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.
Diabetes prevalence
12.3%
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 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 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 and 6 State Registered Nurse in the management of T1D in preparation for 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 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 in 2021 and adaptation of the prevention tools developed in Mali used by the PPE, with the La Réunion University Hospital.
- Achievements in 2021 by the PEs, within the walls of prevention centres, with the community and in health structures and in prenatal consultations, in Moroni, Anjouan and Mohéli: 80 events which affected 556 people.
- Celebration of World Diabetes Day (WDD) on November 14, 2021 with the authorities. Broadcast of TV trailers, short radio programs and a press conference.
- Training of a network of 25 journalists on issues related to diabetes, and awarding of prizes for the best contributions, among the 13 productions made in 2021 in the various media.
- Screening and hypertension days : 100 including 12 on the sidelines of the WDD : in total: 4,560 people screened.
- Actions in schools in the Union of the Comoros : in 2021, 3 training sessions, for 29 education staff on the 3 islands, which led to the realization of 60 activities in 20 classes and affected 631 students.
- Strengthening of patient associations : in 2021, capacity building on prevention actions for 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 central pharmacy for the supply of medicines to Comoros
(Occopharma, september 2018)
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.
Dr Aboubacar Said Anli
General Secretary of Health of the 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 HEALTH PROFESSIONALS IN COMOROS SUPPORTED BY THE LA RÉUNION CHU AND SANTÉ DIABÈTE
Santé Diabète continued, with the Ministry of Health, the training of health professionals working in the hospital structures of the 3 islands of the country. In 2021, this program reached 69 health professionals from the 3 islands who were trained in the management of diabetes (type 1, type 2, gestational diabetes) and its complications. In 2021, 12 of them were trained (6 pediatricians and 6 nurses) in the management of T1D in preparation for the implementation of the Life For A Child (LFAC) program in the country.
The contents of the training and the teaching were carried out with the support of the teams of the NGO Santé Diabète as well as with the two heads of the endocrinology and diabetology department of the University Hospital Center of La Réunion: Dr Nathalie Le Moullec.
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.
English (UK) 
Français