NGO Santé Diabète
Program in Mali

Discover the action carried out by Santé Diabète in Mali since 2003 to improve diabetes management and raise awareness among the population about diabetes risk factors.

Context & key figures

Mali, one of the poorest countries on the planet, also has one of the lowest densities of health professionals in the world with only an average of 0.7 doctors and 2 nurses per 10,000 inhabitants.

This scarcity severely limits the country's ability to provide sufficient, efficient and equitable health services to its population. The burden of infectious diseases remains high with an epidemiological transition which imposes the explosion in the weight of non-communicable diseases (NCDs) such as diabetes, which today affects more than 2 million people in Mali.

 

Human Development Index (HDI)
th
out of 189 countries
Diabetes prevalence
%
Overweight
%
Obesity
%
%
of households with diabetics spend more than
%
from their income to health expenses

Santé Diabète began its actions in Mali in 2003 with an expert analysis of the capacities of the Malian health system in the fight against diabetes.

This expertise, carried out in collaboration with the International Insulin Foundation (IIF), revealed a catastrophic situation for the care of people with diabetes.

  • with only 2 diabetes specialist doctors consulting in only 3 national structures located in the capital city Bamako,
  • a lack of adequate equipment (blood glucose meters, strips etc.) which led to a delay in diagnosis and made patient monitoring almost impossible,
  • a regular lack of medicines in public structures due to numerous supply disruptions,
  • the availability of measurement of glycated hemoglobin (Hba1c) in only one private laboratory in the capital city, Bamako, at a prohibitive price (15 euros for the analysis representing almost 30% of the average salary),
  • less than 10 children were being followed for type 1 diabetes. Difficulties in management - resulted in a very low life expectancy, of only one year after their diabetes screening,
  • there was no specific prevention program or therapeutic education.

Our action

In front of this situation, Santé Diabète decided to develop a program with a comprehensive approach including all the necessary axes for the implementation of quality diabetes prevention and care.

This innovative approach has been translated into practice through action carried out at 5 levels with the following objectives :

strengthening human resources

medicaments

access to medicines

traitement

strengthening of technical platforms and biological diagnostic tools

education

development of prevention and therapeutic education programs

apprentissages

support to the structuring of associations of people with diabetes locally, regionally and at the national level

Our impact

The programs that we have carried out for more than 10 years in Mali (2003) have considerably improved the health care for people with diabetes with, at the end of 2016 :

The opening of 30 diabetes consultations across the country

following more than 15,000 patients in State facilities. Patients, most of whom previously had no access to care or possible follow-up for their disease.

The creation of the first diplomas of specializations in diabetology at the university

70 health professionals specialized in endocrinology and diabetology since 2011.

An important decrease of the price of treatment

48% decrease in the price of a vial of insulin and a division by 10 in the price of a month of treatment with oral antidiabetics.

The emergence of the Federation of Diabetics of Mali

which today brings together 30 patient associations and has now more than 3,000 members as well as 20 "patient experts", and with whom we collaborate closely (prevention missions, therapeutic education sessions, etc.).

The implementation of major prevention and screening actions

to raise awareness on risk factors as widely as possible (national events such as World Diabetes Day, production and distribution of educational tools, screening operations, etc.).

The complete review of the national diabetes plan with the Malian government.

to put in place a long-term and integrated strategy for the fight against diabetes with all the partners.

La formation universitaire - mise en place par le Ministère de  l’enseignement supérieur et de la recherche, l’hôpital du Mali et l’ONG Santé Diabète - a permis de former 16 endocrinologues dont 14 sont déjà  en poste dans différentes structures de santé au Mali en 2018.

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.

A_SDA_Mali_Bamako_maison_diabete_diabetique_210111_9330

Example of an educational tool developed for Mali.

Testimony

Image_19_07_2019_11_54_collee

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-mali

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 people with diabetes living today with normal type 1 diabetes in the country.""

Focus : Education days for young people with diabetes

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 « CONVENTION PROGRAM »
2020 - 2023

The objective of this new program agreement will be to improve the quality of life and health of populations in the targeted countries (Burkina Faso, Mali and the Union of the Comoros) by consolidating the place and the role of civil society (patient associations and associations of healthcare professionals) in a multi-stakeholder network around diabetes to improve prevention, care and support for people affected by this disease. It will also aim to strengthen the use in the global North of the expertise developed in the global South. Finally, it will enable to continue the strengthening the organization and the governance of the NGO Santé Diabète.

The challenge of this three-year program agreement is to continue strengthening the political and strategic frameworks including the fight against diabetes and the health system in order to train even more specialists and generalist health professionals to be able to improve the healthcare of patients with diabetes, but also to continue geographic and financial accessibility to anti-diabetic treatments, in particular insulin. Besides, by supporting the structuring of a diabetes prevention center in each country of intervention, Santé Diabète will allow the strengthening of prevention, care and support actions for people with diabetes and people with risk factors linked to this disease while guiding civil society towards its empowerment.

Even though this program agreement is implemented in Burkina Faso, the Union of the Comoros and Mali, specific objectives have been defined for each country according to the needs identified with the various national implementing partners.

ACHIEVING THESE OBJECTIVES IN MALI WILL REQUIRE :

  • The celebration of 3 world diabetes days and the organization of 60 days of diabetes screening and its risk factors (free of charge for people).
  • Awareness raising :
    • of 21,000 people and 7,000 people with risk factors through a prevention program using peer educators (20) the media (100 shows) and NICTs
    • of 2,800 primary and high school students through a prevention cycle on good health behavior
    • training of 25 journalists working on health
  • Strengthening the health system through the training of : la formation de :
    • A network of 32 diabetes referring physicians and their nurses
    • 620 healthcare professionals to strengthen their skills in the screening and management of uncomplicated diabetes and co-morbidities
    • 280 tertiary level healthcare professionals
    • 50 specialists in endocrinology and diabetology within a graduating course
    • Strengthening therapeutic education for patients with type 2 diabetes through the establishment of a network of peer educators
  • Support the care and therapeutic education of 1,000 children and young adults with type 1 diabetes
  • Improving the availability and decrease the price of essential medicines in the fight against diabetes
  • Computerization of medical data as part of a pilot project in the hospital of Mali
  • Establishment of a « prevention house » held by associations to strengthen prevention actions and therapeutic education
  • Le renforcement de 39 associations de patients et de professionnels de santé
  • Consolidation of the role and actions of these associations
  • The reinforcement :
    • of the national response to diabetes
    • of national standards and procedures for the management of diabetes at the level of the Ministry of Health
    • other policy documents including diabetes (nutrition, maternal health, etc.)
    • of the inclusion of diabetes in the Universal Health Coverage (UHC)

This program is supported by two main partners: the French Development Agency (AFD) and the World Diabetes Foundation (WDF). It also receives support from other national and international partners such as the Auvergne Rhône Alpes region, the City of Grenoble, the Life For A Child program ...

Download the presentation sheet 1 for more information on this program.

2ND PHASE OF THE PROJECT ON PREVENTION AND MANAGEMENT OF DIABETES/HIV/TB COMORBIDITIES

This project is the continuity of a first innovative three-year project aiming at integrating the prevention and management of diabetes/HIV and diabetes/TB comorbidities in Burkina Faso and Mali. This new project will take place in the two Saharan African countries already targeted by the previous project and will be extended to the Union of the Comoros in the Indian Ocean.

This new project will allow :

  • At public policies and national strategies levels : the definition of in-depth standards and procedures based on the curricula of defined health professionals and the definition of the related technical documents; taking into account co-morbidities in the next country concept notes and finally strengthening the knowledge and capacities of CCMs on these themes.
  • At the operational level: continuing to build the capacities of health professionals involved in the management of diabetes, TB and HIV with the development of a clinical mentoring component complementary to theoretical training; the extension of community prevention actions carried out by the PEP networks formed in the two countries with stronger mobilization of civil society organizations (CSOs) and of patient organizations; strengthening of therapeutic education strategies adapted to the comorbidities developed during the previous project.

Even though this program agreement is implemented in Burkina Faso, the Union of the Comoros and Mali, specific objectives have been defined for each country according to the needs identified with the various national implementing partners.

ACHIEVING THESE OBJECTIVES IN MALI WILL REQUIRE :

  • Strengthening of 3 national diabetes programs on the prevention and management of HIV and tuberculosis co-morbidities
  • Strengthening CCMs on the prevention and management of co-morbidities
  • Strengthening the skills of 7 patient associations and CSOs
  • Establishment of a community network of 14 trained community PEPs
  • Training on the management of comorbidities of :
    • 60 students following a medical specialization
    • 192 healthcare professionals working in 3rd referral structures
    • 80 healthcare professionals working in 2nd referral structures
  • 2,250 patients in total with diabetes and TB or diabetes and HIV who will have access to better quality care
  • 15,000 people with diabetes will have access to HIV and TB awareness
  • 10,000 PLWHIV will have access to awareness raising on the risk factors for diabetes and TB.

This program is supported by the 5PC Initiative.

Download the presentation sheet 2 for more information on this program.