Integrated Implementation of Programs Targeting Neglected Tropical Diseases through Preventive Chemotherapy: Identifying Best Practices to Roll Out Programs at National Scale

In 2006 the U.S. Agency for International Development (USAID) established the Neglected Tropical Disease (NTD) Control Program to support national governments in developing successful, cost-efficient NTD programs that integrate disease-specific programs into coordinated national initiatives, in accord with the World Health Organiza- tion recommendations. A 3-stage "roll-out package" has been developed for effectively integrating and scaling up such programs to full-national scale. Stage-1 lays the groundwork—identifying NTD leadership within the Ministry of Health, conducting a national Situation Analysis, formulating a multiyear Plan of Action, and undertaking a funding gap analysis. Stage-2 focuses on scaling up the integrated NTD program—convening national stakeholder meetings, developing annual work plans, carrying out disease mapping, and establishing monitoring and evaluation activities. Stage-3 aims at ensuring effective management—identifying clear roles and responsibilities for partners, and creating a central coordi- nating mechanism. Assessment and reassessment of these complex NTD programs that target literally billions of people are essential to establish "best practice" strategies for long-term public health success. Underpinning most of these initiatives are enormous dona- tions from private sector pharmaceutical companies 3-7 of the specific medications that can be used to treat each disease safely, simply, and effectively through large-scale PCT. The treatment regimens vary from administration once or twice per year to once every 2 years, given either to entire populations at-risk for the disease(s) (i.e., mass drug administration (MDA)) or targeted to specific at-risk groups, such as school-age chil- dren or specific occupational groups. Although it is unques- tioned that these donations† are absolutely necessary for the current global initiatives, it is also important to recognize that the donations alone are not sufficient. There must be two addi- tional, essential spheres of partnership: first, with the minis- tries of health (MOHs) of the affected countries who, together with other public sectors (e.g., education), take responsibility for responding to the very great public health challenge of reaching and treating all the targeted at-risk populations; and second, with funding and technical assistance that can aid the ministries to carry out these programs in countries with insuf- ficient domestic resources to address these challenges alone. A principal source of this external funding support in recent years has been the U.S. Agency for International Develop- ment (USAID). In 2006, USAID established the NTD Control Program, implemented by RTI International, with the expressed purpose of supporting national governments to develop suc- cessful, cost-efficient NTD control programs that integrate or bundle their disease-specific programs into coordinated initiatives and then to link these programs effectively with other elements of their established national health delivery systems. The achievements of the first seven countries partici- pating in this USAID-supported NTD Control Program during its first 3 years have been reviewed in detail. 8 Table 1 summa- rizes key quantitative elements from that earlier description with more current, updated information that includes the NTD Control Program's fourth year. Although these results can be recognized as only output measures not yet trans- lated into impact measures—which are of greatest impor- tance to health and economic development in these affected countries—still it is clear that by any standard, the accomplish- ments of these national NTD control programs after just a few years of operation are both remarkable and commendable. It should not be surprising, however, that the accomplish- ments of these national programs did not come easily or without challenges. Indeed, many lessons were learned over time as good practices became better, better practices became best practices, and best practices improved and evolved into evidence-based policy that can be shared across countries. Because the expansion of integrated national NTD control programs worldwide is still in its infancy, and since many more countries still need to begin their programmatic activi- ties, this report is meant to capture the early experiences of countries introducing and/or scaling up integrated NTD activ- ities during the NTD Control Program's first 4 years and to