Geneva Health Forum Archive

Browse and download abstracts, posters, documents and videos from past editions of the GHF

State-NGO Partnership to Improve the Prevention and Management of Diabetes in Mali

[nggallery id=47]
Author(s): Stéphane Besancon1, Sidibe Assa2, Ibrahim Nientao2
Affiliation(s) 1ONG Santé Diabète, Bamako, Mali, 2Service d'endocrinologie et de diabétologie, Hôpital national du Mali, Bamako, Mali
1st country of focus: Mali
Relevant to the conference theme: Non-communicable chronic diseases
Summary: Mali is one of the poorest countries in the world and has already a diabetes prevalence of 3.3% (Diabetes Atlas, 4rd edition, 2010). In Mali Diabetes is a major cause of death, the leading cause of blindness, and results in 60% of non-traumatic amputations. Despite the limited human resources to improve the care of people with diabetes, Mali has set up pilot approaches, based on close collaboration between the NGO “Santé Diabète” and the Moh of Mali, focusing on decentralization of care, access to medicines, education and prevention
What challenges does your project address and why is it of importance?: Diabetes is a chronic condition affecting more than 250 million people worldwide and kills 3.8 million people per year (Diabetes Atlas, 4rd edition, 2010). According to the International Diabetes Federation (IDF) in 2025, diabetes will affect over 380 million people, making it one of the leading causes of disability and death worldwide. Developing countries will be most concerned by the pandemic,as they will account for 76% of diabetics in the world. This epidemiological transition from “rich” countries to "poor" countries is mainly due to changes in lifestyle including increasing urbanization leading to a nutrition transition, decreased physical activity and a sharp increase in overweight. In West Africa, the alarming increase of diabetes will affect social and economic conditions as the disease affects people during their most productive years of life. The cost of diabetes care and the lack of human resources to handle the increased number of patients will be a major obstacle to the achievement of the Millennium Development Goal (MDG). Prevention of risk factors for the disease, as well as access to care, treatment, education and care of diabetes complications, is the key challenge addressed by the approach developed in Mali.
How have you addressed these challenges? Do you see a solution?: This approach is based on strengthening of the health system through 5 strategic ways:- Strengthening of human resources- Availability of drugs- Accessibility of drugs- Analysis and biological measures and Primary prevention and therapeutic education 1) Strengthening human resources for diabetes management- Ensure reference to the highest level (national hospitals). Creation of a specialization on endocrinology (4 years) and on diabetes (1 year). Establishment of postgraduate training course - Provide referral management at secondary level.  Annual program of training for referring doctors in diabetes management and its complications in regional hospitals and health centers. Annual program of training for doctors in the sanitary districts for the management of diabetes and some of its complications.  Training for other doctor and paramedics on risk factors for diabetes and diabetes screening • Analysis and biological measures- Capacity building at different levels. Hospital: technical support for further analysis in endocrinology. Regional hospitals and health centers: technical support for screening and treatment of diabetes and some complications (diabetic foot, retinopathy) Comminatory health center:  screening and management of uncomplicated diabetes. 2) Drugs - Availability: represents both the ability to develop new drugs that meet the needs but also to make them available in a given country. Work with pharmaceutical companies and generic manufacturers as well as the national pharmacy in Mali so that private wholesalers can make available the desired treatments for diabetes and its complications. 3) Accessibility: is divided into geographical and financial accessibility. The product is available for a patient throughout a given territory at a price at which the patient can buy. Work on two fronts: the negotiation of price initiative differentiated with pharmaceutical companies and work with manufacturers of generic products. Support the national pharmacy in Mali for the expression of needs and respect for the master plan of supply at different levels of the health pyramid. 4) Primary prevention. Once the system of management of diabetes is in place :• Increased knowledge of risk factors for diabetes and other NCDs common risk factors and screening (in practice diabetes and hypertension) with the referral of positive cases to the diabetes consultations. 5)  Therapeutic education- Included in the training programs for capacity building in this area. Establishment of a specific therapeutic education program in the health structures with the diabetes consultations
How do you know whether you have made a difference?: In 2004 Mali only had 2 specialized doctors (1 diabetologist and 1 endocrinologist), consulting in 3 national structures located in the capital Bamako. The problems faced were the following:  lack of adequate material (glycaemia readers, control strips…) which delayed the patients’ diagnostic and mades follow-up difficult, medication was often lacking in the central medical stores, patients provided themselves with products from private pharmacies at a much more important cost (eg: 12$ for insulin vial, 6$ for OAA, 3 $ for glycaemia controls). there was no specific program of prevention and less than 10 patients with type 1 diabetes were followed (with a life expectancy of 1 year at the testing time). The  situation of Mali at the end of 2010 is as follows:  the training of 10 doctors and 20 nurses in specialized services, training of 18 diabetes referral doctors for the different regions, training of 557 doctors and paramedical staff (nurses, midwives etc ...), consultation and management for over 3000 patients with diabetes in 7 regions of Mali and the District of Bamako. For each diabetes consultation there is availability of the testing equipment, educational materials and medicines, the cost of insulin has lowered by 48% (100UI bulb from 6200 francs CFA to 3800 FCFA),  there has been an average lowering of the prices by 10 of oral diabetes pills (20 pills from 2,500 FCFA to 250 FCFA), a specific program has been established for the management of diabetic foot and more than 500 patients with diabetic foot were managed in 2009 at the peripheral level, 95% were followed without referencing and/or amputation. There were 114 follow-up visits at the homes of patients with diabetic foot, the establishment of a therapeutic education program, the establishment of a prevention program that affected over 120 000 people in three regions of Mali as well as the establishment of a specific prevention program in schools affecting more than 4000 students.
Have you or the project mobilized others and if so, who, why and how?: This close cooperation between the state and NGOs for the implementation of actions has: Strengthened the mobilization of local authorities against diabetes, strengthened the mobilization of many donors and established an extensive network of international partners to support the fight against diabetes - France: Pr Halimi, Pr Vialettes Dr. Debussche, Prof. JJ Robert ... - World: Prof Dr Silink (Australia), Professor Delisle (Canada), Professor Jonathan Brown (United States), Pr Belhadj (Oran - Algeria). The Associations include: AFD - Luxembourg Association of Diabetes - Diabetes Association of Australia - Team Type 1 etc .
When your donor funding runs out how will your idea continue to live?: The interventions are part of the Malian national policy which allows a gradual withdrawal of actions for the Malian state

Leave a Reply