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

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 & NTDs

  • Health Systems Strengthening

  • Human resources for health

  • Case study: Community Directed Treatment with Ivermectin

  • Integrating CDTI into health systems

  • Conclusions

Health systems strengthening
Health Systems Strengthening

  • Source: WHO, 2007

Health systems thinking
Health Systems Thinking

Dynamic architecture & interconnectedness of health systems ‘building blocks’

  • Source: WHO, 2009

Health systems strengthening ntds1
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 ntds2
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 ntds3
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
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
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 study1
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 study2
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 study3
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 study4
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

Integration of cdti in health systems
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 systems1
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 systems2
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.

Ntds health systems strengthening the contribution of human resources