NTDs and the Health SystemGhana

Nana-Kwadwo Biritwum

Introduction

• All countries in WHO/AFRO region are know to be endemic for at least 2 Neglected Tropical Diseases (NTDs)

• Ghana is endemic for 10 NTDs including all 5 PC-NTDs

• Call for elimination of Lymphatic Filariasis and Trachoma by 2020 and Onchocerciasis by 2025

• Sustained control of Schistosomiasis and Soil Transmitted Helminthiasis

• Strong move towards integration and coordination of NTDs regionally and within countries (AFR/RC63.R6)

LF, Schisto,

STH

Oncho, Schisto,

STH

LF, Oncho, Schisto,

STH

Trachoma, LF,

Oncho, Schisto, STH

Legend

Neglected Tropical Diseases PC Endemic Map

Global, Regional and National Commitments

Several documents developed to establish commitment and guide process

• WHO Resolutions on NTDs• London Declaration on Uniting to Combat NTDs• Accra Urgent Call for Action• Regional Strategy and Regional Strategic Plan for NTDs • Ghana Master Plan

Programme Structure in Ghana

Elimination Strategies

• Mapping of diseases, Mass Drug Administration, monitoring and evaluation, transmission assessment surveys and surveillance, certification of elimination process

• Effective in-country health system capable of delivering interventions is required

• Integrated NTD programme into the health system

Health System

National

Regional

District

District

District

District

Regional District

National Level

• High political priority is given to NTD interventions• Capacity to plan and coordinate all interventions• Mobilize and distribute resources• Supervision, monitoring and evaluation• Responsible for capacity building at all levels

Management and coordination capacityTechnical and administrative capacity Laboratory capacity

Advantages and achievements

• Wide reach into remote, rural and neglected communities with health education, medicines and other health commodities

• Employed to complete mapping of all PC-NTDs in Ghana

• Facilitated impact assessments

• Led in operational research

Advantages and Achievements

• About 100 million treatments delivered through community structures

• About 30 million school children dewormed

• 69 of 98 lymphatic filariasis endemic districts have stopped treatment

• Trachoma elimination is achieved

• Operational research to inform TAS guidance completed and PTS ongoing

• Structures for effective collaboration between Ghana Health Service, Research Institutions, Universities and Support Centres to fill research gaps

Challenges of the Health System

• Human resource constraints (quantity and quality)

• NTD prioritization by government and the health system at all levels

• Improving collaboration with other ministries, departments and agencies

• Competition between NTDs and other public health programmes

• Resources for addressing morbidity management and disability prevention

• Capacity needs for effective monitoring and evaluation of NTD interventions

• Addressing poverty with NTD interventions

• Limited technical and managerial capacity below the national level for NTDs

Challenges of the Health System

• Existence of various technical gaps that require operational/implementation research

• Creating a common platform for the use of available community structures for delivery of NTD and other public health interventions

• Cross-border transmission of lymphatic filariasis and other NTDs

• Collaboration between programme, research institutions and COUNTDOWN to address research gaps

• Research uptake

Challenges of meeting elimination milestones

• Biannual treatments and annual treatment• Management of Serious Adverse Events• Persistent non-compliance• Post-MDA Surveillance strategy and its implementation• Managing hotspots• Alternative treatment strategies • Volunteer and health worker fatigue

Conclusions

• COUNTDOWN will help Ghana’s achievement of programme missions, goals and objectives and 2020 elimination targets

• Assess reliability and integrity of systems and reporting

• Assess effectiveness and efficiencies of technical tools and guidelines

• Ensure compliance with technical tools and guidelines

• Address research gaps

• Important for research uptake and major decision making and policies

• Provide guidance to NTD programmes in Ghana, Africa and globally