Challenges and opportunities of control and elimination of NTDs in Southern Sudan APPMG December 17, 2008 Presented by Dr. John P. Rumunu (MPH, MB.BS) Director General, Preventive Medicine MoH-GoSS

The Operational Context Large area (640,000 sq. km) and dispersed population (10 m) Prolonged rainy seasons and flooding Post conflict situation Comprehensive Peace Agreement (Jan 9, 2005) Disruption of health infrastructure, health human resources and health care delivery system Population movement- impacting on disease distribution including NTDs

Burden of Neglected Tropical Diseases Parasite Disease (Common Name) Burden Protozoan Human African Trypanosomiasis 1 – 2 million people at risk Leishmaniasis Cyclic (500 - 9000 cases/year), up to 100,000 during epidemics Bacterial Buruli ulcer 1000 (+) cases Leprosy Trachoma 3.9 million at risk in surveyed areas Helminth (Worms) Onchocerciasis (River Blindness) 4.1 million at risk, of which 3.6 million eligible for treatment Lymphatic filariasis (Elephantiasis) All areas surveyed to date found to be endemic Soil-transmitted helminths Schistosomiasis (Bilharziasis) Loiasis Dracunculiasis (Guinea Worm) Approx 20,000 cases in 2006 Unknown Nodding Syndrome The multiple burden of different Neglected Tropical Diseases (NTDs) in Southern Sudan is among the greatest in Africa A total of 12 NTDs are endemic (see next Slide) Many only benefit from intermittent control in response to reported outbreaks, supported by short-term donor funding. The need to implement and scale-up appropriate, cost-effective interventions is nowhere as apparent as in this post-conflict setting

Enabling environment Southern Sudan Interim Health Policy Mission: Commitment to ensure equitable sector-wide, accelerated and expanded quality health care for all people in Southern Sudan, especially women and children Goal: The goal of the Interim Health Policy (2006-2011) is to improve the health of the people of Southern Sudan through strengthening the health system at all levels and in particular increasing and strengthening the coverage of the primary health care system and services, including the referral system

Enabling environment Objectives Improving the delivery of accessible, acceptable, affordable, sustainable, cost effective maternal and child health interventions and nutrition programmes Enhancing and accelerating disease prevention and control programmes Strengthening the health system at all levels Develop a comprehensive approach to resource development including planning, training, and continuous education of management personnel Institutionalize effective partnerships with other stakeholders through coordination and other collaborative mechanisms

Current Status of Interventions Within its policy framework the Government of Southern Sudan (GoSS) immediately recognized NTDs as a major obstacles to be overcome to improve the health of its people The Ministry of Health (MoH) has prioritized the control or elimination of some diseases e.g. Onchocerciasis, Guinea worm and Trachoma Expanding resources to lead the control of human African Trypanosomiasis (HAT) and Visceral Leishmaniasis.

Current Status of Interventions Now MOH moving toward the integrated control of NTDs using preventive chemotherapy (PCT) and complementary approaches, as recommended by the World Health Organization. This approach targets: Soil-transmitted helminths (causing ascariasis, trichuriasis and hookworm disease), Schistosomiasis, Lymphatic filariasis (LF), Trachoma and Onchocerciasis Through Mass Drug Administration (MDA) strategy. A National Integrated NTD Control Programme Technical Committee was established in April 2008 to coordinate this new approach.

National Integrated NTD Control Programme Technical Committee

Coordination of integrated NTD control from central to peripheral level

Opportunities Reconstruction Partnership Enabling environment Emerging Health System Partnership Involvement of national and international stakeholders Funding from DFID (seed money) through COMDIS to conduct a national NTD situation analysis Funding through RTI from USAID Mapping and Subsequent MDA in limited areas Development of evidence-based innovative delivery system for NTDs Control/elimination Opportunity for scaling up intervention to all endemic areas per the mapping result

Conclusion There is high burden of NTDs in Southern Sudan There is political will and commitment as evidenced by policies, strategic plan and structures for NTDs control and elimination Current funding secured is only enough for mapping and small scale PCT through MDA in limited areas Need for more funding to scale up PCT in all endemic areas