Integration of NTD Control
100 years
of living
science efficiency
How
to promote
Dr Anna Phillips
27th June 2014
Date • Location of Event
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
Introduction & context
• 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
What does integration mean?
“Umbrella” NTD program overseas
independent programs
Integration
defined in
different
ways
Integration
with other
sectors
such as
WASH
“Community
based
integrated delivery” –
as part of routine
health or education
programmes
Multiple drugs given at
the same time to one
individual
The Umbrella Coordinated NTD program
• SCI: Provides financial and technical support to country
SCI
MoH/
NGO
Task
Force
• MoH/NGO in-country: Coordinates and finances the integrated NTD control program
• 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
Integration of training, drug delivery, drug storage, and education materials
LF/Oncho MDA
Schisto/STH MDA
Trachoma MDA
DISTRIBUTION
CHANNELS
DRUGS
Mobile clinics
and community
health workers
Teachers in
Schools
Vaccinations
ALB
PZQ
MBZ
ALB
TARGET GROUPS
<5
0-11
12-59
100
years
of
living
years
months
months
5-14 years
science
(enrolled
in school)
Women in
1st trim.
pregnancy
Nonpregnant
women
Community
Drug
Distributors
PZQ
Adults
>15 yrs
&
Nonenrolled
children
ALB
IVM
AZT/TRT
Whole
population
(except under
1 years)
AREAS
Date • Location of Event
Whole
country
STHs areas
SCH & STH
LF &
Oncho
Trachoma
areas
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 administration
Benefits?
• 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
Community based integrated delivery
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
Challenges & Benefits of community
based integrated delivery
Benefits?
• 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
To achieve elimination WHO has identified a number of
“complementary interventions” that need to be implemented.
Veterinary
public health
Provision of
safe water
sanitation
and hygiene
Preventative
chemotherapy
Vector control
Integration with other sectors
Coordination with Water, Sanitation & Hygiene activities:
Trachoma
STH
NTDs associated
with poor Water,
sanitation and
hygiene
Schistosomiasis
Integration with other sectors
Mollusciciding
Vector
Control
Mosquito
Control
Challenges & Benefits of integration
with other sectors
Benefits?
• 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