Table 1 Summary of unmet needs, possible reasons for unmet needs, and new challenges and questions, grouped by main topics of debate

Mass Drug Administration (MDA)

and post-MDA phase

Preventive chemotherapy and transmission control (PCT)-NTDs

PCT-NTDs

PCT-NTDs

• Ensure access to MDA for adults where disease burden is high

• Ensure access to MDAs for disable individuals

• Ensure treatment at PHC level for those that may have missed MDAs

• Limited financial support to target adults in MDAs

• No drug donation available for adults during MDAs

• Drugs donated for MDAs are not available at the PHC level outside campaigns

• Possibly not adequate attention to disables and their need to access to treatments

• Can drug donation be extended to adults (where needed) and be made available at the PHC level?

• Low prevalence reached in some areas where MDA has been ongoing for several years – is MDA still cost-effective if infection is very low (5%–10% prevalence)?

• Risk of disease re-occurrence and/or increase back to initial levels if MDAs are stopped after reaching very low disease prevalence

• MoH very likely in need to take on cost of treatment (including adults) in post-MDA, and/or post elimination phases if there is disease recurrence, and affected individuals still present

Intense Disease Management (IDM)-NTDs

IDM-NTDs

IDM-NTDs (& non NTDs)

• Roll out of blanket treatment for some IDM –NTDs easily managed with annual routine treatment (e.g. yaws)

• Disease mapping not performed as sensitives and specific RDTs not currently available (hence routine treatment cannot be rolled out)

Other diseases that were controlled by MDAs (e.g. scabies, strongyloidiasis, teniosis, cysticocercosis) could become a challenge after MDA campaigns stop, and health structures do not have adequate resources to treat these diseases

Re-mapping after MDA cycle

Monitoring disease transmission

PCT-NTDs

PCT-NTDs

PCT-NTDs

• Mapping of hypo endemic areas after an MDA cycle

• Monitoring disease transmission in pre-elimination stage for certain PCT-NTDs

• Limited availability of sensitive and specific rapid diagnostic tests and /or laboratory tests to assess current infection and disease transmission in low endemic areas

• How would it be possible to confirm disease elimination, and absence of disease recurrence in post-elimination phase if disease transmission and/ or incidence cannot measured?

IDM-NTDs

IDM-NTDs

IDM-NTDs

• Disease burden for many IDM-NTDs and in many countries, where historically reported

(Mapping of these diseases not performed)

• Limited tools and RDTs to map these diseases

• Limited knowledge on how to triage, diagnose, confirm and report cases at the PHC level, for information on disease burden

• Limited resources in laboratories at the heath care level to confirm disease transmission

• How would it be possible to confirm disease elimination, and absence of disease recurrence if the real burden of some of these is not yet known?

Community and community health workers engagement

(CHW = personnel either working on a volunteer basis or occasionally compensated with incentives)

PCT-NTDs

PCT-NTDs

PCT-NTDs

• Engagement of the community in public health interventions to take into account their specific needs

• Community technical support, supervision and motivation for the sustainability of ongoing community health interventions

• Financial recognition of the work already performed by CHWs in MDAs and in integrated MDAs

• Top-down approaches preferred in public health interventions

• Ministry of health limited financial and human resources to support communities in disease prevention, treatment and management (when it could be done at community level)

• Local/national financial limitations for the formalization of CHWs’ role in the health structure, and absence of a clear plan on how to do it

• How can the last cases be found in an elimination context if communities are not educated and sensitised?

• Are the governments willing to retain CHWs and ensure the sustainability of their engagement?

IDM-NTDs

IDM-NTDs

IDM-NTDs

As above

As above

• CHWs workload likely to increase in interventions aimed at disease detection and management at the community level

Primary health care structure:

Case finding and confirmation

Surveillance

Recording disease incidence

PCT-NTDs

PCT-NTDs

PCT-NTDs

• Availability of clear case definitions for suspected and confirmed NTD cases at the health structure level

• Guidance on case finding (active finding)

• Adequate training on patient triaging procedures

• Adequate laboratory resources to confirm NTD cases

• Guidance on how to report disease incidence

• Development of operational NTD surveillance strategies, and work plans

• Revised reporting templates reflecting countries NTD reporting priorities

• Absence of clear guidance at the national level, on disease surveillance approaches

• Very limited monitoring and evaluation process to assess data quality in health data routine reports provided by health facilities

• Iinternational guidelines on surveillance not in line with the new vision on NTD elimination or simply non existent

• Health information system reporting templates not adequate to report NTDs

• Inadequate health data reporting process from decentralized health structures to central level

• Limited national and international interest and \financial support in disease surveillance and in setting disease surveillance strategies

• Post MDA surveillance – how can it be set up if the health system in place does not have enough technical, human and financial resources to implement disease surveillance?

• Emerging and re-occurring diseases: how would it be possible to ensure that diseases that have been eliminated, do not reappear due to neighbouring endemic countries, migrations, wars, and political instability?

IDM-NTDs

IDM-NTDs

IDM-NTDs

As above

As above

• Inability to obtain disease incidence and disease trends

• Low likelihood to confirm disease elimination if disease transmission or incidence are not obtainable

Disability prevention

Intense case management

Home care management

PCT-NTDs

PCT-NTDs

PCT-NTDs

• Disability and complications related to untreated PCT-NTDs and to IDM-NTD adequately addressed in the NTD elimination plans

• Resources to ensure home care management for morbidity related to untreated NTDs

• Disability management related to NTDs not a public health priority in NTD national plans developed in the last decade

• Limited financial support for disability prevention and case management

• People impacted by severe complications related to untreated NTDs are likely to be those individuals living in remote areas – how do we reach them and how can we ensure access to adequate health?

IDM-NTDs

IDM-NTDs

IDM-NTDs

• Adequate resources for managing patients with these diseases at the PHC level

• IDM-NTD case management addressed in the NTD elimination plans

• These diseases have not been adequately addressed in NTD national plans developed in the last decade

• Limited interest in managing these disease due to difficult management, and inadequate resources for disease detection

As above

Integrated disease prevention, management and surveillance of all NTDs

PCT & IDM-NTDs

PCT & IDM-NTDs

PCT & IDM-NTDs

• Integration of these diseases not addressed so far as NTD programmes were generally disease focused (vertical approach), or PCT focused (with integration limited to PCT NTDs)

• Disease focused approaches generally preferred by donors (as easy to assess in terms of outcomes and impact), and more manageable at the MoH level

• MoH NTD master plans generally referring to PCT NTDs only as priority, and not adequately addressing IDM diseases, more difficult to manage

• Integration of disease management at the MoH level will be challenging due to human resources and programme structure specifically establish for disease focused programmes

• Fear of losing positions, jobs and power at every level of the health structure if disease management integration is performed

• Donors to be convinced for allowing financial support initially provided for one disease, to be used for several diseases that may be more effectively dealt with if integrated

Integrated Vector Management

Vector borne NTDs (PCT and IDM)

Vector borne NTDs (PCT and IDM)

Vector borne NTDs (PCT and IDM)

• Testing current vector control strategies in terms of entomological and epidemiological efficacy to assess what works and what does not work

• Integration of entomological surveillance and vector control strategies in the national NTD prevention plan

• Development of new insecticides to cope with emerging insecticide resistance

• Absence of adequate financial support for the development of new insecticides

• Limited technical resources on integrated vector control

• Limited guidance on how to assess what is actually feasible and cost effective

• Limited human resources in developing and piloting new integrated vector control strategies

• Integrated vector control has not been a priority so far in endemic countries

• Vector control for NTDs has not been fully exploited as opportunity for disease prevention

• Lack of international interest in vector control for vector borne NTDs

• Impact of climate change on vector distribution: how do we challenge the spreading of vectors and the subsequent emerging and re- occurring of vector borne diseases if vector control has been so far an untapped opportunity for disease prevention?

• Undeveloped integrated vector control framework in some low income countries, especially in the African continent: how to we address this gap considering the current emerging vector borne diseases?