Combatting Neglected Tropical Diseases in the DRC
The END Fund and its partners, including the African Program for Onchocerciasis Control, the Democratic Republic of the Congo Ministry of Health (MoH) Neglected Tropical Diseases (NTDs) team, and the MoH network of community health workers commit to deliver medicines to treat at least one (1) million additional people per year who are at risk of blinding, disabling and deadly NTDs, specifically targeting lymphatic filariasis, river blindness and intestinal worms that affect both children and adults.
These treatments will be delivered via mass drug administration (MDA) by community health workers at least once a year, as per the World Health Organization (WHO) guidelines, over a three year period (2015-2017). The program will align with the DRC MoH’s national NTD plan, with full participation and approval from the government. Medicines will be procured through the WHO and from drug companies that have committed to donating medicines needed, including ivermectin and albendazole from Merck and GlaxoSmithKline.
MDA is the delivery of medicines to an entire community at risk of, or infected with, the targeted diseases, as shown by conducting baseline disease prevalence mapping. Medicines are distributed by frontline community health workers on an annual or biannual basis, depending on diseases prevalence and intensity. In the case of the DRC, the END Fund has already successfully supported disease mapping, so this program will be built on the information gained from this initiative.
In addition to MDA, this program will include training to thousands of community health workers and communities participating in the NTD control activities. The training is conducted in cascade, train-the-trainer format, led by APOC and the Ministry of Health to health workers involved in the MDA at the national, provincial and community level. This initiative will be part of a larger Ministry of Health (MoH) NTD program and help to add capacity to the MoH and expand the national NTD control program.
The END Fund will work proactively to mobilize and engage a consortium of donors in this initiative, with the anchor donor, Margaret A. Cargill Foundation, already identified and confirmed. The END Fund’s program team and Technical Advisory Committee will also provide technical assistance to implementing partners in the DRC on best practices in NTD control and elimination programs.
The proposed target provinces for this work are Bas Congo, Katanga, Kasai Occidental, and Kasai Oriental. The proposed implementing partners for this program in the DRC are the Ministry of Health, at both the national and provincial levels, and the African Program for Onchocerciasis Control.
The END Fund follows a 10-Step Strategy and will work in alignment with this for the duration of this program:
1. Secure funding: Identify partners such as corporations, foundations, and individuals to sponsor high-impact NTD programs. (Will focus on this Year 1 of the program.)
2. Plan: Engage implementing partners, Ministries of Health, and scientific technical experts to design a coordinated program. (Year 1)
3. Map: Conduct disease prevalence and intensity mapping. (Already completed for the DRC in Q1 2014).
4. Target: Definite targeted populations; formalize treatment strategies. (Already defined)
5. Supply: Facilitate procurement of pharmaceutical donations in partnership with the MoH. (Annually, at least 6 months before MDA)
6. Train: Train health sector personnel from the national to the local level to deliver treatment and keep accurate records. (Annually, usually one month or more before the Q3/Q4 MDA)
7. Promote: Prepare target populations to receive medicines; aid social mobilization through media promotions, door-to-door visits, and community health education. (Also in month or so before MDA)
8. Mobilize and Treat: Equip health facilities with diagnostic treatment; treat the target population through MDA. (Tentatively set for Q3 or Q4 each year in the DRC)
9. Monitor: Monitor and evaluate the program; collect and analyze data; make necessary adjustments to implementation. (Ongoing, with intense effort in quarter following the MDA)
10. Scale: Scale up health, education and prevention programs to the national level (the proposed DRC program will be a pilot that hopefully with success can be scaled up nationally at a later date)
Neglected Tropical Diseases (NTDs) are a group of parasitic and bacterial infectious diseases that affect over 1.5 billion of the world’s most impoverished people, including an estimated 800 million children, according to the World Health Organization (WHO). They cause pain, long-term disability, and are the cause of death for over 500,000 people per year in developing countries. Among children, infection leads to malnutrition, cognitive impairment, stunted growth, and the inability to attend school. Adults suffer from social isolation and are unable to work. Anemia caused by NTDs increases the risk of maternal mortality.
The Democratic Republic of Congo (DRC) has been named a high priority country in the global efforts to control and eliminate NTDs and is one of the highest disease burden countries in sub-Saharan Africa. Only if high-impact and targeted program investments are made in the DRC can the WHO NTD roadmap for the control and elimination of NTDs and the national NTD Plan for the DRC be advanced, contributing to the improvement of the lives of millions of people and significantly reducing the global burden of NTDs.
According to WHO and national statistics, DRC has an immense NTD burden:
– The second highest prevalence of lymphatic filariasis (LF), which causes elephantiasis, in sub-Saharan Africa with an estimated 50 million individuals at risk of the disease,
– The second highest prevalence of hookworm on the continent, with an estimated 31 million people infected,
– Over 30 million individuals are at risk of schistosomiasis, and
– Over 19 million are at risk of river blindness.
Partnerships, funding and coordination are needed to ensure that people at risk of NTDs in the DRC receive the treatment they need to live healthier, more prosperous lives.
The END Fund’s three-year neglected tropical diseases (NTD) program in DRC, running from 2015-2017, is currently implementing mass drug administration (MDA) targeting river blindness, lymphatic filariasis (LF) and deworming to over one million beneficiaries. As the END Fund’s previous implementing partner, the African Programme for Onchocerciasis Control (APOC) sunsetted at the end of 2015. To fill this gap, ESPEN was created out of the WHO to coordinate on these projects. The project includes completing training and communication materials prior to MDA treatment, and training community drug distributors, community health workers, and primary health care workers to distribute and administer NTD treatment. Education efforts and community social mobilization also took place to raise awareness of upcoming treatment campaigns and NTD prevention.
The END Fund is working to provide treatment for one million people affected by neglected tropical diseases (NTDs) in the DRC. To further this commitment, the END Fund is seeking potential investors in this three year project.