Transcript Document

The Schistosomiasis
Control Initiative
Summary for 2012/13
and strategic direction for 2014/20
Professor Alan Fenwick OBE
[email protected]
What is involved
to upscale to country level we need to:
– Mobilise political will
– Define disease distribution – collect mapping
and base line data
– Develop a national plan with strategies at
each district level
– Define drug needs and order drugs
– Develop local advocacy tools
– Conduct training for teachers
– Deliver the drugs
– Monitoring and evaluation
Treating school children is easy
And adults at high risk are
offered treatment
Phase One SCI started with funding from Bill and
Melinda Gates Foundation
Number of Treatments (millions)
Ministries of Health and Education in 6 countries with SCI support
delivered over 43 million cumulative Schistosomiasis treatments
and over 100 million albendazole (purchased)
50
45
40
35
30
2002/3
2003/4
2004/5
2005/6
2006/7
43 m
26 m
25
20
15
12 m
10
5
0
0.1
2002/3
3 m
2003/4
2004/5
SCI Treatment Years
2005/6
2006/7
Number of Treatments (millions)
Phase Two - Ministries of Health and Education with
SCI support and USAID funding
Treatments delivered 2007-2010 shown below
50
4 drugs
45
4 drugs
>40 m
40
>40 m
4 drugs (RTI)
>40 m
35
30
25
20
15
10
Pzq and alb
6 m
Pzq and alb
3 m
5
0
Rwanda/
Burundi
Yemen
Burkina
Faso
SCI supported countries
Niger
Uganda
Number of Treatments (millions)
Phase Three – expansion - Ministries of Health and
Education with SCI support and DFID funding +++
Treatments delivered in 2012/13
50
45
40
35
30
75 million treatments to 8 countries planned for
2011 – 2016 funded by DFID
Could be doubled with a new award
25
20
15
10
Pzq/alb
1m/6m
10 m
8 m
2 m
5
0
8 m
Rwanda/ Yemen
Burundi
Mozambique
3 m
1 m
Tanzania Niger
SCI supported countries
Malawi
Uganda
1 m
Cote
D’Ivoire
Phase Four 2013-2020

Consolidate in existing countries
– DFID – reach national coverage in all 8 countries
– DFID – move towards elimination in Zanzibar,
Uganda and Niger
– DFID expand into Ethiopia and DRC
– Move towards elimination in Rwanda and
Burundi (SCORE and ENDFUND and Private)
– Expansion of coverage in Yemen
– Use donations to move into new countries
(Mauritania, Madagascar, Zimbabwe, Senegal)
Phase Four 2013-2020

A More holistic approach
– Maintain and increase income (more proposals,
maintaining status with givewell and GWWC)
– Strengthen staff (management, new disciplines,
more local staff Ethiopia, DRC)
– Water and sanitation – what shall we do ?
– Behaviour change – is this feasible
– Snail control – when and where
Phase Four 2013-2020

Operational research
–
–
–
–
–
–
–
Monitor drug efficacy
Improving coverage
Gaining and maintaining control
Possibility of elimination
Water and sanitation
Snail control
Cysticercosis
PR and fund
raising
SCI ORGANOGRAM
Director of
Monitoring and
Evaluation
Senior
Biostatistician
Health
Economist
Mathematical
Modeller
Director
Managing Director
Programme Manager
UGA (Niger, Mozambique)
Programme Manager
(Yemen and Ethiopia)
Finance Manager
Programme Manager
(Rwanda, Burundi, Senegal)
ICOSA Project Manager
ICOSA M and E
Liverpool CNTD
Sub-Contract
3 Programme
Managers
DFID (8 Countries)
Finance Officer
Africa Capacity
Building Liaison
Africa country
coordinators
Long and Short Term
Technical Assistants
RESEARCH UNIT
Office
Manager
IMPLEMENTATION UNIT
FINANCE AND
ADMINISTRATION
UNIT
SCI coverage 2003 - 2016
And Yemen
With World
Bank funds
Mauritania
Mali
Senegal
Niger
Burkina Faso
Ethiopia
Cote D’Ivoire
and Liberia
Uganda
DRC
Burundi and Rwanda
Proposed
expansion into
DRC, Ethiopia
Senegal.
Mauritania and
Zimbabwe
Tanzania
Zambia
Malawi and
Mozambique
Zim
With support from the Gates Foundation
USAID/NTD, Geneva Global and DFID, UK
With the new WHA resolution
calling for global
schistosomiasis elimination:
what is the WHO strategy, the
feasibility and what are the
major challenges?
How does this affect SCI ?
Proportion of PC for schistosomiasis, soil-transmitted helminthiases,
lymphatic filariasis, onchocerciasis and trachoma, 2011
Population requiring preventive chemotherapy
~ 873 million
~ 1 410 million
~ 127 million
~ 281 million
13.3
13.7
31.1
41.8
Proportion, %
77.1
~ 243 million
Schistosomiasis
2011
# of counties reported
# of people treated
Coverage (%)
Soil-transmitted
helminthiases
Lymphatic
filariasis
Onchocerciasis
Trachoma
Schistosomiasis
Soil-transmitted
helminthiases
Lymphatic
filariasis
Onchocerciasis
Trachom
a
24
63
34
28
ND
28,140,136
302,523,800
557,434,305
98,089,495
ND
10.4
30.6
39.5
77.1
ND
Joint drug request, review & reporting mechanism
But with pzq there are other sources DFID and USAID
WHO
ORDER
Merck
GSKEisai J&JKGaA
ALBDECMBD PZQ
SHIPMENT
IVM
AZI
MDP ITI
Shipments
Applications
Joint Virtual
Review Panel
Joint Request
+ Joint Report
+ Annual work plan
Regional review groups
National
Programmes
Merck KGaA's expanded commitment of
praziquantel supply for unlimited period
Likely future praziquantel availability
(millions of tablets)
2013
2014
2015
2016
USAID
Annual
commitment
100+
100+
100+
100+
DFID
Confirmed
47
47
47
47
DFID
Not yet
confirmed
23
23
23
23
Other
NGO’s
10
10
10
10
Merck
Incremental
25
75
120
250
205+
255+
300+
430+
Total
The US Government
Launched in 2006 by USAID
The Neglected Tropical Diseases Cooperative
Agreement - Initially $100 million,
and in 2010 a new commitment of $450
million $250 m to “ENVISION”
The British Government
£50 million over 5 years for NTD control
announced in 2008
A new £200 million 4 year commitment
in January 2012
Other donors to/through SCI
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The World Bank
The END FUND (Geneva Global and Legatum)
Childrens Investment Fund Foundation (CIFF)
Vitol
The Bill and Melinda Gates Foundation
SCORE (UGA/ BMGF)
Global Network for NTD control (END7)
Private Donors
www.givingwhatwecan.org
www.givewell.org
How much can we reach out to the countries with maximum
requirements - the 10 highly endemic AFR countries, 2010
10 Countries
Estimated
Infected
population,
2010
Population
received
treatment,
2010
2013 status
Nigeria
36,728,013
2,297,282
Carter C, CIFF, DFID and
USAID
United Republic of Tanzania
23,189,294
1,298,263
USAID, CNTD and SCI
Democratic Republic of the
Congo
19,157,807
-
Ghana
17,644,805
1,739,837
Mozambique
16,326,177
488,359
Madagascar
11,087,896
-
SCI in 2013/14
Kenya
9,396,937
-
Ongoing CIFF
Côte d'Ivoire
8,628,298
657,967
Expanding SCI
Malawi
6,725,050
938,999
Expanding SCI/ CNTD
Ethiopia
6,026,639
-
154,910,915
7,420,707
10 Countries
Starting 2013/14
Ongoing USAID/ CNTD
Expanding 2012/13
Starting 2013
Control of Morbidity
Elimination as a public
health problem
Interruption of
transmission
PCT
100% geographical and
75% national coverage
with PCT
Adjusted PCT and
complementary
interventions
recommended
Intensified PCT in
complementary
interventions essential
Prevalence of heavy
intensity infection <5%
Prevalence of heavy
intensity infection <1%
Reduction of incidence
of infection to zero
Up to 3-6 years from
joining the group
Up to 5 years from
joining the group
Up to 5-10 years from
joining the group
WHO Strategic Plan Milestones
2012
2013
• Global Strategic Plan for SCH is adopted
• Global coordination mechanism is in place
for
Adequate supply of praziquantel
Resources for country level
implementation
Harmonisation of partners activities
• National policies for NTD control including
SCH are in place in 50% of the countries
requiring PCT
• A school-deworming manual including M&E
available
• A resolution on SCH elimination is adopted
WHO Strategic Plan Milestones
2013 • National Plans of Action for NTD control
2014
developed by 75% of the countries requiring
2015
•
•
•
•
•
PCT for SCH
Procedures and Guidelines for verification of
interruption of transmission are established
Interruption of transmission is verified in
countries which request it
Geographical mapping of at least 75% of
countries requiring PCT is completed and PCT
database updated
Guidelines for snail control revised and
disseminated
Training for NTD programmes managers
conducted
The importance of advocacy
Challenge
Lack of political
commitment/
WHO
USAID and DFID
RTI/SCI/CNTD
Integration vs
Coordination
Strategy
• Advocacy for political commitment and
country ownership of programmes –
increased country financial contribution
- High level advocacy by WHO and
donor countries to ensure NTD
programmes are prioritised by
governments
- Encourage an inter sectoral approach
to NTD control
- Advocacy for increased country and
donor support for SCH in particular
- Improve relations between similar
groups be better dialogue control
Questions
Role of
SCH/STH
NDGO
group in
advocacy
at different
levels
The UK Coalition against Neglected
Tropical Diseases (NTDs)
is a
collaborative partnership between UK
organisations actively engaged in
the implementation, capacity building
and research of neglected tropical
disease control at scale
London Centre for NTD
Research


Launched on January 30th 2013
(Sir Roy Anderson)
Partners include
PCD
SCI
London School of Hygiene and Tropical
Medicine
Natural History Museum
Where we are now
Where we can get with
Where we can get with
existing tools and strategies new tools and strategies
Diseases Targeted For Elimination
Guinea worm
Leprosy
Lymphatic filariasis
Blinding trachoma
Sleeping sickness
Diseases Targeted For Control
Schistosomiasis
River blindness
SoilTransmitted
Helminthes
Chagas
Visceral
Leishmaniasis
2020
Goals