All-Party Parliamentary Group on Malaria and NTDs16th October 2012Elaine Ireland, Head of Policy, Sightsavers

NTDs & Health Systems Strengthening – the contribution of human resources

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Health Systems Strengthening & NTDs

•Health Systems Strengthening

•Human resources for health

•Case study: Community Directed Treatment with Ivermectin

•Integrating CDTI into health systems

•Conclusions

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Health Systems Strengthening

Source: WHO, 2007

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Health Systems Thinking

Source: WHO, 2009

Dynamic architecture & interconnectedness of health systems ‘building blocks’

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Health Systems Strengthening & NTDs

•Group of 17 parasitic diseases

•Affect over 1 billion of the world’s poorest people

•Most prevalent in rural areas, urban slums, conflict zones

•Severe impact on poverty

•Most common NTDs: lymphatic filariasis, onchocerciasis, soil-transmitted helminthiasis, schistosomiasis, trachoma

Neglected Tropical Diseases

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Health Systems Strengthening & NTDs

•NTD programmes – vertical or horizontal?

•Key health system challenges for NTD programmes include: • Human resource development• Logistics & infrastructural development• Information systems• Governance• Financing

•NTDs largely found in remote, rural and often conflict affected area

Health System Challenges

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Health Systems Strengthening & NTDs

•Global human resource for health crisis

•57 countries with critical health worker shortages

•Global deficit of 2.4 million doctors, nurses and midwives

•African region is “at the epicentre of the global health workforce crisis”

•African region has 24% of the burden of disease but only 3% of health workers and commands less than 1% of world health expenditure

Human resources for health

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HSS & NTDs – contributions to overcoming the HRH crisis

“Community-directed treatment not only advances health promotion and disease control, it also strengthens basic health

system structures… helping countries work towards their Millennium Development Goal commitments”

(APOC, 2007)

Community-directed treatment with Ivermectin – a case study of NTD contributions to HSS

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CDTI – A case study

•CDTI – key strategy for control of Onchocerciasis

•Essential element is the network of community drug distributors who deliver the ivermectin treatment

•Estimated that in 2007 close to one million DALYs averted by APOC* through CDTI

•Low cost solution – APOC has spent just over $112 million during the 12 years of operating the programme

* APOC is the African Programme for Onchocerciasis Control

The role of the community in strengthening human resources for health

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CDTI – A case study

Source: APOC, 2007

No. of DALYs averted by APOC’s community directed treatment activities in countries that have APOC projects and predictions for future gains to 2015

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CDTI – A case study

Community-based treatment:

•Top-down•Distribution by mobile team of health workers•Community is involved•Community actions are led by health workers•Timing of drug distribution decided at central level

Community-based vs. Community-directed treatment

Community-directed treatment:

•Grassroots focused •Based on community ownership•Treatment provided by community drug distributors •Community leads the process, planning and management of treatment•Timing of drug distribution determined by community members

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CDTI – A case study

General:

•Better targeting & timing of treatment campaigns•Increased coverage•Improved take up of treatment

Human resources for health:

•Dramatic increase in the number of human resources (CDDs) to implement the control programme•Provision of a huge personnel resource base, particularly at the community level•Relieve pressure on overstretched health workforce

Benefits of CDTI

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CDTI – A case study

Health systems strengthening:

•Extend health promotion activities to areas that are unreachable by the health system•Development of low-cost technologies, adaptable for other disease control programmes•Strengthen surveillance in ways that improve countries’ resilience to disease outbreaks•Contribute to health information systems data collection•Increased and sustained treatment coverage•Initiation and expansion of other community-based interventions

Benefits of CDTI

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CDTI – A Case Study

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Integration of CDTI in health systems

“Integration increases efficiency, decreases the burden on health systems, improves access to health services, and improves the cost-effectiveness of health spending while

maintaining treatment coverage”.

(APOC, 2007)

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Integration of CDTI in Health Systems

Community drug distributors now also contribute to:

• Albendazole distribution (for LF)• Praziquantel distribution (for schisto)• Mebendazole distribution (for worms)• Malaria bed-net distribution and malaria treatment programmes• Vitamin A distribution programmes• Vaccination campaigns• Directly observed treatment for TB• Provision of family planning aids

Benefits of CDTI go beyond onchocerciasis…

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Integration of CDTI in health systems

CDTI projects in several APOC countries are supplying additional public health interventions along with ivermectin:

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Conclusions

•For NTD control programmes to be sustainable they need to be integrated into the health system

•The CDTI approach for onchocerciasis control provides an example of how vertical, disease control programmes can contribute to health systems strengthening

•Establishing a network of community health volunteers can alleviate the pressure on the health workforce – to be successful though, there has to be a strong sense of community ownership of disease control programmes

•Well established CDTI programmes also offer good scope for developing an integrated approach to disease control and increased access to health services.

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“CDTI has served as a channel for health interventions to improve access to services and better

health”

(Former National Onchocerciasis Coordinator, Cameroon).

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