ESTHER presentation

ESTHER presentation

On the frontline of the fight against HIV

At the heart of the response

Esther, a solidarity based initiative

Built up on shared dynamics

ESTHER - Together for a Networked Hospital

Therapeutic Solidarity - contributes to the roll out

of French health development aid.

It aims to strengthen capacities in the fight

against HIV/AIDS and its associated infections in

developing countries.

From a French initiative...

The therapeutic solidarity initiative (ESTHER), founded on hospital twinnings and a transfer of skills for the

global care of PLWHIV, was launched in 2001.

ESTHER is a governmental aid agency operating under supervision of the Ministry of Foreign and European Affairs

and the Ministry of Labour, Employment and Health. ESTHER’s principles and programmes reflect the main thrust

of French policy on the international fight against AIDS: field action, presence and support,

concrete assistance from wealthy nations to resource-poorer ones for securing access to

medicines, setting decentralised cooperation in motion through hospital and town-hospital





networks, and support to non-governmental organisations (NGOs). Prof Dominique




Israël-Biet is the GIP ESTHER’s chair of the Board, Dr Gilles Raguin its Managing Director.


Member since 2012


Member since 2002


Member since 2004


Member since 2004


Member since 2008


Member since 2002


Member since 2004

... to the birth of a

European network

From its inception, GIP ESTHER adopted a

European dimension with the involvement

of Spain, Italy and Luxembourg. Germany,

Austria, Belgium and Portugal became

members in 2004. The addition of Greece in

2006, Norway in 2008, Switzerland in 2011

and Ireland in 2012 brought the number of

States participating in the ESTHER European

Alliance up to 12.

The Alliance has developed projects in

40 partner countries in Africa, Asia, Latin

America, the Middle East and South East



Member since 2004


Member since 2011


Member since 2006


Member since 2002


Member since 2002

Key development partners

ESTHER works in partnership with the following international organisations: UNAIDS, UNICEF, UNODC and

UNITAID. Agreements have been signed, with the WHO, the Global Fund to fight AIDs, Tuberculosis and Malaria, the

World Food Programme and the International Hospital Federation.

ESTHER develops projects with funding from the AFD (French Development Agency): paramedical training in

Côte d’Ivoire and Niger, mediator/psychosocial counsellor training in Benin and Chad...

ESTHER, geographic coverage

In 2012, ESTHER was present in 19 partner countries:











togo BeNIN



Central African






A network: to build up strength

Our operational strategy

ESTHER bases its action on sharing experiences and

medical progress, pooling resources and know-how,

and training local stakeholders.

Hospital partnerships

and hospital expertise mobilisation

ESTHER frames its interventions on hospital twinnings so as to mobilise health professionals and improve healthcare

practices through presence and support: doctors, pharmacists, nurses, laboratory technicians, administrators...

Some fifty French hospitals have been twinned with 78 reference hospitals and over 100 decentralised healthcare

sites spread throughout the partner countries.

Extra hospital health

technical assistance mobilisation

ESTHER also aims to mobilise French healthcare expertise through its technical assistance projects or support to

healthcare systems, particularly in the fields of HIV, tuberculosis, co-infections, hospital hygiene and medicines.

Some striking figures...




live with




new infections

in 2010




rose by 20%

in Sub-Saharan Africa

between 2009

and 2010



Objectives 2015:

reduce the number

of new infections in

children by 90%,

and reduce the number

of maternal deaths

associated with AIDS

by 50%

(Source UNAIDS - Report 2011)

Integration into AIDS

and other national healthcare programmes

ESTHER contributes to strengthening national health policies in its partner countries.

It focuses support on national authorities, national AIDS committees, national AIDS

programmes and the implementation of national strategies and plans.

The projects receiving ESTHER’s support are developed jointly by partner teams and national

authorities. They receive ESTHER’s validation through its Project Examination Committee.

Training and support

for health human


ESTHER contributes

in millenium

development goals


The unsatisfactory results obtained for MDG 4

(child health), 5 (maternal health) and 6 (the fight

against HIV/AIDS, malaria and other diseases)

compelled the international community to boost

its commitment and support to ensure these goals

are met by 2015. ESTHER has kept in step with

the changing strategies, and developed a growing

number of activities offering a combined response

to MDGs 4, 5 and 6.

On-going training at the heart of ESTHER’s


ESTHER works through its hospital twinnings and

in partnership with training teams to strengthen

the skills of state-employed and associative staff

in their care of and support for patients living with

HIV. ESTHER also supports the decentralisation

of care, framed by referral centre mentoring of

outlying healthcare units.

Strengthening community stakeholders’ capacities

is also a focus point of ESTHER’s operational


Updating knowledge through e-learning:

ESTHER provides on-going training

( for the teams

involved in AIDS care in lower resource

countries. It offers online training as top up

sessions to the training delivered on-site.

Joint action and support

What we do

ESTHER aims to strengthen access to treatment

and care for persons infected by HIV/AIDS, and

bolster health systems at both hospital and

community level.

Access to therapeutic care

and laboratory follow up

ESTHER’s work is focused on strengthening best diagnosis, care and treatment practices.

ESTHER supports national supply plans and medicine and reagent stock management (Procurement

and stock management systems).

Vulnerable populations

and groups at risk

ESTHER provides specific support to the most

vulnerable population groups, and focuses

specific programmes on their needs: orphans

and children at risk, prisoners, drug users and

sex-workers, MSM (men having sex with men).

Maternal and child

health care

The elimination of mother to child transmission

is a strategic priority for ESTHER. There are too

few pregnant women being tested and treated

preventively; the figure must increase.

The early diagnosis and care of children is also

a priority. Mother-child programmes need closer

alignment with other components of mother

and child healthcare. Thus ESTHER contributes

to bolstering the ties between care for HIV

infections and maternal, neonatal and newborn


Support to community organisations

The comprehensive care approach carried out by ESTHER implies providing support to community and civil

society organisations. This implies dialogue on activities and programmes for associations in wealthier countries,

and support for care activities - notably the provision of information to PLWHIV, support for treatment observance

and psychological and social support for persons treated with ARVs - for those in partner countries.

Such support is largely provided by psychosocial counsellors or mediators. ESTHER helps to train these groups and

calls for professional recognition of their skills. Since its inception in 2002, ESTHER has contributed to the training

of/support for over 500 psychosocial counsellors/mediators. ESTHER lobbies for this new healthcare profession to

be accorded official status, as part of the task-shifting required to address the human resources crisis.

Project follow-up and evaluation

Monitoring and evaluating projects is of critical importance. From the outset of a project, specific monitoring

indicators are defined so as to measure progress.

ESTHER provides software on its website ( for patient follow up - adults, children and pregnant

women: ESOPE. It facilitates individualised patient follow-up (electronic medical file), the management of the

patients’ register at the care site (activity report and cohort) and the production of national statistics and indicators

for evaluation purposes (transmission and compilation of the cohort data at national level).

Operational research

In partnership with the National AIDS Research

Agency, ESTHER contributes to developing

operational research with teams with global

spread, with the aim of improving intervention


Hospital hygiene

The security of patients and healthcare workers

is a major issue in all countries. Every year,

healthcare-associated infections affect over

1.4 million people.

ESTHER develops programmes for the accidental

exposure to blood and hospital hygiene as part of

its hospital partnerships.

In 2011, ESTHER also became involved in the

African Partners’ programme for Patient Security

(APPS), in liaison with the WHO and the French

Minister of Health, based on European and African

hospital partnerships.


Together for a Networked Hospital Therapeutic Solidarity


62 boulevard Garibaldi - 75015 PARIS - France

Tél : (+33) (0)1 53 17 51 50

Fax : (+33) (0)1 53 17 51 57

Mail :

President: Pr Dominique ISRAËL-BIET

Director: Dr Gilles Raguin

Projects Department: Pierre MENDIHARAT

Medical and Scientific Department: Dr Christophe MICHON

Administrative and Finance Department: Florence MACLAIR

European Affairs and International Relations: Farid LAMARA

Communication: Nadine LEGRET

Design and layout: Atropine ( Photos : ESTHER. The use of photos of individuals should in no circumstances be interpreted as an indication of their health status.

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