This report, prepared by the International Insulin Foundation (IIF) in collaboration with Santé Diabète Mali (SDM), is to be the first stage in a collaborative process between different national and international stakeholders to find creative means to improve the welfare of people with Type 1 diabetes in Mali. The IIF aims to mobilise different areas of expertise and resources to frame practical proposals to help Mali provide the care that people with Type 1 diabetes require. In parallel this report hopes to contribute positively to the development of a chronic disease policy in Mali.


Key Findings

All these issues need to be placed in Mali’s general health care context where problems of staff, infrastructure and resources are omnipresent.

• Data and Information:
  • No standardised means of collecting information on patients
  • Lack of information on the number of people with diabetes in Mali
• Insulin:
  • Not available to patients at lowest possible price
  • Not available, without disruption, in the public sector
  • High price of insulin for patients
• Materials:
  • Syringes not available in the public sector
  • 5% Value Added Tax (VAT) on syringes
• Diabetes Care:
  • No guidelines or treatment protocols
  • No organisation and coordination of care and referrals
  • Sub-optimal use of existing health pyramid in Mali
  • Long waiting times
  • Lack of patient education
• Diagnosis:
  • Lack of availability of appropriate materials at the appropriate levels of the health system
  • Problems with the supply of reagents and other materials to laboratories
  • Healthcare worker education:
  • Lack of basic knowledge of frontline healthcare workers
  • No continued education and training
• Diabetes Association:
  • Lack of a clear definition of its role
  • No organisational structure on a national level
• Other:
  • Better cooperation and coordination needed between all stakeholders (Ministry of Health, WHO, clinicians, Association Malienne de Lutte Contre le Diabète (AMLD), SDM, etc.)
  • Draft policy document on Non Communicable Diseases (NCDs) does not take into account the realities of diabetes outside Bamako
  • Lack of coordination with regards to donations
  • Traditional healers play an important role in provision of care
  • High overall financial burden on patients

Recommendations

Keeping in mind the resource restrictions present in Mali the following recommendations aim to make best use of limited resources also in order to benefit patients with diabetes as well as other areas of health care in Mali.

• Data and Information:
  • Carry out a basic survey to assess the prevalence of diabetes in Mali
  • Develop a standardised patient information sheet or record keeping system
• Insulin:
  • Develop proper purchasing and distribution mechanisms at the Pharmacie Populaire du Mali (PPM)
  • Explore possibilities for Mali to join the Novo Nordisk LEAD Initiative
  • Registration of generic insulin manufacturer
  • Decision by government to provide insulin for free or at a subsidised cost
• Materials:
  • Add syringes to Essential Drug list
  • Remove 5% VAT on all materials necessary for proper diabetes care
• Diabetes Care:
  • Define the role of each level of the health system in diabetes care for each region
  • Identify focal point for diabetes care in each region
  • Develop guidelines for organisation of diabetes consultations and inclusion of patient education
  • Adapt IDF guidelines to Mali
• Diagnosis:
  • Develop a realistic and sustainable Essential Equipment list for each level of the health system
  • Develop a supply chain for laboratory materials
• Healthcare worker education:
  • Improve basic healthcare worker training to include more on diabetes care and Non Communicable Disease (NCD) management
• Diabetes Association:
  • Diabetes Association to analyse its role in the caring and support of people with diabetes in Mali
  • Organisation AMLD as a national entity
• Other:
• Establishment of a working group on diabetes in Mali
• Reorientation of the policy document based on the RAPIA findings
• Establishment of donation guidelines and control mechanisms
• Inclusion of traditional healers in diabetes programmes
• Find novel and sustainable ways to address the financial burden that diabetes puts on the individual and the health system

A full copy of the report can be downloaded here: 

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