Table 1 Pakistan, Muzzafarabad : to illustrate choice of priority condition, integrated approach, health promotion and community engagement

The prevalence of diabetes in Pakistan is estimated by the WHO to be 9.8% [18]. In 2016 more than 15% of lower limb amputations followed-up at the physical rehabilitation center of Muzzafarabad, Pakistan were related to diabetes complications.

Recognising the burden of diabetic foot problems which could be prevented, the health directorate of Muzzafarabad asked the ICRC in 2017 to support them in decentralisation of diabetes care from tertiary to the PHC level, with links to the community and referral to secondary and tertiary care as needed.

Engagement of the local authorities and community allowed to set priorities in training of staff at PHC and community levels, adaptation of existing diabetes management protocols, provision of diagnostic equipment including point of care devices, development of patient files, recall system and context specific health promotion activities in the community and bridging the gap of therapeutic patient education. A review of the programme in collaboration with a local university will allow to plan a moving on strategy.