The national prevalence of diabetes in Mali has been on a steady increase in the past decade and now affects 3.3% of the population. The disease is a major cause of mortality and morbidity, being the number one cause of blindness and representing 60% of non-traumatic amputations.In 2004 the NGO Santé Diabète Mali (SDM) carried out a survey that revealed a worrying situation in Mali with regard to prevention and treatment of diabetes.The survey showed an extreme shortage of doctors with only about four qualified doctors in the whole country to provide diabetes care. Equipment and medicines were virtually non-existent. There was a general apathy and lack of awareness about prevention and management both among the general population and health care professionals, and no political consideration to deal with the increasing burden of diabetes. Furthermore, the costs of receiving treatment and advice were extremely high, and with Mali being one of the poorest countries in Africa, access to services was very limited.Accordingly, a 2004-2007 action plan was set up by SDM. As part of this action plan WDF has supported three projects, WDF04-074, WDF05-114 and WDF07-251. The action plan has greatly improved diabetes care in the country by decentralising services and increasing access to care and treatment. Furthermore, the knowledge and skills of the health care professionals have improved, and so has awareness among the general population. In addition, there is a growing political commitment to prioritise diabetes with a national policy currently being developed.In spite of these huge improvements, Mali still has a long way to go in terms of providing quality care to everybody, and gestational diabetes and eye complications are still neglected areas of care.The overall aim of this project is to reduce diabetes-related mortality, morbidity and complications in the district of Bamako, the regions of Timbuktu, Sikasso, Mopti, Ségou, Kayes, Gao, Koulikoro and the Douentza district.
In close partnership with local authorities as well as other public and private partners, SDM seeks to build a holistic approach to the prevention and treatment of diabetes and its complications in Mali. This current project builds upon the structures already created from 2004 onwards. It aims at strengthening the operational plans set up by the regional health directorate in 2009, which entails decentralisation of primary and secondary care services. Furthermore, the project seeks to extend prevention and treatment of diabetic foot and to introduce screening and treatment of gestational diabetes and eye examinations.The project consists of five main components which are all a continuation of SDM’s previous work:1. Knowledge-improvement of diabetes, associated risk factors and complications. This component involves creating awareness through yearly camps in all target areas, development of IEC materials and broadcasting on radio, TV, schools etc.2. Skills-improvement of health care workers in terms of detection and treatment of diabetes and its complications. This component consists of repeated training of health care providers in general care, diabetic foot, diabetic retinopathy and gestational diabetes in order to improve the quality of care. 22 referral doctors will be trained as trainers and are expected to train approximately 500 other health care professionals. Furthermore, the nursing degree course in Bamako will be strengthened. The Step-by-Step methodology for prevention and care of diabetes related foot problems is currently being applied in three regions and will be extended to cover three more. Gestational diabetes management and eye screening programmes will be introduced and integrated into district clinics of three regions that are doing particularly well with regard to other service delivery.3. Provision of access to quality care at all levels of the health care system. This component involves an expansion of diabetes care at primary care level. Diabetes care units will be established in two additional remote regions (Gao and Koulikoro) reaching a potential of 160,000 people with diabetes. To ensure equity in access to care, a mobile diabetes care clinic equipped with basic screening tools and oral medications will be available for the nomads in the North of the Timbuktu region. This population is considered to be particularly vulnerable and hard to reach due to their nomadic lifestyle.4. Protection and promotion of the rights of people living with diabetes. This component consists of capacity building of 18 district diabetes associations previously established with support from WDF. As institutions, they are expected to carry out a watch-dog function and will receive training on how to protect and promote the rights of people living with diabetes. Furthermore, local members of the diabetes associations will be trained as peer educators. The purpose is to create a network of “expert patients” who can provide advice on self-monitoring, prevention of complications, diet, physical activity, prevention of risk factors etc.Information-gathering on diabetes-related morbidity and the level of knowledge in the population. This component involves information-gathering. In order to evaluate the impact of the project a large prospective survey including 200 people with diabetes will be carried out. The survey will include anthropometric measures and questionnaires on levels of knowledge, attitudes and behaviour before and after the project interventions.
• 56 doctors and nurses trained in prevention and treatment • 26 referral doctors were trained as trainers (ToT) in general care• 75 health professionals trained diabetic foot • 504 health professionals were trained in gestational diabetes • 50 diabetes patients trained as peer educators• Capacity-building of 18 diabetes associations conducted• 64 days information on diabetes and its complications were organized