tools and resources to cater to the needs of diabetes patients . at this time
, there is no statistical analysis to prove the positive outcome of this collaboration or the education tool used .
there was no randomized controlled trial conducted to prove effectiveness or impact of the tool or the model .
nonetheless , any effort in this direction to educate patients on self - management goes a long way and the clinical benefit can not be underestimated .
moreover , although , the impact of the tool was not studied in this model , there are other reports of positive impact with this tool.(7 ) while the world is now discussing how the private sector can get engaged and share stakes in the business of community health , this is a small step in that direction and testament to the transformative potential of innovative thinking .
no single sector has all the answers to reverse the path to this national catastrophe .
 contextrising number of diabetes cases in india calls for collaboration between the public and private sectors.aims:municipal corporation of greater mumbai ( mcgm ) partnered with eli lilly and company ( india ) [ eli lilly ] to strengthen the capacity of their diabetes clinics.materials and methodsmedical officers , dispensaries and assistant medical officers ( amos ) located at attached health posts were trained on an educational tool , diabetes conversation map ( dcm ) by a master trainer . 
 this tool was then used to educate patients and caregivers visiting the mcgm diabetes clinics.resultstwenty-eight centers conducted 168 sessions , and 1616 beneficiaries availed the education over six months . 
 general feedback from health providers was that dcm helps clear misconceptions among patients and caregivers in an interactive way and also improves compliance of patients.conclusionsthis communication highlights a unique public - private partnership where the sincere efforts of public sector organization ( mcgm ) were complemented by the educational expertise lent by a private firm . 
Introduction
Materials and Methods
Results
Implementation of the Education Model
Discussion