STRATEGY FOR MANAGEMENT OF ESRD IN MOROCCO

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

16%

Etat28%

coopération internationale

1%

Ménages51%

Paiement direct des employeurs

4%

M. Benghanem Gharbi

Cumulative number of the centers of dialysis

0

20

40

60

80

100

120

140

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

34%

56% 1%

9%

Public

Semi-public

Privé

Militaire

Offer in dialysis (2005)

114 Dialysis Centers

36%57%

1%

6%

1 351 Dialysis Machine*

*113/114 centers

18%

5%

76%

1%

Offer in dialysis (2005)

37%7%

54% 2%Public

Semi-public

Privé

Militaire

131 Nephrologists

41%

9%

48%

2%

656 nurses*

373 nursing auxiliaries** 113/114 centers

Offer in dialysis (2005)

37%

7%

55%

1%

Public

Semi-public

Privé

Militaire

4 845 dialyzed patients*

Prevalence: 162,09 pmp*

3,59 3,774,25

3,41 3,13

0

1

2

3

4

5

6

Global Public Semi-public Privé Militaire

Ratio patient/haemodialysis machine*

* 113/114 centers

Renal Transplantation

0

5

10

15

20

25

30

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

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 CASES

100 pmp/year

Hemodialysis

23 pmp/year

Transplantation

<1 pmp/year

Peritoneal Dialysis

<1 pmp/year

And the rest ?

75 pmp/year

DEATH

M. 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

75%

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)

2005

STRATEGIC APPROACH

NEW CASES

HemodialysisTransplantation Peritoneal Dialysis

DEVELOPMENT 1 transplantation =

10 saved years of dialysis

Development

Proximity

Quality

SCREENING& PREVENTION

M. Benghanem Gharbi

Opening of dialysis centers

0

2

4

6

8

10

12

Public

Semi-public

Privé

Militaire

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

  PopulationDetection

ESRDDetected

Cases Objective

HDHD

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

  PopulationDetection

ESRDDetected

Cases Objective

RTRT

Nb of

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

0

100

200

300

400

500

Besoins PrévisionsM. Benghanem Gharbi

2005

New cases

100 pmp/y

Hemodialysis

72 pmp/year

Transplantation

2 pmp/year

Peritoneal Dialysis

1 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 GharbiService de Néphrologie, CHU Ibn Rochd, Casablanca

• M. BelghitiDHSA, Ministry of health of Morocco

• Y. LemsefferMAGREDIAL