NTDs and eye health: lessons learnt and opportunities for collaboration

1. 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

2. NTDs and Eye HealthTrachoma • Strategy for eliminating blinding Trachoma • Surgery of Trichiasis • Antibiotic MDA • Facial cleanliness • Environmental Change

3. NTDs and Eye HealthOnchocerciasis • Strategy for elimination of the disease • MDA • (Rehabilitation of the blind)

4. Other NTDs and MDA • Lymphatic Filariasis • Strategy for Elimination • MDA • Morbidity control • Shistosomiasis • MDA • Water and Sanitation • ?? Snail control • STH • MDA • Water and Sanitation

5. Community Directed Treatment with Ivermectin (CDTI) in action

6. Mectizan treatments approved for Onchocerciasis

7. Mectizan treatments approved for Lymphatic Filariasis

8. 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

9. 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

10. Community involvement

11. 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?

12. 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.

13. 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.

14. 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

15. Let’s finish the job properly!