Context & key figures
Located in the Indian Ocean, this country is among the poorest in the world. The density of healthcare professionals is extremely low, with only 1.9 doctors per 10,000 inhabitants and barely 2.6 nurses per 5,000 inhabitants on average.
This shortage severely limits the healthcare system’s ability to meet the population’s needs, particularly regarding non-communicable diseases, which now constitute a major epidemiological burden, notably diabetes.
Diabetes prevalence
11,7 %
Santé Diabète began its field actions in the Union of the Comoros in 2015.
The 2015 assessment highlighted an alarming situation, which, through a needs analysis, led us to define priority actions to improve the care and access to treatment for people living with diabetes in the country:
- Geographic and financial accessibility to diabetes care
- Availability of medicines, consultation, follow-up and diagnostic tools
- Number of healthcare professionals trained in diabetes management
- Actions to prevent diabetes risk factors
- The organization of the health system to adapt it to the management of chronic diseases
Our action
Building on the experience developed in Mali and Burkina Faso, Santé Diabète has implemented a structured program with a comprehensive approach, encompassing all the necessary components to establish quality diabetes prevention and care.
This innovative approach has been put into practice through a five-level strategy aimed at achieving the following objectives:
strengthening human resources
access to medicines
strengthening of technical platforms and biological diagnostic tools
developing prevention and therapeutic education programs
Support for the development and structuring of diabetes patient associations at the local, regional, and national levels
Our impact
Our support for the national strategy to combat diabetes in the Union of the Comoros has enabled us to achieve significant results between 2020 and 2023 for the Ministry of Health and Solidarity and for people with diabetes on the country's 3 islands.
Strengthening access to care
- Continuation of our training actions for 3rd reference and 2rd reference health professionals, in particular post-graduate education (UPE) with 25 health professionals in partnership with the Ministry of Health of the Comoros and the CHU of the Reunion.
- Training of 32 health professionals working in 2nd referralstructures, with the Non-Communicable Diseases focal point at the Comoros Ministry of Health, and the La Réunion University Hospital.
- Training of 12 health professionals, including 6 pediatricians and six nurses dedicated to type 1 diabetes care, as well as the implementation of the Life For A Child (LFAC) program in the country.
- Intensive online nutrition course : 68 health professionals enrolled in the intensive nutrition course, including 36 doctors, 30 nurses and 2 midwives.
Prevention and management of comorbidities Diabetes/HIV and diabetes/TB
As part of a project funded by L’Initiative/Expertise France on diabetes/HIV and diabetes/TB comorbidities, aimed at better integrating care for affected individuals:
- Development and revision of prevention tools and training modules for patients and healthcare professionals.
- Implementation of training activities for health workers in collaboration with the Ministries of Health and national training teams of: 16 doctors and 17 paramedical diabetes reference staff; 13 doctors and 17 paramedical HIV reference staff; 14 doctors and 17 paramedical tuberculosis (TB) reference staff.
- Implementation of patient prevention actions with the training of 12 peer educators to carry out community-based diabetes prevention for people living with HIV and to prevent HIV/TB among 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 design of national policy documents on the fight against non-communicable diseases and national strategies for the fight against diabetes.These documents were disseminated by the Ministry of Health.
Prevention
Opening of houses for the prevention of diabetes and its risk factors :
- In 2021, the launch of a diabetes prevention house, jointly with the Association Comorienne de Lute contre le Diabète (ACLD), marked the beginning of prevention and patient support workshops within these houses.
- Training of 16 patient peer educators and adaptation to the local context of the prevention tools developed in Mali and used by the PPE, with the CHU de la Réunion.
- Carried out by peer educators (PE), within the walls of the prevention houses, in the community and in health facilities and prenatal clinics, in Moroni, Anjouan and Mohéli: 733 events reaching 9,465 people.
- Celebration of World Diabetes Day (WDD) with the authorities. Broadcast of TV trailers, radio spots and a press conference.
- Training of a network of 25 journalists on issues related to diabetes, with awards presented for the best contributions across various media.
- Screening and hypertension days : 60, including 12 on the sidelines of World Diabetes Day. In total, 7,987 people were screened.
- Actions in schools in the Union of the Comoros : 3 training sessions were conducted for 29 education staff in the three islands. These led to 60 awareness sessions in 20 classrooms, reaching 631 students.
- Strengthening of patient associations : Capacity building on prevention activities for 35 people from partner associations across the three islands.
Strengthening national dialogue frameworks and access to medicines
Implementation validation of a framework for dialogue on antidiabetic drugs co-led by the Ministry of Health and our NGO, with the validation of a major donation of antidiabetic medicines delivered to the Comorian government by Santé Diabète. The second meeting made it possible to carry out a comprehensive follow-up on these supplies and their use, particularly with the central purchasing agency.
Working session with the managers of the Comoros Central Pharmacy for Medicine Supply (Ocopharma).
Training of Diabetes Patient Associations (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).
Testimony
Mariatou Assane
"Thanks to the glycated hemoglobin analyzers provided by Santé Diabète to Fomboni Hospital, I can better manage my diabetes and no longer need to travel to Mayotte or Tanzania to have these tests done.""
Mariatou Assane is 50 years old and lives with type 2 diabetes. She previously had to travel every year, accompanied by her husband, either to Mayotte or Dar Es-Salam to undergo this test, incurring significant financial costs that affected her entire family.
Dr Aboubacar Said Anli
Secretary General of the Comoros Ministry of Health
"Towards a new strengthened South-South collaboration between Mali and the Comoros"
In November 2018, Santé Diabète organized a study visit to Mali to exchange experiences with their partners in the fight against diabetes. This visit provided us with a concrete understanding of the actions being carried out and how the national diabetes strategy is implemented in Mali.
We were first able to have an extensive exchange with the Secretary General of the Ministry of Health and the head of NCDs to analyze their strategic positioning, the implementation of their NCD and diabetes programs, and how the ministry coordinates this response with all stakeholders (NGOs, patient associations, clinicians, etc.).
We then visited the field to meet the teams and observe the many initiatives carried out by Santé Diabète, the Ministry of Health, and patient associations. Following this highly constructive first visit, we will establish, with the support of Santé Diabète, a strengthened South-South collaboration between Mali and the Comoros.
FOCUS: TRAINING OF HEALTH PROFESSIONALS IN COMOROS SUPPORTED BY THE HOSPITAL OF THE RÉUNION AND SANTÉ DIABÈTE
Santé Diabète, in collaboration with the Ministry of Health, continued training healthcare professionals working in hospital facilities across the country’s three islands. This program reached 69 healthcare professionals, who were trained in the management of diabetes (type 1, type 2, and gestational diabetes) and its complications. Twelve of them (six pediatricians and six nurses) received specialized training in type 1 diabetes care, alongside the implementation of the Life For A Child (LFAC) program in the country.
The training content and instruction were delivered with the support of the Santé Diabète NGO teams, as well as Dr. Nathalie Le Moullec, Head of the Endocrinology and Diabetology Department at the University Hospital of Réunion.
This new program aims to improve the quality of life and health of populations in the targeted countries (Burkina Faso, Mali, and the Union of Comoros) by strengthening the role of civil society (patient associations and health professional associations) within a multi-stakeholder network on diabetes to enhance prevention, care, and support for people living with the disease. It also seeks to promote the use in the Global North of expertise developed in the Global South. Finally, it will contribute to further strengthening the governance and organizational capacity of the NGO Santé Diabète.
The challenge of this new three-year programme is to continue strengthening 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, and also to continue improving the geographical and financial accessibility of anti-diabetic treatments, particularly insulin. 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 Comoros, and Mali, specific objectives have been defined for each country based on needs identified in collaboration with the various national implementation partners.
ACHIEVING THESE OBJECTIVES IN COMOROS WILL REQUIRE :
- The celebration of 3 world diabetes days and the organization of 150 free screening events for diabetes and its risk factors, offered at no cost to participants.
- Awareness raising :
- Reach 21,000 people and 2,100 people with risk factors thanks to a prevention programme using peer educators and the media
- Reach 3,300 primary and secondary school pupils through a health behavior prevention cycle.
- Train 25 journalists working on health-related topics.
- 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 of the price of essential medicines in the fight against diabetes
- The development of a prevention centre by associations to strengthen prevention and therapeutic education initiatives
- Strengthening of 6 associations of patients and health professionals
- Consolidation of the role and actions of these associations
- Reinforcing:
- the national response to diabetes
- 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.)
- the inclusion of diabetes in the Universal Health Coverage (UHC)
The programme is supported by three main partners: Agence Française de Développement (AFD), the Helmsley Charitable Trust and the World Diabetes Foundation (WDF). It is also supported by other international partners such as Grenoble City Council and the Life For A Child programme.
This project builds on an initial innovative three-year initiative aimed at integrating the prevention and management of Diabetes/HIV and Diabetes/Tuberculosis (TB) comorbidities in Burkina Faso and Mali. The new project will continue in these two Sub-Saharan African countries targeted by the previous initiative and is expanded to include the Union of the Comoros in the Indian Ocean.
The project ended in March 2025 in Burkina Faso and the Union of the Comoros. It concluded on December 31, 2023, in Mali.
This new project makes it possible to:
- At the level of public policies and national strategies: the development of detailed standards and procedures based on the established health professionals’ curricula, along with the related technical documents; the inclusion of comorbidities in upcoming country concept notes; and finally, the strengthening of knowledge and capacity of the Country Coordination Mechanisms (CCM) on these issues.
- 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 the Comoros involves:
- 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 4 patient associations and CSOs
- Establishment of a community network of 8 trained community patient peer educators
- 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 programme is supported by the Initiative.
