Mauritius has a high burden of non-communicable diseases (NCDs), due to risk factors such as physical inactivity, unhealthy diets, alcohol abuse and tobacco use, combined with an aging demographic. One in five people in Mauritius is affected by Type 2 diabetes, which leads to a high rate of foot amputations — a complication, with an estimated 85 percent of avoidable amputations.[1][2] In response to this affliction, the Government of Mauritius, in collaboration with the World Health Organization (WHO), established foot care services across regional hospitals and clinics, and inaugurated a dedicated Diabetic Vascular Centre in 2007. 

Despite these efforts, data from 2022 reveal an increase in the incidence of lower limb amputations among diabetic patients, with 403 new cases recorded, a rise from the 211 cases documented in 2008. While date from 2022 show an incidence of lower limb amputations (403 new amputations) higher than in 2008 (211), an analysis of trends reveals that the growth rate of amputations has decreased from 2016 to 2022 compared to the period between 2008 and 2015. This decrease suggests a gradual impact of the interventions over time. Regarding re-amputations (two surgeries on the same limb), there were 118 cases in 2010. This number rose to a peak of 338 cases in 2020 before dropping to 264 cases in 2022.[3]

In 2022, WHO recommended further decentralization of foot healthcare and facilitated nurses training to better address diabetic neurovascular complications. By enhancing infrastructure and equipment, broadening access, and investing in skilled personnel, the number of amputations is expected to reduce in Mauritius, subsequently improving the quality of life of people living with diabetes. 

How did Mauritius, with the support WHO, achieve this?

In 2007, WHO partnered with the Ministry of Health and Wellness (MoHW) in Mauritius and other collaborators to set a robust foundation for improvements in diabetic care. Together, they developed the National Service Framework for Diabetes (NSFD), a ten-year program intended to position those living with diabetes at the centre of healthcare services.[4]

“Mauritius remains steadfast in its commitment to elevate the standards of care for diabetic patients. We will therefore pursue awareness and prevention efforts as well as continuously build the capacity of staff to improve service delivery and efficiency.”

- Dr Kailesh K. S.  Jagutpal, Minister of Health and Wellness, Republic of Mauritius

Over the course of the next decade, the Government of Mauritius mobilized resources, leading to the opening of a Diabetes and Vascular Health Centre and seven decentralized Diabetic Foot Care Clinics (DFCCs) across the main island, and one in Rodrigues outer island. Located in regional hospitals and primary healthcare facilities, these DFCCs were staffed with seventeen specialized nurses and equipped with vital resources including podiatry chairs provided by WHO in 2018. The DFCCs follow dedicated pathways for screening and providing specialized care for patients with foot ulcers. 

^{Diabetic foot care clinics in Mauritius follow dedicated pathways for screening and provide specialized care for patients suffering from foot ulcers}
Photo credit: WHO Mauritius

By 2019, these efforts bore fruit as the DFCCs screened over 60,000 diabetic patients and treated 25,000 cases of diabetic foot ulcers.[5] To further improve capacity for service provision, in 2020 and 2021, WHO Mauritius mobilized necessary resources for the procurement of podiatry kits. Despite these significant advancements, there was a remaining need to elevate the quality of care and ensure timely interventions to further reduce the prevalent number of amputations. In response, WHO supported a comprehensive assessment of foot care services upon the request of the Ministry of Health and Wellness to identify areas for improvement to strengthen care. 

In 2022, an international expert, engaged by WHO, conducted a situation analysis of foot care services in Mauritius. This was the country's first comprehensive assessment of foot care services which was undertaken through extensive desk reviews, regular meetings with WHO offices, and an on-site field visits. The assessment addressed several critical facets, such as infrastructure, organization of care, prevention and treatment of foot ulcers, and the diagnosis and management of peripheral arterial disease and foot infections. The results illuminated the challenges the country was facing and the necessity for a clear action plan to boost foot care delivery.

In response to the assessment, the MoHW with technical support from WHO, charted out a clear action plan based on the identified needs. This includes further decentralizing foot care services through the creation of additional foot care clinics to reach universal preventive foot care, which will be accessible from the first point of care of diabetic patients. The objective is to bring foot care services closer to the people, enhancing access and timely interventions. The action plan also prioritizes human resource development and cost-effective educational initiatives for primary prevention, leading to a holistic and sustainable approach to foot care in Mauritius. To build human resource capacity, WHO collaborated with the local foot care focal points to design a five-day training program in podiatry care for diabetic foot care nurses. This program was launched in 2022 with an experienced podiatrist conducting both theoretical and practical sessions and has enriched the seventeen specialized DFCC nurses' knowledge and skills. Certificates were awarded to recognize their achievements and motivate their continued commitment to improving foot care for diabetic patients.

“The new skills acquired during the five-day training will help me to improve the foot care services I provide. The work we are doing is very meaningful.  I am happy to work towards preventing amputation among diabetic people.”

- Mr Youdhistir Guness, Diabetic Foot Care Nurse in Mauritius

The collaboration between the government of Mauritius and WHO has led to significant progress in the quality and timeliness of foot care services for diabetic patients. With the establishment of DFCCs, the specialized training of foot care nurses, and plans for decentralized foot care clinics, Mauritius demonstrates a steadfast commitment towards ensuring comprehensive and effective foot care for people living with diabetes, reducing amputations, preventing disability and improving health outcomes.