Overview of ESTHER model:Status and perspectives

Dr Gilles Raguin Director

www.esther.fr

IAS, july 2012

FRENCH HOSPITALS

Ministry of Health in Partner countries

Capacity building

• Training

• Lab support

• PSM

• M and E

• Psycho -social support

HOSPITALS ANDCBOS IN

PARTNER COUNTRIES

PARTNERSHIPS

ESTHER is a public operator

IAS, july 2012

19 partner countries 15 in Africa BéninBurkina FasoBurundiCamerounCôte d’IvoireGabon GhanaLibériaMarocMaliNigerRCA SénégalTchad Togo 3 in Asia

CambodgeLaosVietnam1 in the

Carribean : Haïti

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173 sites supported by ESTHER in 2011

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RESULTS 2011 (1): 158.000 PVVIH on ART

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RESULTS 2010 (2) for 113 367 pts(2011 results pending)

Nb sitesassesses

Nb sites withdata

Nb patients Nb patients On ART

Nb persons with PSS

Treatment Sites

121 100 113 367 74 500 (66%) 35 831

N and % of LTFU at M12

43% 11%

143 sites in 17 countries assessedResponse rate: 79%

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RESULTS (3)Indicators Availability Number (%) % Range

N patients 94% 113 367 NA

N and % children < 2 yrs on ART

23% (19/82 sites) 803 (34%) 8% – 100%

N and % neonates w DNA PCR < 3 months

29% 786 (84%) 11% – 100%

N and % pregnant women w complete PMTCT

63% ( 54/86 sites) 1 784 (58%)

8% – 100%

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Training: a priority in order to mitigate the Health Human resources crisis

En 2011, 4400 health providers trained

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Psychosocial support: a know how and a priority for ESTHER

855 counselors and community health workers trained

132 partner CBOs

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Main mode of intervention: hospital partnerships

46 french hospitals involved

2011 : French caribean hospitals

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Types of expertise mobilized

Doctors (77%)Nurses, midwives and labtechs (15%)

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Hospital Twinnings in 2012: limits and perspectives

• Capacities limited by financial crisis and health reforms

• New modes of intervention linked to external funding (UNITAID/AFD/GF) w specific TORs (52%)

• New strategies and objectives: Health system strengthening, MCH (MDGs 4 and 5), patient safety, more operational research

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FOCUS 1 : Mother and child 2010

• 12 000 pregnant women with PMTCT

• 4 000 neonates with early infant diagnosis

35 reference maternities in 12 countries

FOCUS 2 : Laboratory strengthening

In 2010, 88 laboratories supported by ESTHER In 17 countries

-Imrprove access to innovative technologies for VLT: OPPERA project (UNITAID)-Strengthen lab networks

?

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% of Lab offerin

g HIV te

sting

% of Lab offerin

g CD4

% of Lab offerin

g VL

% of Lab offerin

g genotyp

ing

% of Lab offerin

g EID

% of Lab offerin

g the TB

diagnosis

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

FOCUS 3 : Key populations

Prisoners inCôte d’Ivoire IDUs in

Dakar

MSM in CAR

-Discrimination still major-MSM and IDUs in Africa: the hidden epidemic

?

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Conclusion• Hospital partnerships is the backbone of ESTHER

programs (solidarity and expertise)• However, evolutions are ongoing to adapt to new

constraints and new fundings• Strategy 2012-2014– 1/ Move from a site approach to a national approach,

aligned on national strategies and a bilateral-multiteral approach

– 2/ Move from a vertical, disease based approach, to a more transversal approach: health system strenthening

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aknowledgements• To the 28 ESTHER staff members at the headquarters

and 73 local staff in countries• To all hospital and CBOs partners in french hospitals

and partner countries • To the technical and financial partners

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