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