SeriesIntegration of control of neglected tropical diseases into health-care systems: challenges and opportunities
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,
References (58)
“Neglected” diseases but unrecognized successes—challenges and opportunities for infectious disease control
Lancet
(2004)- et al.
Advancement of global health: key messages from the Disease Control Priorities Project
Lancet
(2006) - et al.
Translations of health sector SWAps—a comparative study of health sector development cooperation in Uganda, Zambia and Bangladesh
Health Policy Plan
(2006) - et al.
A blueprint for success: integration of neglected tropical disease control programmes
Trends Parasitol
(2006) - et al.
Projected benefits from integrating NTD programs in sub-Saharan Africa
Trends Parasitol
(2006) - et al.
Dracunculiasis (Guinea worm disease) eradication
Adv Parasitol
(2006) - et al.
Control of onchocerciasis
Adv Parasitol
(2006) Lymphatic filariasis: treatment, control and elimination
Adv Parasitol
(2006)Elimination of transmission of lymphatic filariasis in Egypt
Lancet
(2006)Combating the “other diseases” of MDG 6: changing the paradigm to achieve equity and poverty reduction?
Trans R Soc Trop Med Hyg
(2008)
Achieving the Millennium Development Goals
Lancet
Priority setting and the ‘neglected’ tropical diseases
Trans R Soc Trop Med Hyg
Neglected tropical diseases and the Global Fund
Lancet
Rescuing the bottom billion through control of neglected tropical diseases
Lancet
Performance of predictors: evaluating sustainability in community-directed treatment projects of the African programme for onchocerciasis control
Soc Sci Med
“Rapid-impact interventions”: how a policy of integrated control for Africa's neglected tropical diseases could benefit the poor
PLoS Med
The neglected tropical diseases: the ancient afflictions of stigma and poverty and the prospects for their control and elimination
Adv Exp Biol Med
Mass campaigns versus general health services: what have we learnt in 40 years about vertical versus horizontal approaches?
Bull World Health Organ
A framework for assessing the performance of health systems
Bull World Health Organ
District health systems in a neoliberal world: a review of five key policy areas
Int J Health Plan Manag
Programme activities: a major burden for district health systems?
Trop Med Int Health
Primary health care: from aspiration to achievement
World Health Forum
Integration of health care delivery. Report of a WHO Study Group
WHO Tech Rep Ser
Core Health Indicators 2007 Database. Per capita government expenditure on health at average exchange rate (US$)
Eradication: lessons from the past
Bull World Health Organ
Resolution 50.29
Global leprosy situation, 2005
Wkly Epidemiol Rec
Towards the elimination of onchocerciasis
Ann Trop Med Parasitol
Control of Chagas disease
WHO Tech Rep Ser
Cited by (112)
Larvicidal potential of gold and silver nanoparticles synthesized using Acalypha fruticosa leaf extracts against Culex pipiens (Culicidae: Diptera)
2021, Journal of Asia-Pacific EntomologyAedes-borne viral infections and risk of emergence/resurgence in Sub-Saharan African urban areas
2020, Journal of Biosafety and BiosecurityHave there been efforts to integrate malaria and schistosomiasis prevention and control programs? A scoping review of the literature
2024, PLoS Neglected Tropical DiseasesProvider and User Acceptability of Integrated Treatment for the Control of Malaria and Helminths in Saraya, South-Eastern Senegal
2023, American Journal of Tropical Medicine and HygieneReconstructive Surgery for the Neglected Tropical Diseases: Global Gaps and Future Directions
2023, Plastic and Reconstructive Surgery - Global Open