Elsevier

The Lancet

Volume 375, Issue 9709, 9–15 January 2010, Pages 160-165
The Lancet

Series
Integration of control of neglected tropical diseases into health-care systems: challenges and opportunities

https://doi.org/10.1016/S0140-6736(09)61249-6Get rights and content

Summary

Although progress has been made in the fight against neglected tropical diseases, current financial resources and global political commitments are insufficient to reach the World Health Assembly's ambitious goals. Increased efforts are needed to expand global coverage. These efforts will involve national and international harmonisation and coordination of the activities of partnerships devoted to control or elimination of these diseases. Rational planning and integration into regular health systems is essential to scale up these interventions to achieve complete eradication of these diseases. Programmes with similar delivery strategies and interventions—such as those for onchocerciasis, lymphatic filariasis, and soil-transmitted helminthiasis—could be managed on the same platform and together. Furthermore, better-resourced programmes—such as those for malaria, HIV/AIDS, and tuberculosis—could work closely with those for neglected tropical diseases to their mutual benefit and the benefit of the entire health system.

Introduction

Neglected tropical diseases are still a major public health concern for most developing countries. The five most common neglected diseases are lymphatic filariasis, onchocerciasis, soil-transmitted helminthiasis, schistosomiasis, and trachoma.1, 2, 3 However, with the development of more effective treatments in the past 20 years, several implementation strategies have attempted to control, eliminate, and even eradicate these diseases with varying degrees of success.1 Key determinants of success have been how effectively these treatments and strategies have been integrated into health systems of endemic countries, and the existence, reach, and quality of health systems.1, 2 The traditional debate of vertical versus horizontal programmes has continued.4, 5, 6, 7, 8 Programmes are called vertical because they are directed, supervised, and executed, either wholly or to a great extent, by a specialised service with dedicated health workers. Horizontal programmes seek to tackle health problems on a wide front and on a long-term basis through the creation of a system of permanent institutions commonly referred to as general health services.4, 5 However, such debates should look at how best disease control programmes (especially those targeted for elimination) could leverage the health system and vice versa, to strengthen and improve health-care delivery in general.

Section snippets

Challenges of health-care delivery

Over the years, health-care systems in developing countries have attempted to improve health status with public health interventions (eg, vaccinations, health education, vector control, and drug treatment programmes) for diseases that cause the greatest burden of ill health.6 Basic health service focused on clinical care through the development of a network of clinics to treat the most common conditions.5, 6 Primary health-care programmes in the late 1970s recognised that this network was

Disease elimination and eradication through health systems

Elimination and eradication of human disease has been pursued for more than a century. However, with the exception of smallpox, no disease has been eradicated, although there are encouraging signs for polio and guinea worm.13 Malaria, yellow fever, and yaws eradication programmes had been unsuccessful; nevertheless, they substantially contributed to an improved understanding of the complexities of achieving disease control.13 In 1997, the World Health Assembly passed a resolution for the

Integration of neglected tropical disease control into health-delivery systems

Integration—the process by which disease control activities are functionally merged or tightly coordinated within the context of multifunctional health-care delivery—might be more difficult to achieve than co-implementation of some key activities23, 24 because it increases accessibility and equity of services.25, 26 Experiences with integration processes in several countries show that successful integration requires thorough preparation and planning, and several hurdles need addressing, many of

Financing of neglected tropical disease programmes in an integrated health system

Another challenge to the effective integration of control of neglected tropical diseases into the health system is the financing mechanisms that currently exist for these programmes. Because many of these programmes are established through international resolutions, various attempts have been made to mobilise resources from the international community. Many disease-endemic countries have, therefore, not systematically captured such programme activities in their health budgets nationally and

Conclusions

Neglected tropical diseases are possibly the worst diseases in terms of their destructive effects and their association with political instability and civil strife. They are the most common infections of the poorest billion people, causing chronic, debilitating, disabling, and disfiguring effects. These diseases tend not only to occur in poor settings but also to exacerbate poverty and to destabilise communities.55, 56 Their integration into the health system makes programmes sustainable,

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