1. Kabatereine Narcis NEED FOR IMPROVING IN-COUNTRY CAPACITY FOR BETTER DELIVERY. AFRICAN SCI CAPACITY BUILDING ADVISOR BASED IN UGANDA

2. Some of my roles As SCI Capacity building advisor and as a member of WHO/Geneva WG for Capacity building, I participate in:  Identifying existing efforts and gaps in CS and Prioritize needs in order to accelerate rate of scale –up of country programmes,  I participate in training consultants who train country staff’,  I train country staff as SCI Capacity building Advisor or on behalf of WHO. Examples of existing CS courses include: NTD Programme Managers Course M&E course Working on district managers training course As a Member of WHO/RPRG, reviewing progress of country NTD Programmes and advise on way forward.

3. WHY IN-COUNTRY CAPACITY BUILDING?

4. According to existing data According to existing data on global preventive chemotherapy, additional 350 million people per year Approximately additional 350 million people per year must be reached by 2015 Requiring global rate of 8 to 10 million new treatments per month This is not being reached at The current treatment rate. Current and projected proportion of people (2008-2020) receiving PC for at least one disease among LF, SCH and STH out of the estimated number of people requiring PC (excluding India and Bangladesh)

5. Mapping gaps at Country and District levels PC NTDs Countries with Mapping gaps Number (%) of districts to be mapped LF17655 (14%) ONCHO12374 (9%) SCH22972 (20%) STH241,031 (21%) TRA191,690 (40%)

6. PC NTD Mapping Status Confirmation mapping (1) Not Started (7) Partially mapped (15) Complete mapping (23) Not Applicable (2) Not AFRO Schistosomiasis

7. THEMATIC AREAS FOR CAPACITY STRENGTHENING FOR PREVENTIVE CHEMOTHERAPY "Sunflower concept"

8. Other Areas that urgently require capacity building include :  Epidemiological survey skills  Financial management skills  Social science skills  Training of health workers on health centre based disease management

9. For Elimination, We need more sensitive diagnostic tools  Eg. Kato Katz method for S.mansoni diagnosis is not adequately sensitive  CCA has been shown to be more sensitive in a multi- country SCORE study.  Uganda and Rwanda are currently re reassessing schistosomiasis distribution using CCA  and capacity building is needed to scale-up use of CCA for re-evaluation in elimination phase in many other countries..  CCA can be used as an RDT to improve facility based schistosomiasis managemen.

10. Impact monitoring  Prevalence and intensity of infection  Micro/macro haematuria stool  Anaemia  Growth  Clinical complications  Educational achievement  Cost-effectiveness Process monitoring  Drug procurement and management  Monitoring of side-effects  Quality of drug distribution  Training of teachers and CDDs  Health education  Political and financial support  Advocacy and publicity  Inter-sectoral collaboration, e.g. WASH Coverage monitoring  Geographical coverage  Epidemiological coverage  Programme coverage CAPACIITY BUILDING NEEDED FOR MONITORING IN MOST COUNTRIES

11. 11 ULTRASOUND & Clinical examination of schistosomiasis Ultrasound examination –WHO guidelines –portable machine Aloka SSD-500

12. Training in integrated vector management (IVM)  Vector identification  Pesticide handling and management  Insecticide applications  Environmental Impact assessment  Insecticide resistance management  testing impact of pesticide applications etc..

13. Timely data retrieval and reporting  Timely data retrieval from the field is a problem due to inadequate logistics or demand for incentives by volunteer drug distributors.  However, some electronic tools eg smart phones have been tested and they work and such training is important.

14. There is need to;  shift from disease-specific to intervention-specific approaches  It is important to synergize control efforts with existing health systems  especially with successful in country disease control channels eg, ITN.  Strengthen partnership and NTD coordination at National and district levels,  Strengthen health facility based disease management. Capacity building needed at country level for all these issues. Way Forward considering sustainability

15. SOME RECENT IN-COUNTRY CAPACITY BULDING

16. Mapping done By the trained Local Techncians Malawi: Over 40 Technicians trained and they have completed Schisto / STH Map.

17. Rwanda: 64 technicians recently trained and are re-mapping using both CCA and Kato Katz to produce a map for elimination phase.

18. IN ETHIOPIA: 175 technicians trained and mapped 500 Woredas including 2790 schools 5752790

19. Coverage validation surveys to evaluate accuracy of reported coverage

20. Main Challenge  To promote country ownership even when CS gap exists, it may not be attended to until the country feels it as a priority.  Hence CS scale-up rate is slow.

21. Thank you …