integration of ntd control how to promote efficiency dr anna phillips 27 th june 2014
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Integration of NTD Control How to promote efficiency Dr Anna Phillips 27 th June 2014. The Evolution of NTD Integration. Introduction & context. Forefront of many development agendas as donors seek more effective and sustainable ways to achieve goals Why integrate NTDs? - PowerPoint PPT PresentationTRANSCRIPT
100 years of living science
Date • Location of Event
Integration of NTD Control How to promote efficiency
Dr Anna Phillips
27th June 2014
The Evolution of NTD Integration
BMGF
• In 2003, SCI commenced in six countries with funds from BMGF to launch National Schistosomiasis & STH vertical control programs
USAID
• In 2007, SCI was awarded a grant from USAID to integrate the National SCH/STH control programs with other NTDs – primarily LF and Blindness
DfID
• In 2010, additional funding from DfID was gained to support the National SCH/STH control programs across 8 countries in coordination with other NTD programs
• Forefront of many development agendas as donors seek more effective and sustainable ways to achieve goals
• Why integrate NTDs?• Usually overlap in their geographical distribution• NTD control generally depends on mass drug administration• Combined drug delivery could minimize costs and increase
coverage
Introduction & context
What does integration mean?
Integration defined
in different
ways
“Umbrella” NTD program overseas independent programs
Multiple drugs given at the same time to one
individual
“Community based integrated delivery” –as part of routine health or education
programmes
Integration with other
sectors such as WASH
The Umbrella Coordinated NTD program
Integration of training, drug delivery, drug storage, and education materials
LF/Oncho MDA Schisto/STH MDA Trachoma MDA
SCI• SCI: Provides financial and technical support to country
MoH/NGO
• MoH/NGO in-country: Coordinates and finances the integrated NTD control program
Task Force
• In-country NTD Task Force: Technical committee consists of MoH NTD focal point; NGO representatives; WHO; MoH NTD Vertical Program managers; and MoE provides technical/strategic support to the vertical NTD programs
FINANCIAL SUPPORT FROM NGO
TECHNICAL SUPPORT FROM TASK FORCE
100 years of living science
Date • Location of Event
Community Drug
Distributors
Wholecountry
DIS
TRIB
UTI
ON
CH
AN
NEL
STA
RG
ET G
RO
UPS
DR
UG
S
PZQMBZ
V a c c i n a t i o n sAZT/TRT
ALBALB PZQ IVM
ALB
SCH & STH
0-11 months
12-59 months
5-14 years (enrolled in school)
Adults >15 yrs
& Non-
enrolled children
Whole population
(except under 1 years)
Women in 1st trim.
pregnancy
Non-pregnant women
AR
EAS LF &
OnchoTrachoma
areasSTHs areas
Teachers in Schools
Mobile clinics and community health workers
<5 years
Challenges & Benefits of coordinated PCT
Benefits?
• Cost-effective (especially in resources)• Time efficient to coordinate drug delivery/training etc• Increase coverage if more resources are available for sensitisation and
advocating for one single campaign• Facilitates donor reporting with single report to be compiled
Challenges?
• Power struggle between vertical programs, particularly those established
• Combined education messages can be confusing• Complications when diseases start to become ‘eliminated’• Quality of care can be affected– treatment saturation• Increased workload for those implementing the MDA i.e. CDDs • Reduced financial allocation to NTDs • Delays to one of the drugs impacts on treatment of the other diseases
Triple Drug Administration
What is triple drug administration?
Providing individual drugs – Ivermectin/Albendazole/PZQ simultaneously
Which SCI country has implemented this?
Currently Mozambique is carrying out triple MDA in selected areas
Challenges & Benefits of triple drug administrationBenefits?
• Several studies have recently shown triple drug administration of IVM/ALB/PZQ as safe
• Has stimulated further studies examining the possibility of other combinations such as IVM/ALB/ZITH combination
• Significant cost-efficiency of combining two campaigns
Challenges?• Different treatment strategies used for different diseases
• Dependent on prior MDA history for each disease
• Currently not yet endorsed by the WHO
• Delays to one of the drugs impacts on treatment of the other diseases
The use of a common point of service at the community level to reach populations with current services in either routine or campaign approach.
Examples include:• Mother to Child Health days • Deworming through school feeding programs • Bed net distribution programs
Community based integrated delivery
Challenges & Benefits of community based integrated
deliveryBenefits?
• Increased treatment coverage
• No risk of the NTD campaign being delayed by MoH priority campaigns such as Polio vaccines
• Cost-effective to combine transport, training, staff resources, sensitisation etc
Challenges?
• Reluctance from other well-funded programs to coordinate
• At risk of being vulnerable to delays in such campaigns
Integration with other sectors
Preventative chemotherapy
Vector control
Provision of safe water sanitation
and hygiene
Veterinary public health
To achieve elimination WHO has identified a number of “complementary interventions” that need to be implemented.
Integration with other sectors
Coordination with Water, Sanitation & Hygiene activities:
NTDs associated with poor Water, sanitation
and hygiene Trachoma
Schistosomiasis
STH
Integration with other sectors
Vector Control
Molluscicid
ing
Mosquito
Control
Challenges & Benefits of integration with other
sectorsBenefits?
• MDA alone insufficient to break diseases cycle. Essential to have a more holistic approach in the move towards elimination.
• Long term cost-benefits
• Trachoma program already implementing the F & E elements of SAFE
Challenges?
• Short-term cost challenges – interventions such as WASH are expensive
• Lack of donors funding such integration mechanisms
• Depends on combining different skill sets between sectors
• Environmental challenges, particularly with vector control
Thank you