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 …