{"id":22928,"date":"2025-04-17T15:07:16","date_gmt":"2025-04-17T13:07:16","guid":{"rendered":"https:\/\/santediabete.org\/?p=22928"},"modified":"2025-04-17T19:33:01","modified_gmt":"2025-04-17T17:33:01","slug":"renforcer-les-systemes-de-sante-face-aux-comorbidites-bilan-de-4-annees-daction-au-mali-au-burkina-faso-et-aux-comores","status":"publish","type":"post","link":"https:\/\/santediabete.org\/en_en\/2025\/04\/17\/renforcer-les-systemes-de-sante-face-aux-comorbidites-bilan-de-4-annees-daction-au-mali-au-burkina-faso-et-aux-comores\/","title":{"rendered":"Strengthening healthcare systems in the face of comorbidities: 4 years of action in Mali, Burkina Faso and the Comoros"},"content":{"rendered":"<p><strong>Since 2021, <a href=\"https:\/\/santediabete.org\/en_en\/2021\/06\/01\/une-deuxieme-phase-2021-2024-de-notre-projet-de-renforcement-de-la-prevention-et-de-la-prise-en-charge-des-comorbidites-diabete-vih-et-diabete-tb\/\">Sant\u00e9 Diab\u00e8te has been running an ambitious project<\/a> in <a href=\"https:\/\/santediabete.org\/en_en\/sante-diabete-en-action\/programme-mali\/\">Mali<\/a>, in <a href=\"https:\/\/santediabete.org\/en_en\/sante-diabete-en-action\/programme-humanitaire-burkina-faso\/\">Burkina Faso<\/a> and in the <a href=\"https:\/\/santediabete.org\/en_en\/sante-diabete-en-action\/union-des-comores\/\">Comoros<\/a>.  The aim is to improve the quality of life of people living with diabetes, HIV and tuberculosis, by offering integrated management of these often interrelated diseases.<\/strong><\/p>\n<p><strong>For four years, this project brought together healthcare professionals, associations, ministries and communities to build new ways of caring for and preventing disease.<\/strong><\/p>\n<h3><strong>Achievment:<\/strong><\/h3>\n<ul>\n<li><strong>Enhancing the skills of healthcare professionals to provide better care for co-morbidities<\/strong><\/li>\n<\/ul>\n<p>To enhance the skills of care providers, curricula were developed and adapted to each country, thanks to collaboration between experts in endocrinology, pneumology and infectiology from the three countries. The first training sessions quickly revealed a specific need: to distinguish content based on professional profiles. For example, <strong>two distinct curricula have been developed:<\/strong> one for doctors, the other for nurses and paramedics. <strong>Each were adapted to the realities and needs of national healthcare systems.<\/strong><\/p>\n<p>As a result, nearly <strong>400 professionals<\/strong> were trained through theoretical modules and clinical mentoring. This dynamic has improved the follow-up of more than<strong> 700 patients<\/strong> living with co-pathologies.<\/p>\n<div id=\"attachment_22944\" style=\"width: 610px\" class=\"wp-caption aligncenter\"><img data-recalc-dims=\"1\" decoding=\"async\" aria-describedby=\"caption-attachment-22944\" class=\"wp-image-22944 size-medium\" src=\"https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/PHOTO-2024-09-14-06-44-36-1.jpg?resize=600%2C438&#038;ssl=1\" alt=\"\" width=\"600\" height=\"438\" srcset=\"https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/PHOTO-2024-09-14-06-44-36-1.jpg?resize=600%2C438&amp;ssl=1 600w, https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/PHOTO-2024-09-14-06-44-36-1.jpg?resize=1024%2C748&amp;ssl=1 1024w, https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/PHOTO-2024-09-14-06-44-36-1.jpg?resize=768%2C561&amp;ssl=1 768w, https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/PHOTO-2024-09-14-06-44-36-1.jpg?resize=16%2C12&amp;ssl=1 16w, https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/PHOTO-2024-09-14-06-44-36-1.jpg?w=1080&amp;ssl=1 1080w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><p id=\"caption-attachment-22944\" class=\"wp-caption-text\">Supervision of doctors and nurses specializing in the care of patients with diabetes, tuberculosis and HIV, Grande Comore, September 2024.<\/p><\/div>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>An innovative community approac<\/strong><strong>h<\/strong><\/li>\n<\/ul>\n<p><strong>The community approach was one of the pillars of the project<\/strong>, based on the active involvement of patients right from the design stage. Prevention and therapeutic education materials were developed with patients, taking into account their reality, needs and health practices.<\/p>\n<p>A network of <strong>48 patients peer educators<\/strong> (PPE) has been trained to carry out awareness-raising, guidance and support activities. Their mission: to inform, guide and support their peers living with <a href=\"https:\/\/santediabete.org\/en_en\/le-diabete\/\">diabetes<\/a>, HIV or tuberculosis. Thanks to their interventions:<\/p>\n<ul>\n<li><strong>32 000 <\/strong><strong>people living with <\/strong><strong>HIV<\/strong> were made aware of the risks associated with diabetes, including <strong>3 500<\/strong> who were referred to the Diabetes Prevention Centers for individualized support;<\/li>\n<li><strong>13 500 people with diabetes<\/strong> were trained in HIV and tuberculosis prevention, including <strong>1 500<\/strong> who were referred to an HIV testing center.<\/li>\n<\/ul>\n<p>The <strong>Diabetes Prevention Centers<\/strong>, who were created or reinforced in each country, have played an essential role in welcoming, informing and supporting patients.<\/p>\n<blockquote><p>\u00ab <em>Thanks to the activities carried out by the peer educators at the Centre M\u00e9dical de Pissy where I'm being treated for HIV, I recognized the signs of diabetes. The Maison de la Pr\u00e9vention referred me to a diabetologist, and I was quickly treated. Today, I'm better able to manage both illnesses and, in turn, I give talks to help other patients. <\/em>\u00bb says a patient from Burkina Faso.<\/p><\/blockquote>\n<p>&nbsp;<\/p>\n<div id=\"attachment_22929\" style=\"width: 610px\" class=\"wp-caption aligncenter\"><img data-recalc-dims=\"1\" decoding=\"async\" aria-describedby=\"caption-attachment-22929\" class=\"size-medium wp-image-22929\" src=\"https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/IMG-4481-1.jpg?resize=600%2C450&#038;ssl=1\" alt=\"\" width=\"600\" height=\"450\" srcset=\"https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/IMG-4481-1-scaled.jpg?resize=600%2C450&amp;ssl=1 600w, https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/IMG-4481-1-scaled.jpg?resize=1024%2C768&amp;ssl=1 1024w, https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/IMG-4481-1-scaled.jpg?resize=768%2C576&amp;ssl=1 768w, https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/IMG-4481-1-scaled.jpg?resize=1536%2C1152&amp;ssl=1 1536w, https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/IMG-4481-1-scaled.jpg?resize=2048%2C1536&amp;ssl=1 2048w, https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/IMG-4481-1-scaled.jpg?resize=16%2C12&amp;ssl=1 16w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><p id=\"caption-attachment-22929\" class=\"wp-caption-text\">Refresher training for patient peer educators on comorbidities, September 2023 in Mali<\/p><\/div>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Strengthening institutional and associative actors<\/strong><strong>s<\/strong><strong> for a common objective<\/strong><\/li>\n<\/ul>\n<p>At the start of the project, many institutional and community actors were unaware of the links between diabetes, HIV and tuberculosis, and the practical implications of these co-morbidities for healthcare systems. To fill this gap, <strong>a working paper<\/strong> has been drawn up in each country, outlining the current situation and identifying the specific challenges involved in integrating the three diseases.<\/p>\n<p>This document served as the basis for <strong>for awareness-raising and capacity-building work<\/strong> involving ministries of health, national HIV, tuberculosis and diabetes programmes, the <span style=\"font-style: normal !msorm;\"><em>C<\/em><\/span><span style=\"font-style: normal !msorm;\"><em>ountry-Coordination Mechanism<\/em><\/span> (CCM, the national structure coordinating funding requests to the Global Fund), hospitals, patient associations, local NGOs and HIV\/AIDS, tuberculosis and hepatitis sector units.<\/p>\n<p>This <strong>multi-stakeholder mobilization<\/strong> has laid the foundations for a <strong>more integrated governance<\/strong>, build common messages, and strengthen advocacy leading to the inclusion of diabetes\/HIV and diabetes\/tuberculosis co-morbidities in Global Fund grants, as well as in each country's national strategy documents.<\/p>\n<h3><strong>Faced\u00a0<\/strong><strong>Challenges<\/strong><strong> :<\/strong><strong> a weakened dynamic and obstacles to overcome<\/strong><\/h3>\n<p>For a year, the project progressed smoothly in all three countries. But at the end of 2022, a major turning point occurred: in Mali, the authorities announced <strong>the end of French public funding<\/strong> (Government announcement N\u00b0042). The project, supported by the Agence Fran\u00e7aise du D\u00e9veloppement group, must therefore be suspended. While this decision has meant a complete halt to our actions in Mali, it has not broken the momentum: in Burkina Faso and the Comoros, the team has reorganized to consolidate achievements, adjust strategies and capitalize on progress.<\/p>\n<p>On the ground, however, other structural obstacles have emerged. The integration of co-morbidities can only be effective if countries have<strong>a functional, high-quality healthcare offer for each of the pathologies concerned<\/strong>. While most countries benefit from a robust HIV system, diabetes care is often fragmented, underfunded and inequitable. This imbalance is particularly glaring for patients living with a dual pathology: while HIV treatment is free, diabetes treatment (insulin, oral antidiabetics, blood glucose meters, test strips) <a href=\"https:\/\/www.lemonde.fr\/sciences\/article\/2022\/05\/30\/diabete-le-prochain-defi-pour-les-pays-a-revenu-limite-sera-d-acceder-aux-innovations_6128237_1650684.html\">remains almost entirely the patient's financial responsibility<\/a> , in contexts where Universal Health Coverage is virtually non-existent. <strong>This lack of access is a major obstacle to continuity of care and to the effectiveness of any integrated approach.<\/strong><\/p>\n<p>Although the project has made it possible to include co-morbidities in Global Fund grants, their consideration remains marginal, as these issues are still perceived as secondary by the lessor, despite the advocacy carried out in each country and the real scale of the need.<\/p>\n<p><span style=\"font-weight: normal !msorm;\"><strong>This observation reinforces more than ever the need for a <\/strong><\/span><b><strong>targeted, coordinated, regional advocacy<\/strong><\/b><span style=\"font-weight: normal !msorm;\"><strong> the <a href=\"https:\/\/linitiative.expertisefrance.fr\/le-diabete-et-ses-comorbidites-un-enjeu-de-sante-publique-en-afrique\/\">make comorbidities a priority for public policies and funding agencies<\/a>.<\/strong><\/span><\/p>\n<div id=\"attachment_22931\" style=\"width: 610px\" class=\"wp-caption aligncenter\"><img data-recalc-dims=\"1\" decoding=\"async\" aria-describedby=\"caption-attachment-22931\" class=\"size-medium wp-image-22931\" src=\"https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/imgpreview.jpeg?resize=600%2C600&#038;ssl=1\" alt=\"\" width=\"600\" height=\"600\" srcset=\"https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/imgpreview.jpeg?resize=600%2C600&amp;ssl=1 600w, https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/imgpreview.jpeg?resize=300%2C300&amp;ssl=1 300w, https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/imgpreview.jpeg?resize=768%2C768&amp;ssl=1 768w, https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/imgpreview.jpeg?resize=12%2C12&amp;ssl=1 12w, https:\/\/i0.wp.com\/santediabete.org\/wp-content\/uploads\/2025\/04\/imgpreview.jpeg?w=960&amp;ssl=1 960w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><p id=\"caption-attachment-22931\" class=\"wp-caption-text\">Consultation meeting on the management of diabetes\/TB diabetes\/HIV comorbidities in the Global Fund country grant, attended by the Ministry of Health and the CCM-Comores, in September 2024.<\/p><\/div>\n<h3><strong>Next steps:<\/strong><strong> amplifying impact and removing obstacles<\/strong><\/h3>\n<p>The year 2025 will mark an important step forward: for the first time, Global Fund grants <strong>will include prevention and management of comorbidities<\/strong> diabetes\/HIV and diabetes\/tuberculosis in the three project countries.<\/p>\n<p><strong>Sant\u00e9 Diab\u00e8te will support this implementation<\/strong> by contributing its technical expertise, training tools and support for the structuring of more integrated, community-based care systems. At the same time, several countries in West Africa and the Indian Ocean have expressed their desire to replicate the experience. Inspired by presentations made at AFRAVIH (Alliance Francophone des Acteurs de sant\u00e9 contre le VIH et les infections virales chroniques) and at regional symposia, <strong>they are now seeking Sant\u00e9 Diab\u00e8te's support<\/strong> to initiate similar projects.<\/p>\n<p>But this advance also raises a requirement: <strong>meeting systemic challenges<\/strong> highlighted by the project. In particular, the lack of access to essential diabetes drugs and equipment is a major obstacle to true integration. This is why Sant\u00e9 Diab\u00e8te will continue its advocacy on two levels:<\/p>\n<ul>\n<li><strong>With the Global Fund, to broaden its scope to include diabetes inputs in co-morbid situations.<\/strong><\/li>\n<li><strong>With governments, to ensure that diabetes care is a permanent part of Universal Health Coverage (UHC) schemes.<\/strong><\/li>\n<\/ul>\n<p>Our ambition for the future is therefore clear: <strong>extend the impact to the whole region, reinforce existing models, and make comorbidities a collective public health priority in Africa.<\/strong><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: right;\"><em>by Mo\u00efse Nguemeni, technical director of Sant\u00e9 Diab\u00e8te<\/em><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>","protected":false},"excerpt":{"rendered":"<p>Depuis 2021, Sant\u00e9 Diab\u00e8te m\u00e8ne un projet ambitieux au Mali, au Burkina Faso et aux Comores.\u00a0 L\u2019objectif\u00a0: am\u00e9liorer la qualit\u00e9 de vie des personnes vivant avec le diab\u00e8te, le VIH et la tuberculose, en proposant une prise en charge int\u00e9gr\u00e9e de ces maladies, souvent li\u00e9es entre elles. Pendant quatre ans, ce projet a rassembl\u00e9 des&hellip;<\/p>","protected":false},"author":15,"featured_media":22943,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[4],"tags":[],"class_list":["post-22928","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-actu"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.7 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Renforcer les syst\u00e8mes de sant\u00e9 face aux comorbidit\u00e9s : bilan de 4 ann\u00e9es d\u2019action au Mali, au Burkina Faso et aux Comores &#8211; Sant\u00e9 Diab\u00e8te<\/title>\n<meta name=\"description\" content=\"Depuis 2021, Sant\u00e9 Diab\u00e8te m\u00e8ne un projet ambitieux au Mali, au Burkina Faso et aux Comores pour am\u00e9liorer la qualit\u00e9 de vie des personnes vivant avec le diab\u00e8te, le 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