PRE VENTING NEGLEC TED TROPIC AL DISEASES OF POVERT Y JUNE 2014 Working in Partnership 88849 Global Support for the Neglected Tropical Diseases Agenda There is global support for the control builds on the river blindness approach can conclude if the other continues and elimination of Neglected Tropical to address other preventable NTDs ivermectin treatment in the same area. Diseases (NTDs) in low income including lymphatic filariasis, trachoma, In most APOC countries, lymphatic countries. In 2012, as part of the soil-transmitted helminths, and filariasis treatment coverage is low and London Declaration on Neglected schistosomiasis. scaling up lymphatic filariasis programs Tropical Diseases, the pharmaceutical would also cover areas previously industry collectively committed to Collaboration is Key untreated for river blindness. donate most of the drugs necessary for With a growing commitment to Strategies to control several of the an Africa-wide NTD program. address all preventable NTDs, other NTDs also depend on mass These donations present an exceptional ambitious targets and milestones have drug administration (MDA) and can opportunity for countries and been set at the global, regional, and build on the experiences with river development partners to build on the national levels. From the World Bank’s blindness and lymphatic filariasis. success of the river blindness programs perspective, achieving these targets For trachoma, soil-transmitted and expand the effort to address all calls for partnership and improved helminths, and schistosomiasis, preventable NTDs using a common collaboration among programs. there are fewer operational synergies community delivery system to distribute The river blindness and lymphatic with river blindness and lymphatic preventive medicines, as well as to filariasis treatment programs are a great filariasis programs. However, there are build health systems that can provide example of the need for coordination. opportunities for collaboration at the case management for intensive disease They are already closely linked because local implementation level (where management (IDM) NTDs. The same ivermectin (Mectizan®) has formal districts increasingly work in health delivery system can deliver medicines regulatory approval and is donated systems teams rather than in disease- for NTDs and for seasonal malaria by Merck & Co. for both diseases. specific teams), as well as for advocacy, control, as well as distribute insecticide- Also, in areas where the two diseases resource mobilization, and overall treated bed nets to prevent mosquito- are both endemic, neither program policy and strategic planning. borne diseases. According to the 2013 Lancet Commission on Investing in Figure 1. Predicted end year of treatment for APOC projects Health, the “elimination of (high burden NTDs) for such low costs… represent[s] very good value for money.” Community Health Systems Provide a Way Forward For the past 40 years, the endemic countries of Africa, together with the World Health Organization (WHO), World Bank and other development partners, the pharmaceutical industry, and non-governmental organizations, have prioritized the control of river blindness through the Onchocerciasis (river blindness) Control Programme (OCP) and the African Programme for Onchocerciasis Control (APOC). The end year of treatment was predicted for each APOC project using the simulation model ONCHOSIM, taking into account the precontrol endemicity level in the project area and the The success of these programs has reported coverage and duration of ivermectin treatment in the project. led to a call for a larger program that Further, collaboration between Timeline for Elimination prevalent, and for clinics and health preventable NTD programs can be personnel to have the capacity to By 2015, foci in some countries will have particularly developed in the areas of provide effective case management. stopped treatment, but no country will drug delivery, logistics, surveillance, and be certified as having achieved national New Funding Strategies disease mapping. A collaborative effort elimination. However, by extending would also ensure that communities treatment to 2020, 12 countries may from the World Bank are motivated to play a lead role in drug More countries are choosing to use World achieve national elimination of river distribution beyond 2015. Bank funding mechanisms to address blindness, protecting more than 60 million people. Further, projections NTDs. The International Development Increased WHO show that 80 percent of OCP and Association (IDA)—the World Bank Technical Assistance APOC countries will have eliminated Group’s fund for the poorest countries— In 2013, all 47 Health Ministers from Sub- river blindness by 2025. Accelerated is supporting African countries that Saharan Africa committed to supporting actions and special strategies are being cannot afford to buy NTD drugs. Some a regional effort to control, with an aim developed to speed up the progress of countries are allocating portions of their to eliminate, all five preventable NTDs the remaining countries. IDA resources to national NTD programs. from the continent. The WHO Regional To date, about US$120 million has been WHO has published a comprehensive Office for Africa has played a lead role committed to NTDs in Africa from a roadmap to support the control, in supporting countries with creating combination of national and regional elimination and eradication targets for national master plans for NTDs. In some IDA programs, including the Senegal NTDs through 2020. This evidence-based countries, the National Onchocerciasis River Basin Project, a multisectoral Health, strategic plan entitled Accelerating Task Force is being transformed into Nutrition and Education Project in work to overcome the global impact of a National NTD Task Force. These are neglected tropical diseases: A roadmap Madagascar, and a new regional initiative positive developments which will for implementation, aims to overcome to support the NTD agenda in the promote sustainable integrated the global impact of NTDs by guiding West African Sahel. A new World Bank- national programs. effective coordination and support at executed trust fund, supported by the Bill To help countries achieve this the country level and by serving as a and Melinda Gates Foundation, is helping transition, plans are underway to resource for the implementation of catalyze these contributions. In addition, help APOC extend its operations policies, strategies, and interventions. the World Bank’s Africa Region is working beyond 2015 and transition from a with partners to leverage donor support single-disease entity to an expanded Ensuring that Health to countries, building on the multidonor regional NTD initiative entitled Systems Effectively trust fund APOC model. Programme for the Elimination of Address Intensive Case management of IDM diseases Neglected Diseases in Africa (PENDA). Disease Management can also benefit from IDA allocations. This new regional entity may build on the governance structure of APOC, (IDM) NTDs Increasingly, countries are adopting Much of the current effort on NTDs a Results-Based Financing approach, and increase technical assistance to in poor countries is focused on the which helps support increased access support elimination goals, especially preventable NTDs that can be eliminated to clinics and public health personnel at in surveillance, evaluation, resource by MDA. There are other important NTDs the periphery. Efforts are underway to tracking and mobilization, and of the poor that require clinical case increase the use of the approach with coordination. Initially, technical management with a focus on a curative regard to IDM NTD diseases. assistance might expand to include lymphatic filariasis in the 30 co- approach. These include HAT (human Disease elimination can only be endemic countries and then grow to African trypanosomiasis or sleeping determined nationally after treatment include all countries where lymphatic sickness), VL (visceral leishmaniasis or has been stopped, post-treatment filariasis is present. Further, the new kala azar) and Chagas disease. surveillance has been carried out, and regional entity could help strengthen For several of these diseases there an independent verification process has service health delivery mechanisms at is a need for more effective, simpler certified that elimination targets have the community level and deliver other and safer treatments, but much been met. Although the challenges are preventable NTD control measures can be done with what is already considerable, the prospect of control where there is a clear comparative available. There is a critical need to and elimination of preventable NTDs advantage. This may result in both ensure that health systems in low throughout Africa is very real. PENDA will cost savings and a greater need for income countries reach into the rural help support the way forward to meeting technical assistance. areas where these diseases are most the vision of Africa free from NTDs.