progress report: n ational lf and sth programme in nepal

Government of NepalMinistry of Health and Populations

Progress Report:National LF and STH Programme

in Nepal

Dr Babu Ram MarasiniPM & RPRG Meeting, SEARO

Jakarta, Indonesia23-26 September, 2014


Country Profile

• Total population: 27,311,978• Geography: Three ecological zone: Mountain, Hills and Plain

Administrative divisionDevelopment regions: 5Zones: 14Districts:75

Mid western region

Eastern regionCentral region

Western region

Far western region


Health Administration and Service Delivery

Central Level

Regional level

District and Community level


Background: LF

• Mapping: 2001, 2005 & 2012

• Average prevalence: 13%• Endemic districts (IUs):

61• Parasite: W. Bancrofti• Vector: C.

Quinquifasciatus• Year MDA started: 2003• Geographical coverage

achieved in 2013• By 2014, MDA stopped in

20 IUs.

DOLPA

MUGU

JUMLA

KAILALI

BARDIYA

HUMLA

DOTI

SURKHET

NAWALPARASI

KAPIL-BASTU RUPAN-DEHI

DANGBANKE

ACHHAM KALIKOT

JHAAMORANGSIRAHA

SAPTARI

DARCHULA

BAJHANG

BAITADI

DADEL-DHURA

KANCHAN-PUR

BAJURA

PARSA

BARARAUT-AHAT

DHANUSA

MAHO-TARI

SUNSARI

SARLAHI

DHADING

MAKAWAN-CHITWAN

KASKIBAGLUNG

TANAHU

PALPA

SYANGJA

PARBAT

ARGHAKHACHI

GULMI

UDAYAPUR

SINDHULI

ILAM

BHOJ-PUR

PACHETHAR

DHAN-KUTA

TAPLEJUNG

RAMECH

HAP

OKHAL-DHUNGA

TERHA-THUM

KHOTANG

LALIT

KATHMSULUK-HUMBU

DOLAKHA

SANKHUWA-SABA

NUWAKOTSINDHU-PALCHOK

KAVRE

RASUWALAMJUNG

GORKHA

PYUT-HAN

ROLPASALYAN MYAGDI

DAILEKHJAJARKOT

RUKUM

MUSTANG

MANANG

LF Endemicity and MDA Status: 2014

N

E

MDA stopped (20 Districts)

Two round completed (10 districts)

Non endemic districts (14)

Five rounds completed (10 Districts)Four rounds completed (10 Districts)Three rounds completed (10 Districts)

Continuation after 6 rounds (1 district)

Index


LF Elimination Programme: Key Milestones

Mapping

2001/2005

2003

MDA initiated in 1 IU & then scaled up in subsequent

years

Pre TAS in 16 and remapping

in 3 IUs

2010/2011

2011

MDA stopped in

5 IUs

TAS in 5 IUs

2012

MDA rolled out to all endemic

districts; TAS in 16 districts

2013

Step 1: Mapping Step 2: MDA Implementation Step 3: Surveillance

MDA stopped in 15 IUs, TAS1 in 5 IUs, Pre TAs in 10 IUs

2014


National Programme OverviewIndicator LF STH

Year of inception of the national programme

2001 2000

Target date for elimination 2020

Name of administrative unit for implementation of PC

District District

Total # administrative units requiring PC at the start of the programme

61 75

Total population requiring PC in the country

25 million 10,384,014


PC Programme and Financing

• Contributors to the 2013/2014 programme costs (and rough estimate of contributions by each):

Contributor Funding (US$)National government 1.7 million (for LF)

Sub-national government -

Internal donors (___) -External donors (USAID) 1.5 million (for LF)

Others (WHO) LF: 803,510 (Albendazole and TA)STH: 100,000 (Albendazole)


PC Programme Achievements 2013

Indicator Targeted Achieved

M&E

Total # sentinel and spot check sites surveyed (LF) 0 0Total # sentinel sites surveyed (STH) 4 4

Total # IUs where stopping-MDA TAS implemented (LF) 16 16Total # IUs which passed TAS and stopped MDA (LF) 16 15Total # IUs where surveillance TAS implemented (LF) 0 0

MMDP# IUs where hydrocele surgeries performed 5 3# IUs where lymphedema and ADLA management provided 0 0

Activities

Targeted Achieved#

administrative units for PC

# people#

administrative units for PC

# people

PCMDA2 (DEC + ALB) 41 14762884 41 10933596T3 (ALB/MBD) for STH 1st round 34 34T3 (ALB/MBD) for STH 2nd round 75 75


Progress Towards LF Elimination

Started MDA ≥5 MDA rounds Surveillance MMDP access

IUs IUs IUs IUs

MMDP access

Post MDA surveillance

≥ MDA rounds

Started MDA

0% 20% 40% 60% 80% 100% 120%

10%

33%

51%

100%


Progress Towards STH Scale Up


PC Coverage, 2013

* 65% for LF and 75% for STH** reported coverage was verified by coverage survey or similar independent activity

PC typeNo. of districts IUs (districts) receiving PC

No. of districts IUs (districts) with

reported coverage above target*

No. of districts IUs (districts)

where coverage was verified**

MDA2 (DEC + ALB) 41 35 21T3 (ALB/MBD) for STH 1st round 34 34 0T3 (ALB/MBD) for STH 2nd round 75 75 0


Impacts of MDA in Sentinel Sites (LF)# SS/SC sites

Sentinel Sites<1% mf

Sentinel Sites≥1% mf

Spot Check sites

<1% mf

Spot Check sites

≥1% mf

Baseline Survey 24 37 10 1

Latest surveys (post-MDA)

- - - -

Note: All reports not available


PC Monitoring and Evaluation

• Post MDA coverage survey• Transmission assessment survey (TAS)• Pre-transmission assessment survey • Monitoring during PC implementation (MDA)

• SAE protocol– Detection: training to volunteers on possible SAEs and

reporting/self reporting, – Management: Programme provides free treatment of SAEs – Reporting: number of and types of SAEs


Progress to date in assessing transmission Number# administrative units currently eligible for surveys to stop mass treatment 0 (10 in 2015)

# administrative units where surveys to stop mass treatment were conducted 21

# administrative units where criteria was passed and mass treatment stopped 20

• Integrated assessment of STH considered? Yes

LF Transmission Assessment Survey to Stop MDA


LF Transmission Assessment: Forecasting

YearNumber of IUs to

be coveredTAS1 TAS2 TAS3

Total number of EUs

ICT/LF ST Required*

2014 - 5 - 2 3500

2015 10 - 5 8000

2016 10 16 5+7 20000

2017 10+14 5 5+7+2 22,500

2018 10 10 5+5 16,000

2019 16 7 12,000

2020 10+14 10 5+7+5 28,000

*sum of the total sample size required for each EU assessed;


MDA Status, TAS and Post MDA Survey Plan

Note: No colour significance. Resource identified till 2016.

MDA start year 2003-2005 2007 2010 2011 2012 2013

No. of districts enrolled

5 16 10 10 10 10

End date for 6 rounds

2010/ 2011 2013 2015 2016 2017 2018

MDA status in 2014 -Stopped in 15, continued in 1 IU

5 rounds 4 rounds 3rounds 2 rounds

Follow up survey done done - Not done 2014 2015

Pre TAS - 2012 2014 (ongoing) 2015 2016 2017

TAS (after 6 rounds) 2011 (done) 2013 (done) 2015 2016 2017 2018

1st periodic survey 2014 (ongoing) 2016 2018 2018 2020 2020

2nd periodic Survey 2017 2018/19 2020/21 2020/21 2022/23 2022/23

Survey in 14 non endemic districts

2017 & 2020


Integrated Vector Management (LF)

• No LF specific IVM activities• LLIN distribution (malaria programme)• Space spraying/indoor residual spraying for

malaria and Kala-azar• IEC/BCC/awareness• Monitoring and evaluation are done by

specific programme (eg: LLIN coverage survey, vector survey, LLIN durability study etc)


LF- MMDP – StrategyLF

National policy exist? YesOrganizational placement within the government (who is responsible?)

Epidemiology and Disease Control Division at the central level

How integrated with the health service?

Service is provided through integrated health service

Training of service providers conducted (by who? How frequent?)

Has been planned for 2014 (In two hospitals and 3 PHCCs/districts)

Patient mobilization and registration (by who? How?)

District health system


LF- MMDP – Monitoring and Evaluation

LFDescribe how MMDP services are currently monitored and reported to the national programme

• Districts and regional health directorate implement and monitor the MMDP activities (eg surgery camps)

• Reported directly to programme and HMIS

How is “access” determined?

• MMDP activities are organized in health facilities and communities based on the morbidity/case loads

Is there any quality assessment of provided services?

• Monitoring during implementation


Best Practices

Multi-sectoral involvement ( mobilization of school teachers and local leaders)

Media mobilizationSchool health and nutrition week


Challenges and Issues

LF•Urban coverage•Post MDA surveillance•Morbidity management•Low lying river valleys STH•Monitoring•Achieving and sustaining coverage•Reaching non-enrolled school children


Programme Plan Activities

2014 target 2015 target# administrative

units for PC # people # administrative units for PC # people

PCMDA2 (DEC + ALB) 41 14762884 41 15,981,384T3 (ALB/MBD) for STH 1st roundT3 (ALB/MBD) for STH 2nd round

Activities 2014 Target 2015 Target

M&E

# districts/IUs where coverage surveys are planned for any PC diseases 21 22

# IUs where pre-TAS sentinel site and spot checks planned (LF) 10 10

# IUs where TAS for stopping MDA is planned (LF) - 10# IUs where STH survey integrated with LF TAS planned - -

# IUs where MMDP is to be evaluated (LF) - -# IUs where surveillance activities are to be carried out (LF) 5 20

MMDP # IUs where MMDP services newly initiated (LF) 3 3IVM # IUs where IVM coordinated to target LF vectors - -


PC Medicine Request for 2015　 ALB (LF) ALB (STH) MBD DEC

required 15695317 10673078 (SAC) - 39238293

in stock 0 10000000 - -

in pipeline - - - -

requested to WHO 15695317 10673078 (For SAC) - -

requested toMDP (IVM) or ITI (AZI)

Procured from other sources(source, # tablets and target age group)

-Government

procurement for Pre SAC

-

39238293 (Government procurement,

2-70 years)


Thank you !

progress report: n ational lf and sth programme in nepal

Documents

mda tas

endemic districts ius

endemic districts tas

sth programme

programme costs

populations6pc programme

mda status

quinquifasciatusyear