Scaling up ART in Sénégal: specifics needs for

strategic information

Mame Awa Toure MD, MScAIDS/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. 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

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

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

Increasing government budget

250 millions

1475 millions

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1998 1999 2000 2001 2002 2003

BudgetTotal

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

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

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

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)

Monitoring ART Adults, Children,

PMTCT Post Exposure Prophylaxis Psycho-social and adherence support Supportive research:

Monitoring drugs resistance Promoting clinical trials

Chain of distribution

National procurement pharmacy

Treatment centers Regional procurement pharmacy

Fann Pharmacy Regional hospital/ Districts

HPD, IHS

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

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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

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 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 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 (5)

O the r Public S e c torE duca tion

YouthW om en a nd s oc ia l deve lopm e nt, W ork a nd E m ploym e nt

HIV E p ide m io logic a l S urve i l la nc eM O H

C ivi l soc ie ty orga niza tions , pr iva te s e ctorC BO, NG O s , F BO s

NA C AM & E Unit

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

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 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