Context & key figures
Mali, one of the poorest countries in the world, faces a critical shortage of healthcare professionals, with only 0.7 doctors and 2 nurses per 10,000 inhabitants. At the same time, the burden of Non-Communicable Diseases (NCDs) continues to grow, with 3.6% of the adult population suffering from diabetes and 18% from hypertension.
This shortage seriously compromises the healthcare system’s ability to guarantee adequate, efficient and equitable services. Moreover, the epidemiological transition accentuates this problem, combining a persistent prevalence of infectious diseases with an exponential rise in non-communicable diseases such as diabetes.
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
access to medicines
strengthening of technical platforms and biological diagnostic tools
development of prevention and therapeutic education programs
support to the structuring of associations of people with diabetes locally, regionally and at the national level
Our impact
The programmes we have been running on the ground in Mali since 2003 have considerably improved the way people with diabetes are cared for. Between 2020 and 2023, we achieved significant results:
Prevention
Opening of houses for prevention of diabetes and risk factors :
- Launch in 2021 of a diabetes prevention house, jointly with the NGO Walé and start of prevention and support workshops for people in the houses.
- Launch in 2021 of regional prevention houses (Kayes, Timbuktu, Ségou and Sikasso).
- Training of 20 patient peer educators (PPE) and development of prevention tools used by the PPE.
- 764 presentations by PEs, reaching 7,921 people, were held in prevention centres, in the community, in health facilities and in pre-natal consultations.
Celebration of World Diabetes Day (WDD) with the presence of the Minister for Health. Broadcast of TV trailers, radio programs and a press conference.
- Training of a network of 25 journalists on diabetes-related issues, with prizes awarded for the best contributions in the various media.
Screening and hypertension days : 162 days organized. In all, 16,538 people were screened in the 6 communes of Bamako and in the regions.
- Actions in schools : 2 training courses for 78 education staff in the regions and districts of Bamako (Koulikoro, Sikasso, Mopti, Timbuktu). This led to 84 presentations in 28 classrooms, reaching 1,296 pupils.
- Strengthening of patient associations : Skills-building in prevention for 30 people from Fenadim member associations in Bamako, Sikasso, Kayes, Ségou and Timbuktu.
Strengthening access to care
- Continuation of our diploma courses (D.E.S in endocrinology and diabetology and DU in diabetology). 23 students benefited from it in West and Central Africa.
- Continuation of our training actions for 3th reference and 2th reference health professionals, in particular post-graduate education (UPE) provided by the Malian Society of Endocrinology and Diabetology (Somed).
- Reinforcement of the clinical skills of the 32 pairs of diabetes referral nurses from Bamako and the various regions of Mali, taking care of more than 20,000 patients in the field, in conjunction with the Ministry of Health and Somed.
- Management of T1D and therapeutic education : in partnership with the Mali Hospital and the University Hospitals of Geneva, strengthening of the management and TPD of children and young adults with T1D and training of 11 referring doctors diabetes on T1D. Organisation of 24 therapeutic education days for 260 children and their parents. Training of 10 pediatricians from the capital Bamako and 5 regions of the country on the management of diabetes in children and adolescents at the Mali Hospital. Strengthening of Dr Togo’s skills as part of the ETP diploma from Geneva hospitals.
- Intensive online nutrition course : in Mali, 65 health professionals enrolled in the intensive nutrition course, including 27 doctors, 28 nurses and 10 doctor students in endocrinology.
Chair in philosophy at the hospital
In 2021, launch of the chair in philosophy at the hospital in Mali: development of a curriculum on the holistic approach to care in order to strengthen the relationship between health professionals and patients with diabetes through the delivery of a course 3-day intensive on the humanities in health and the caregiver / patient relationship at the Mali Hospital by Pr Cynthia Fleury.
Prevention and management of comorbidities Diabetes/HIV and diabetes/TB
As part of a project on diabetes/HIV and diabetes/TB co-morbidities, with the aim of better integrating the care of :
- Development and revision of prevention tools and training modules for peer educators, patients and health professionals.
- Implementation of training actions for health workers in conjunction with the ministries of health and teams of national trainers of: 38 doctors and 34 diabetes referral paramedics; 24 doctors and 24 HIV referral paramedics; 20 physicians and 20 paramedical referents Tuberculosis (TB).
- Implementation of patient prevention actions with the training of 19 peer educators to ensure community prevention of diabetes in people with HIV and prevent HIV / TB in people with diabetes.
- Production of an advocacy note for national stakeholders on issues related to diabetes / TB and diabetes / HIV comorbidities.
Strengthening national policy frameworks
Santé Diabète supported the Ministry of Health in the graphic formatting of national policy documents for the fight against non-communicable diseases and national strategies for the fight against diabetes. The produced documents were disseminated by the Ministry of Health.
Strengthening national dialogue frameworks and access to medicines
Establishment of a a framework for dialogue and presentation of the various data on the availability of antidiabetic treatments as well as their prices and exchanges to improve this availability.
The university course, set up by the Ministry of Higher Education and Research, Mali Hospital and the NGO Santé Diabète, has trained 85 endocrinologists from 11 different African countries, more than 30 of whom are already working in various health facilities in Mali.
Example of an educational tool developed for Mali.
Testimony
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 1,500 young diabetics now living normally with 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.
2023 - 2026 program
2023 - 2026
The aim of this programme will be to improve the quality of life and health of people in the target countries (Burkina Faso, Mali and the Union of the Comoros) by consolidating the place and role of civil society (patients' associations and associations of healthcare professionals) in a multi-player diabetes network to improve prevention, care and support for people suffering from this disease. It will also aim to strengthen the use in the North of expertise developed in the South. Finally, it will enable the governance and organisation of the Santé Diabète NGO to be further strengthened.
The challenge of this three-year program is to continue to strengthen the political and strategic frameworks, including the fight against diabetes and the healthcare system, in order to train even more specialists and general practitioners so as to be able to increase the care provided to patients suffering from diabetes, as well as to continue to make anti-diabetic treatments, particularly insulin, geographically and financially accessible. In addition, by helping to set up a diabetes prevention centre in each country where it operates, Santé Diabète will be able to step up prevention, care and support for people with diabetes and those with risk factors linked to the disease, while guiding civil society towards empowerment.
Although this program is being implemented in Burkina Faso, the Union of the Comoros and Mali, specific objectives have been defined for each country based on the needs identified with the various national implementing partners.
ACHIEVING THESE OBJECTIVES IN MALI WILL REQUIRE :
- Celebration of 3 world diabetes days and the organization of 150 free screening days and its risk factors (free of charge for people).
- Awareness raising :
- of 35,000 people and 7,000 people with risk factors thanks to a prevention programme using peer educators and the media
- of 3,500 primary and secondary school pupils 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 40 diabetes referral doctors and their nurses
- 750 healthcare professionals to enhance their skills in the detection 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 1 750 children and young adults with type 1 diabetes
- Improving the availability and decrease of the price of essential medicines in the fight against diabetes
- Computerization of medical data on a pilot basis in Mali
- Associations to set up a prevention centre to step up prevention and therapeutic education initiatives
- Strengthening 39 patient and healthcare professional associations
- 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
- of other policy documents including diabetes (nutrition, maternal health, etc.)
- of the inclusion of diabetes in the Universal Health Coverage (UHC)
This programme is supported by two main partners: the World Diabetes Foundation (WDF) and the Helmsley Charitable Trust. It also receives support from other international partners such as the Life For A Child 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.
The project will end on 31 December 2024 in Burkina Faso and the Union of the Comoros. It ended on 31 December 2023 in Mali.
This new project, which is currently being completed, will enable :
- 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.
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 the Country Coordinating Mechanis 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 programme is supported by the Global Fund.
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