Mali, one of the poorest countries on the planet, also has one of the lowest densities of health professionals in the world with only 0.7 doctors and 2 nurses on average per 10 000 inhabitants.
This shortage significantly restricts the country's ability to provide its people with sufficient, efficient and equitable health services. The epidemiological transition imposes a burden of infectious diseases which remains high with, in addition, the explosion of the weight of noncommunicable diseases (NCDs) like diabetes which affects today more than 2 million Malians.
Santé Diabète started its field actions in Mali in 2003 by carrying out an expertise to analyze the capacities of the Malian health system in the fight against diabetes.
This expertise, carried out in collaboration with the International Insulin Foundation (IIF), highlighted a catastrophic situation for the care of people with diabetes.
- only 2 medical specialists consulting for diabetes in only 3 national structures located in the capital Bamako,
- lack of adequate equipment (blood glucose meters, strips etc.) which led to a delay in diagnosis and made it almost impossible to follow up on patients,
- a regular lack of drugs in public structures due to numerous supply disruptions,
- the measurement of glycated hemoglobin (Hba1c) was only possible in one private laboratory from the capital, Bamako, at a prohibitive cost (15 euros per analysis representing almost 30% of the average salary),
- less than 10 children were followed for type 1 diabetes. The management difficulties led to a very low life expectancy since it was only a year after screening for their diabetes,
- there was no specific program of prevention and therapeutic education.
Faced with this situation, Santé Diabète has decided to develop a program with a global approach including all the axes necessary for the implementation of prevention and quality care for diabetes.
This innovative approach was concretized in practice by a 5-level action with the objectives:
strengthening human resources
access to drug
strengthening technical platforms and biological assessments
the development of prevention and therapeutic education programs
support for the structuring of diabetic patient associations locally, regionally and nationally
The programs that we have carried out in the field for more than 10 years in Mali (2003) have considerably changed the care of people with diabetes with, at the end of 2016:
The opening of 30 diabetes consultations across the country
taking care of more than 15,000 patients in state structures. Patients, most of whom previously had no access to care or possible follow-up to their illness.
The creation of the first diplomas of diabetology specializations at the university
70 healthcare professionals specializing in endocrinology and diabetology since 2011.
A sharp drop in the cost of treatment
48% reduction in the cost of a vial of insulin and a 10-fold reduction in the cost of a month of treatment with oral anti-diabetics.
The emergence of the Mali Diabetic Federation
which today brings together 30 patient associations and now has more than 3,000 members as well as 20 "expert patients", and with whom we collaborate closely (prevention missions, therapeutic education sessions, etc.).
The implementation of important prevention and screening actions
to raise awareness of risk factors as widely as possible (national events such as World Diabetes Day, production and dissemination of educational tools, screening operations, etc.).
The complete review of the national diabetes plan with the Malian government.
to set up a long-term and integrated strategy for the fight against diabetes with all the partners.
University training - set up by the Ministry of Higher Education and Research, the Mali hospital and the NGO Santé Diabète - has made it possible to train 16 endocrinologists, 14 of whom are already employed in various health structures in Mali in 2018.
Example of an educational tool developed for Mali.
Rokia Sanogo, 17 years old
living in an isolated village in Mali
"Thanks to the programs of the NGO Santé Diabète, I now have access to consultations with specialized doctors at Sikasso hospital and benefit from completely free treatment for my diabetes (insulin doses, test strips glucose).
Having no electricity or a fridge at home, storing my insulin - which must be kept absolutely cool - was a big problem for me.
During the education sessions, the doctors taught me how to store insulin in a plastic bag placed in the cool earth and this system works very well. I can finally live with my diabetes! "
Dr Graham Ogle
Director of the international program Life for a Child
"Ten years ago, there were less than 15 children with type 1 diabetes alive in Mali, with a life expectancy of no more than 1 year on average after their diagnosis.
Thanks to the excellent work of Santé Diabète in partnership with Life for a Child, the situation has improved considerably with more than 650 young diabetics living today with normal type 1 diabetes in the country."
Focus: Education camp for young diabetics
Santé Diabète has been piloting educational days in Bamako for young people under the supervision of both doctors and instructors since 2017.
Divided into 2 groups (young people from 2 to 14 years old accompanied by their parents and adolescents over 15 years old), the objective of these days is twofold: to allow these young people to talk to each other about their illness and to contribute mutual support while improving the management of their illness through the organization of therapeutic education workshops.
These days were very successful with more than 500 young people who have already taken part in this program.
The new action program
2017 - 2019
The challenge of this new three-year program is to train even more specialists and general practitioners to be able to follow the mass of diabetic patients while gradually integrating the prevention and management of diabetes / HIV and Diabetes / TB comorbidities.
This program will also aim to consolidate the role of patient associations in prevention and therapeutic education actions. Santé Diabète is also mobilizing so that the state plays an increasingly strong role in the prevention and management of diabetes, in particular by including this disease in the universal health insurance plan which should be implemented at Mali in the coming years.
ACHIEVING THESE OBJECTIVES WILL PASS BY:
- the organization of 100 days of free screening for diabetes and its risk factors
- awareness :
- 2,000 people with diabetes or at risk through an SMS prevention program
- 5,000 primary and secondary school students through a prevention cycle on good health behavior
- prevention 10,000 patients with diabetes or suffering from a diabetes / TB or diabetes / HIV comorbidity through activities carried out by a panel of 16 peer educators
- training of :
- 90 healthcare professionals managing diabetes,tuberculosis and / or HIV
- 625 health professionals to strengthen their skills in the screening and management of uncomplicated diabetes and in the management of comorbidities
- 15 tertiary level health professionals trained to carry out therapeutic education sessions and develop a targeted action plan for 3rd referral hospital services
- diploma training 40 specialists in endocrinology and diabetology
- support for care 650 children and young adults with type 1 diabetes
- Improving the availability and price of essential drugs in the fight against diabetes
- computerization of medical data as a pilot in the Mali hospital
- the reinforcement :
- national standards and procedures for the management of diabetes and comorbidities at the level of the Ministry of Health
- of the national diabetes control policy
- other political documents including diabetes (nutrition, maternal health ...)
- inclusion of diabetes in Universal Health Coverage (UCH) in Mali
- The consolidation of the role and actions of the National Federation of Diabetics of Mali (Fenadim) and the Malian Society of Endocrinology and Diabetology (Somed)
This new triennial program 2017 - 2019 is composed of 3 projects which are consolidated in a program allowing Mali to build an ambitious national policy of fight against diabetes.
This program is supported by two historic partners: the French Development Agency (AFD) and the World Diabetes Foundation (WDF).
Santé Diabète has also acquired funding from the 5% Initiative (contribution from France to the Global Fund) for the integrated management of certain comorbidities.
Download the presentation sheet for more information on this program.