Contributions_Autumn_2022

Newsletter Autumn 2022

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Malaria Elimination: to biolarvicide or not to?

The Tanzania National Malaria Control Program (NMCP), in collaboration with partners, has made significant strides in the fight against malaria, resulting in remarkable reduction in malaria burden. The National Malaria Strategic Plan (NMSP) 2021-2025 aims to reduce even further the malaria prevalence in children under 5 years old from 7% in 2017 to less than 3.5% in 2025 . NMSP 2021-2025 has three core strategies, i.e. integrated malaria vector control (IMVC); malaria diagnosis, treatment and preventive therapies (MDTPT); surveillance, monitoring and evaluation (SME) and three supportive strategies, i.e. program management; commodities and logistics management; social behaviour change and advocacy.

Under IMVC, NMCP has mainly been implementing two interventions: i) distribution of Long Lasting Insecticide-treated Nets (LLINs) across the country through various channels, ii) Indoor Residual Spraying (IRS) in select high endemic councils. In addition to these two interventions, there is a strong desire from the government to add Larval Source Management (LSM) as another vector control intervention across the country. However, World Health Organization (WHO) recommends LSM as a supplemental vector control intervention, suitable mostly in urban settings and where breeding habitats are few, fixed and findable.

NMCP has partnered with the Swiss Tropical and Public Health Institute (Swiss TPH) in a project funded by the Swiss Agency for Development and Cooperation (SDC) titled Towards Elimination of Malaria in Tanzania (TEMT). The TEMT project plans to implement LSM in three councils in Tanga region (Handeni District Council-DC, Lushoto District Council-DC, and Tanga City Council-CC). The councils were selected to represent both rural and urban settings, as well as different malaria risk strata: low ‘Lushoto DC with 0.1%’, moderate ‘Tanga CC with 17.7%’ and high ‘Handeni DC with 37.6%’ prevalence. The experiences and evidence gathered during implementation will be used to advise the government (and NMCP) on scale-up and financing of LSM intervention to other councils.


1. What is LSM?

LSM is the management of water bodies that are potential mosquito breeding sites in order to prevent completion of mosquito’s life cycle2. It controls immature aquatic stages of mosquitoes (larvae), hence reducing abundance of adult mosquito vectors. There are four types of LSM: i) habitat modification (a permanent alteration of the environment e.g. land reclamation); ii) habitat manipulation (a recurrent activity e.g. flushing of streams); iii) larviciding (regular application of biological or chemical insecticides to water bodies); and iv) biological control (introduction of natural predators to water bodies).

2. Structure and modality of implementation of LSM intervention

Guidelines and Standard Operating Procedures: NMCP, in collaboration with Swiss TPH – TEMT project and other partners, has developed Standard Operating Procedures (SOPs) to guide LSM implementation. Six (6) SOPs have been developed. Each SOP provides guidance to one of the six key areas of LSM implementation. These are: i) advocacy, community mobilization and engagement, ii) participatory mapping and habitat identification (baseline data collection); iii) setup and logistics; iv) application of biolarvicide; v) monitoring and evaluation; and vi) environmental management for vector control.

Structure of LSM implementation: LSM is coordinated at the national level by NMCP and Swiss TPH – TEMT project. Implementation of LSM follows a community-based approach whereby community members (Community Owned Resource Persons – CORPs) are responsible for mapping, identification of breeding habitats, and application of biolarvicide within their areas. Two (2) CORPs are selected per village. CORPs are supervised by officers at village, ward, council and regional levels using existing local government structures.

Biolarvicide products: The program is using two biolarvicide products: BACTIVEC (Bacillus thuringiensis var. israelensis - Bti) and GRISELESF (Bacillus sphaericus - Bs) which are produced locally, in Kibaha (Pwani region) by Tanzania Biotech Products Limited (TBPL). These are biological products whose active ingredient targets only larvae stages of mosquitoes. Both products are safe to humans, animals and the environment.

Application of biolarvicide: Both products (BACTIVEC and GRISELESF) have a residual effect of seven (7) days when applied to breeding habitats. Therefore, the products need to be re-applied weekly. As per developed SOPs, the application of biolarvicide follows a temporal approach based on rainfall pattern, i.e. councils with a unimodal rainfall pattern apply biolarvicide for two rounds in a year (before and after the rain season), while councils with a bimodal rainfall pattern apply biolarvicide for three rounds in a year (before the first rain season, between the two rain seasons, and after the second rain season). Each round of application of biolarvicide comprises of eight (8) weeks whereby biolarvicide is applied in weeks 1, 2, 3, 4, 6 and 8 and skipped in weeks 5 and 7.


3.    Launch of LSM intervention:

The current strategy of implementation of LSM intervention as per developed guidelines and SOPs was launched nationally by the Tanzania Minister of Health, Hon. Ummy A. Mwalimu, on 19th July 2022 in Tanga CC (as Tanga CC is one of the three councils implementing LSM intervention). The event was also attended by Ambassador of Switzerland to Tanzania and Representative to the East African Community, Didier Chassot.

The Minister’s key messages during the inauguration were for: i) the region and councils to ensure LSM is implemented effectively within their areas and reports are submitted timely, ii) everyone to take proactive measures to destroy breeding habitats and keep the environment clean, and iii) effective analysis of the results to inform the government during scale-up of LSM intervention to other councils.
The Ambassador of Switzerland expressed the continued support and collaboration of the Government of Switzerland with the Government of Tanzania on health and other sectors.

Both the Minister and the Ambassador, with other officials had the chance to visit one of the breeding habitats for a demonstration on how to apply biolarvicide and to officially launch the intervention. See pictures below.

4.    Status of LSM implementation

The following activities have been conducted towards implementation of LSM intervention:
  • Development of Standard Operating Procedures and M&E tools for LSM

Standard Operating Procedures (SOPs) for LSM were developed by NMCP and Swiss TPH, in collaboration with other organizations/institutions, including: President's Office - Regional Administration and Local Government (PO-RALG), National Institute for Medical Research (NIMR), Sokoine University of Agriculture (SUA), Ifakara Health Institute (IHI), Research Triangle Institute (RTI International), USAID’s Vector Control Activity project (TVCA), Vector Link, TBPL, and WHO. A total of six (6) SOPs, with respective M&E tools, have been developed. All SOPs were reviewed by an External Reviewer and after addressing all inputs, the final SOPs were translated to Kiswahili for use at the council and sub-council levels.

  • Advocacy for LSM intervention – Tanga:
Advocacy meetings were conducted in July 2021 in each of the three (3) councils; Handeni DC, Lushoto DC and Tanga CC, as well as the regional level. The meeting at the regional level was chaired by Regional Commissioner and meetings at the council levels were chaired by the respective District Commissioners. The meetings were conducted for two days whereby day one focused on introduction to LSM program structure and implementation modality, while day two focused on LSM council microplanning.
  • LSM Orientation/Training of National level trainers
Cascaded training was conducted from August to December 2021. Training of national level trainers was conducted in August 2021 whereby 20 participants were trained. Training for regional and council teams was conducted in September 2021 whereby eight (8) participants from each council and three (3) participants from the regional level were trained. At the sub-council level, two participants per ward (Ward Executive Officer-WEO and Ward Health Officers), two participants per village/street (Village/ Mtaa Executive Officer-VEO/MEO, chairperson) and two CORPs per village were trained. Sub-council level training was conducted from October to December 2021. Across all levels, a total of 1,421 participants have been trained on LSM intervention through in-class theory sessions as well as practical sessions in the field.
  • Procurement and distribution of biolarvicides, equipment, and M&E tools/forms
As per SOPs, the following equipment are required for implementation of LSM intervention: spray pumps, gumboots, larval trays and dippers. Quantification of each equipment was based on the number of CORPs. All equipment were procured and transported to the respective councils together with SOPs and M&E tools/forms. Moreover, 17,240 litres of biolarvicide have been procured from TBPL and distributed to the councils to be used during the first round of application of biolarvicide.
  • Mapping and baseline data collection on breeding habitats
All three councils conducted mapping and baseline data collection on breeding habitats in February 2022. Data on breeding habitats (including type, size, larvae, and pupa count) was collected weekly for 4 weeks. The average number of breeding habitats (and estimated size in m²) was 15,333 (471,539 m²) across all three councils; 12,203 (325,701 m²) in Handeni DC, 2,126 (92,122 m²) in Lushoto DC and 1,005 (53,717 m²) in Tanga CC.
  • Application of biolarvicide – Round
First round of application of biolarvicide across all three councils started in June 2022, after rain season (masika), and concluded in July 2022, completing 8 weeks of application.  

5.    Next steps

  1. Feedback meetings with regional and council teams discussing the facilitators and barriers to smooth implementation of LSM intervention
  2. Analysis of entomological and epidemiological data following completion of the first round of application of biolarvicide
  3. Preparation for second round of application of biolarvicide across all three councils
  4. Cost-benefit analysis report to support the government’s planning, resource allocation, and policy decision making

6.    Conclusion

This approach of LSM implementation as guided by SOPs using exclusively governmental mechanisms as well as locally produced biolarvicide products is expected to contribute important real-world experience on the potential of this form of vector control across a range of ecologies and transmission situations. Results of this approach will advise the government during scale-up on this intervention in other councils.

More information:
Contact: 
Dennis Kailembo (author)
Noela Kisoka (co-author)
Swiss Tropical and Public Health Institute, Tanzania

Photo: 
Demonstration of application of biolarvicide on breeding habitats with the Tanzania Minister of Health – Hon. Ummy A. Mwalimu and Ambassador of Switzerland to Tanzania – H.E. Didier Chassot ©TEMT Project

Primary healthcare providers in Albania meet emerging needs of the population

The primary healthcare (PHC) sector in Albania is undergoing several changes aiming to better respond to the increasing burden of non-communicable diseases and the overall ageing of the population.

Two strategic documents are presently under implementation, namely the National Health Strategy 2021-2030 and the Strategy on Development of Primary Healthcare Services (2020-2025). Recently, the Ministry of Health and Social Protection (MoHSP) reformulated the Statute of Primary Health Care Centres in order to introduce reformative changes impacting the organization and range of services offered at PHC level, profiles and roles of healthcare providers and general management of healthcare centres.

Since July 2022, primary healthcare facilities are classified in 4 categories: providing basic services; providing 24/7 health services (including emergencies); health centres (HCs) oriented towards Health and Social care; and HC offering specialized care. Several adjustments are being implemented, of which the integration of social care at PHC level is a novelty for Albania. Additionally, the range of services has been extended, including planned home care services for homebound patients, physical rehabilitation, and psychosocial services.

To this end, the Health for All Project (HAP) is supporting the health authorities in implementing several interventions including the development of new profiles of PHC professionals and updating of existing ones.

The updated profile of Family Doctor introduces the concept of a Family Medicine unit (family doctor and family nurse working in the same catchment area) and improves the communication among members via regular peer exchanges and referrals for specialized psychosocial or health-socio services. The reviewed profile of HC Manager gives a more detailed insight to the Manager’s role at HC level regarding the organization of the service, financial management, human resources, and continuous quality improvement.

The roles of nurses at PHC level were reviewed to improve performance of nurses regarding health education and health promotion services; prevention, self-management, and chronic disease management; proactive nursing care at home; nursing care for school-aged children. Considering the integration of social and health services and physical rehabilitation as new services offered at PHC level, profiles for social workers and physiotherapists as part of the multidisciplinary team at PHC were also developed. In terms of nurse management, the role of head nurse is strengthened in the updated profile that aims at better contribution in service organization, professional development of the nursing staff and the continuous quality improvement.

HAP is providing support to local health authorities and 21 HCs that are piloting the new profiles of family nurses regarding: (i) improvement of nurses’ clinical skills and capacities through tailored accredited hands-on trainings, (ii) reorganization of services within health centres and health posts, allowing nurses to be more autonomous in their work with patients, and (iii) implementation of updated clinical protocols and guidelines on NCDs that include specific documents and procedures carried out/administered by nurses. So far, a total of 430 family nurses and home-based care nurses are involved in training sessions on practical skills for nursing care for chronically ill patients affected by NCDs and provision of home-based care. As a result, around 115,000 inhabitants of the communities served by these nurses are receiving a broader range of services of better quality.


Contact:
Irma Qehajaj 
Health for All Project (Albania)
info@hap.org.al 

​Photo: ©HAP 2022

Global Act on NCD Week – participation of the Republic of Moldova

Non-communicable diseases continue to kill around 41 million people every year, accounting for over 70% of all deaths worldwide and causing half of all global disabilities. Moldova experiences a high NCDs burden, particularly high rates of CVDs with 35% of all deaths in Moldova due to hypertension alone. In the last years, Moldova has made strong commitments to address risk factors and non-communicable disease prevention, strengthening intersectoral collaboration and community empowerment for health promotion focused on behaviour change and capacity building on evidence-based health planning using health profiles.

Moldova joined the 2022 NCD Alliance’s initiative “Act on NCDs” with the slogan “Invest to Protect”. The Healthy Life Project facilitated this collaboration with the Ministry of Health, National Agency for Public Health, Local Public Authorities, medical institutions and civil society organizations. Public events, communication campaigns to raise awareness of preventable behavioural risk factors (Flash-mob, marathon, and dances) and NCDs screening (checking blood pressure, blood sugar, and body weight) and consultations and informative support on nutrition and healthy diet were organized at the district and community levels, involving more than 30’000 people.

With inputs from:
Lilia Onea, Ala Curteanu & Helen Prytherch

More information
Contact: 
Constantin Rimis
SDC’s Healthy Life Project: Reducing the Burden of Non Communicable Diseases (NCDs) in Moldova
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Photo:
©Healthy Life Project

Effect of Training Programs on the Performance of Health Managers

Delivering tailor-need management trainings, using adequate methods and content was fundamental for improving the Health Managers’ performance. Out of 438 doctors and nurses in managerial roles who attended the trainings, 48.5% were women and 51.5% were men, working in Main Family Medicine Centers (MFMC) and Directorate of Health and Social Welfare (DHSW) across all Kosovo municipalities.

“These training courses have shaped me professionally. As a newly elected manager, aiming to do a good job, I found the professional support I needed to work in such a challenging environment! What I found valuable then, is that I’ve had a motivated team dedicated to implement best practices that I have learnt during the training courses!” said Dr. Luljeta Zahiti, Manager at MFMC of the Municipality of Vushtrri (2014-2021).

Planning and implementation of Primary Health Care services, management of healthcare resources, healthcare finance management, management, leadership and partnership, quality management, monitoring and evaluation.

Based on the Health Managers’ impressions, being in a supportive learning climate helped them improve further communication in the team, boost their morale and cooperative spirit.

“Personally, the management training helped me to increase productivity of all employees by motivating and promoting value. As a manager, it increased my confidence, and ability to implement strategies, mitigate internal conflict and train subordinates to perform better.” said Dr. Fevzi Sylejmani, Manager at MFMC in the Municipality of Mitrovica.

This capacity building intervention seeking to improve management capacities was accompanied by mentoring and coaching support at the health centers. International Experts and AQH team continually support and guide the Municipalities on change implementation. Primary Health Care management sees the quality management cycle as a guiding process for designing, implementing, monitoring and evaluating quality improvement projects. To this end, the municipalities depend on these principles when designing the long-term Primary Health Care strategic planning.

Contact: 
Zana Aqifi
SDC’s Accessible Quality Healthcare Project implemented by Swiss Tropical and Public Health Institute
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Photo:
©AHQ projects

Community perceptions of facilitators and barriers to postnatal care in Laos

Qualitative research was conducted in the two districts in Luang Prabang (LPB) Province where the Swiss Red Cross implemented its Maternal, Neonatal Child Health (MNCH) programme, Chomphet and Phonexay Districts. 33 in-depth interviews and six focus group discussion (FGD) were conducted with 54 women who had given birth in the last six months.

The research found that traditional practices, problems in road access, and transportation costs are barriers to access postnatal care, particularly for the second and third visit as recommended by WHO. In order to sensitize mothers and caretakers for the importance of PNC, as well as ease access to PNC, the project team, together with Laos Health Services, developed a PNC self-assessment tool for mothers and their newborns within the PNC period. The mother and caretakers in the household are instructed by the health workers on how to do the self-assessment and how to use the self-assessment form. If any of the signs and symptoms depicted on the self-assessment form are detected, the health worker must be informed either by telephone or by visiting the health center.
The self-assessment tool is presently being tested and was evaluated end of October 2022 and will be shared in the next newsletter.



Find the full report here

Contact: 
Monika Christofori-Khadka
Swiss Red Cross
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Photo:
©Swiss Red Cross

Impact of Air Pollution on Maternal and Child Health Project in Mongolia

In winter months, the levels of PM2.5 pollution in Ulaanbaatar city (UB) can reach 1,985 micrograms per cubic meter — nearly 80 times the level WHO estimates as safe. The vast majority of pollution is caused by the burning of coal for heating of gers (i.e. traditional tents). Children in particular are suffering from a dramatic increase in morbidity and fatality rates due to increased exposure to air pollution during the cold season. Pneumonia is now the second leading cause of under-five child mortality; and a 3.5-fold increase in fetal deaths in the winter months has been documented in UB. These harmful effects are likely to manifest throughout their lives - limiting their ability to learn and later to earn a living and fulfil their potential as adults - in turn fueling intergenerational cycles of disadvantage.

SDC commissioned UNICEF Mongolia to implement the aforementioned four year project. At the impact level, the project aims to contribute to: 1) reduced prevalence of pneumonia among children under 5; and 2) reduced incidence of pregnancy risks related to air pollution. In order to achieve the impact, the project aims to achieve the following outcomes: 1. Improved capacity to generate and disseminate data, research, analysis and information on air pollution and maternal and child health (MCH); 2. Preschool children and pregnant women are at lower health risk from air pollution through community-level risk reduction measures; and 3. Maternal and child health (MCH) risk reduction measures are integrated in relevant national and local policies.

Swiss TPH was mandated to conduct the external final evaluation of the project, which is ending in December 2022. Our team, consisting of a MCH and evaluation expert (Dr. Leah F. Bohle), and two air pollution experts (Mrs. Meltem Kutlar Joss and Dr. Delgerzul Lodoisamba) conducted the evaluation. The team used a mixed-method approach, including a document review, key-informant interviews, focus group discussions, site visits, and a validation workshop among stakeholders. The evaluation was guided by the OECD criteria.

The project was rated as highly relevant and stakeholders confirmed the positive impact of activities. Particularly the introduction of innovative solutions, and advocacy leading to behavior change at various levels, need to be emphasized. The evaluation resulted in three recommendations and seven suggestions which are currently taken up by the UNICEF Mongolia team.

Contact: 
Leah Bohle
Swiss Tropical and Public health Institut
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Photo:
©Leah F. Bohle

Piggybacking on Maternal and Neonatal Health programs to address NTDs in Nepal

​​​Background

More than a billion people across the world, 1 in every 6, are infected by at least one of the twenty Neglected Tropical Diseases (NTDs). Many of them are ancient diseases, have a burden at least the same as tuberculosis and malaria, yet remain largely overlooked, best characterized as a “chronic pandemic”. Most NTDs have low mortality rates but people suffering are subject to severe lifelong disabilities. The ‘neglect’ of NTDs therefore not only refers to the diseases but also the people who represent the bottom billion, the poorest of the poor, most marginalized, stigmatized and often have no political voice. The systematic neglect is well represented in the official development assistance provided to NTDs, a mere 0.6% share compared to for example 36.3% for HIV. The NTD roadmap 2030 from the World Health Organization (WHO) identifies two main cross-cutting approaches to tackle their burden: ‘mainstreaming into Health Systems’ and ‘coordination with relevant programs’.

Project Setting

The Essential Health Project (EHP) is a registered health project collaborating with the Nepal government, managed by the Swiss NGO FAIRMED, along with other civil society organizations, tackling a wider scope of health systems strengthening, with focused activities in both Maternal and Neonatal Health (MNH) and NTDs (focus on Leprosy & Lymphatic Filariasis) programs.

The focus on these two NTDs stems from the high co-endemicity, very similar self-care management methodologies and functioning joint services in Nepal by various NGOs in partnership with the local government. The geographical spread of the EHP project spans across three districts in the Terai plains of Southern Nepal, namely Kapilvastu, Rupandehi and Nawalparasi West. The EHP has been running since 2019 with the goal of improving the health status of communities through accountable and equitable health service delivery systems. As of 2021, the project has reached 8’918 pregnant mothers and newborns, 573 NTDs (Leprosy + Lymphatic Filariasis) affected persons, trained 825 health workers, 1’728 female community health volunteers (FCHVs) and 326 health mother groups (HMGs) made of 4’865 members.

Piggybacking on community level MNH program and structures

Rationale:
One program that in recent years in Nepal has made significant progress driven by sustained investments is maternal and neonatal health (MNH), with maternal mortality rates dropping by close to 70% since 2000. The three key activities that have driven progress in Nepal with MNH are strengthening of primary health care centres; establishment of community directed interventions; and sustained knowledge diffusion through mothers’ groups. There is growing evidence in how NTDs disproportionately affect women and children in Nepal, not only during pregnancy due to anaemia and iron deficiency, but over the life-course for socio-cultural reasons and because of the stigma it causes. Therefore, identifying pathways through which MNH programs and engaging women can lead to effective interventions tackling NTDs, is critical.

Key actors and their roles:
  • MNH program: Female-Community-Health-volunteers (FCHV), Health-Mother-Group (HMG)
  • MNH structures: Health-Post-In-Charge (HP-IC), Auxiliary-Nurse-Midwife (ANM), Auxiliary-Health-Worker (AHW)
  • Health leadership: Municipal, District and Provincial health departments
  • Community members: Leprosy & Lymphatic filariasis Self-Help-Groups (SHGs) and local civil society organizations (CSOs)

FCHV: Female Community Health Volunteers – Community-level maternal & child health program. The cadre was created to enable safe birthing and motherhood. They are members living in the local community they work in.

Health Mother Groups: A group of usually 15-20 women of child bearing age in each small village, formed specifically to disseminate government programs and MNH related best practices. One of the group members is elected to be the FCHV. These mother groups are formed by the local government in partnership with the community members and form a critical part of the MNH structures in the community.

Health post in-charge: They are not medical doctors, but health assistants whose responsibility is to ensure the smooth functioning of that ward’s health post and to execute the maternal and child programs. The responsibility also includes managing auxiliary nurse midwives (ANM), auxiliary health workers (AHW), skilled birth attendants (SBA) and a sanitation worker.

Auxiliary Nurse Midwife: Responsible for antenatal, birthing, and postnatal care of women attending the birthing centre located within the health post.

Auxiliary Health Worker: Responsible for outpatient department, monthly outreach clinics and skin camp coordination.

Self Help Group: Group of people affected by either leprosy or lymphatic filariasis. They are officially registered, meet once a month, are trained on self-care by health post in-charge and registered in the health post to facilitate timely follow-ups if needed.

How the program works:

The starting point of this integration are naturally the MCH programs and structures. It starts with first creating a pool of NTD trainers, through a training of trainers. This is a 5-day training and involves doctors who are government health workers from the region and based in the region.

This is then cascaded down to the health workers who are based in the periphery health posts, the first point of service delivery to the people in the community. This is a 3-day training that involves practical real-life scenarios on when to screen, suspect, diagnose and confirm NTDs, for example, during Antenatal care (ANC) visits, or immunization camps or monthly outreach camps or post-natal care (PNC) home visits etc. This is often provided to health post in-charges, nurse midwives and auxiliary health workers. They then train community health volunteers and persons affected. This way the system is strengthened on NTD knowledge and practical implementation in everyday work of the health system.
Figure-1: The training cascade that is the trigger for integration


The key modes of how the intersection happens are:

Community Awareness: Trained community health volunteers (FCHV) disseminate NTD awareness messages through the mothers’ groups meetings and their community visits. The mothers then become key channels through which awareness further spreads within the community.

Case detection: The FCHVs also play a key role in various other health campaigns (immunization, Vitamin A, NCD camps) and are visiting door to door most of the community members within their catchment areas. Opportunistic screening and initial suspicion of leprosy or lymphatic filariasis is done through this.

Another point of intersection is during the (Antenatal care) ANC visits from pregnant women to their local health post. This is when the NTD-trained nurse midwives, who conduct the ANC check-ups, also screen the women for NTDs endemic in that region. Once someone has been diagnosed positive for an NTD, say leprosy, they are counselled and recommended for treatment. Where challenges do remain is in following-up with further contact tracing in the communities. This is a complex issue owing to the highly stigmatized nature of some of these NTDs, where maintaining privacy becomes extremely critical. The ANC visit compliance rate is increasing consistently in Nepal and has been significantly incentivized monetarily by national and local governments. This provides a major boost and rationale for this integration.

Yet another intersection happens when the NTD-trained auxiliary health worker (AHW) visits the community once a month, during outreach camps. These visits usually happen in communities that live more than an hour’s walk away from the nearest health post. During these outreach clinics the AHW screens for leprosy and lymphatic filariasis amongst those who visit these monthly camps. Once suspected, they are referred to the health post for further confirmatory processes. Here is another point where frequent loss to follow-up have been addressed by ensuring the community health volunteers then reach out to the concerned community members to visit the health post and seek service, usually along with social mobilizers of the EHP project.

Community based rehabilitation: Those identified with disabilities or physical impacts from the NTDs already manifesting, are provided with self-care training by the trained health workers and FCHVs. This ensures effective wound care management and improvement of conditions. The affected persons are also at a certain frequency provided with supportive supervision on self-care by trained health workers and social mobilizers in the community, often in their homes.
Figure-2: Flow-chart of the modes of integration of MNH and NTD


The engine that coordinates and manages these complex partnerships and engagement is the project managers and social mobilizers, who are members of the local villages, recruited into the project by FAIRMED and its partner Nepalese civil society organizations. They ensure consistent coordination at all three tiers of the federal structure of Nepal and persistent, rigorous mobilization at a household-by-household level in the community, with the people.

What is coming up - Sustainability and country ownership

The key next steps are for the scaling up to all endemic districts within Nepal, within the country national program and limited external dependency. An operational research study has recently been concluded on this piggybacking approach, on what works, what does not and where the challenges lie. The publishing of this research in the coming months will provide key insights.

Two key actions in the recent months indicate optimism for such developments.
  • The NTD training cascade started in the EHP project was adapted, updated, and launched as the government of Nepal (Lumbini Province) official NTD training manual.
  • For the first time, this training manual was backed up with governmental budgetary allocation towards its implementation in the most recent June 2022 budget cycle.
These are green shoots that if nurtured, sustained, and followed up could lead to a big boost towards addressing the needs of people affected by NTDs in Nepal.

Recent visit by Swiss Alliance against NTDs (SANTD) and International Federation of Anti-Leprosy Associations (ILEP) delegates

In combination with the ‘2022 international NGO conference on NTDs’ in Kathmandu, a three-person delegation from ILEP and SANTD, visited the EHP project in Lumbini Province, to see this integration of MNH and NTDs in action. This will pave the way for wider international dissemination of such pragmatic operational and opportunistic integration mechanisms to address the persistent and often nationally, severely under-funded NTD programs.

Contact: 
Bharath Sundar
FAIRMED
Photo: NTD screening during Antenatal care (ANC) visit of pregnant women​
​©FAIRMED


Products Development Partnerships and their donors meet in Geneva

Representatives of key donors and Products Development Partnerships (PDPs) met in Geneva in October 2022 upon initiative of the SDC to discuss about collaborative working and allow strategic discussions on key issues related to R&D, access and financing. The complementarity of global health actors, the importance of Geneva and the contribution of PDPs on PPR were also highlighted at an event at the Swiss Residence.

A product development partnership (PDP) is a non-profit organizational structure that enables the public, private, academic, and philanthropic sectors to aggregate funding for the development of drugs, vaccines, and other health tools as public goods. PDPs target neglected diseases whose solutions lack commercial incentives, and which disproportionately affect people in developing countries. The SDC currently supports four PDPs: Medicines for Malaria Venture (MMV), Foundation for Innovative New Diagnostics (FIND), Drugs for Neglected Diseases initiative (DNDi) and the Innovative Vector Control Consortium (IVCC). The PDP Funders’ Group (PFG) is an informal network of the main public and private organizations providing funding to one or more Product Development Partnerships (PDPs). The PFG was created 20 years ago to bring together funders with a common interest in supporting PDPs. Since then, a great deal has been achieved, primarily focused on developing a united approach and set of reporting tools for PDPs to use with all funders. The Group meets every other month virtually in order to 1. Exchange information on ongoing funding projects and 2. Coordinate approaches and funding strategies on R&D and Access of medical products.

Mid-October. The SDC hosted a three days meeting that brought together 40 representatives of PDPs and their main donors. Colleagues from Australia (DFAT), Germany (KFW), the Netherlands (MoFA), the Republic of Korea (KOICA), Switzerland (SDC), the United Kingdom (FCDO), the United States (USAID), the Bill & Melinda Gates Foundation and Wellcome were present. PDPs were: MMV, IVCC, FIND, DNDI, IAVI, IVI, TB Alliance, Pop Council and GARDP. A first day for donors only was the opportunity to exchange on global R6D funding, funding strategies and priorities. The second day focused on issues to be addressed by the combined efforts of funders and PDPs such as:

  • How to address late-stage product development, preparation for introductions to countries and markets, and access requirements.
  • Obstacles in the current system for prequalification and country approval of new products.
  • How to match expectations with current and future funding envelopes.
  • How to take best advantage of changes in the global health ecosystem since COVID, including increased focus on pandemic preparedness.
  • How to consider non-financial resources and how they can be identified, increased and shared

The Swiss Representative to the UN, H.E. Jürg Lauber, welcomed the group for a reception at his residence in Cologny. During a brief panel discussion, David Reddy (CEO of MMV), Mel Spigelman (CEO of TB Alliance) and Françoise Vani (Global Fund, External Relation Director) discussed the complementarity of Geneva-based health actors, the value of Geneva as global health capital and their contribution to the pandemic preparedness and response.

Contact:
Olivier Praz
SDC Health Focal Point, Senior Policy Advisor, Switzerland
olivier.praz@eda.admin.ch​


Cover photo: ©Helvetas / Flurina Rothenberger​​