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Integration of NTD Control How to promote efficiency Dr Anna Phillips 27 th June 2014

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?

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Integration of NTD Control How to promote efficiency Dr Anna Phillips 27 th June 2014

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  1. Integration of NTD Control How to promote efficiency Dr Anna Phillips 27th June 2014

  2. The Evolution of NTD Integration

  3. 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

  4. What does integration mean?

  5. The Umbrella Coordinated NTD program FINANCIAL SUPPORT FROM NGO TECHNICAL SUPPORT FROM TASK FORCE

  6. Community Drug Distributors Mobile clinics and community health workers Teachers in Schools DISTRIBUTION CHANNELS V a c c i n a t i o n s ALB ALB PZQ AZT/TRT PZQ IVM DRUGS MBZ ALB <5 years 12-59 months 0-11 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 TARGET GROUPS LF & Oncho Whole country Trachoma areas AREAS STHs areas SCH & STH

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. Integration with other sectors Coordination with Water, Sanitation & Hygiene activities:

  14. Integration with other sectors

  15. 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

  16. Thankyou

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