Transcript mapping gaps – schisto and sth

Kabatereine Narcis
AFRICAN SCI CAPACITY BUILDING ADVISOR BASED IN UGANDA
NEED FOR IMPROVING IN-COUNTRY CAPACITY FOR
BETTER DELIVERY.
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.
WHY IN-COUNTRY CAPACITY BUILDING?
According to existing data on global
preventive chemotherapy,
Approximately additional 350 million people per year must be reached
by 2015
Current and projected proportion of people (2008-2020) receiving PC for at least one disease among
•
Requiring global rate of
8 to 10 million new treatments
per month
•
•
This is not being reached at
The current treatment rate.
LF, SCH and STH out of the estimated number of people requiring PC (excluding India and Bangladesh)
Mapping gaps at Country and
District levels
PC
NTDs
LF
ONCHO
SCH
STH
TRA
Countries with
Mapping gaps
17
12
22
24
19
Number (%) of
districts to be
mapped
655 (14%)
374 (9%)
972 (20%)
1,031 (21%)
1,690 (40%)
PC NTD Mapping Status
Schistosomiasis
Not Started (7)
Partially mapped (15)
Complete mapping (23)
Confirmation mapping (1)
Not Applicable (2)
Not AFRO
THEMATIC AREAS FOR CAPACITY STRENGTHENING FOR PREVENTIVE CHEMOTHERAPY
"Sunflower concept"
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
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 multicountry 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.
CAPACIITY BUILDING NEEDED FOR MONITORING IN MOST
COUNTRIES
Coverage monitoring
Geographical coverage
Epidemiological coverage
Programme coverage
Process monitoring
Impact monitoring
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 Prevalence and intensity of
infection
 Micro/macro haematuria stool
 Anaemia
 Growth
 Clinical complications
 Educational achievement
 Cost-effectiveness
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
ULTRASOUND & Clinical examination of
schistosomiasis
Ultrasound examination
– WHO guidelines
– portable machine
Aloka SSD-500
11
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..
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.
Way Forward considering sustainability
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.
SOME RECENT IN-COUNTRY CAPACITY
BULDING
Malawi: Over 40 Technicians trained and they have completed
Schisto / STH Map.
Mapping done
By the trained
Local Techncians
Rwanda: 64 technicians recently trained and are
re-mapping using both CCA and Kato Katz to produce
a map for elimination phase.
IN ETHIOPIA: 175 technicians trained and mapped
500 Woredas including 2790 schools
575
2790
Coverage validation surveys to evaluate accuracy of reported
coverage
Schistosomiasis control in Uganda
(yearly mass treatment with PZQ)
2003 distribution
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.
Thank you …