Introduction

At a joint action Forum  held in Kuwait in December 2011, it was reaffirmed the endorsement to pursue the elimination, through implementation of preventive chemotherapy interventions, for selected neglected tropical diseases (NTDs) in Africa, in the context of increased support to community level health systems strengthening.

NTDs lead to chronic and debilitating physical and mental symptoms which affect about two billion people worldwide including more than 500 million children. The African region bears about 40% of the global burden of neglected tropical diseases.  47 countries of the region are endemic for at least two of the NTDs while 36 of them are co-endemic for at least 5 of these disease which affect the most vulnerable people and the poorest communities. 

Working groups of stakeholders involved partners of World Health Organization (WHO), World Bank, National Governments of endemic countries, non-governmental development organizations (NGDOs), pharmaceutical firms, and financial development donors, including Kuwait Fund, were convened several times during 2015 to facilitate consensus on key aspects of anew NTD program, to pave the way for implementation to control and eliminate selected diseases that require preventive chemotherapy (pc-NTDs).

The Expanded Special Project for the Elimination of Neglected Tropical Diseases (ESPEN)

ESPEN was established during 2016 within the regional office of Africa of World Health Organization (WHO/AFRO), in consultation with the main stakeholders that endorsed the plans of action for the period for 2016-2020.  ESPEN is a regional programme for the control and elimination of five preventive chemotherapy for neglected tropical diseases (5-PC-NTDs) to protect millions of people in Africa by 2020, as phase one.

Goal and Objectives

The goal of the program is to contribute to an accelerated reduction in the burden of diseases of the 5 pc-NTDs, by providing technical supports for endemic countries in their efforts to control and eliminate targeted NTDs, and thereby contributing to poverty alleviation, productivity, and improve quality of life of affected people in the African region, taking into account the full advantage of effective donated medicines.  The main objectives to achieve such goal are:

• Provision of technical assistance and supports to national governments
• Assist in capacity building of national and region experts
• Provide supports to communities to scale-up implementation efforts

The program has developed coordinated mapping and mass drug administration guidelines for the benefits of countries in the implementation of their NTD plans of actions.  Coordinated interventions against NTDs integrated within the primary healthcare remains the best approach for achieving eradication, control and elimination targets.

Selected Diseases

The program focuses on the elimination of 5 pc-NTDs which are the most endemic in the WHO African region:

1. Lymphatic Filariasis (LF): affects about 120 million people worldwide, the African region accounts for 30% of the global burden, and more than 400 million people living in at risk areas in Africa.
2. Onchocerciasis (ONCHO):  About half a million people are blind mostly in Africa, and 18 million people need annual treatment.
3. Schistosomiasis (SCHISTO):  endemic in over 90% of the WHO African region, about 450 million people are at risk of contracting the diseases, 43% of them are school aged children.
4. Soil transmitted Helminthiasis (STH): about 2.2 billion people are infected worldwide, and about 150,000 die annually, about 290 million need treatment every year in Africa.
5. Trachom (TRA): about 2.2 Million people being visually impaired worldwide, about 185 million people are living in at risk areas in Africa.

The main reasons for selecting above mentioned diseases are:

• Availability of preventive chemotherapy drugs donated free of charge by pharmaceutical firms.
• Availability of know-how technology for field surveying and mapping.
• Experience gained in mass drug distribution and administration.
• Commitments of national governments giving priority of NTDs to be integrated in the primary healthcare.

The program is guided by a steering committee and Regional Program Review Group (RPRG) to:

• Ensure action plans with sound technical, logistical and financial supports
• Review and make recommendations on budget and allocation of funds and mobilization.
• Review strategic and action plans of National NTDs groups for achieving their targets and goals.
• Review and approve technical results of mapping and advise on required interventions.
• Provide appropriate mentoring and technical guidance.
• Identify gaps and needs.

Budget Distributions

An estimated amount of US$ 10-12 million are required annually to execute the high priority actions and cover the key activities which include technical supports such as epidemiological and entomological surveillance, mapping and monitoring, in addition to drug administration interventions, transmission control and planning and resource mobilization.  Also, to conduct technical review meetings, office running costs, logistic support, such as equipment and furniture supplies, conduct workshops and training, and strengthening human resources capacity building.

Partnership

WHO, represented by its regional office for Africo (WHO/AFRO) is responsible for the monitoring and implementation of the plans of action.  The programme is a collaborating partnership between the following:

1.      Endemic Countries:  Review their needs and mobilize financial resources at national level.  They provide assistance to facilitate the activities of NGDOs involved.

2.      Financial Donors:  Participate in financing the activities, as well as review plans of action at regional and national levels.  They also play an active role in monitoring the stream of funds at country and regional level.

3.      Donors of Medicines:  Ensure delivery of medicines as requested in coordination with national programmes, WHO and drug donation programmes.

4.      Non-Governmental Development Organizations (NGDOs):  Composed of a number of organizations and institutions in collaboration with ministries of health in endemic countries and national NGOs.  They are involved in the management, financing and capacity building.

Role of WHO/AFRO:  Ensure coordination functions as follows:

• Serves as the Secretariat
• Undertake advocacy and communication
• Facilitate ministerial engagement
• Coordinate cross-border activities
• Organize peer reviews by countries
• Prepare documentation and disseminate experience
• Promote scientific and research activities
• Provide technical guidance and support
• Undertake regional planning, surveillance, monitoring and evaluation
• Facilitate management and logistics

Fiscal Agents:  Responsible for the establishment and management of trust fund. Assist in resource mobilization.

Financing Mechanisms:  The funding required is through multifaceted approach including direct donor contributing to countries, direct funding by government of endemic countries, pooled donor funds through a trust fund, and direct donor contributions to NTD entity.  Some donors support countries  directly through NGDOs that support implementation in the countries.

Stakeholders:  The required budget in mobilized from different sources including international and domestic financial contributions.  The list of stakeholders include but not limited to donors (Kuwait Fund, World Bank, DFID, END Fund, USAID, ADB and others), Pharma and medicine donation programmes, NGDOs and endemic countries.