The following is part of a training exercise for MSc Students in International Health and Tropical Medicine, University of Oxford * equal contribution from all co-authors listed by alphabetic order Opportunities fr from th the BEST Framework to facilitate Universal Health Coverage for vulnerable populations th through Neglected Tropical Dis iseases in investments Prepared by: Dr. Zineb Bentounsi (Morocco) Mahnaz Hossain Fariba (Bangladesh) Dr. Vitalis F. Feteh (Cameroon) Dr. Lilian Ibe (Nigeria) MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine
Outline Background NTD Fight- Achievements and Challenges BEST Framework: Opportunities & Limitations Recommendations Conclusion
Background In 2003, decision was made to group those diseases under the label of Neglected Tropical Diseases (NTDs) today official WHO list of NTDs = 20 diseases. London Declaration in 2012 sets the target to eliminate/eradicate NTDs by 2020 & re-awakens intersectoral cooperation. NTDs currently affect over 1.5 billion people in the World’s Poorest Countries NTD disproportionately affect vulnerable populations children, women, refugees, nomadic and indigenous communities
NTD Fight- Achievements 10 countries have Onchocerciasis has eliminated Lymphatic been eliminated in Filariasis. the Americas 5 countries Guinea worm disease have eliminated only remains in 2 Trachoma. countries 68% drop in sleeping Guinness record : sickness cases total of 1.8 billion between 2011-2016 treatments were donated
NTD Fight- Challenges Funding Conflict & Migration Additional $300 to $400 million every Syria: Re-surgence of Leshmaniasis year until 2020 Harmonization of Control Strategies Monitoring & Evaluation Human Rights Access to Populations Equity & Non-Discrimination Geographical & Cultural Barriers Ethical Considerations
BEST Framework Adopted by Neglected Tropical Disease NGO Network 1. Clearer message – stronger advocacy 2. Joint framework – improved integration 3. Comprehensive framework – rationalised funding and programmes structures Image Credit: http://www.ntd-ngonetwork.org/best-framework
BEST Framework -B ehaviour • Personal Hygiene • Livestock Handling Physical • Treatment Seeking Behaviours Behaviours • Fighting stigmatisation of NTD patients Attitudes • Collaborate with other sectors that also focus on behavioural change, e.g the WASH sector Institutional Behaviours
BEST Framework- E nvir ironment • Environmental Sanitation • Reduce a major reservoir of human infections • Preventing & Controlling Zoonotic Disease outbreaks, epidemics & pandemics • Integrated Vector Management & Veterinary Public Health Services Minimize Morbidity & Economic Losses
BEST Framework- S ocial In Inclusion Ensure inclusion of vulnerable Progressing towards populations in NTD Universal Health interventions. Coverage Inclusive policies Ensure access to services Empowering communities Ensure access to services Empowering (including rehabilitation) communities for women, children, affected by NTDs by people with disabilities ensuring their and other targeted participation in population groups designing programmes.
BEST Framework- T reatment • Variety of methods ranging from Mass Drug Administration (MDA) of preventive chemotherapy to surgery. • Incorporating NTD chemotherapy into already existing health programs like HIV/AIDS or malaria provides another opportunity for holistic and sustainable care. • Synergy between controlling NTDs and improving nutrition policies Hotez P et al (2018) PLoS Negl Trop Dis 12(5): e0006137 designed to incorporate both will be more cost effective and have better health outcomes.
BEST Framework-Limitations How to effectively How to change monitor and manage culturally embedded data? practices? Behaviour Environment Social Treatment How to economically How to deliver Inclusion empower NTD treatment to every patients? NTD patient?
Recommendations Invest in Community Health Workers • Improve access to Vulnerable Population. • Deliver treatment • Strengthen data collection and analysis • Take care of supply chain management • Do health promotions and intensify community engagement • Facilitate earlier referrals Need for Capacity building of CHW
Recommendations Invest in Information Systems • Monitoring environmental data and epidemiology of diseases • Monitor Mass Drug Administration • Facilitate earlier referrals Image credit: www.sightsaver.org
Conclusion • Strides have been made in the current global fight against Neglected Tropical Diseases (NTDs), but NTDs still affect the world’s poorest billion • Interdisciplinary cooperation from the design of health policies to their implementation as advocated in the BEST Framework is recommended • NTD investment should include holistic health system strengthening and community engagement as means to ensure sustainable Universal Health Coverage
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