Changing Diabetes(C) in Children: A Public-Private Partnership Delivering Diabetes Care to Children in Low- and Middle-Income Countries

Addressing the consequences of type 1 diabetes (T1D) in low- and middle-income countries (LMICs) is a formidable challenge. Many children do not receive treatment, leading to severe illness and early death. In 2009, Novo Nordisk A/S (NN), F. Hoffmann-La Roche Ltd (Roche), the International Society for Pediatric and Adolescent Diabetes (ISPAD), and the World Diabetes Foundation (WDF) formed a global partnership-the Changing Diabetes© in Children (CDiC) program. The overall purpose of CDiC was to make care and life-saving medicine available to children and youth with T1D in LMICs. CDiC's overarching ambition was to ensure that no child should die from T1D. CDiC's approach encompassed four core components: educating patients, training healthcare staff, establishing or refurbishing clinics, and providing medicines and medical supplies. At the international level, CDiC was incorporated into NN's headquarters in Denmark, where a small secretariat coordinated its work. At the national level, CDiC representatives at NN affiliates worked in tandem with local implementation partners and national health authorities to implement the program. At the regional level, CDiC appointed regional managers to coordinate implementation. By 2020, CDiC had reached almost 30,000 children in 15 LMICs in Africa, the Middle East, Southeast Asia, and Latin America. In view of this successful expansion, CDiC and its global partners announced a new goal of reaching 100,000 children and youth by 2030. This goal potentially posed significant strategic and operational challenges for the partnership, such as development of the program's governance structure and partnership model, new and innovative management tools, procedures, and digital solutions in order to expand across multiple country boundaries and cultures effectively. Overall, the ambition of reaching 100,000 children by 2030 raised key questions about how the long-term sustainability and exit of the program could be ensured.