Objective
The objective of the SNF Quality, Equity & Outcomes (QEO) Program is to improve health outcomes for children and adolescents living with type 1 diabetes (T1D) in low-resource settings by delivering an integrated system of care that combines clinical services, education support, psychosocial interventions, workforce training, and continuous quality improvement.
The program is designed to address the persistent gap between insulin access and real-world outcomes. Through comprehensive care delivery, peer-led support systems, research and evidence generation, and capacity building for frontline health workers, the QEO Program aims to improve glycemic outcomes, strengthen continuity of care, reduce preventable complications, and generate scalable models for T1D care in sub-Saharan Africa.
Background Rationale
Over the past two decades, significant progress has been made in expanding access to insulin and diabetes supplies for children living with type 1 diabetes (T1D) in sub-Saharan Africa. These efforts have saved lives and strengthened the foundation of T1D care across the region. However, despite these advances, many children continue to experience blood glucose outcomes that remain above target, preventable complications, and early mortality.
Improving clinical outcomes in low-resource settings requires more than insulin access alone. Effective T1D management depends on stable nutrition, literacy and numeracy, psychosocial support, continuity of care, reliable transportation to clinics, and health workers trained to manage a complex lifelong disease. In many settings, children are managing insulin in households where food is not guaranteed and clinics may be hours away.
The Sonia Nabeta Foundation (SNF) was established ins 2016 and since then, SNF has developed a model of care that combines insulin access with nurse-led clinics, Warrior Educator programs, home visits, education support, psychosocial services, and growing research and data systems. The QEO Program represents the next phase of this work and consolidates these interventions into one coordinated platform designed specifically to improve clinical outcomes for children living with T1D in low-resource settings.
Description of Project
Type 1 diabetes (T1D) remains a life-threatening condition for children in sub-Saharan Africa. Despite decades of global insulin donation and access programs, many children continue to experience blood sugar levels that remain above target, preventable complications, and early death. The reason is increasingly clear: insulin alone is not enough.
Managing T1D is complex. It requires continuous decision-making, reliable access to care, stable nutrition, literacy, psychosocial support, and health workers trained to manage a lifelong disease. In many low-resource settings, children are trying to manage insulin in households where food is not guaranteed, clinics are difficult to reach, and basic disease understanding cannot be assumed. These barriers continue to undermine outcomes even where insulin is available.
The Sonia Nabeta Foundation (SNF) was established in 2016 and today, SNF supports more than 5,000 children and young adults living with T1D through 40 clinics in Uganda and one specialized clinic in Ghana. Over the years, SNF has developed a model of care that combines insulin access with nurse-led clinics, peer-led Warrior Educator programs, psychosocial support, home visits, education support, and growing research and data systems.
The proposed Quality, Equity & Outcomes (QEO) Program represents the next evolution of this work.
The QEO Program will bring together five connected areas of work into one coordinated system designed specifically for low-resource settings:
Comprehensive Care Delivery
Children with T1D will receive structured clinical care, regular monitoring, access to insulin and supplies, nutrition support, and consistent follow-up systems designed to reduce preventable complications and avoidable deaths.
Research & Evidence Generation
The program will generate real-world evidence on what improves outcomes for children with T1D in low-resource settings. Continuous data collection and quality-improvement systems will help refine care and inform policy and practice across Africa.
Educational Resources & Support
The program recognizes education as a critical part of T1D care. Children will receive uninterrupted schooling and support that strengthens literacy, numeracy, and disease understanding, all essential for safely managing insulin and long-term health.
Psychosocial & Economic Support
Children and families will receive counseling, peer support, and practical assistance that helps reduce stigma, strengthen mental health, and improve long-term treatment adherence.
Capacity Building
The program will train nurses, clinicians, and Warrior Educators to strengthen local T1D expertise and improve the ability of health systems to care for growing numbers of children living with type 1 diabetes.
Together, these activities form a comprehensive care, training, and evidence platform designed to improve clinical outcomes while strengthening durable systems of care. The program will serve as a coordinated center for clinical care, workforce training, applied research, and education support, helping generate practical solutions that can be adapted across low-resource settings.
The objective of the QEO Program is to improve health outcomes for children and adolescents living with type 1 diabetes (T1D) in low-resource settings by delivering an integrated system of care that combines clinical services, education support, psychosocial interventions, workforce training, and continuous quality improvement.
Anticipated Outcome
The QEO Program is expected to improve clinical outcomes and quality of life for children and adolescents living with T1D in Uganda.
Anticipated outcomes include improved glycated hemoglobin (HbA1c) levels, reduced preventable acute complications, improved clinic retention, strengthened disease proficiency among children and caregivers, and improved psychosocial wellbeing and peer-support systems. The program also aims to strengthen local T1D expertise by training nurses, clinicians, and Warrior Educators who can extend care, follow-up, and education within underserved communities.
In addition, the QEO Program will generate continuous real-world evidence and quality-improvement data that can help inform future T1D care models, workforce development strategies, and implementation approaches across low-resource settings.
Relevance to T1D
The QEO Program directly addresses the major barriers that continue to undermine clinical outcomes and quality of life for children with type 1 diabetes (T1D) in low-resource settings.
T1D is a complex lifelong condition that requires continuous monitoring, insulin dosing decisions, nutrition management, disease proficiency, psychosocial stability and uninterrupted access to care. In Uganda and many low-resource settings, children and families must manage T1D while facing food insecurity, long travel distances to clinics, limited access to trained health workers, stigma, and fragile health systems. These factors directly influence whether children can safely and consistently manage insulin and maintain blood glucose levels within target range.
The QEO Program addresses these challenges through an integrated model that combines clinical care, psychosocial support, education support, workforce development, and continuous quality improvement into one coordinated system. The program also generates real-world evidence and implementation knowledge that can inform broader T1D care strategies across Africa and other low-resource settings globally.