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Scaling up ART in Sénégal: specifics needs for strategic information. Mame Awa Toure MD, MSc AIDS/STI Division, MOH Senegal. Introduction. Senegal: a west African country Area: 196.722 km² Population estimated to 10 millions 11 regions and 30 departments/ provinces.

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scaling up art in s n gal specifics needs for strategic information

Scaling up ART in Sénégal: specifics needs for strategic information

Mame Awa Toure MD, MSc

AIDS/STI Division, MOH Senegal

introduction
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
the senegalese initiative for access to arvs isaarv
The Senegalese Initiative for Access to ARVs : ISAARV
  • A Governmental initiativelate 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
2000 2006 accelerating phase of isaarv
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 financialparticipation
    • Increasing demand
financial participation
Financial participation
  • Government subsidycon’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
isaarv managerial structures
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
services delivery package
Services delivery package
  • District level : operational level
    • Counseling, certain OI management,
    • * PMTCTservices,
    • Referral functional system,
    • Monitoring ARV (next step)
  • Hospital level : district + ARV
    • ARV entry point
      • Rapid functionality of structures
needs coverage
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
needs coverage 2
Needs, coverage (2)
  • Monitoring ART
    • Adults,Children,
  • PMTCT
  • Post Exposure Prophylaxis
  • Psycho-social and adherence support
  • Supportive research:
    • Monitoring drugs resistance
    • Promoting clinical trials
slide12

Chain of distribution

  • National procurement pharmacy
  • Treatment centersRegional procurementpharmacy

Fann Pharmacy Regional hospital/ Districts

HPD, IHS

isaarv up to date
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
how does the data collection work
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
strategic objectives
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
m e approach
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
m e approach 2
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
m e approach 4 next steps by end of 2003
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 ???
specifics needs
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
specifics needs1
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
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