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Chatbot answers COVID-19 questions from refugees with noncommunicable diseases in Jordan

The World Diabetes Foundation is assisting Jordan’s public health authorities in using new interactive and digital methods to communicate with people with diabetes and other noncommunicable diseases in Jordan about what to do during the COVID-19 pandemic. The World Diabetes Foundation has also supported the training of healthcare professionals in counselling and treating people with these diseases during the pandemic. The Novo Nordisk Foundation is supporting this initiative.

People with noncommunicable diseases have a high statistical profile in Jordan. More than 10% of the population has diabetes, and this proportion is probably even higher for the many refugees from Syria currently living in Jordan. However, outreach related to diabetes and other noncommunicable diseases presents a major challenge in a country like Jordan, in which the many refugees, and now also COVID-19, place additional pressure on the healthcare system.

“Although Jordan has many people with diabetes and other noncommunicable diseases, giving these people priority has often been challenging because of the huge pressure on the healthcare system, especially resulting from the more than 600,000 registered Syrian refugees,” says Jakob Sloth Madsen, Senior Advisor, World Diabetes Foundation.

The fact that people with noncommunicable diseases are more likely to die from COVID-19 became very clear in spring 2020. The Novo Nordisk Foundation therefore awarded a grant of DKK 5 million to the World Diabetes Foundation for a project targeting both Syrian refugees and Jordanians with these diseases during the COVID-19 pandemic.

The Royal Health Awareness Society is coordinating the initiative in Jordan, and Jordan’s Ministry of Health is implementing it as one of Jordan’s COVID-19 initiatives.

The Society and the Ministry jointly disseminate knowledge on COVID-19 to people with noncommunicable diseases, so they know how to take care of themselves. In addition, these efforts generally strengthen the health system so that it is more capable of caring for these people.

“It means a lot to receive this support from the Novo Nordisk Foundation, which fortunately acted very quickly. This meant that, in collaboration with our local partners and the public health authorities, we supported a targeted initiative in the early stages of the COVID-19 outbreak for people with noncommunicable diseases in Jordan,” says Jakob Sloth Madsen.

Digital counselling, chatbots and text messages
The World Diabetes Foundation has supported the in-service training of more than 250 healthcare professionals – including nurses and nutritionists. The courses focus on using personal protective equipment and counselling people with noncommunicable diseases during the pandemic. Some of the counselling was initially carried out face to face, but when Jordan, like most other countries, locked down, this became virtual instead.

The virtual communication not only comprises individual online meetings but is also based on an existing specially developed chatbot. The support provided by the Novo Nordisk Foundation and the World Diabetes Foundation to the Royal Health Awareness Society and Jordan’s public health authorities has enabled a module specifically on COVID-19 and noncommunicable diseases to be added. People can therefore get answers to the most common questions about COVID-19 and noncommunicable diseases. The recently completed module, which has been approved by Jordan’s public health authorities, is expected to be used by more than 10,000 people per week.

“Our partners in Jordan had to think very innovatively. In the past, healthcare professionals would typically meet patients at clinics or go out and knock on people’s doors. We have now had to become more digital because of the risk of transmitting COVID-19,” adds Jakob Sloth Madsen.

One challenge has been that many of the people with noncommunicable diseases are older and do not necessarily have access to a computer or smartphone. They have therefore received text messages with direct links in an attempt to make assistance easier.

The initiative has also included developing videos on how people with noncommunicable diseases can protect themselves during the pandemic and how they can manage their illness. The videos and other information material have been shared on Facebook and WhatsApp and have reached more than 21,000 people so far.

Funding from foundations helps to reduce silo thinking
People with noncommunicable diseases generally receive inadequate attention in low- and middle-income countries. This is even more difficult in a country like Jordan, which is experiencing both a massive influx and a large number of resident refugees. But Jakob Sloth Madsen thinks that this situation may change with COVID-19.

“In a refugee camp and in other areas with many refugees, the acute problems are naturally dealt with first. This is why noncommunicable diseases have not received as much attention – because they do not cause you to die immediately. Nevertheless, diseases like diabetes pose a great and growing burden on people, their families and society as a whole, straining a healthcare system already under pressure. COVID-19 appears to have changed this mindset. We cannot continue to think in silos that artificially differentiate between acute infectious diseases and chronic noncommunicable diseases. People with noncommunicable diseases are especially vulnerable to COVID-19,”explains Jakob Sloth Madsen.

Although helping people with noncommunicable diseases is a current priority, the initiative also aims to prevent future generations from being affected as severely. Thirty young people have therefore been trained to talk to other young people about the importance of healthy eating and exercise and have reached out to 700 other young people so far.

Further information

Christian Mostrup, Senior Programme Lead, +45 3067 4805, [email protected]