No public
health programme has ever expanded as quickly as the Global Programme
to Eliminate LF. Governments in endemic regions increasingly view
the programme as a tangible way to address poverty and improve health.
As a result, annual treatments have jumped rapidly, up from 25 million
in 12 countries in 2000 to over 250 million in 39 countries in 2004.
Despite the
rapid progress of the global effort to eliminate lymphatic filariasis,
much remains to be |
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| done.
By the end of 2005, all countries where LF exists are expected to
finish mapping to identify endemic areas. Following mapping, Ministries
of Health in each country develop a national elimination programme
to provide annual mass drug administration, as well as to alleviate
suffering of infected individuals through hygiene and surgery. Although
the Global Alliance has generous donors and strong partners, the programme
still has many needs. In fact, there are a number of countries in
Africa and Asia that have already completed mapping and are poised
to initiate a programme, but cannot do so for lack of funding. Even
in countries with established LF programmes, there is the annual challenge
of securing funds for the costs associated with MDA, as well as morbidity
programmes targeted at alleviating suffering of infected individuals.
In addition, the Global Alliance also hopes to secure funds for in-country
capacity-building for programme managers for fundraising training
and workshops to explore alternative funding sources such as debt
relief and funds for programme integration.
The following
is a list of specific needs in order for the Global Programme to
meet its goal of eliminating LF by 2020:
- Diethylcarbamazine
(DEC): DEC is used in combination with albendazole in
countries where river blindness is not co-endemic or as a sole
strategy in some countries. While GSK and Merck & Co., Inc.
have pledged to provide unlimited quantities of the other two
drugs needed to eliminate LF, the Global Alliance currently is
able to purchase DEC at cost, but does not have a donor to provide
DEC for free. The annual estimated cost for global DEC needs is
approximately $1 million.
- Country
Specific Needs: Since MDA must occur for at least five
consecutive years, even if the first few years are funded, a national
LF Elimination Programme may have subsequent funding needs related
to MDA. These needs may include social mobilization costs, training
for community volunteers, food and travel allowance for the volunteers,
and monitoring and evaluation activities. The Global Alliance
estimates that MDA costs between $ 0.03 and $ 1.00 per person
per year depending on the country. As the MDA costs are closely
linked with the use of human resources, MDA tends to be more expensive
in countries with more developed economies.
- Fundraising
Training for In-Country Programme Managers: As each endemic
country initiates an LF Elimination Programme, the local programme
managers receive fundraising training to learn how to access local
funding sources. Ultimately, this investment will lead to more
sustainable and effective national elimination programmes. Such
training costs are between $5,000 and $8,000 per country. The
annual need depends on the number of countries both ready to initiate
a programme and interested in training.
- LF
Regional Support Centre in Africa: Established in 2005,
the LF Regional Support Centre is located at the Noguchi Institute
in Accra, Ghana. The Centre provides technical, programmatic,
and advocacy support to LF Elimination Programmes, as well as
other LF-related disease programmes in Africa. The annual budget
for the LF Regional Support Centre is $215,000.
- Mapping
Costs: Before a country can begin an LF Elimination Programme,
local health officials must map the country to determine where
LF is endemic and decide on the geographic areas (implementation
units or IUs) where the programme will take place. IUs can run
the gamut in size from village, district, country, or other unit
depending on the specific needs of the country. Once the IU is
defined, the health officials sample up to 250 individuals within
each IU using finger-prick blood tests to determine the level
of filarial infection. If 1% or more of the population tests positive,
then the area is considered endemic and will require mass drug
administration. The cost for mapping a country typically runs
in the $20,000 to $40,000 range depending on the number of IUs
in the country. At present, 15 African countries remain unmapped.
- Regional
Program Review Group (RPRG): On an annual basis, the
six Regional Program Review Groups, comprised of representatives
from WHO, other Global Alliance partners and the respective region,
meet to discuss the implementation of the global elimination strategy
within the regional context. While the global strategy serves
as a framework, each region and country make modifications based
on their circumstances. Typically, the LF programme managers from
a region meet at the same time as the RPRGs. These meetings are
critically important to the success of LF elimination since they
provide a unique opportunity for the program managers to exchange
experiences, learn and teach "best practices", and recognize
their essential role in ensuring the success of the Regional and
Global Programme activities. The annual cost of the RPRG meetings
ranges between $20,000 and $40,000 per region.
For
more information about how you can aid in this global effort, please
contact:
In North America, Pamela Hooper
In Europe, Tasha Boerner
In Asia and Africa, Sandra Libunao
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