NTDs & Health Systems Strengthening – the contribution of human resources

1. All-Party Parliamentary Group on Malaria and NTDs 16th October 2012 Elaine Ireland, Head of Policy, Sightsavers NTDs & Health Systems Strengthening – the contribution of human resources

2. Health Systems Strengthening & NTDs • Health Systems Strengthening • Human resources for health • Case study: Community Directed Treatment with Ivermectin • Integrating CDTI into health systems • Conclusions

3. Health Systems Strengthening • Source: WHO, 2007

4. Health Systems Thinking Dynamic architecture & interconnectedness of health systems ‘building blocks’ • Source: WHO, 2009

5. Health Systems Strengthening & NTDs Neglected Tropical Diseases • Group of 17 parasitic diseases • Affect over 1 billion of the world’s poorest people • Most prevalent in rural areas, urban slums, conflict zones • Severe impact on poverty • Most common NTDs: lymphatic filariasis, onchocerciasis, soil-transmitted helminthiasis, schistosomiasis, trachoma

6. Health Systems Strengthening & NTDs Health System Challenges • NTD programmes – vertical or horizontal? • Key health system challenges for NTD programmes include: • Human resource development • Logistics & infrastructural development • Information systems • Governance • Financing • NTDs largely found in remote, rural and often conflict affected area

7. Health Systems Strengthening & NTDs Human resources for health • Global human resource for health crisis • 57 countries with critical health worker shortages • Global deficit of 2.4 million doctors, nurses and midwives • African region is “at the epicentre of the global health workforce crisis” • African region has 24% of the burden of disease but only 3% of health workers and commands less than 1% of world health expenditure

8. HSS & NTDs – contributions to overcoming the HRH crisis Community-directed treatment with Ivermectin – a case study of NTD contributions to HSS • “Community-directed treatment not only advances health promotion and disease control, it also strengthens basic health system structures… helping countries work towards their Millennium Development Goal commitments” • (APOC, 2007)

9. CDTI – A case study The role of the community in strengthening human resources for health • CDTI – key strategy for control of Onchocerciasis • Essential element is the network of community drug distributors who deliver the ivermectin treatment • Estimated that in 2007 close to one million DALYs averted by APOC* through CDTI • Low cost solution – APOC has spent just over $112 million during the 12 years of operating the programme • * APOC is the African Programme for Onchocerciasis Control

10. CDTI – A case study No. of DALYs averted by APOC’s community directed treatment activities in countries that have APOC projects and predictions for future gains to 2015 • Source: APOC, 2007

11. CDTI – A case study Community-based vs. Community-directed treatment • Community-based treatment: • Top-down • Distribution by mobile team of health workers • Community is involved • Community actions are led by health workers • Timing of drug distribution decided at central level • Community-directed treatment: • Grassroots focused • Based on community ownership • Treatment provided by community drug distributors • Community leads the process, planning and management of treatment • Timing of drug distribution determined by community members

12. CDTI – A case study Benefits of CDTI • General: • Better targeting & timing of treatment campaigns • Increased coverage • Improved take up of treatment • Human resources for health: • Dramatic increase in the number of human resources (CDDs) to implement the control programme • Provision of a huge personnel resource base, particularly at the community level • Relieve pressure on overstretched health workforce

13. CDTI – A case study Benefits of CDTI • Health systems strengthening: • Extend health promotion activities to areas that are unreachable by the health system • Development of low-cost technologies, adaptable for other disease control programmes • Strengthen surveillance in ways that improve countries’ resilience to disease outbreaks • Contribute to health information systems data collection • Increased and sustained treatment coverage • Initiation and expansion of other community-based interventions

14. CDTI – A Case Study

15. Integration of CDTI in health systems • “Integration increases efficiency, decreases the burden on health systems, improves access to health services, and improves the cost-effectiveness of health spending while maintaining treatment coverage”. • (APOC, 2007)

16. Integration of CDTI in Health Systems Benefits of CDTI go beyond onchocerciasis… • Community drug distributors now also contribute to: • Albendazole distribution (for LF) • Praziquantel distribution (for schisto) • Mebendazole distribution (for worms) • Malaria bed-net distribution and malaria treatment programmes • Vitamin A distribution programmes • Vaccination campaigns • Directly observed treatment for TB • Provision of family planning aids

17. Integration of CDTI in health systems CDTI projects in several APOC countries are supplying additional public health interventions along with ivermectin: Source: APOC, 2007

18. Conclusions • For NTD control programmes to be sustainable they need to be integrated into the health system • The CDTI approach for onchocerciasis control provides an example of how vertical, disease control programmes can contribute to health systems strengthening • Establishing a network of community health volunteers can alleviate the pressure on the health workforce – to be successful though, there has to be a strong sense of community ownership of disease control programmes • Well established CDTI programmes also offer good scope for developing an integrated approach to disease control and increased access to health services.

19. “CDTI has served as a channel for health interventions to improve access to services and better health” • (Former National Onchocerciasis Coordinator, Cameroon).