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In Mali, one person in particular has major plans for revising diabetes care. Mr. Stéphane Besancon left France to run a non governmental organisation (NGO), whose aim is to improve the prevention and management of diabetes in the Sub Saharan country of Mali in Africa.
Three projects funded by World Diabetes Foundation may well help Mr. Besancon reach his goal.
Diabetes in Mali
More than 100,000 Malians suffer from diabetes. Doctors estimate that only 30% of these patients can afford the required medical treatment and this leads to a disproportionately high prevalence of complications such as high blood pressure and serious retinopathy.
“Santé Diabète Mali” was created in 2001 by the biologist and nutritionist Mr. Stéphane Besancon in cooperation with an endocrinologist and a diabetologist in order to alleviate the suffering caused by diabetes and its complications.
Nutritional study - a base for education material
Today, the NGO has completed the first of three projects supported by World Diabetes Foundation (WDF); “Nutrition and diabetes in Mali”. The aim was to analyze the Malian diet in a diabetic perspective and to sensitise the Malian population on diabetes in general as well as on the link between food consumption and diabetes.
Sensitisation was done through trained educators reaching more than 400,000 people in Bamako, the capital of Mali, in combination with the dissemination of information material.
The two current projects build upon the lessons from the first project in which nutritional research results have made it possible to establish new guidelines for nutritional management of patients with diabetes in Mali.
Today, these guidelines are disseminated by specialists and health care staff through the training organised by Santé Diabète Mali. During the implementation of the first project an urgent need for trained health care personnel in the field of diabetes was revealed.
A step by step approach towards complete diabetes programme
The projects “Training of health care personnel” and “Improvement of prevention, care and diabetic foot project” address in particular the need of trained personnel, and aims at creating a network between patients to prevent the development of complications due to diabetes.
Mr. Besancon describes how the projects were designed to supplement each other: “We had an idea of a total programme including research, primary prevention, staff training, equipping consultations, education of patients, access to medication etc.”
He adds; “However, we had to gradually develop our research and action approach as the evolution of our projects progressed”.
Improvements already visible
Comparing the situation in 2003 to that in 2006, the improvements that benefited people with diabetes became more evident.
In 2003 there were just 3 diabetes specialists in the hospital of Bamako, now there are 12 referral doctors trained to obtain a decentralized diabetes care and 340 health workers trained on diabetes issues.
In 2003, there was only little primary prevention in the population and no specific tools of education; today education tools are adapted and diabetes prevention actions have reached more than 55,000 people.
Diabetes care also suffered from a lack of specialised diabetes consultation outside the hospital and from the limited access to medication in the public sector. From 2006, consultations specially equipped with screening and analysis material in 3 regions of Mali were available.
The availability of medicines such as oral anti-diabetic drugs and insulin has increased and prices have been reduced.
The latest project embraces six major cities of Mali to decentralise diabetes care and prevention. In addition to health care professionals and educating the general population and people with diabetes, focus is put on prevention of foot complications, replicating a training model developed by another WDF supported project “Step by Step”
Local champions important for projects to succeed
“WDF places great emphasis on the presence of what we call a local champion in the implementation of WDF funded interventions”, says Mrs. Sanne Frost Helt, Programme Manager at the World Diabetes Foundation.
“Local champions are individuals or organisations that are willing to and capable of carrying the torch locally, guiding the process and effectively pushing the diabetes agenda”, she explains. “Without this push, the impact of an otherwise well designed intervention may suffer”.
Being present where the action is needed, Mr. Besancon has learned to identify the problems and needs: “In developing countries there is a lack of structured national policies and resources allocated to manage non-communicable diseases and diabetes. To achieve a good result, it’s very important to involve the various national actors; the person in charge of drugs, doctors and patient associations etc. - and to create a network between them”, elaborates Mr Besancon.
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