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 : km² 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% M. Benghanem Gharbi

Cumulative number of the centers of dialysis

Offer in dialysis (2005) 114 Dialysis Centers Dialysis Machine* *113/114 centers

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

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

Renal Transplantation 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

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

Dialysis 2007

MS/DHSA Structures of care Number 2007 % Objectives in the medium terme HD %96 % PD390.7 %1.5 % Transplantation %2.5 % Total %

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 offer Hemodialysis Population Detection ESRD Detected Cases Objective HD Nb of HD machines Offer , % Offer , % Offer , %

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 Nb of RT unit Offer , ,5%1373 Offer , ,5%3357 Offer , ,5%4759

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 Detected Cases Patients to treat HDRT Cost (Millions DHS) Offer , ,40 (52,22 Million €) Offer , ,20 (117,34 Million €) Offer , ,20 (117,34 Million €)

Nephrologists training Need: 28/year; Training: 11/year M. 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 PREVENTION M. Benghanem Gharbi Perspectives

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 POSTERS GUIDES

World Kidney Day 1 40 CONFERENCES

World Kidney Day 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. Belghiti DHSA, Ministry of health of Morocco Y. Lemseffer MAGREDIAL