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 employeurs4%

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 3,77 4,25

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

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

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

DevelopmentProximity

Quality

SCREENING& PREVENTION

M. Benghanem Gharbi

Opening of dialysis centers

0

2

4

6

8

10

12

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

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 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