Transcript Scaling up ART in Sénégal: specifics needs for strategic information Mame Awa Toure MD, MSc AIDS/STI Division, MOH Senegal.

Scaling up ART in Sénégal:
specifics needs for strategic information
Mame Awa Toure MD, MSc
AIDS/STI Division, MOH Senegal
Introduction
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Senegal: a west African country
Area: 196.722 km²
Population estimated to 10 millions
11 regions and 30 departments/ provinces.
Resources constrained settings: GDP of 500$ US.
Concentrated HIV epidemic
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Low HIV prevalence in general population less than 2%
5-20% in high risk group
The Senegalese Initiative for Access
to ARVs : ISAARV
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A Governmental initiative late 1997
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Political commitment : increasing annual subsidy
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Collaboration of ANRS: technical support, project design
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First step : Pilot study
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Building up a model according limited resources
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Evaluation before extension (collaboration with ANRS)
Second step : scale up for nationwide access
2000- 2006
Accelerating phase of ISAARV
 Political comittement
 Government subsidy increased
 Subsidy included to the national budget line
 Credit IDA : MAP
 Expanding Fund and Partnership for ARV
program
 government,
 WB, GF, USAID/FHI, UE, GTZ, UN agencies…
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Decrease of the of financial participation
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Increasing demand
Increasing government budget
5000
4000
Budget
Total
3000
1475 millions
2000
1000
250 millions
0
1998
1999
2000
2001
2002
2003
Financial participation
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Government subsidy con’t
October 2000: ACCESS Program
Levels of financial participation
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SES assessed by a social workers team
A package including drugs, CD4 count and viral load
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Low income: $30- $7 per month
Government officers $60- $15
About 80% of patients treated free of charge
ISAARV managerial structures
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Health facilities level: hospital/treatment centers
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Medical committees
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Psycho-social support committees
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Enrollment and medical follow up
PEP documentation and management
Adherence support, accompaniment counseling…
PLWHA clubs
Coordination level: HIV/AIDS Division, MOH
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Drugs and reagents management committee
PMTCT management committee
VCT piloting committee
Services delivery package
District level : operational level
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Counseling, certain OI management,
* PMTCT services,
Referral functional system,
Monitoring ARV (next step)
Hospital level : district + ARV
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ARV entry point
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Rapid functionality of structures
Needs, coverage
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ISAARV components
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prior Conditions:
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HIV testing available/ VCT
ARV Treatment Centers
Counseling, treatment of OI, use of Cotrimo…
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Laboratories capacity : CD4, routine exams
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Training of health personals
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ARV monitoring committees
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Needs, coverage (2)
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Monitoring ART
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Adults, Children,
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PMTCT
Post Exposure Prophylaxis
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Psycho-social and adherence support
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Supportive research:
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Monitoring drugs resistance
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Promoting clinical trials
Chain of distribution
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National procurement pharmacy
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Treatment centers
Fann Pharmacy
HPD, IHS
Regional procurement
pharmacy
Regional hospital/ Districts
ISAARV up to date
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Extension to the remaining
regions by end of 2003
juin-03
avr-03
févr-03
oct-02
déc-02
juin-02
août-02
avr-02
déc-01
févr-02
oct-01
août-01
process
avr-01
Active local sponsorship in
juin-01
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déc-00
5 out of 11 regions involved
Inclus
févr-01
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1350 patients included Period
Aout 98 - may 2003
oct-00
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1600
1400
1200
1000
800
600
400
200
0
How does the data collection
work?
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Patient monitoring
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Detailed patient data base for the first 100
naives patients enrolled to the pilot phase,
Database on 80 patients enrolled in the
two clinical trials ANRS1204/ ANRS1206
Few initiatives on the remaining
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Data not being collected regularly
Lack of systematized data collection
Strategic objectives
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Nationwide access to ARV drugs planned
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Increasing number of PLWHA treated
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Strenghten capacities in the 11 regions
7000 patients by 2006
 M&E system urgently needed!!!
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Weak part of the program to be improved
M&E approach
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M&E system already in place
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For other priority diseases
except HIV/AIDS new strategies (PMTCT, ART..)
Building up process for HIV/AIDS:
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Capacity building**
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M&E Unit: NACA, MOH, and other ministries
Strengthening technical resources: training
M&E approach (2)
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M&E plan developed
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Workshop in June 2003: set of indicators for
each components ** (UNGASS/MAP)
M&E tools and Operational guidelines to be
developed
training
Data collection plan
M&E approach (5)
NACA
M&E Unit
Other Public Sector
Education
Youth
Women and social development, Work and Employment
HIV Epidemiological Surveillance
MOH
Civil society organizations, private sector
CBO, NGOs, FBOs
M&E approach(4)
next steps by end of 2003
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Workshop series
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Update and reinforce competencies in M&E within
targeted sectors (health, education, youth…)
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M&E tools development
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Priority for the Health sector
TOT, training series
Data collection plan
Data collection forms
Defining evaluation system and calendar
M&E sub- units to be set up at the regional level,
Contracting services ???
Specifics needs
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Lack of technical resources :
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Urgent need to
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Strenghten HR capacities in M&E
Recruit human resources for M&E units at each level
More use of available data
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Systematisation of information,
Regular data collection
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For patient monitoring and program monitoring
Specifics needs
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ARV delivery system to be improved
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Logistical issues
Better planning of Evaluations for all
ISAARV components
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Evaluation of the pilot phase (ANRS 02)
More in-dept Cost-effectiveness analysis
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External expertise needed