NGO Santé Diabète
Program in Comoros

Find out the action that Santé Diabète has been carrying out since 2015 in the Union of the Comoros to improve the conditions of care and raise awareness in the population.

Context & key figures

Located in the Indian Ocean, the Union of the Comoros is among the poorest countries in the world. Coverage of health professionals is very low, with only 1.9 doctors on average per 10,000 inhabitants and barely 2.6 nurses per 5,000 inhabitants.

This low coverage does not yet enable to provide the population with sufficient health services, in particular for non-communicable diseases (NCDs) which have become an epidemiological burden throughout the country, with the example of diabetes which now affects nearly 12.3% of the population.

Human Development Index (HDI)
th
out of 189 countries

Diabetes prevalence

12.3%

Overweight
%
Obesity
%
Adults who are not physically active
%

Santé Diabète began its field actions in the Union of the Comoros in 2015.

The assessment of the situation in 2015 highlighted an alarming situation which led us, thanks to the analysis of the needs, to define priorities for action to improve the care and access to treatment of people with diabetes in the country :

  •  Geographic and financial accessibility to diabetes care
  • The availability of medicines, consultation, follow-up and diagnostic devices
  • The number of health professionals trained in the management of diabetes
  • Actions to prevent diabetes risk factors
  • The organization of the health system to adapt it to the management of chronic diseases

Our action

Based on the experience developed in Mali and Burkina Faso, Santé Diabète has set up a structuring program with a global approach including all the axes necessary for the implementation of prevention and management of diabetes quality.

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

Our support for the national strategy to fight diabetes in the Union of the Comoros has made it possible to obtain important results for the Ministry of Health and Solidarity as well as for people with diabetes on the 3 islands of the country.

Strengthening of national policy documents

  • Support to the drafting of a national strategic framework for the fight against diabetes in the Union of the Comoros.
  • Support to the Ministry of Health by working on the training of health professionals but also by starting prevention actions and strengthening patient associations.
  • Organization by Santé Diabète of a study visit to Mali in order to share experiences with partners in the fight against diabetes.

Prevention

Jointly with the Ministry of Health, we have implemented many activities allowing better prevention and earlier diagnosis of diabetes :

  • Organization of 2 global diabetes days accompanied by prevention campaigns in the media.
  • Implementation of 60 days of screening for diabetes and its risk factors, which affected 6,088 people and made it possible to diagnose 488 new people with diabetes.

Strengthening the skills of healthcare professionals

We have set up, together with the Ministry of Health, a continuing medical training program in order to strengthen the skills of healthcare professionals in the management of diabetes through two main activities :

  • Training of 184 health professionals from hospital, secondary and community structures on the country's 3 islands.
  • Funding granted to these health structures to strengthen the technical platforms (blood glucose meters, Hba1c readers, etc.).

Support of civil society

  • Santé Diabète trained the 3 main associations of the 3 islands: the Comorian Association for the Fight against Diabetes (ACLD), NARIENSHI and the House of Diabetics of Mohéli (MDM).
  • Through its interventions, our organization minds not to replace local actors and instead seeks capacity building and support towards the autonomy of local partners.
20180921_Seance de travail Ocopharma

Working session with the managers of the central pharmacy for the supply of medicines to Comoros
(Occopharma, september 2018)

20180918_Formation_APAD

Training of Associations of Patients with Diabetes (APAD) organized by Santé Diabète with the support of the NGO Walé in collaboration with the Ministry of Health, Solidarity, Social Protection and Gender Promotion (Moroni, September 2018).

Testimony

Mariatou Assane

"Thanks to the glycated hemoglobin analysis readers provided by Santé Diabète at Fomboni hospital, I can better treat my diabetes and I no longer have to travel to Mayotte or Tanzania to carry out these analyzes."

Mariatou Assane, a 50-year-old diabetic, previously had to go each year, accompanied by her husband, either to Mayotte or to Dar Es-Salam, to practice this analysis, with very significant financial costs and impacting her whole family.

portrait Dr A.S. Anli Comores

Dr Aboubacar Said Anli

General Director of Health of Comoros

"Towards a new strengthened South-South collaboration between Mali and the Comoros"

In November 2018, Santé Diabète organized a study visit to Mali so that we can exchange our experiences with their partners in the fight against diabetes. This study visit allowed us to have a very concrete vision of the actions carried out and the way in which the national policy of fight against diabetes is implemented in Mali.

We were first able to talk at length with the Secretary General of the Ministry of Health and the person in charge of NCDs in order to analyze both their strategic positioning, the implementation of their program to fight against NCDs and diabetes as well as the way in which the ministry coordinates this response with all stakeholders (NGOs, patient associations, clinicians, etc.).

We then went to the field to meet the teams and the many actions carried out by Santé Diabète, the Ministry of Health and patient associations. At the end of this very constructive first visit, we will establish, with the support of Santé Diabète, enhanced South-South collaboration between Mali and the Comoros.

FOCUS : TRAINING OF HEALTHCARE PROFESSIONALS SUPPORTED BY THE UNIVERSITARY HOSPITAL OF LA RÉUNION & SANTÉ DIABÈTE

Together with the Ministry of Health, Santé Diabète trained health professionals working in hospital structures on the country's 3 islands. In 2017-18, this program reached 153 health professionals from the 3 islands who were trained in the management of diabetes (type 1, type 2, gestational diabetes) and its complications.

The contents of the training and teaching were produced with the support of teams from the NGO Santé Diabète as well as with the two heads of the endocrinology and diabetology department of the Reunion University Hospital Center: Dr Nathalie Le Moullec and Dr Xavier Debussche.

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 COMOROS 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 11,000 people and and 2,000 people with risk factors through a prevention program using peer educators (16) the media (100 shows) and NICTs
    • of 3,300 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 :
    • A network of 16 diabetes referring physicians and their nurses
    • 46 healthcare professionals to strengthen their skills in the screening and management of uncomplicated diabetes and co-morbidities
    • 72 tertiary level healthcare professionals
  • Strengthening therapeutic education for patients with type 2 diabetes through the establishment of a network of peer educators
  • Improving the availability and decrease the price of essential medicines in the fight against diabetes
  • Establishment of a « prevention house » held by associations to strengthen prevention actions and therapeutic education
  • Strengthening of 6 associations of patients and health professionals
  • 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 COMOROS 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 4 patient associations and CSOs
  • Establishment of a community network of 8 trained community PEPs
  • Training on the management of comorbidities of :
    • 24 healthcare professionals working in 3rd referral structures
    • 32 healthcare professionals working in 2nd referral structures
  • 500 patients in total with diabetes and TB or diabetes and HIV who will have access to better quality care
  • 1,000 people with diabetes will have access to HIV and TB awareness
  • 1,000 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.