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NZMed J 2000; 113: 364-6
In November 1992, the South Auckland Diabetes Plan was launched.1 Diabetes had hitherto been recognised as a major problem in South Auckland.2'3 The Plan, an attempt to stimulate local effort to meet the needs clearly defined by the South Auckland Diabetes Survey,4"6 was developed by a representative committee ('the South Auckland Community Diabetes Planning Group') and distributed to all local general practitioners (GPs) and agencies involved in the delivery of care to diabetes. The South Auckland Diabetes Project (SADP), with its diabetes research team, was established concurrently to address those activities unlikely to be undertaken by either general practice or secondary services.7 Immediately after the launch of the Plan, the New Zealand health reforms led to the local establishment of five different Independent Practitioner Associations (IPAs), the replacement of most of the existing hospital management and major changes in health promotion activities.
An economic evaluation of the Plan confirmed that its 'net benefits' were 'significantly positive'. An evaluation by the Ministry of Health and the Northern Regional Health Authority in July 1993 supported the implementation of the Plan and funding for the SADP.9 Plans for the Northern Regional Health Authority in 1996,10 New Zealand11 and Otago12 have been built upon that from South Auckland. At the time of the Plan, a referee of the paper1 prophetically asked who would ensure implementation of the plan. It is timely to review the extent to which the Plan was implemented, barriers to that process and lessons learnt along the way.
Implementing the South Auckland Diabetes Plan
The Plan defined primary, secondary and tertiary prevention strategies to enhance quality of life issues, and reduce the growth in social and financial costs caused by diabetes. There were 68 recommendations grouped into 38 major recommendations: eight related to patient and community empowerment, nine to access to care, sixteen to improving coordination and standardisation of care and five to diabetes detection. Figure 1 summarises recommendations in the Plan, displaying which components were funded directly (at least in part) and which were implemented.
The South Auckland Health diabetes services established six new community clinics two to three years after the launch of the Plan and transferred a diabetes nurse specialist from the outpatient services to the wards....