Plan Stratégique Intégré de Lutte Contre les Maladies Non Transmissibles (MNT) 2019–2023

Objectives

Mali’s 2019–2023 Integrated Strategic Plan for Non-Communicable Diseases seeks to improve population health and wellbeing by reducing morbidity, premature mortality, disability and complications associated with priority non-communicable diseases.[1]It aligns with Sustainable Development Goal 3.4, which calls for a one-third reduction in premature non-communicable disease mortality by 2030 through prevention and treatment while promoting mental health and wellbeing.[2]

• Prioritise cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, sickle-cell disease, and mental illnesses including epilepsy.[3][4]
• Strengthen prevention, quality care, research, partnership and coordination, and surveillance across every level of the health system by 2023.[1]
• Reduce exposure to modifiable risk factors, including tobacco use, harmful alcohol consumption, unhealthy diets, inadequate fruit and vegetable consumption, physical inactivity, overweight, obesity and hypertension.[5][6]
• Reduce premature deaths and disability while improving workforce competencies, diagnostic and therapeutic resources, medicine availability, standard care procedures and evidence on disease burden and effective interventions.[7][8]
• Deliver prevention through social and behavioural change communication, community mobilisation, advocacy, early screening and risk-factor reduction.[7]
• Support screening and prevention campaigns for hypertension, diabetes, sickle-cell disease, gynaecological cancers and mental disorders; promote hepatitis B birth-dose vaccination, human papillomavirus vaccination for children aged 9 to 13, tobacco control, salt reduction, healthy diets and physical activity.[9][10]
• Improve care capacity for priority conditions through trained personnel, functional infrastructure, equipment, specific medicines and standard protocols, including the World Health Organization essential intervention package.[11][10]
• Generate evidence through operational research, disease registries, prevalence surveys and risk-factor surveillance, including the STEPwise Approach to Surveillance survey.[11][12]

Implementation

The plan uses a decentralised, multisectoral implementation model that combines prevention in communities and facilities with strengthened referral care, research, surveillance and coordinated action across central, regional, district and facility levels.[1][13]Technical oversight rests with the Ministry of Health and Public Hygiene, while the National Directorate of Health provides the secretariat for implementation arrangements.[14]

• Implement interventions throughout the health-system pyramid, with the central level planning, coordinating and supervising; regional authorities overseeing district annual plans; districts delivering operational plans; and facilities providing prevention and treatment services.[13]
• Establish a National Interministerial Coordination Committee as a subcommittee of the Health Sector Development Programme technical committee, bringing together public and private sectors, civil society, communities, development partners and technical partners; convene it twice yearly.[14]
• Assign relevant ministries responsibility for their designated interventions and engage non-health sectors on risk factors and social determinants.[14][13]
• Mobilise civil-society organisations for public and political awareness, community participation and prevention, and involve private-sector actors in health-promotion programmes and responsible commercial practices.[14]
• Train and recruit health workers; adapt curricula; develop and disseminate disease-specific guides and modules; rehabilitate or develop facilities; equip services; and supply specific medicines through the essential-medicines supply system.[11]
• Develop specialised capacity, including sickle-cell care units, mental-health services, oncology and palliative-care services, regional respiratory services, diabetes research capacity and diagnostic services for sickle-cell disease.[15][16]
• Designate regional and local focal points for each priority disease, establish stakeholder consultation arrangements, map relevant associations and non-governmental organisations, and hold regular meetings with technical and financial partners.[11][17]

Surveillance is intended to quantify disease burden, trends, risk factors and determinants through integration of non-communicable disease data into the National Health and Social Information System.[1][11]The District Health Information Software 2 supports nationwide data transmission from community health centres, referral health centres and hospitals, with facility data reviewed locally and transmitted through regional health directorates or directly by hospitals to the Planning and Statistics Unit.[18][19]Existing routine data are limited largely to recorded cases and deaths for selected conditions, and inadequate risk-factor surveillance constrains in-depth analysis.[19]

• Monitor activities using indicators, definitions, calculation methods, reporting frequencies, data sources and assumptions recorded in the integrated action plan.[20]
• Use supervision reports, annual activity reports, training reports, delivery records, registry data, survey reports, diplomas, recruitment orders and equipment-receipt documents as verification sources.[21][12]
• Conduct annual dedicated supervision, an annual non-communicable disease review, mid-term evaluations in 2020 and 2022, and a final evaluation in 2023 under the Health and Social Development Programme framework.[17][22]
• Track World Health Organization voluntary targets on tobacco, alcohol, physical inactivity, hypertension, salt intake, diabetes, obesity, essential medicines, basic technologies, medication and counselling.[22]

The estimated total cost is 11,540,050,000 West African CFA francs for 2019–2023.[23]Care represents 62% of the cost and prevention 22%, reflecting prior limited integration of non-communicable diseases into the minimum health-service package and consequent needs for service delivery, workforce development and equipment.[23]Financing is expected from the State budget and alternative sources, including insurance, mutual-health schemes and technical and financial partners; the available material does not specify annual commitments or a quantified funding gap.[11][14]

Monitoring & Evaluation

The plan establishes surveillance, monitoring and evaluation as core strategic functions for tracking the burden, risk factors, service delivery and outcomes of priority non-communicable diseases. It combines routine health-information reporting, disease-specific registries, population surveys, activity monitoring and scheduled plan evaluations.[1][7][20]

• Integrate non-communicable disease data into the National Health and Social Information System, drawing particularly on the Local Health Information System and Hospital Information System to monitor incidence, prevalence, mortality and service activity.[19][11]
• Address current information gaps, as available routine data mainly record cases and deaths for selected conditions and do not adequately capture risk-factor surveillance.[19]
• Use the District Health Information Software 2 for monthly facility reporting, data review and correction, transmission through Regional Health Directorates, and central compilation by the Planning and Statistics Unit; hospitals report directly to that unit.[18][19]
• Designate regional and local focal points for priority diseases, conduct annual dedicated supervision, and use annual reviews and activity reports to support implementation oversight.[11][17]
• Strengthen population-based cancer registries in Bamako and Kati, extend registration progressively to other regions, and use registry reports as verification sources.[12]
• Implement the STEPwise Approach to Surveillance 3 survey to measure non-communicable disease risk-factor prevalence and update the evidence base established by the 2007 survey.[24][12]
• Track indicators covering communication-plan availability and dissemination, screening campaigns and cases screened, workforce training and recruitment, equipment provision, supervision, registry coverage and risk-factor prevalence.[12][20][25]
• Monitor screening for hypertension, diabetes, sickle-cell disease, gynaecological cancers and mental disorders through annual campaigns across 75 health districts.[20]
• Use training reports, diplomas, recruitment orders, delivery notes, reception certificates, supervision reports, activity reports, meeting minutes and survey reports as activity-level verification sources.[21][12][15][26]
• Conduct mid-term evaluations in 2020 and 2022 and a final evaluation in 2023 under the Health and Social Development Programme IV framework.[22]
• Hold the National Interministerial Coordination Committee responsible for technical, administrative and financial management, implementation supervision, links with regional and district bodies, and periodic evaluation at all levels.[14]
• Track the World Health Organization voluntary targets, including reductions in tobacco use, harmful alcohol consumption, physical inactivity, hypertension and diabetes, alongside targets for essential medicines, technologies, medication and counselling availability.[22]

Costing & Financing

The five-year 2019–2023 integrated plan was costed through activity-based annual programming. Its reported total estimated cost is 11,540,050,000 West African CFA francs, while one extract refers more broadly to a required budget of 11 billion CFA francs.[8][27]

• Allocate the largest reported share, 62%, to strategic axis 2 for care, reflecting the limited prior integration of non-communicable diseases into the minimum health-service package and associated requirements for services, training and equipment.[8][23]
• Allocate 22% of total costs to prevention under strategic axis 1.[23]
• Finance implementation through the State budget and alternative sources, including insurance, mutual-health schemes and technical and financial partners.[11]
• Mobilise technical, material and financial support from development partners, civil society and other sectors; the extracts do not quantify partner commitments or financing gaps.[2][14]
• Cost workforce training, specialist recruitment and diagnostic and therapeutic equipment, although the recruitment activity in the extracted table is marked as pending without a stated amount.[21]
• Treat activities without a stated financial cost as routine activities or activities whose costs are incorporated into other budgeted activities.[8]
• Provide no explicit economic assumptions, annual financing commitments, expenditure framework or quantified funding-gap analysis beyond the stated costs and financing sources.[8][14]