ESPEN

Eliminating Schistosomiasis morbidity in Africa

ESPEN: Expanded Special Project for Elimination of NTDs

ESPEN is a special project established in a spirit of partnership between endemic countries in the African region, PC-NTDs partners and WHO. ESPEN provides technical and operational support to endemic countries to accelerate control and elimination of 5 PC-NTDs. ESPEN enables the coordination among MoHs and their stakeholders acting as a bridge and meeting point.

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ESPEN Priority areas 2018-2020 ESPEN Priority areas 2018-2020

1. Scaling UP: Reaching 100% geographical coverage of PC –NTDs (current coverage 59% in AFRO for the overall 5 PC NTDs).

2. Scaling DOWN: Supporting countries to Stop treatment and achieve WHO Validation as soon as of elimination is reached;

3. Strengthening information systems for evidence based decision and measuring progress towards elimination. Enhancing the NTD Portal : better data for higher impact

4. Improve the utilization of donated medicines to reach those who need them (as part of Dr Moeti’s commitment to the CEO Round Table)

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$15M

14

132M

30M

ESPEN by numbers: First year impact

START UP FUNDING MOBILIZED IN FIRST 12 MONTHS

COUNTRY NTD ELIMINATION ANNUAL WORK PLANS DEVELOPED

DRUG TABLETS RECOVERED THROUGH SUPPLY CHAIN ANALYSIS IN 7 COUNTRIES

PEOPLE newly targeted with MDA in 15 COUNTRIES; 32 countries operational support by ESPEN

41 COUNTRIES SHARING SUBNATIONAL DATA AND MAPS THROUGH THE NTD PORTAL ntd.afro.who.int

SCH

SAC Adults

41

100.3M 88.4M

29 14

49 ND

83 ND

67.9M 13.4M

57 11

PC implementation

Number of countries requiring PC1

Number of people requiring PC

Number of countries implemented and reported

Proportion (%) of districts implemented PC2

Proportion (%) of districts achieving effective coverage3

Number of people treated

Coverage (%)4

Preventive chemotherapy in 2016 – African Region

WHO/ESPEN Data system

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Integrated NTD database

TIPAC

Data collection at country level

Review of the JAP by ESPEN

Regional clearance of the JAP

DA

TA V

ALI

DA

TIO

N

JAP received at WHO/HQ

ESPEN - Data analysis, visualisation and score card

Country submitting JAP

JRSM

JRF

EPIRF

GHO - Data reporting and visualisation

Upload data into NTD portal

DA

TA

VA

LID

AT

ION

Severe morbidity still occurs in Africa

Bertrand, Cameroon 2010

Uganda, 2017

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• 6th RPRG: Recommendation on Schistosomiasis advocacy in the African region

– Recognizing that :

• schistosomiasis is a focal disease,

• district level average prevalence estimates leaves out sections of the population otherwise recommended for treatment in high prevalence regions,

• Adults in high prevalent areas are not being targeted as recommended

• cases of extreme morbidity are still observed in several areas,

…The goal to eliminate morbidity by 2025 may not be on target.

Burkina Faso

Zimbabwe Togo

Consistent high coverage over several years

Schistosomiasis: School Age Children (SAC)

Cameroon

Angola

Eritrea

Guinea Bissau

Congo

DRC

South Sudan

Starting MDA, and needing to scale up

Gabon

Chad

The Gambia

Comoros

Namibia South Africa

Botswana

Equatorial Guinea Not yet implementing or reporting

Category Country Consistent high coverage; need of Impact assessment surveys for Schisto (and STH )

Burkina Faso Cameroon, Nigeria (some States/LGAs), Togo, Zimbabwe. Malawi, Mali, Mozambique Senegal

Countries in need of scale up (suboptimal coverage) CAR, DRC, Ethiopia, Nigeria, (Some states/LGAs) Benin, Cote D’Ivore, Ghana Guinea, Kenya, Liberia, Mauritania, Madagascar, Niger, Sierra Leone, Zambia. Tanzania Mainland, Uganda (Review denominator)

In need to start their control programmes (no coverage 2004- 2015)

South Africa, South Sudan, Botswana, Equatorial Guinea, Gambia, Chad.

Starting or re- starting: in need of partnerships for technical and financial support

Angola, Congo, Gabon, DRC, Eritrea, Guinea Bissau, South Sudan, Swaziland

Need a survey to update the situation of schisto and develop an elimination agenda

Algeria

Need to verify interruption of transmission Mauritius

Not implementing/ reporting Botswana, Chad, Comoros, Equitorial Guinea, Gambia, Namibia, South Africa.

Summary : Country status for Schistosomiasis preventive chemotherapy (2016)

Activities

Supporting countries to reach 100% geographical coverage Site level data analysis to re-define disease prevalence Refinement mapping of SCH where needed: opportunities to integrate with other mapping surveys (Oncho) PZQ projection based on sub-district level endemicity Building capacity of Programme Managers on the new WHO PM guide on Molluscicides (Snail intermediate host control ) to control morbidity in high prevalent areas Impact assessments in countries with >5 MDA rounds

Country

# IUs Implementing

Geographical coverage

Proportion of IUs requiring PC and achieved effective

coverage

Burundi 21/21 100% 85.71%

Kenya 62/62 100% 24.40%

Malawi 29/29 100% 100%

Mali 47/47 100% 100%

Mozambique 160/160 100% 95.63%

Geographical coverage: Countries implementing to scale

Country # IUs Implementing Geographical coverage IUs not

covered Angola 73/162 45.06 89

Benin 34/76 44.74 42

Cameroon 85/113 75.22 28

Central African Republic 7/8 87.5 1

Chad 0/90 0 90

Congo 3/.6 33.33 4

Democratic Republic of the Congo 108/375 28.8 267

Ethiopia 116/432 26.85 316

Gabon 9/44 20.45 35

Geographical coverage: # of IUs not implementing (1/2)

Country # IUs Implementing Geographical coverage IUs not covered Guinea 6/7 85.71 1

Liberia 5/14 35.71 9

Madagascar 35/105 33.33 70

Nigeria 204/599 34.06 395

Swaziland 53/55 96.36 2

Uganda 76/186 40.86 110

Zambia 38/101 37.62 63

TOTAL 1,522

Geographical coverage: # of IUs not implementing (2/2)

Country # of IU SCH ISUs Map gap

Angola 164 162 2

Central African Republic 17 8 9

Chad 100 90 1

Ethiopia 839 432 48

Nigeria 774 599 50

Total 110

SCH Mapping Gaps

Cameroon Nov 2016 Pemba Sept 2017 Burkina Faso, Sept 2017

Cameroon Tanzania Mainland Cote d’Ivoire

Ethiopia Tanzania Zanzibar Niger

Malawi Uganda Burkina Faso

Mali Zimbabwe Senegal

Niger Ethiopia Cameroon

Nigeria Ghana Togo

The Sudan Mozambique Burundi

Tanzania (Mainland and Zanzibar

Benin

Zambia Rwanda

Zimbabwe

Building capacity Snail control in the African Region

SCH/STH Impact assessments After 5 or 6 years of PC implementation, it is necessary to (re)-evaluate the epidemiological situation. The impact assessment for STH can be conducted simultaneously to a TAS or independently According to the results of the assessment the PC intervention should be re-planned.

Category Country

> 5 rounds of treatment

Benin, Burkina Faso, Cameroon, Nigeria (some States/LGAs), Togo, Senegal , Mali, Burundi, Rwanda, Sierra Leone Ghana, Tanzania Mainland, Uganda Zimbabwe, Malawi, Mozambique, CAR, Ethiopia, Nigeria, (Some states/LGAs) Cote D’Ivoire, Guinea, Kenya, Liberia, Madagascar, Niger, Zambia

SCH / STH : Countries that are conducting or ready for impact assessments

SCH/STH: Morbidity control agenda

WASH Advocacy: Moving from a MDA-focused intervention to intensified / integrated interventions including sanitation, access to clean water, etc.)

Accelerate the scaling up of MDA to reach 100% geographical coverage and at least 75% of SAC

Advocacy: to extend treatment to all populations in need:

Children < 5 years: urgent need of pediatric PZQ

Out of school children and adults

Coordination: partners Matrix

Guidance to countries close to elimination: Algeria, Mauritius, Botswana??

ESPEN NTD Portal : ntd.afro.who.int

The NTD Portal is an open access platform that enables health ministries and stakeholders to share, and exchange program data, in support of their NTD control and elimination goals.

Country progress

Trachoma

Lymphatic Filariasis

Schistosomiasis

NTD Portal enhancement

Site level maps and data

Historical coverage since reported to WHO

Projections 2017-2020

Master and Annual plans and Budgets

Partners matrix

2016-2020 LF Projections

For an Africa free of NTDs T h a n k y o u f o r y o u r a t t e n t i o n

D r M a r i a R e b o l l o P o l o - r e b o l l o p o l o m @ w h o . i n t