Tag Archives: HKI

Ownership of Treatment Efforts for NTDs in Mali

Africa, Global Health, NTDs, , , , , , , , , ,

Community drug distributors in Cinzana, Mali prepare for mass drug distribution. Photo ©HKI.

As it takes a village to raise a child, it takes a community to control and eliminate NTDs. In Mali’s Segou Region resides Cinzana, a town made of 39 villages with 15,000 inhabitants with a high number of NTD cases. Diseases suffered by the area include trachoma, schistosomiasis, soil-transmitted helminthiasis, and lymphatic filariasis. Fortunately, Mali is one of 12 countries supported by an initiative funded by USAID called the NTD Control Program. Beginning in 2007, the Program partnered with the country’s Ministry of Health to distribute drugs and treatment to control NTDs. In Cinzana, distribution is conducted by a community group comprised of volunteers. Effective delivery of drugs to each infected individual can pose as a lofty endeavor. Limited resources and poor road infrastructures act as barriers to getting drugs to individuals in the outskirts of Cinzana, and becomes an even greater obstacle during the rainy seasons.

Despite these challenges, the NTD Control Program has been highly successful. By the end of 2009, the entire area of Cinzana received treatment. Much of this success is attributed to the community’s willingness to participate and be a part of the Program’s activities. Volunteers quickly recognized that effective distribution could only be reached if there was a large number of community drug distributors (CDDs). Thus, one of Cinzana’s economic interest groups, the Association of Community Health (ASACO), garnered the support of 200 much needed CDDs. In addition to the increase of CDDs, ASACO along with Mali’s government also provided more resources conducive to effective disease control such as notebooks, pens, and dosing poles, which are wooden tools used to identify the correct drug dosage for each individual.

Through community involvement and participation, Cinzana was able to reach 100% geographic coverage rates. Cinzana pledges to continue its diligence and dedication to the work of the NTD Control Program, working toward reaching goals and controlling NTDs.

To do your part in controlling and eliminating NTDs, please visit the Global Network website to get involved.

Support for NTD control in Mali is provided by USAID through a grant to Helen Keller International. Program activities are a part of the NTD Control Program led by RTI International. For more information, please visit http://ntd.rti.org/.

Can large scale disease control programs be sustained?

Africa, Global Development, Global Health, malaria, NTDs, Public Health, disease control, funding, , , , ,

Reprinted with permission from: Malaria Free Future

By: Bill Brieger

Roll Bank Malaria (RBM) was launched in 1998, but actual scale up to universal coverage is only happening in 2010. By Comparison, the African Program for Onchocerciasis Control (APOC) took off in 1996 and has been scaled up for several years in all but a few of its endemic countries. Granted, APOC has a relatively smaller target area, but it now regularly reaches over 127,000 African villages with annual doses of ivermectin.

Both programs have in common the need to sustain their scaled up for many years into the foreseeable future if disease elimination is to be achieved.

This need for a long term perspective causes concern when one reads about a threat to continued funding for APOC’s Borno State, Nigeria project, and raises speculation whether malaria efforts may face the same threat a few years down the line.

Photo Courtesy of http://www.malariafreefuture.org/blog/?p=972

APOC started with a very clear vision of sustainability. APOC, a government entity (state, province, district, or country) and a non-governmental development agency (NGDO) would enter into a financial and programmatic 5-year partnership to establish community directed treatment with ivermectin (CDTI – see photo of CDTI in Cameroon at right). APOC’s financial contribution would be largest in the first year, when the overall budget would be largest because of start up costs.

Over time, program costs were to reduce, as would costs per person treated because of economies of scale. APOC’s share of the budget would decrease relative to that of the government partner, though the overall budget to maintain the program into the future was expected to be smaller and more manageable to the government partner with some continued support from the NGDO.

Free supplies of ivermectin from the Mectizan Donation Program would continue as long as there was need, but by the sixth year of operation, it was hoped that countries could sustain their own CDTI efforts. Apparently this has not been easy.

Evidence of problems with Borno’s CDTI project surfaced in 2007 at a meeting of APOC’s Technical Consultative Committee where the following report was shared. “Borno has maintained a good geographic and therapeutic coverage. However, the project has the following challenges:

* Non-release of funds by state and LGAs
* Inadequate number of FLHF staff
* Selection and training of more CDDs
* Obtaining funds from the government

IRIN now reports that after 11 years of operation “The (Borno State) government was supposed to provide counterpart funds to run the river blindness programme, but it has not done so, (according to) Borno State’s onchocerciasis coordinator Galadima.” Hellen Keller International (HKI) is Borno’s NGDO partner for CDTI and has been trying to make up the slack.

Unfortunately “HKI funding has been hit by the global recession, says (a representative). ‘Since the recession our donors have turned their attention elsewhere with little consideration for Africa and this affects the volume of funds for intervention projects like the onchocerciasis.’

Project staff complained to IRIN that, “We have been crippled financially due to lack of state counterpart funding. We sometimes find it hard to fuel our vehicles and go for supervision in the affected communities.”

There were hopes that another four years of government funding would put Borno within reach of elimination goals, but project staff lament that, “If the project stops at this stage, the effects will be devastating. It will turn the tide of the success we have achieved which will be quite disastrous.”

Let’s move this scenario forward to 2015 and change the disease to malaria. Let’s assume that talk of funding ceilings by donors has become a pressing reality and countries need to contribute more to sustain malaria interventions and achieve elimination. Let’s hope we don’t wind up again like malaria control did in the 1950s and ‘60s – eliminating the programs, not the disease.

PS – The IRIN article does have some potential technical problems. It referred to the CDTI as a program to create ‘immunity’ to onchocerciasis, whereas ivermectin actually is a drug to kill the microfilaria of the parasite and keep infection at a low level until such time as adult worms die and transmission in the community stops. There is also concern about the figure of $18 per person treated. Normally at this advanced stage of the program we should be talking in terms of cents, not dollars. These technical problems with the article do not detract from its serious financial message.


Bill Brieger is currently a Professor in the Health Systems Program of the Department of International Health at Johns Hopkins University as well as the Senior Malaria Adviser for JHPIEGO, JHU’s family and reproductive health affiliate. He was a Professor in Health Education at the African Regional Health Education Centre, University of Ibadan, Nigeria, from 1976 to 2002. His research interests have focused on the social and behavioral aspects of tropical disease control, and in the area of malaria research, funded by the Unicef/UNDP/World Bank/WHO Tropical Disease Research program (TDR) and USAID implementing partners, this has included acceptability of pre-packaged antimalarial drugs, urban malaria, role of patent medicine sellers in malaria treatment, and community and cultural perceptions of malaria as a basis for village health worker training and health education.

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Night 6: Trachoma

NTDs, NTDs and Hannukah 2009, Water and Sanitation, , , SAFE, , trichiasis, , , Erin Hohlfelder

Ever had an eyelash in your eye?  It’s a common–and really painful–experience that almost everyone can relate to.  Now think of the pain experienced in the few minutes until you can remove the eyelash, but multiply it by thousands, and you’ll come close to understanding the pain caused by trachoma long before it even reaches its most well-known manifestation: blindness.

Trachoma - baby with fliesA single exposure to trachoma bacterium does not in itself cause blindness. Repeated exposure to the disease — through person-to-person contact or infected flies — over time eventually causes the inside of the eyelid to turn inward — a condition called trichiasis — and the eyelashes to scrape and scar the cornea, leading to the formation of corneal opacities and painful and irreversible blindness. Trachoma is particularly common in children under five and the adults – mainly women – who care for them. In some rural communities, 60 – 90 percent of children are infected.  Adult women are three times more likely to develop the blindness associated with trachoma, attributed in part to their caretaking of very young children.

Trachoma is the world’s leading cause of preventable blindness. More than 84 million people in 56 countries worldwide have active trachoma, and an estimated eight million have lost their sight due to complications from the disease.

Treatment for trachoma focuses on active symptom elimination and future prevention efforts. A major comprehensive public health strategy approved by the World Health Organization, called SAFE, is underway to treat trachoma epidemics in rural Africa and other parts of the developing world. The combination of surgery (S), antibiotics–typically azyithromycin/Zithromax (A), facial cleanliness (F) and environmental educational efforts (E) is a multi-pronged approach to the disease and has shown promising results.

Between 1999 and 2006, nearly 41 million antibiotic treatments for blinding
trachoma were administered worldwide.  For more information, visit organizations like the International Trachoma Initiative and Helen Keller International.

“The Clinical Side of Tropical Disease”: Part 4 of a Student’s Perspective on NTD Fieldwork

Uncategorized, , MSF, ,

Emily Cotter is a second-year medical student at George Washington University in Washington DC.  This summer, through Global Network founding collaborator Helen Keller International, Emily worked on NTDs in Sierra Leone.  Below is the final installment of her 4-part series detailing her experiences.

After working on the public health side of NTD control projects earlier in the summer, I thought it would be interesting to see the clinical side of the NTD world. Emmanuel, a Community Health Officer student (essentially the equivalent of a medical student) who works closely with HKI staff on NTD projects, was scheduled to work at a clinic in July.  I decided to shadow him at the clinic for a couple of weeks, which brought me to Bo, the second-largest city in Sierra Leone. 

The health care system in Sierra Leone is all fee-for-service.  In many areas of the country the average income is $0.11 per day and the cost of seeing a health care provider is usually at least a couple of dollars. Due to this, most people don’t get the care they need and if they do visit the healthcare system they present very late when it is usually a dire emergency. Médecins Sans Frontièrs (MSF, also known as Doctors Without Borders) has been working in Sierra Leone since the beginning of the country’s civil war and supports a few clinics around Bo.  The government runs these primary care clinics; however, MSF provides the medications and covers the patient fees at these clinics while also operating a secondary health care referral center.  This referral center can accommodate minor surgeries and monitor cases of severe malaria, malnutrition and other complex health problems.  Emmanuel was placed at one of the MSF-supported primary care clinics for his practical experience and I was very excited to have a chance to learn more about their operations on the ground – I’ve wanted to work with MSF for more than a decade! 

Most of the pediatric patients who came to the clinic were either infected with Plasmodium falciparum (malaria) or were extremely malnourished. The rainy season had begun in Sierra Leone, which I learned brings with it malaria and malnutrition season.  MSF operates both in-patient and outpatient therapeutic feeding programs so I saw quite a few very sick kids being treated for marasmus and kwashiorkor (different types of malnutrition).  I was continually struck by the contrast between the health problems in the United States relating to obesity and the other side of the hunger spectrum that I witnessed in Sierra Leone. 

There was an “unholy trinity” of childhood anemia etiologies: malaria, malnutrition, and helminth infections ravaged children and left many severely anemic. Some children had dangerously low hemoglobin levels – from 4.2 g/dl to 3.2 g/dl, and even as low as 2.5 g/dl! (Hemoglobin levels should be above 12 or 13 g/dl; it is usually considered an emergency if they fall below 7 g/dl.).  A young child actually died at the clinic one day; she was incredibly anemic, had severe malaria, and went into heart failure. Clinic health care workers typically send the kids with low hemoglobin levels to the MSF referral center where the children receive a blood transfusion.  Given the lack of infrastructure and reliable access to electricity, no large blood bank exists in Sierra Leone.  Instead, parents are asked to donate blood for their kids if their blood type matches.  Another child with a dangerously low hemoglobin level came to the clinic the afternoon the girl died and no family member was able to donate blood for her.  Being O+ and an almost-universal donor, I gave a pint of my blood for her.  The blood draw was not the greatest, so for the subsequent two weeks my bruise was a visible reminder of the devastation of tropical diseases in this region of West Africa.

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