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. 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

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) 131 Nephrologists 656 nurses* 373 nursing auxiliaries* * 113/114 centers

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

8. Renal Transplantation CHU Ibn Rochd, Casablanca CHU Ibn Sina, Rabat Hôpital Cheikh Zayd, Rabat M. Benghanem Gharbi

9. 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

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 NEW CASES HemodialysisTransplantation Peritoneal Dialysis DEVELOPMENT 1 transplantation = 10 saved years of dialysis Development Proximity Quality SCREENING & PREVENTION M. Benghanem Gharbi

14. Opening of dialysis centers

15. Dialysis 2007

16. MS/DHSA Structures of care Number 2007 % Objectives in the medium terme HD5 73797 %96 % PD390.7 %1.5 % Transplantation1372.3 %2.5 % Total5 913100 %

17. 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

18. MS/DHSA Projection of offer Hemodialysis Population Detection ESRD Detected Cases Objective HD Nb of HD machines Offer 2007 30 860 0000,00028 92164% 5 737 1 589 Offer 2015 33 503 0000,000413 40196% 12 865 2 573 Offer 2030 37 994 0000,000518 99796% 18 237 3 647

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. MS/DHSA Projection of offer Renal Transplantation Population Detection ESRD Detected Cases Objective RT Nb of RT unit Offer 200730 860 0000,00028 9211,5%1373 Offer 201533 503 0000,000413 4012,5%3357 Offer 203037 994 0000,000518 9972,5%4759

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. MS/DHSA Cost of plan ESRD Detected Cases Patients to treat HDRT Cost (Millions DHS) Offer 2007 0,00038 921 5737137 587,40 (52,22 Million €) Offer 2015 0,000413 401 12865337 1 320,20 (117,34 Million €) Offer 2030 0,000518 997 18237475 1 871,20 (117,34 Million €)

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

24. 2005

25. 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 2010-2015

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. 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

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. Benghanem Gharbi Service de Néphrologie, CHU Ibn Rochd, Casablanca M. Belghiti DHSA, Ministry of health of Morocco Y. Lemseffer MAGREDIAL