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STRATEGY FOR MANAGEMENT OF ESRD IN MOROCCO

STRATEGY FOR MANAGEMENT OF ESRD IN MOROCCO. K. Soulami Service 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)

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STRATEGY FOR MANAGEMENT OF ESRD IN MOROCCO

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  1. STRATEGY FOR MANAGEMENT OF ESRD IN MOROCCO K. Soulami Service de Néphrologie CHU Ibn Rochd, Casablanca ESPN, Lyon, September 11-14, 2008

  2. 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$

  3. 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% Financing of health care (2005) M. BenghanemGharbi

  4. Cumulative number of the centers of dialysis

  5. Offer in dialysis (2005) 114 Dialysis Centers 1 351 Dialysis Machine* *113/114 centers

  6. Offer in dialysis (2005) 656 nurses* 131 Nephrologists * 113/114 centers 373 nursing auxiliaries*

  7. Offer in dialysis (2005) Ratio patient/haemodialysis machine* 4 845 dialyzed patients* * 113/114 centers Prevalence: 162,09 pmp*

  8. Renal Transplantation CHU IbnRochd, Casablanca CHU IbnSina, Rabat HôpitalCheikhZayd, Rabat M. BenghanemGharbi

  9. Outcome of the ESRD population in Morocco (estimation 2005) NEW CASES 100 pmp/year Transplantation <1 pmp/year Hemodialysis 23 pmp/year Peritoneal Dialysis <1 pmp/year And the rest ? 75 pmp/year DEATH M. BenghanemGharbi

  10. 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

  11. 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)

  12. 2005

  13. STRATEGIC APPROACH SCREENING& PREVENTION NEW CASES Transplantation Hemodialysis Peritoneal Dialysis DEVELOPMENT1 transplantation =10 saved years of dialysis Development Proximity Quality M. BenghanemGharbi

  14. Opening of dialysis centers

  15. Dialysis 2007

  16. Structures of care MS/DHSA

  17. 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

  18. Projection of offerHemodialysis MS/DHSA

  19. 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

  20. Projection of offer Renal Transplantation MS/DHSA

  21. 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

  22. Cost of plan MS/DHSA

  23. Nephrologists training Need: 28/year; Training: 11/year M. BenghanemGharbi

  24. 2005

  25. Perspectives 2010-2015 New cases 100 pmp/y The rest 25 pmp/year Transplantation 2 pmp/year Hemodialysis 72 pmp/year Peritoneal Dialysis 1 pmp/year PREVENTION M. BenghanemGharbi

  26. 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

  27. World Kidney Day 1 4 000 POSTERS 10 000 GUIDES

  28. World Kidney Day 1 40 CONFERENCES

  29. 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 2

  30. World Kidney Day 3 • Meeting with all representatives of Ministry of Health in all administrative regions of Kingdom for information and sensitization

  31. 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

  32. THANKS • M. BenghanemGharbiService de Néphrologie, CHU IbnRochd, Casablanca • M. BelghitiDHSA, Ministry of health of Morocco • Y. LemsefferMAGREDIAL

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