Prof CP Ramachandran
1/63, Off Jalan Tunku
Kuala Lumpur 50480
WHO Focal Point
Dr John Ehrenberg
The First Technical Working Group Meeting on LF elimination in the Pacific Island Countries was held in Nadi from 9 to 11 June 2008 to review the progress made and to shape the next steps towards elimination in this region. Major findings were as follows:
Four Pacific Island Countries (Cook Islands, Niue, Tonga and Vanuatu) achieved below 1% antigenemia prevalence and a significant reduction in antigenemia prevalence was observed in several other countries like American Samoa, Fiji, Kiribati, Samoa and Tuvalu.
PNG remains the biggest challenge. Past MDA did not achieve effective coverage. Financial and human resources constraints are the main challenges and there is an urgent need to address government and MOH commitment to the program. In late 2007 the possibility of using DEC-salt was evaluated and a pilot study should be implemented soon to assess the feasibility of using this strategy in PNG settings.
High quality data were collected since 2007 providing a solid base for decision making.
Significant progress has been made towards LF elimination in the Pacific Island Countries. Following the extensive and statistically sound surveys conducted in 2007 the Pacific Programme to Eliminate Lymphatic Filariasis was re-established on scientific evidence. The achievement of < 1% antigenemia prevalence at national levels in four countries and the significant reduction in Mf prevalence observed in most countries clearly indicate the success of the strategy used in this part of the world. As countries move closer towards the elimination goal it became obvious that the initial “one size fits all strategy” was no longer appropriate and strategies had to be tailored to provincial or divisional levels. Similarly in 2007 a “post MDA active surveillance strategy for the Pacific Island Countries” has been developed addressing the specific situation of this region. This strategy has been implemented since then by several countries.
The First Workshop on Lymphatic Filariasis and Other Helminthiases for Pacific Program Managers was held in Port Moresby, Papua New Guinea from 9 to 12 November 2009.
Overall Pacific Island Countries are on the right tract towards LF elimination. PNG now has a clear direction for a way forward with a plan to pilot MDA and DEC salt starting in 2010. However, good record keeping and data management are critical with all relevant information and a dossier. During this meeting country and district-tailored strategies have been developed and target dates for elimination set up together with an estimation of the budget required for reacing elimination status for each country.
Monitoring and evaluation is still an essential part of LF elimination programs and the Pacific countries continue to use the Post MDA active surveillance strategy developed in 2007.
Countries with low coverage are encouraged to follow the re-enforced strategy which includes: - shorter MDA, having a full time LF coordinator, encouraging DOT and strong commitment from the Ministry. Coverage should always be above 80%.
In 2009 and with the support of the Pacific Leprosy Foundation based in new Zealand a solid and systematic morbidity control programme has been established for the Pacific with preliminary figures from Fiji indicating an unexpected high burden of LF patients, with about half being hydrocele cases. The burden of LF is now being assessed systematically in most Pacific Island Countries and Program managers are encouraged to learn clinical aspects of LF and to utilize findings from morbidity assessments as a tool in resource and social mobilization.
Also in 2009 JICA has extended commitment to provide DEC and ICT for the PICs until 2015.
A Social Mobilization and Training team from WHO headquarters, Geneva, has been assisting countries such as the Philippines by providing COMBI (Communication-for-Behavioural-Impact) training with national support. The outcome was a complete door-to-door mass drug administration (MDA) campaign in several provinces, used as a model for further scaling-up.
National programme managers agree that, despite substantial efforts, current funding gaps will hamper full implementation of lymphatic filariasis elimination activities. However, innovative fund-raising activities are under way. For example, the Japanese government funded Health Fairs in 2003, at which immunization was offered to rural populations; it is hoped that this will become a model of synergy with other programmes. The Fairs will be limited to appropriate areas, however, and nationwide door-to-door MDAs will become the norm. The Chair of the Western Pacific PRG reports that Member States have achieved coverage of about 17% of the at-risk population of 210 million.