Download NTDs and eye health: lessons learnt and opportunities for

NTDs and eye health:
lessons learnt
and opportunities for collaboration
Adrian D Hopkins
Director: Mectizan Donation Program
Task Force for Global Health
Emory University; Atlanta, USA
NTDs and Eye Health
Trachoma
• Strategy for eliminating blinding Trachoma
–
–
–
–
Surgery of Trichiasis
Antibiotic MDA
Facial cleanliness
Environmental Change
NTDs and Eye Health
Onchocerciasis
• Strategy for elimination of
the disease
– MDA
– (Rehabilitation of the blind)
Other NTDs and MDA
• Lymphatic Filariasis
– Strategy for Elimination
– MDA
– Morbidity control
• Shistosomiasis
– MDA
– Water and Sanitation
– ?? Snail control
• STH
– MDA
– Water and Sanitation
Community
Directed
Treatment with
Ivermectin
(CDTI) in action
Mectizan treatments approved
for Onchocerciasis
160000000
140000000
120000000
100000000
80000000
60000000
40000000
20000000
0
Mectizan treatments approved
for Lymphatic Filariasis
140,000,000
120,000,000
100,000,000
80,000,000
60,000,000
40,000,000
20,000,000
0
Other NTDs
• NTDs without community diagnosis methods
• NTDs with difficult or toxic treatments
• NTDs with complicated individual diagnostic
tools
• These diseases require Intensified Disease
Management (IDM) for case finding, laboratory
diagnosis and individual care
• HAT, Leprosy, Chagas Disease, Leishmaniasis,
Leprosy, Buruli Ulcer and others
What are NTDs and
relationship to Blindness
• Both diseases of the poor
– More prevalent in the “bottom billion”
– Occur where health services are inaccessible
– The two major causes of infectious blindness are
NTDs for MDA
– No simple strategies for some diseases.
• Disease management strategies
– Community diagnosis
– Require community mobilisation
– Require a multi-sectorial approach
Community involvement
Linking CBR,
VHWs, and CDDs
• Same community but different programmes and
different workers. WHY?
– Why are there different vertical programmes with
different funding sources and controls?
– Is it impossible to coordinate eye care with other
activities?
• Why is CBR not empowering enough to become
CDR?
Advocacy
• Clear simple messages
–
–
–
–
Tool ready strategies
Simple cost strategies
Clear results
Defined impact
• Success in what you can do leads to research
funding for what you cannot do
• Long-term commitment.
– NO 3 year programmes.
Needs for Political Commitment
• Need wide stakeholder input at international and
national level, WHO, governments (MoH M of
Finance, M of Education) with NGDOs and
WHO in country.
• Need peer pressure between governments, using
regional meetings (success of APOC)
• Need to involve local governments. Local
priority setting
• Need strong advocacy to medical authorities.
Challenges with Integration
• Morbidity Control and prevention
–
–
–
–
–
Emphasis on MDA - pill packages & coverage
Who will attend to the visually impaired
Who will care for eyes and limbs
Who will do the health education
Who will attend to water and sanitation
• Specificity
– Reduction to lowest common denominator
– No flexibility for alternative drug regimens
– What about specific control/elimination parameters
Let’s finish the job properly!