Main topics of the NTD debate | Unmet needs | Possible reasons for unmet need | New challenges and questions |
---|---|---|---|
Mass Drug Administration (MDA) and post-MDA phase | Preventive chemotherapy and transmission control (PCT)-NTDs | PCT-NTDs | PCT-NTDs |
• Ensure access to MDA for adults where disease burden is high • Ensure access to MDAs for disable individuals • Ensure treatment at PHC level for those that may have missed MDAs | • Limited financial support to target adults in MDAs • No drug donation available for adults during MDAs • Drugs donated for MDAs are not available at the PHC level outside campaigns • Possibly not adequate attention to disables and their need to access to treatments | • Can drug donation be extended to adults (where needed) and be made available at the PHC level? • Low prevalence reached in some areas where MDA has been ongoing for several years – is MDA still cost-effective if infection is very low (5%–10% prevalence)? • Risk of disease re-occurrence and/or increase back to initial levels if MDAs are stopped after reaching very low disease prevalence • MoH very likely in need to take on cost of treatment (including adults) in post-MDA, and/or post elimination phases if there is disease recurrence, and affected individuals still present | |
Intense Disease Management (IDM)-NTDs | IDM-NTDs | IDM-NTDs (& non NTDs) | |
• Roll out of blanket treatment for some IDM –NTDs easily managed with annual routine treatment (e.g. yaws) | • Disease mapping not performed as sensitives and specific RDTs not currently available (hence routine treatment cannot be rolled out) | Other diseases that were controlled by MDAs (e.g. scabies, strongyloidiasis, teniosis, cysticocercosis) could become a challenge after MDA campaigns stop, and health structures do not have adequate resources to treat these diseases | |
Re-mapping after MDA cycle Monitoring disease transmission | PCT-NTDs | PCT-NTDs | PCT-NTDs |
• Mapping of hypo endemic areas after an MDA cycle • Monitoring disease transmission in pre-elimination stage for certain PCT-NTDs | • Limited availability of sensitive and specific rapid diagnostic tests and /or laboratory tests to assess current infection and disease transmission in low endemic areas | • How would it be possible to confirm disease elimination, and absence of disease recurrence in post-elimination phase if disease transmission and/ or incidence cannot measured? | |
IDM-NTDs | IDM-NTDs | IDM-NTDs | |
• Disease burden for many IDM-NTDs and in many countries, where historically reported (Mapping of these diseases not performed) | • Limited tools and RDTs to map these diseases • Limited knowledge on how to triage, diagnose, confirm and report cases at the PHC level, for information on disease burden • Limited resources in laboratories at the heath care level to confirm disease transmission | • How would it be possible to confirm disease elimination, and absence of disease recurrence if the real burden of some of these is not yet known? | |
Community and community health workers engagement (CHWÂ =Â personnel either working on a volunteer basis or occasionally compensated with incentives) | PCT-NTDs | PCT-NTDs | PCT-NTDs |
• Engagement of the community in public health interventions to take into account their specific needs • Community technical support, supervision and motivation for the sustainability of ongoing community health interventions • Financial recognition of the work already performed by CHWs in MDAs and in integrated MDAs | • Top-down approaches preferred in public health interventions • Ministry of health limited financial and human resources to support communities in disease prevention, treatment and management (when it could be done at community level) • Local/national financial limitations for the formalization of CHWs’ role in the health structure, and absence of a clear plan on how to do it | • How can the last cases be found in an elimination context if communities are not educated and sensitised? • Are the governments willing to retain CHWs and ensure the sustainability of their engagement? | |
IDM-NTDs | IDM-NTDs | IDM-NTDs | |
As above | As above | • CHWs workload likely to increase in interventions aimed at disease detection and management at the community level | |
Primary health care structure: Case finding and confirmation Surveillance Recording disease incidence | PCT-NTDs | PCT-NTDs | PCT-NTDs |
• Availability of clear case definitions for suspected and confirmed NTD cases at the health structure level • Guidance on case finding (active finding) • Adequate training on patient triaging procedures • Adequate laboratory resources to confirm NTD cases • Guidance on how to report disease incidence • Development of operational NTD surveillance strategies, and work plans • Revised reporting templates reflecting countries NTD reporting priorities | • Absence of clear guidance at the national level, on disease surveillance approaches • Very limited monitoring and evaluation process to assess data quality in health data routine reports provided by health facilities • Iinternational guidelines on surveillance not in line with the new vision on NTD elimination or simply non existent • Health information system reporting templates not adequate to report NTDs • Inadequate health data reporting process from decentralized health structures to central level • Limited national and international interest and \financial support in disease surveillance and in setting disease surveillance strategies | • Post MDA surveillance – how can it be set up if the health system in place does not have enough technical, human and financial resources to implement disease surveillance? • Emerging and re-occurring diseases: how would it be possible to ensure that diseases that have been eliminated, do not reappear due to neighbouring endemic countries, migrations, wars, and political instability? | |
IDM-NTDs | IDM-NTDs | IDM-NTDs | |
As above | As above | • Inability to obtain disease incidence and disease trends • Low likelihood to confirm disease elimination if disease transmission or incidence are not obtainable | |
Disability prevention Intense case management Home care management | PCT-NTDs | PCT-NTDs | PCT-NTDs |
• Disability and complications related to untreated PCT-NTDs and to IDM-NTD adequately addressed in the NTD elimination plans • Resources to ensure home care management for morbidity related to untreated NTDs | • Disability management related to NTDs not a public health priority in NTD national plans developed in the last decade • Limited financial support for disability prevention and case management | • People impacted by severe complications related to untreated NTDs are likely to be those individuals living in remote areas – how do we reach them and how can we ensure access to adequate health? | |
IDM-NTDs | IDM-NTDs | IDM-NTDs | |
• Adequate resources for managing patients with these diseases at the PHC level • IDM-NTD case management addressed in the NTD elimination plans | • These diseases have not been adequately addressed in NTD national plans developed in the last decade • Limited interest in managing these disease due to difficult management, and inadequate resources for disease detection | As above | |
Integrated disease prevention, management and surveillance of all NTDs | PCT & IDM-NTDs | PCT & IDM-NTDs | PCT & IDM-NTDs |
• Integration of these diseases not addressed so far as NTD programmes were generally disease focused (vertical approach), or PCT focused (with integration limited to PCT NTDs) | • Disease focused approaches generally preferred by donors (as easy to assess in terms of outcomes and impact), and more manageable at the MoH level • MoH NTD master plans generally referring to PCT NTDs only as priority, and not adequately addressing IDM diseases, more difficult to manage | • Integration of disease management at the MoH level will be challenging due to human resources and programme structure specifically establish for disease focused programmes • Fear of losing positions, jobs and power at every level of the health structure if disease management integration is performed • Donors to be convinced for allowing financial support initially provided for one disease, to be used for several diseases that may be more effectively dealt with if integrated | |
Integrated Vector Management | Vector borne NTDs (PCT and IDM) | Vector borne NTDs (PCT and IDM) | Vector borne NTDs (PCT and IDM) |
• Testing current vector control strategies in terms of entomological and epidemiological efficacy to assess what works and what does not work • Integration of entomological surveillance and vector control strategies in the national NTD prevention plan • Development of new insecticides to cope with emerging insecticide resistance | • Absence of adequate financial support for the development of new insecticides • Limited technical resources on integrated vector control • Limited guidance on how to assess what is actually feasible and cost effective • Limited human resources in developing and piloting new integrated vector control strategies • Integrated vector control has not been a priority so far in endemic countries • Vector control for NTDs has not been fully exploited as opportunity for disease prevention • Lack of international interest in vector control for vector borne NTDs | • Impact of climate change on vector distribution: how do we challenge the spreading of vectors and the subsequent emerging and re- occurring of vector borne diseases if vector control has been so far an untapped opportunity for disease prevention? • Undeveloped integrated vector control framework in some low income countries, especially in the African continent: how to we address this gap considering the current emerging vector borne diseases? |