Plan stratégique de lutte contre le diabète

Objectives

The five-year strategic plan seeks to establish a multidisciplinary national programme for diabetes surveillance, prevention and control in Senegal, responding to a growing non-communicable disease burden associated with demographic, urban and lifestyle change.[1][2]Its central purpose is to generate reliable evidence, influence national policy and build local and regional capacity for diabetes prevention, detection, management and control.[2][3]

• Establish a national baseline on diabetes prevalence, incidence, risk factors and complications, including obesity, hypertension and lipid disorders, as well as population beliefs, perceptions and behaviours.[4][3][5]
• Develop a nationwide action plan for diabetes prevention, screening, diagnosis, treatment, follow-up and complication prevention.[3][6]
• Decentralise screening, diagnosis and care to regional hospitals, health centres and district-level services, reducing dependence on the Dakar-based national reference centre.[7][6]
• Strengthen the Marc Sankalé National Diabetes Centre’s national reference, normative and referral functions, including its diagnostic and treatment capacity.[8][9]
• Improve access to insulin, oral antidiabetic medicines and related care, while promoting generic oral antidiabetic medicines and equivalent arrangements for antihypertensive medicines.[9]
• Promote operational research on priority topics, including diabetes in pregnancy, childhood diabetes, diabetic foot, diabetic retinopathy and telemedicine.[3]
• Increase public awareness of diabetes risk factors, warning signs, complications, prevention, treatment and routes to care through communication for behaviour change.[9]

The strategy recognises that older prevalence evidence is insufficient and may understate the current burden: hospital prevalence reportedly rose from 1.1% in 1957 to 8.5% in 1985, while annual new cases at the Marc Sankalé reference centre increased from about 200 in 1980 to more than 2,000 from 2000 onwards.[10]The supplied material does not set out a distinct strategic objective or action programme for obesity beyond treating it as a diabetes-related risk factor to be measured.[1][5]

Implementation

Implementation combines a national evidence-generation programme, decentralised routine diabetes services, strengthened referral care and communication activities. Governance is intended to operate through national, regional and district structures, with ministerial leadership and participation from public institutions, professional groups, partners, local authorities and community organisations.[11][6][8]

• Conduct a national cross-sectional baseline survey across Senegal’s 11 medical regions using the World Health Organization STEPS tool, comprising questionnaires, anthropometric and blood-pressure measurements, and blood tests for glucose, cholesterol and albuminuria.[5]
• Apply stratified two-stage random sampling in rural and urban areas among people aged 15 to 75 years, targeting approximately 2,966 participants from around 1,000 households or compounds.[5]
• Establish and use sentinel sites, selected with the national statistics service, and train 30 medical students as survey investigators after contextual adaptation, pilot testing and protocol validation.[11]
• Govern the survey through a ministerially appointed steering committee led by the Coordinator for Non-Communicable Diseases and involving health directorates, the national statistics service, health education services, the World Health Organization, private actors, specialists, ethics representatives, technical resource persons and private doctors’ representatives.[11]
• Integrate diabetes screening, diagnosis and care into routine services through virtual diabetes units in regional hospitals and health centres, supported by protocols, standardised data collection, referral and counter-referral arrangements, training, supervision and facility equipment.[6][8]
• Equip health centres with at least four blood-glucose meters and strips for glucose, ketone and albumin testing, and equip regional hospital laboratories for more comprehensive monitoring, including glycated haemoglobin and microalbuminuria.[8]
• Expand the Marc Sankalé Centre with laboratory capacity, resuscitation rooms, medical-gas installations, electronic medical records and electronic links to peripheral diabetes units.[9]
• Maintain and evaluate the insulin-accessibility network linking the National Pharmaceutical Procurement agency, the ASSAD cooperative, regional hospital pharmacies and district pharmacies, while making insulin and oral antidiabetic medicines available at treatment sites.[9]
• Deliver a five-year communication campaign through television, radio, print media and public displays, including weekly specialist television programmes in French and six principal national languages and two journalist-training seminars annually.[9][12]

Service delivery builds on longstanding outpatient diabetes care at Abass Ndao Hospital and the National Diabetes Control Programme, but the material identifies significant operational constraints.[4][7]The Dakar reference centre has experienced infrastructure and staffing shortfalls, while decentralised services have had mixed functionality: Nabil Choucair Health Centre reduced pressure on the reference centre, whereas a diabetes centre at Ziguinchor Regional Hospital was not functioning because of insufficient staff.[7]The plan therefore includes workforce development for trainers and health personnel, strengthened infrastructure, coordination and supervision logistics, and improved referral capacity.[6][8]

Monitoring is intended to use baseline data, sentinel surveillance, standardised service data, pilot-project assessment and evaluation of existing National Diabetes Control Programme activities.[3][5][6]Computerised records and electronic information exchange are intended to improve patient traceability and communication between the reference centre and peripheral units.[9]The source does not specify numerical performance indicators, reporting intervals, data-management arrangements, outcome targets or formal accountability procedures.[3][6][12]

Monitoring & Evaluation

Monitoring and evaluation are framed around establishing reliable national evidence on diabetes prevalence, incidence, risk factors, complications, service use and population knowledge, attitudes and practices. Historical evidence relies largely on hospital statistics and limited surveys, while available prevalence studies are described as outdated and likely to understate the burden.[1][4][10]The five-year plan therefore proposes a national baseline survey and surveillance system to generate reference data for assessing interventions and informing prevention, detection, treatment and resource-allocation decisions.[2][3]

• Establish a national diabetes and risk-factor surveillance system using sentinel sites, covering adult men and women and examining established and potential risk factors.[3]
• Measure baseline prevalence of diabetes, obesity, hypertension and lipid disorders, alongside beliefs, perceptions and behaviours related to diabetes.[3][5]
• Conduct the national cross-sectional survey across Senegal’s 11 medical regions using the World Health Organization STEPS tool, including questionnaires, anthropometric and blood-pressure measurements, and testing for glucose, cholesterol and albuminuria.[5]
• Apply stratified two-stage random sampling in rural and urban areas among people aged 15 to 75 years, with a planned sample of 2,966 people in about 1,000 households.[5]
• Test and validate survey arrangements through a pre-survey, including determination of the appropriate STEPS level, protocol validation and dissemination of pre-test results before the main survey.[11]
• Assess district-level prevention pilots, review National Diabetes Control Programme activities, and identify barriers and opportunities affecting diabetes control.[3]
• Standardise diabetes data collection and operate monitoring and evaluation systems at health-centre and regional-hospital levels, alongside referral and counter-referral arrangements.[6]
• Use computerised medical records and electronic links between the Marc Sankalé National Diabetes Centre and peripheral diabetology units to strengthen patient traceability and information exchange.[9]

Service-performance concerns include patients at the Marc Sankalé Centre receiving one consultation annually rather than the stated norm of four, because of constrained premises and high referral volumes.[7]No evaluation had been conducted for the diabetes-care initiative in Fatick.[7]The source proposes evaluation of the action plan and of the insulin-accessibility scheme established in 2002, but does not specify numerical indicators, reporting schedules, data-management standards, outcome targets or formal accountability procedures.[6][9][12]

Costing & Financing

Financing information is fragmented and primarily concerns insulin subsidies, patient charges and resource requirements. Public resources have historically been concentrated on medicines, particularly insulin, rather than a comprehensive package of prevention, screening and chronic-care services.[1][4]The state subsidy for purchasing human insulin is reported at nearly 300,000,000 CFA francs annually, while insulin-dependent patients are estimated to account for about 10% of people with diabetes in Senegal.[10]

• Maintain a subsidy of more than 250,000,000 CFA francs to preserve the previous price when human insulin was introduced in 2002.[4]
• Record patient-facing charges for education, follow-up consultations, laboratory testing, insulin, diabetic-foot dressings, amputation and dialysis, although the source does not formally identify the currency for these amounts.[2]
• Recognise that dressing materials for diabetic-foot care are paid exclusively by patients.[2]
• Mobilise resources for the proposed STEPS survey, including survey preparation, training, pilot work, sentinel-site selection and data collection.[11]
• Resource decentralised diabetes care through facility equipment, laboratory products, infrastructure, staffing, training, medicine supply, coordination and supervision logistics.[6][8][9]

A central financing weakness is the reported absence of funding for the National Diabetes Control Programme.[2]The source does not provide a complete programme budget, financing plan, named funding sources, quantified funding gap, allocation framework or economic assumptions for the proposed surveillance, decentralisation, communication and service-strengthening activities.[2][11][6][8][9][12]