Efforts to expand global coverage targeting of neglected tropical diseases (NTD) must involve national and international harmonisation and coordination of the activities of partnerships devoted to control or elimination of these diseases. The issues are discussed in the second paper in the Lancet Series on Neglected Tropical Diseases, written by Professor John O Gyapong, Ghana Health Service, Accra, Ghana, and colleagues.
In order to scale up NTD interventions to achieve elimination or effective control, programmes must be integrated into the regular health system of countries. The authors say: "Programmes with similar delivery strategies and interventions—such as those for onchocerciasis, lymphatic filariasis, and soil-transmitted helminthiasis—could be managed on the same platform and together. Furthermore, better-resourced programmes—such as those for malaria, HIV/AIDS, and tuberculosis—could work closely with those for neglected tropical diseases to their mutual benefit and the benefit of the entire health system."
The authors point out the need for careful planning prior to any integration/co-implementation programme. They say: "The process of integration and co-implemen-tation needs careful planning. Published reports indicate that careful planning and preparation need to precede implementation of the integration process. This stage should include a realistic situation analysis, commitment building, formulation of clear plans for integration, training of health workers, and provision of adequate and timely information to the public."
They add: "The community-directed treatment approach provides opportunities for health services to work closely with the community to deliver interventions. Community volunteers are capable, motivated, and reliable. However, such volunteers should be incentivised to provide the essential service that bridges the link between health centre and community."
They conclude: "A more prudent financing mechanism needs to be developed. NTDs need to pool resources together for co-implementation of their activities; however, the resources currently available are woefully inadequate to achieve the elimination goals of these diseases. A more effective resource-mobilisation plan—including leveraging resources for the health sector to control malaria, tuberculosis, and HIV/AIDS—should be pursued. We need to address the social structures in which NTDs flourish, and invest in research and development for new diagnostics and drugs. Developed countries must provide access to medicines and innovations for the elimination or control of these diseases."
Professor John O Gyapong, Ghana Health Service, Accra, Ghana. T) + 233 (0) 24 426 5081 E) John.Gyapong@ghsmail.org
Professor David Molyneux, of the Liverpool School of Tropical Medicine, UK. T) +44 (0) 7780 991 824 E) David.Molyneux@liverpool.ac.uk
For full Series paper 2, see: http://press.thelancet.com/ntd2.pdf
For this week's Editorial on the NTD sleeping sickness, see: http://press.thelancet.com/editorials0901.pdf
Journal
The Lancet