Kabatereine Narcis
NEED FOR IMPROVING IN-COUNTRY CAPACITY FOR BETTER DELIVERY.
AFRICAN SCI CAPACITY BUILDING ADVISOR BASED IN UGANDA
Some of my roles As SCI Capacity building advisor and as a member of WHO/Geneva WG for
Capacity building, I participate in:
Identifying existing efforts and gaps in CS and Prioritize needs in order to accelerate rate of scale –up of country programmes, I participate in training consultants who train country staff’,I train country staff as SCI Capacity building Advisor or on behalf of WHO.
Examples of existing CS courses include:NTD Programme Managers Course M&E courseWorking on district managers training course
As a Member of WHO/RPRG, reviewing progress of country NTD Programmes and advise on way forward.
WHY IN-COUNTRY CAPACITY BUILDING?
According to existing dataAccording to existing data on global preventive chemotherapy,
Approximately additional 350 million people per yearadditional 350 million people per year must be reached by 2015
• Requiring global rate of 8 to 10 million new treatments per month
• This is not being reached at
• The current treatment rate.
Current and projected proportion of people (2008-2020) receiving PC for at least one disease among LF, SCH and STH out of the estimated number of people requiring PC (excluding India and Bangladesh)
Mapping gaps at Country and Mapping gaps at Country and District levelsDistrict levels
Mapping gaps at Country and Mapping gaps at Country and District levelsDistrict levels
PC NTDs
Countries with Mapping gaps
Number (%) of districts to be
mapped
LF 17 655 (14%)
ONCHO 12 374 (9%)
SCH 22 972 (20%)
STH 24 1,031 (21%)
TRA 19 1,690 (40%)
PPC NTD Mapping StatusC NTD Mapping Status
Confirmation mapping (1)
Not Started (7)
Partially mapped (15)
Complete mapping (23)
Not Applicable (2)
Not AFRO
Schistosomiasis
THEMATIC AREAS FOR CAPACITY STRENGTHENING FOR PREVENTIVE CHEMOTHERAPY
"Sunflower concept"
Other Areas that urgently require capacity
building include:
Epidemiological survey skills Financial management skills
Social science skills Training of health workers on health centre
based disease management
For Elimination, We need more sensitive diagnostic tools
Eg. Kato Katz method for S.mansoni diagnosis is not adequately sensitive
CCA has been shown to be more sensitive in a multi-country SCORE study.
Uganda and Rwanda are currently re reassessing schistosomiasis distribution using CCA
and capacity building is needed to scale-up use of CCA for re-evaluation in elimination phase in many other countries.
.CCA can be used as an RDT to improve facility
based schistosomiasis managemen.
Impact monitoringPrevalence and intensity of infectionMicro/macro haematuria stoolAnaemia GrowthClinical complicationsEducational achievementCost-effectiveness
Process monitoringDrug procurement and managementMonitoring of side-effectsQuality of drug distribution Training of teachers and CDDsHealth educationPolitical and financial supportAdvocacy and publicityInter-sectoral collaboration, e.g. WASH
Coverage monitoringGeographical coverageEpidemiological coverageProgramme coverage
CAPACIITY BUILDING NEEDED FOR MONITORING IN MOST COUNTRIES
11
ULTRASOUND & Clinical examination of schistosomiasis
Ultrasound examination – WHO guidelines– portable machine
Aloka SSD-500
Training in integrated vector management(IVM)
Vector identificationPesticide handling and managementInsecticide applicationsEnvironmental Impact assessmentInsecticide resistance management testing impact of pesticide applications etc..
Timely data retrieval and reporting
Timely data retrieval from the field is a problem
due to inadequate logistics or demand for incentives by volunteer drug distributors.
However, some electronic tools eg smart phones have been tested and they work and such training is important.
There is need to; shift from disease-specific to intervention-specific
approachesIt is important to synergize control efforts with
existing health systems especially with successful in country disease
control channels eg, ITN.Strengthen partnership and NTD coordination at
National and district levels,Strengthen health facility based disease
management.
Capacity building needed at country level for all these issues.
Way Forward considering sustainability
SOME RECENT IN-COUNTRY CAPACITY BULDING
Mapping doneBy the trainedLocal Techncians
Malawi: Over 40 Technicians trained and they have completedSchisto / STH Map.
Rwanda: 64 technicians recently trained and are re-mapping using both CCA and Kato Katz to produce a map for elimination phase.
IN ETHIOPIA: 175 technicians trained and mapped 500 Woredas including 2790 schools
575 2790
Schistosomiasis control in Uganda(yearly mass treatment with PZQ)
2003 distribution
Coverage validation surveys to evaluate accuracy of reported coverage
Main Challenge To promote country ownership
even when CS gap exists, it may not be attended to until the country feels it as a priority.
Hence CS scale-up rate is slow.
Thank you …