STRATEGY FOR MANAGEMENT OF ESRD IN MOROCCO

transcript

K. SoulamiService de Néphrologie

CHU Ibn Rochd, Casablanca

ESPN, Lyon, September 11-14, 2008

MOROCCO

• Capital: Rabat• 16 administrative regions• Area : 710 850 km²• 30 860 000 inhabitants • Annual increase : 1,4% (2004)• Rate of urbanization: 55,08%• Life Expectancy : 68–72 y• GNP PPP: 4100 US$

Financing of health care (2005)

Total financing of the national system of health is deficient : meadows of 19 billion DHS a year, that is 670 DHS per capita (60Є)

5% of GNI (Tunisia 7% , Iran 5,5%, Jordan 9%, Lebanon 12%, Algeria 8%)

Lack of the solidarity of financing: Household 51%, State 28%, medical insurance 16%

Couverture médicale

Etat28%

coopération internationale

Ménages51%Paiement direct

des employeurs4%

M. Benghanem Gharbi

Cumulative number of the centers of dialysis

75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0 1 2 3 4 5 6 7

56% 1%

Public

Semi-public

Privé

Militaire

Offer in dialysis (2005)

114 Dialysis Centers

36%57%

1 351 Dialysis Machine*

*113/114 centers

54% 2%Public

Semi-public

Privé

Militaire

131 Nephrologists

656 nurses*

373 nursing auxiliaries** 113/114 centers

Public

Semi-public

Privé

Militaire

4 845 dialyzed patients*

Prevalence: 162,09 pmp*

3,59 3,77 4,25

3,41 3,13

Global Public Semi-public Privé Militaire

Ratio patient/haemodialysis machine*

* 113/114 centers

Renal Transplantation

1985198619871988198919901991199219931994199519961997199819992000200120022003200420052006

CHU Ibn Rochd, Casablanca

CHU Ibn Sina, Rabat

Hôpital Cheikh Zayd, Rabat

M. Benghanem Gharbi

Outcome of the ESRD population in Morocco

(estimation 2005)NEW CASES100 pmp/year

Hemodialysis23 pmp/year

Transplantation<1 pmp/year

Peritoneal Dialysis<1 pmp/year

And the rest ?75 pmp/year

DEATHM. Benghanem Gharbi

Opportunities• Democratic transition• Ethical dimension and political pressure• Medical insurance

• Hospital reform• Reform of public expenditures• Socio-professional mobilization (NGO)• Preventable disease• Elaboration of clinical practice guidelines

Medical Insurance

200520072015

30%16%

Difficulties• Demographic Transition

(Urbanization: 55,08%, LE : 68 – 72)• Epidemiological Transition

(Diabetes: 6,6% and HT: 33,6% 20 years)• Progression of disease (5 to 8% per year)• Important lack in human resources • Only 2 training centers• Importance of logistics to set up• Financial cost (preval: if 500 pmp 8,5% of HE)

STRATEGIC APPROACH

NEW CASES

HemodialysisTransplantation Peritoneal Dialysis

DEVELOPMENT 1 transplantation =

10 saved years of dialysis

DevelopmentProximity

Quality

SCREENING& PREVENTION

M. Benghanem Gharbi

Opening of dialysis centers

PublicSemi-publicPrivéMilitaire

Dialysis 2007

MS/DHSA

Structures of care

Number2007 % Objectives in the

medium terme

HD 5 737 97 % 96 %

PD 39 0.7 % 1.5 %

Transplantation 137 2.3 % 2.5 %

Total 5 913 100 % 100 %

MS/DHSA

Organization of treatment of ESRD

• Typology of ESRD centers– Units of screening and orientation– Center type I: Dialysis without hospitalization and without

nephrologists– Center type II: Dialysis without hospitalization with nephrologists– Center type III: Dialysis with nephrologists and hospitalization– Center type IV : Type III with transplantation

MS/DHSA

Projection of offerHemodialysis

Population DetectionESRD

DetectedCases

Objective HD HD Nb of HD

machines

Offer 2007 30 860 000 0,0002 8 921 64% 5 737 1 589

Offer 2015 33 503 000 0,0004 13 401 96% 12 865 2 573

Offer 2030 37 994 000 0,0005 18 997 96% 18 237 3 647

Strategy of Ministry of Health to answer the current need of dialysis

• Make profitable existing dialysis centers• Development of a public-private partnership

– purchase of dialysis service with private nephrologists– creation of new dialysis centers in the framework of

the INDH in partnership with civil society• Creation of new public centers

MS/DHSA

Projection of offer Renal Transplantation

Population Detection ESRD

Detected Cases

Objective RT RT

RT unit

Offer 2007 30 860 000 0,0002 8 921 1,5% 137 3

Offer 2015 33 503 000 0,0004 13 401 2,5% 335 7

Offer 2030 37 994 000 0,0005 18 997 2,5% 475 9

Strategy of Ministry of Health to develop renal transplantation

• Strengthening of existing centers (Casablanca, Rabat)

• Creation of 2 new transplantation centers (Marrakech, Fez)

• Development of pediatric kidney transplantation• Development of kidney transplantation from

cadaveric donor

MS/DHSA

Cost of plan

ESRD DetectedCases

Patients to treat HD RT Cost

(Millions DHS)

Offer 2007 0,0003 8 921 8 921 5737 137 587,40(52,22 Million €)

Offer 2015 0,0004 13 401 13 401 12865 337 1 320,20(117,34 Million €)

Offer 2030 0,0005 18 997 18 997 18237 475 1 871,20(117,34 Million €)

Nephrologists trainingNeed: 28/year; Training: 11/year

Besoins PrévisionsM. Benghanem Gharbi

New cases100 pmp/y

Hemodialysis72 pmp/year

Transplantation2 pmp/year

Peritoneal Dialysis1 pmp/year

The rest 25 pmp/year

PREVENTIONM. Benghanem Gharbi

Perspectives 2010-2015

CRD Morocco Program

1- Estimation of prevalence of CRD in Moroccan population

2- Identification of subjects at risk of developing CRD and establishing : program of treatment monitoring over period of 5y

World Kidney Day 14 000 POSTERS10 000 GUIDES

World Kidney Day 140 CONFERENCES

World Kidney Day 2

• 5000 posters in 2500 units of care

• Mass media emission

• Website document

• Announcement of National Strategy for management of ESRD by Ministry of Health

World Kidney Day 3

• Meeting with all representatives of Ministry of Health in all administrative regions of Kingdom for information and sensitization

Strategy for management of ESRD in Morocco

• Three important objectives – Management of the current need for dialysis

– Control of the evolution of ESRD and development of CRD prevention

– Developing the activity of kidney transplantation

THANKS• M. Benghanem Gharbi

Service de Néphrologie, CHU Ibn Rochd, Casablanca

• M. BelghitiDHSA, Ministry of health of Morocco

• Y. LemsefferMAGREDIAL

STRATEGY FOR MANAGEMENT OF ESRD IN MOROCCO

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