Taking on one of Africa’s top killers (hint: it’s not what you think)

September 7, 2017 by Jolayne Houtz

For Africans with diabetes, medicines and supplies are often hard to access. We’re working to erase those barriers.

Alfred Samba, a rural farmer in Senegal, has been living with diabetes for more than 15 years. He struggles to get access to affordable care and treatment. Photo: PATH/Gabe Bienczycki.

Alfred Samba, a rural farmer in Senegal, has been living with diabetes for more than 15 years. He struggles to get access to affordable care and treatment. Photo: PATH/Gabe Bienczycki.

Diabetes was once considered a disease of the rich in Senegal.

In Alfred Samba’s rural village northeast of Dakar, only Alfred’s relatively well-off neighbors could afford the kinds of food, time-saving gadgets, and leisurely lifestyle choices that seemed to be precursors to the disease.

So Alfred, a gaunt, 74-year-old farmer with salt-and-pepper hair, was surprised when a doctor diagnosed him with diabetes more than 15 years ago. And he noticed he wasn’t alone—each year, more and more of his neighbors got the same news from their doctors.

“Now, even poor people get it,” he said. “If it keeps up increasing like this, it will be worse than HIV.”

In fact, it already is.

Diabetes on the rise

Diabetes and other chronic (or noncommunicable) diseases are the leading cause of death and disability worldwide. Three-quarters of those living with diabetes are in low- and middle-income countries.

By 2040, diabetes cases in Africa are expected to more than double from 14.2 million to 34.2 million, according to the International Diabetes Federation.

In Senegal and other African countries, governments are responding aggressively to this growing health threat, and that’s putting new strains on health systems and resources already stretched thin by ongoing battles against infectious diseases such as malaria, tuberculosis, and HIV/AIDS.

A diabetes patient gets treatment for a foot wound from a healthcare worker.

A diabetes patient gets treatment for a foot wound at the podiatry clinic at the Marc Sankale Diabetes Center in Dakar. Photo: PATH/Gabe Bienczycki.

PATH and other leading international health organizations are calling for urgent action to improve access to prevention and care for diabetes and other chronic diseases and conditions such as hypertension, cardiovascular disease, and cancer.

Medicines out of reach

Patients in Senegal and elsewhere in Africa often have trouble getting the essential medicines and supplies they need to prevent or treat chronic diseases.

In Alfred’s case, the health clinic nearest his home doesn’t stock diabetes medicines. While he qualifies for free medication from a government health center about an hour’s drive away, he can’t afford the cost of transportation or the medical consultation fees.

Once his initial supply of medicines ran out, Alfred started drinking a tea brewed with leaves from a local tree to help him manage his diabetes. He tries to stay healthy by working extra hard on his farm, although lately, Alfred noticed he’s been losing weight, a possible sign of uncontrolled diabetes.

Alfred’s doctor prescribed a different diet than what the rest of the family eats, but the extra cost strained the family’s budget. Now, “I eat what the family eats, just less of it,” he said.

A united front against chronic diseases

People walking on the street in Dakar, Senegal.

It’s not just rural patients who have trouble getting the care they need. At the Marc Sankale Diabetes Center in Dakar, four diabetes specialists—still rare in Senegal—see up to 50 patients each per day. Photo: PATH/Gabe Bienczycki.

PATH and our partners are launching a first-of-its-kind, global coalition to improve access to essential medicines and health products to prevent and treat noncommunicable diseases (NCDs).

The cross-sector Coalition for Access to NCD Medicines & Products, led by PATH, brings together governments, the private sector, philanthropic and academic institutions, and civil-society organizations to tackle barriers countries face in procuring, supplying, and distributing essential medicines and technologies.

The goal: to reduce premature deaths from NCDs by 25 percent by 2025. The coalition will partner with countries to help them achieve the target of 80 percent availability of affordable technologies and essential medicines, including generics, required to treat major chronic diseases in public and private facilities.

There’s still a long way to go. A global landscape report led by PATH in 2015 found that medicines and supplies for diabetes are rarely available in most public and private health care facilities in low- and middle-income countries.

Connecting patients with treatment

It’s not just rural patients who have trouble getting the care they need.

Pierre Sakho is a high school math teacher who lives close to one of Senegal’s leading diabetes treatment centers in the capital, Dakar.

Just minutes from Pierre’s home, the Marc Sankale Diabetes Center provides patient education and screening, nutrition services, diabetes supplies and medicines, and a podiatry clinic financed by Rotary International. Four diabetes specialists—still rare in Senegal—see up to 50 patients each per day.

A patient meets with a healthcare worker in a clinic.

Pierre Sakho, a high school math teacher with diabetes, meets with Dr. Maimouna Ndour Mbaye, a diabetes specialist at the Marc Sankale Diabetes Center in Dakar, Senegal. Photo: PATH/Gabe Bienczycki.

Yet by the time Pierre, a 50-year-old father of seven, was diagnosed with diabetes five years ago, the disease had progressed so much that the toes on his right foot had to be amputated. He struggles with the cost of his medicines and special diet (more vegetables and chicken, less rice than the rest of the family).

During a recent consultation, his doctor, Maimouna Ndour Mbaye, chastised Pierre for not wearing specially fitted shoes or using a crutch, supplies he can’t afford.

Dr. Mbaye says some patients buy glucose test strips one at a time from the center’s pharmacy because they can’t afford the price of a full pack.

“If we tell people to come (for treatment), and there are no resources to help them, what’s the point of that?” she asked. “We have to make sure the resources are available.”

A top priority for Senegal

A doctor meets with diabetes patient Fatou Gueye for a routine check-up and blood pressure check.

The Marc Sankale Diabetes Center in Dakar serves more than 41,000 patients and sees about 3,500 new cases each year. Photo: PATH/Gabe Bienczycki.

PATH has collaborated closely with Senegal’s Ministry of Health and Social Action to assess Senegal’s disease burden, evaluate the supply chain for essential medicines and supplies, and develop an e-learning platform to help teach primary care providers how to diagnose and manage patients.

The government is implementing a national plan to address NCDs through a recently created division of the Ministry of Health. Additional training for health workers and a national campaign to end diabetes are expected to lead to more awareness and earlier diagnosis and treatment.

In 2016, PATH led the launch of a new Senegal-based, public-private coalition called ACT NOW: Better Care for Noncommunicable Diseases. The group will serve as a partner to the country’s health authorities to mobilize resources, improve training, and raise awareness in the fight against chronic diseases.

Making progress against diabetes in Senegal

The concept of a chronic disease that requires careful self-management over many years remains unfamiliar to many Senegalese, with some patients stopping treatment when they start to feel better. Still, the country is making progress, said Professor Said Norou Diop, director of the Marc Sankale Diabetes Center.

“When I arrived here as a young intern in 1979, . . . there was no screening. The patients came with complications. Seven percent of patients had to be amputated; 20 percent of patients arrived for the first time in a diabetic coma,” he said.

Now, the center performs many fewer amputations, and people show up earlier seeking diagnosis and treatment.

Senegal’s next challenge, he said, is to ensure all patients have access to high-quality care close to home, whether that’s in busy Dakar or in rural villages tended by community health workers.

Bringing together cross-sector partners in the new PATH-led coalition will support Senegal and other countries in mobilizing new resources and donors and strengthening systems, markets, supply chains, and policies to reduce the toll of chronic diseases.