All-Party Parliamentary Group on Malaria and NTDs
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All-Party Parliamentary Group on Malaria and NTDs 16 th October 2012 Elaine Ireland, Head of Policy, Sightsavers. NTDs & Health Systems Strengthening – the contribution of human resources. Health Systems Strengthening & NTDs. Health Systems Strengthening Human resources for health

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NTDs & Health Systems Strengthening – the contribution of human resources

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All-Party Parliamentary Group on Malaria and NTDs

16th October 2012

Elaine Ireland, Head of Policy, Sightsavers

NTDs & Health Systems Strengthening – the contribution of human resources

Health Systems Strengthening & NTDs

  • Health Systems Strengthening

  • Human resources for health

  • Case study: Community Directed Treatment with Ivermectin

  • Integrating CDTI into health systems

  • Conclusions

Health Systems Strengthening

  • Source: WHO, 2007

Health Systems Thinking

Dynamic architecture & interconnectedness of health systems ‘building blocks’

  • Source: WHO, 2009

Health Systems Strengthening & NTDs

Neglected Tropical Diseases

  • Group of 17 parasitic diseases

  • Affect over 1 billion of the world’s poorest people

  • Most prevalent in rural areas, urban slums, conflict zones

  • Severe impact on poverty

  • Most common NTDs: lymphatic filariasis, onchocerciasis, soil-transmitted helminthiasis, schistosomiasis, trachoma

Health Systems Strengthening & NTDs

Health System Challenges

  • NTD programmes – vertical or horizontal?

  • Key health system challenges for NTD programmes include:

    • Human resource development

    • Logistics & infrastructural development

    • Information systems

    • Governance

    • Financing

  • NTDs largely found in remote, rural and often conflict affected area

Health Systems Strengthening & NTDs

Human resources for health

  • Global human resource for health crisis

  • 57 countries with critical health worker shortages

  • Global deficit of 2.4 million doctors, nurses and midwives

  • African region is “at the epicentre of the global health workforce crisis”

  • African region has 24% of the burden of disease but only 3% of health workers and commands less than 1% of world health expenditure

HSS & NTDs – contributions to overcoming the HRH crisis

Community-directed treatment with Ivermectin – a case study of NTD contributions to HSS

  • “Community-directed treatment not only advances health promotion and disease control, it also strengthens basic health system structures… helping countries work towards their Millennium Development Goal commitments”

  • (APOC, 2007)

CDTI – A case study

The role of the community in strengthening human resources for health

  • CDTI – key strategy for control of Onchocerciasis

  • Essential element is the network of community drug distributors who deliver the ivermectin treatment

  • Estimated that in 2007 close to one million DALYs averted by APOC* through CDTI

  • Low cost solution – APOC has spent just over $112 million during the 12 years of operating the programme

  • * APOC is the African Programme for Onchocerciasis Control

CDTI – A case study

No. of DALYs averted by APOC’s community directed treatment activities in countries that have APOC projects and predictions for future gains to 2015

  • Source: APOC, 2007

CDTI – A case study

Community-based vs. Community-directed treatment

  • Community-based treatment:

  • Top-down

  • Distribution by mobile team of health workers

  • Community is involved

  • Community actions are led by health workers

  • Timing of drug distribution decided at central level

  • Community-directed treatment:

  • Grassroots focused

  • Based on community ownership

  • Treatment provided by community drug distributors

  • Community leads the process, planning and management of treatment

  • Timing of drug distribution determined by community members

CDTI – A case study

Benefits of CDTI

  • General:

  • Better targeting & timing of treatment campaigns

  • Increased coverage

  • Improved take up of treatment

  • Human resources for health:

  • Dramatic increase in the number of human resources (CDDs) to implement the control programme

  • Provision of a huge personnel resource base, particularly at the community level

  • Relieve pressure on overstretched health workforce

CDTI – A case study

Benefits of CDTI

  • Health systems strengthening:

  • Extend health promotion activities to areas that are unreachable by the health system

  • Development of low-cost technologies, adaptable for other disease control programmes

  • Strengthen surveillance in ways that improve countries’ resilience to disease outbreaks

  • Contribute to health information systems data collection

  • Increased and sustained treatment coverage

  • Initiation and expansion of other community-based interventions

CDTI – A Case Study

Integration of CDTI in health systems

  • “Integration increases efficiency, decreases the burden on health systems, improves access to health services, and improves the cost-effectiveness of health spending while maintaining treatment coverage”.

  • (APOC, 2007)

Integration of CDTI in Health Systems

Benefits of CDTI go beyond onchocerciasis…

  • Community drug distributors now also contribute to:

    • Albendazole distribution (for LF)

    • Praziquantel distribution (for schisto)

    • Mebendazole distribution (for worms)

    • Malaria bed-net distribution and malaria treatment programmes

    • Vitamin A distribution programmes

    • Vaccination campaigns

    • Directly observed treatment for TB

    • Provision of family planning aids

Integration of CDTI in health systems

CDTI projects in several APOC countries are supplying additional public health interventions along with ivermectin:

Source: APOC, 2007


  • For NTD control programmes to be sustainable they need to be integrated into the health system

  • The CDTI approach for onchocerciasis control provides an example of how vertical, disease control programmes can contribute to health systems strengthening

  • Establishing a network of community health volunteers can alleviate the pressure on the health workforce – to be successful though, there has to be a strong sense of community ownership of disease control programmes

  • Well established CDTI programmes also offer good scope for developing an integrated approach to disease control and increased access to health services.

  • “CDTI has served as a channel for health interventions to improve access to services and better health”

  • (Former National Onchocerciasis Coordinator, Cameroon).

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