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Scaling up ART in Sénégal: specifics needs for
strategic information
Mame Awa Toure MD, MSc
AIDS/STI Division, MOH Senegal
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Introduction
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
Low HIV prevalence in general population less than 2%
5-20% in high risk group
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The Senegalese Initiative for Access to ARVs : ISAARV
A Governmental initiative late 1997 Political commitment : increasing annual subsidy
Collaboration of ANRS: technical support, project
design
First step : Pilot study Building up a model according limited resources
Evaluation before extension (collaboration with ANRS)
Second step : scale up for nationwide access
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2000- 2006Accelerating 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…
Decrease of the of financial participation
Increasing demand
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Increasing government budget
250 millions
1475 millions
0
1000
2000
3000
4000
5000
1998 1999 2000 2001 2002 2003
BudgetTotal
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Financial participation
Government subsidy con’t October 2000: ACCESS Program Levels of financial participation
SES assessed by a social workers team A package including drugs, CD4 count and viral
load Low income: $30- $7 per month Government officers $60- $15
About 80% of patients treated free of charge
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ISAARV managerial structures
Health facilities level: hospital/treatment centers Medical committees
Enrollment and medical follow up PEP documentation and management
Psycho-social support committees Adherence support, accompaniment counseling… PLWHA clubs
Coordination level: HIV/AIDS Division, MOH Drugs and reagents management committee PMTCT management committee VCT piloting committee
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Services delivery package
District level : operational level Counseling, certain OI management, * PMTCT services, Referral functional system, Monitoring ARV (next step)
Hospital level : district + ARV ARV entry point
Rapid functionality of structures
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Needs, coverage ISAARV components
prior Conditions: HIV testing available/ VCT ARV Treatment Centers Counseling, treatment of OI, use of Cotrimo… Laboratories capacity : CD4, routine exams Training of health personals ARV monitoring committees
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Needs, coverage (2)
Monitoring ART Adults, Children,
PMTCT Post Exposure Prophylaxis
Psycho-social and adherence support Supportive research:
Monitoring drugs resistance Promoting clinical trials
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Chain of distribution
National procurement pharmacy
Treatment centers Regional procurement pharmacy
Fann Pharmacy Regional hospital/ Districts
HPD, IHS
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ISAARV up to date
1350 patients included Period Aout 98 - may 2003
5 out of 11 regions involved
Active local sponsorship in
process
Extension to the remaining
regions by end of 2003
0
200400
600
800
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Inclus
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How does the data collection work?
Patient monitoring 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 Data not being collected regularly
Lack of systematized data collection
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Strategic objectives
Nationwide access to ARV drugs planned Strenghten capacities in the 11 regions
Increasing number of PLWHA treated 7000 patients by 2006
M&E system urgently needed!!! Weak part of the program to be improved
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M&E approach M&E system already in place
For other priority diseases except HIV/AIDS new strategies (PMTCT,
ART..)
Building up process for HIV/AIDS: Capacity building**
M&E Unit: NACA, MOH, and other ministries Strengthening technical resources: training
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M&E approach (2)
M&E plan developed 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
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M&E approach (5)
O ther Publ ic S e c torE duca tion
YouthW om en a nd s oc ia l de ve lopm e nt, W ork a nd E m ploym e nt
HIV E pide m io logica l S urve i l la nceM O H
C ivi l soc ie ty orga niza tions , pr iva te se c torC BO , NG O s, F BO s
NA C AM & E Unit
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M&E approach(4)next steps by end of 2003
Workshop series Update and reinforce competencies in M&E within
targeted sectors (health, education, youth…) Priority for the Health sector TOT, training series
M&E tools development 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 ???
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Specifics needs
Lack of technical resources : Urgent need to
Strenghten HR capacities in M&E Recruit human resources for M&E units at each
level
More use of available data Systematisation of information, Regular data collection
For patient monitoring and program monitoring
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Specifics needs
ARV delivery system to be improved Logistical issues
Better planning of Evaluations for all ISAARV components Evaluation of the pilot phase (ANRS 02) More in-dept Cost-effectiveness analysis
External expertise needed