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 just 2.6 nurses per 5,000 inhabitants on average.
This severe shortage significantly limits the health system’s ability to meet the needs of the population, especially in the face of non-communicable diseases, particularly diabetes, which now represent a major epidemiological buden.
Diabetes prevalence
11,7 %
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
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
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 3th reference and 2th 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 Meeting.
- 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 et 6 IDE à la prise en charge du DT1 et déploiement du programme Life For A Child (LFAC) dans le pays.
- 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 with the aim of better integrating the care of people :
- Development and revision of prevention tools and training modules for patients and healthcare professionals.
- Implementation of training actions for health workers in conjunction with the ministries of health and teams of national trainers of: 16 doctors and 17 diabetes referent paramedics; 14 physicians and 17 paramedical referents Tuberculosis; 13 HIV referral physicians and 17 paramedics.
- Implementation of patient prevention actions with the training of 12 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.These documents produced were disseminated by the Ministry of Health.
Prevention
Opening of houses for prevention of diabetes and risk factors :
- Launch in 2021 of a diabetes prevention house, jointly with l’association comorienne de lute contre le diabète (ACLD), and launch of prevention and support workshops for people inside and outside the house.
- Training of 16 patient peer educators and adaptation 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 diabetes-related issues, with prizes awarded for the best contributions in the various media.
- Screening and hypertension days : 60, including 12 in conjunction with WDD. In total: 7,987 people screened.
- Actions in schools in the Union of the Comoros : 3 training courses for 29 education staff on the 3 islands, leading to 60 events in 20 classes and reaching 631 pupils.
- Strengthening of patient associations : Strengthening the prevention skills of 35 people from partner associations on the 3 islands.
Strengthening national dialogue frameworks and access to medicines
Implementation validation of a framework for dialogue on antidiabetic drugs co-managed by the Ministry of Health and our NGO and validation of a large allocation of antidiabetic drugs given to the government of the Comoros by Santé Diabète. The second meeting made it possible to carry out a complete follow-up of these allocations and their use, in particular with the central purchasing office.
Working session with the managers of the Comoros central drug supply pharmacy (Ocopharma).
Training of Associations of Patients with Diabetes (APAD) organised 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 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 is 50 years old and lives with type 2 diabetes. Previously, she had to travel every year, accompanied by her husband, either to Mayotte or Dar Es Salaam, to have this test carried out, at great financial cost and with a huge impact on her whole 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 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 HEALTH PROFESSIONALS IN COMOROS SUPPORTED BY THE LA RÉUNION CHU AND SANTÉ DIABÈTE
Santé Diabète continued to work with the Ministry of Health to train healthcare professionals working in hospitals on the country's 3 islands. This programme involved 69 healthcare professionals from the 3 islands who were trained in the management of diabetes (type 1, type 2, gestational diabetes) and its complications. Twelve of them were trained (6 paediatricians and 6 nurses) in the management of T1DM with the introduction of the Life For A Child (LFAC) programme in the country.
The training content and teaching were developed with the support of teams from the NGO Santé Diabète and the head of the endocrinology and diabetology department at the Centre Hospitalier Universitaire de la Réunion: Dr Nathalie Le Moullec.
2023 - 2026 program
2023 - 2026
The aim of this new program 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 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 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 COMOROS WILL REQUIRE :
- The 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 21,000 people and 2,100 people with risk factors thanks to a prevention programme using peer educators and the media
- 3,300 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 :
- 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
- 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)
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.
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 the Union of the Comoros and Burkina Faso. It ended on 31 December 2023 in Mali.
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 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.
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