Equitable access for diabetic foot care

Setting the scene

At the National Referral Hospital (NRH), Solomon Islands, at least 60% of inpatients on the general surgery ward have severe diabetic foot wounds.¹_. People with diabetic foot wounds often present to hospital so late that amputation is needed to save their life. While life-saving, amputation can increase the risk of further complications, challenges and costs. If people with diabetic foot wounds were identified early, amputation could be prevented.

More women than men experience disability in the Solomon Islands. Yet, women in the Solomon Islands struggle to access appropriate health care because of workloads at home, lack of transport and cultural requirements for family permission². Better understanding of specific barriers (what makes it harder) and facilitators (what makes it easier) experienced by women and men needing to access diabetic foot care services is an important step towards designing equitable services.

Taking action

To increase understanding of how services can improve equitable access for all people, local project officers and our partners in the Solomon Islands will:

• Talk with people who use diabetes services to identify barriers and facilitators to access diabetic foot care services
• Run workshops with health personnel to discuss and plan ways to reduce barriers and increase facilitators, based on what service users say
• Support the development of key recommendations to the Ministry of Health and Medical Services for the design of services to be more equitable and improve access for all people.

How and who

This project has received ethics approval from the Solomon Islands Health Research and Ethics Review Board (SIHRERB). Partners at the National Referral Hospital have expressed enthusiasm and are excited to learn more from people in different regions of the Solomon Islands.

This project will be driven by local project officers Goretti Kodovaru and Sira Tauriki from the Solomon Islands National University (SINU) with support from nurses at the National Referral Hospital, Roselyn Mataki and Jordanna Laejama. The barriers and facilitators are unique in each context throughout the Solomon Islands, with 85% of the population living in rural areas.

Our team of interviewers made initial plans to travel to different areas of the Solomon Islands by car, boat and plane to talk with people about the barriers and facilitators in their own context. The planned locations for interviews and focus groups included:

• Malaita – Kilu’ufi Hospital
• Ngella – Tulagi Hospital
• Good Samaritan Hospital
• National Referral Hospital
• Kukum Clinic
• Visale Clinic.

However, lockdowns and travel restrictions due to civil unrest and a recent outbreak of COVID-19 have changed our plans. The team in the Solomon Islands have displayed outstanding resilience and creativity to adapt to the challenges of the turbulent environment and continue the project.

What is next?

The interview team are now working to reach out to people across the Solomon Islands and conduct interviews over the phone. Interview participants will receive diabetic foot care bags which include information about how to access services, how to care for your feet and basic foot care materials, such as soap.

The team at Motivation Australia are inspired by our partners’ commitment to the project and their ongoing resilience, creativity and hard work to overcome challenges. We are proud to be able to support our partners and look forward to learning more from people throughout the Solomon Islands about how diabetic foot care service design can be more equitable and improve access for all people.