100 years of living science Date Location of Event Integration of NTD Control How to promote efficiency Dr Anna Phillips 27 th June 2014

The Evolution of NTD Integration BMGF In 2003, SCI commenced in six countries with funds from BMGF to launch National Schistosomiasis & STH vertical control programs USAID In 2007, SCI was awarded a grant from USAID to integrate the National SCH/STH control programs with other NTDs – primarily LF and Blindness DfID In 2010, additi onal fundi ng from DfID was gaine d to supp ort the Natio nal SCH/ STH contr ol progr ams acros s 8 count ries in coor dinati on with other NTD progr ams

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 Introduction & context

What does integration mean? Integration defined in different ways “Umbrella” NTD program overseas independent programs Multiple drugs given at the same time to one individual “ Community based integrated delivery” – as part of routine health or education programmes Integration with other sectors such as WASH

The Umbrella Coordinated NTD program Integration of training, drug delivery, drug storage, and education materials LF/Oncho MDASchisto/STH MDATrachoma MDA SCI SCI: Provides financial and technical support to country MoH/ NGO MoH/NGO in-country: Coordinates and finances the integrated NTD control program Task Force In-country NTD Task Force: Technical committee consists of MoH NTD focal point; NGO representatives; WHO; MoH NTD Vertical Program managers; and MoE provides technical/strategic support to the vertical NTD programs FINANCIAL SUPPORT FROM NGO TECHNICAL SUPPORT FROM TASK FORCE

100 years of living science Date Location of Event Community Drug Distributors Whole country DISTRIBUTION CHANNELS TARGET GROUPS DRUGS PZQ MBZ V a c c i n a t i o n s AZT/TRT ALB PZQ IVM ALB SCH & STH 0-11 months months 5-14 years (enrolled in school) Adults >15 yrs & Non- enrolled children Whole population (except under 1 years) Women in 1 st trim. pregnancy Non- pregnant women AREAS LF & Oncho Trachoma areas STHs areas Teachers in Schools Mobile clinics and community health workers <5 years

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

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

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

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 Community based integrated delivery

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

Integration with other sectors Preventative chemotherapy Vector control Provision of safe water sanitation and hygiene Veterinary public health To achieve elimination WHO has identified a number of “complementary interventions” that need to be implemented.

Integration with other sectors Coordination with Water, Sanitation & Hygiene activities: NTDs associated with poor Water, sanitation and hygiene TrachomaSchistosomiasis STH

Integration with other sectors Vector Control Mollusciciding Mosquito Control

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

Thank you