Overview
The Malian public healthcare system is based on a 3-level pyramid model. The primary level comprises of community health centers, providing basic care. These centers do not necessarily host doctors, but often only paramedical staff. The secondary level comprises of reference health centers, with doctors, and regional hospitals. The tertiary level comprises national hospitals, which offer specialist care. This health care system is run by the Ministry of Health agencies at all levels. The system is officially provided with drugs through a national drug-supply system, monitored by the Malian Central Pharmacy and its regional stores. It must be noted that many private drugstore exist and also supply public health centers and hospitals.
Nowadays, type 1 diabetes is not manageable at all levels but only at secondary and tertiary levels through an international program (Life For a Child, International Diabetes Foundation) operated by the NGO Santé Diabète (opens in a new tab) (SD) in close collaboration with the Ministry of Health and the team of Professor Sidibe on the ground. In early 2016, at least 400 children under 25 were part of the program throughout the country.
Health financing is currently based on a national health insurance system, with only two levels of repayment, depending on if the patient is from the public sector or indigent. Santé Diabète is now working with the public authorities so that every type 1 diabetic child can be part of the indigent regime. The Malian health authorities are also working on the implementation, by 2018, of universal health cover so that all the population to have access to the same basic level of care.
What happens if you need to see a doctor?
Every child diagnosed with type 1 diabetes is referred to a health center able to manage the disease, whose doctor has been trained by Santé Diabète. Through the Life for A Child (LFAC) program operated by Santé Diabète, every type 1 diabetic child under 25 has free access to basic care, treatment and individual medical monitoring. Thanks to international and national support, Santé Diabète recently created a national unit for type 1 diabetic management in Bamako. This unit offers an international-standardized quality for care, education and follow-up and allows a qualitative management of complications and diabetic emergencies.
Who decides what doctors can prescribe?
What doctors can prescribe is both decided by the health authorities, through the national scheme of drug supply, and Santé Diabète and the LFAC program, whose drugs are directly provided by the International Diabetes Foundation.
Practically, what is it like to live with type 1 diabetes in Mali?
First of all, it must be noted that living with type 1 diabetes in Mali today is much better than 10 years ago. In that time, a child diagnosed with type 1 diabetes had only one year at most to live after diagnosis due to lack of access to appropriate care in the country. Now, every child with type 1 diabetes can benefit from better access to care thanks to the large net of diabetes management unit built by Santé Diabète throughout the country and thanks to the thousands of medical staff the NGO has trained over the past 10 years. Free donations of treatment and monitoring and the building of the National Unit of Type 1 Diabetes Management (with support of the Malian Ministry of Health and the World Diabetes Foundation) means that children’s living conditions have increased. However, many challenges still must be met in Mali in order to enhance living conditions and improve access to care. There is currently no insurance scheme that covers insulin. Territorial cover needs to be expanded and deepened. Educational programs for children with diabetes must be adapted to the Malian context.
What about getting admitted to hospital?
When a patient arrives in hospital, his admission depends on if he is in an emergency situation or if he comes only for check-up. If it is an emergency, he will be directly oriented towards emergency services. If not, he will be directed towards the type 1 diabetes unit.
How does diabetes care vary throughout Mali?
Diabetes care throughout Mali is based on the same scheme and benefits from the same support and donations from Santé Diabète and IDF in collaboration with the different Ministry of Health structure at each level in the country. Every doctor and medical staff managing diabetes in Mali has received the same training program. In terms of diabetes management, only the level of care varies (check-up or complication management), depending on the health-system level the patient goes to. Therefore, the quality of diabetes care does not vary a lot throughout the country. What can vary instead is the geographical cover and access to care which is about the distance between patients and care units. For instance, since 2012, Malian northern regions suffer from a poor access to care and treatment due to the current political and security crisis. The situation has pushed type 1 diabetics to move towards other regions or towards the capital.
Thank you to the amazing team at Santé Diabète (opens in a new tab) for providing this information and for the work they have done to make life better for people with diabetes in Mali.
Last updated 2016
