Bi-national Commission on Health Guyana Suriname

1. Bi-national Commission on HealthGuyana Suriname Neglected Tropical Diseases Dr. ShamdeoPersaud Chief Medical Officer GUYANA

2. NTD Control • Guyana on 1 of four in the Americas where LF still endemic and 3 other NTD • Development of National Plan • Identification of Priorities • LF – Targeted for elimination by 2016 • STH – Targeted for control by 2015 • Chagas – Elimination of vertical and Blood Transfusion transmission; control of Oral and vector transmission • Leprosy – Elimination • ONCO and SCH not transmitted • Dengue, Leptospirosis and Malaria remain endemic in selected Regions

4. SEROLOGY PREVALENCEOF LF ANTIGEN Key: Prevalence Red=20%-50% Yellow=4-20% Green< 4% Ministry of Health, Guyana

5. Plan for Transmission Interruption • Phase one (2003 – 2007) • Social Mobilization • Develop, distribute, promote and use DEC salt • Monitoring and evaluation progress at sentinel sites • Phase two (2008 – 2015) • Synergies with other neglected diseases • Evaluation of Phase one • Identify “Hot Spots” using surveillance information • Implement MDA with DEC and Albendazole • Monitor and evaluation progress at sentinel and spot check sites Ministry of Health, Guyana

6. Endemic LF IUs in Guyana Ministry of Health, Guyana

7. Phase oneSalt Fortification • Adding beneficial chemical to salt • Does not alter taste or other qualities of salt • To combat public health problems (IDD, Dental Caries, Malaria, LF) Iodine Deficiency Disorder (IDD) • Inadequate iodine in the body • Disease observed as enlarged thyroid, Mental retardation and Cretinism, but several stages of physical sluggishness, learning disability, growth retardation and childhood morbidity Iodized Salt- successful in eliminating these problems Ministry of Health, Guyana

8. DEC-Salt for Mass Treatment • Program Launched in July 2003 • 2003 to early 2004 - 480 tons imported • Hurricane in Jamaica disrupted production, New plant commissioned in March 2005 • Salt became blue in 2006 • Production recommenced in August 2005 • 2005 – 49 tons • 2006 – 80 tons • 2007 – 290 tons • Production stop in August 2007 Ministry of Health, Guyana

9. Phase IIMass Drug Administration • Region 5 – Annually form 2009 - 2015 • Population - 52,428 • Eligible Pop – 47,000 • Population Treated - (2008 =81.7) (2010 =84%) • Region 2 – one round 2009 • Region 6 – one round 2010 • Region 4 – 2010 -2015 • Georgetown/East Bank/East Coast • 360,000* • Eligible 300,000* Ministry of Health, Guyana

10. Phase IIMass Drug Administration • Region 3 – Annual 2012 – 2016 • Population - 103,061 • Eligible Pop – 91,000 • Region 10 – Annual 2012 – 2016 • Population – 41,112 • Eligible Pop – 37,200

11. Integrated NTD ProgramBackground • The Georgetown Sanitation Improvement Project (GSOP) was developed by the Government of Guyana to improve the sanitation in the Capital City • Project was supported by Inter-American Development Bank (IDB) • Guyana Water Incorporated is the executing Agency a

12. Sentinel Monitoring Ministry of Health, Guyana

13. GSIP The aims of the program are: • Improve the operational performance of the Georgetown sewerage system through the reconstruction of its most critical components; • Strengthen GWI operational and financial performance by improving asset management and decreasing energy consumption; • Limit the transmission of the water-related diseases lymphatic filariasis and intestinal helminthiasis.

14. Results of Baseline Study

15. Training • Develop MDA guidelines in accordance with the Program Managers Guidelines • Procure all essential medicines (DEC, albendazole) and supplies • Training and orientation of health workers • Requirement and training of community volunteers and supervisors

16. Mass Drug Administration • Packaging of medication • Implement MDA (door to door, Booths at Health Centers and Outreach teams) • Collect and analysis program data on Coverage • Conduct Coverage survey (post treatment survey)

17. Mass Drug Administration Implementation Unit – Demerara/Mahaica (Region IV) • Population – 310, 320 (41.3% Guyana's Population) • Eligible population – 301,000 • Divided into 3 areas • The City of Georgetown – Prevalence 28% (ICT) • East Coast Demerara – Prevalence 16.5 % (ICT) • East Bank Demerara – Prevalence -10.8% (ICT)

18. Guyana Mass Treatment Chart NTD (LF/STH)

19. Coverage – Region IVYear 1

20. Monitoring and evaluation • Program coverage – Data management • Survey coverage – Post treatment cluster surveys • Morbidity • Reporting • IDB and GWI • National and Regional Programs • Impact evaluation • Surveillance • National feedback

21. Challenges • Capacity – Technical and administrative (PAHO/WHO and MOH assisted), Training (University Interns) • Supervision and Data management – PAHO supported training and coordination • Administrative and Logistic Support – Transport, Office space, Medicine storage and packaging (MOH provided all support) • Procurement and supplies chain – DEC Procurements from Brazil, ALB donation from GSK • Social Mobilization – Mass Media program was late and did not reach target population, MOH and GWI used their individual to enhance SM and HW conducted community Mobilization

22. Innovations • Training of Volunteers from Community and Faith Based Organization • Target large employers – Ministries, work places and Institutions • Establishment of Distribution Points mainly at Health facilities • Special Outreaches and “Mop-up” Exercises • Public Education – opportunities to “talk health” • Integrated Vector management.

23. Leprosy situation at national level,2011

24. Prevalence at first sub-national administrative level, 2011

25. Thank You