Sustainability Plan- Lesson Learnt on Neglected Tropical Diseases in Tanzania- A Mini Review

Introduction

Neglected Tropical Diseases (NTDs) are communicable diseases linked with poverty and prevalent in areas with poor sanitation, inadequate safe water supply and substandard housing conditions [1]. NTDs are estimated to affect over one billion people in the world, majority being in developing countries [1]. NTDs refers to a group of 17 medically diverse diseases prevalent in tropical and subtropical areas in Africa, Asia, and South America [2]. NTD programs in endemic countries are playing a technical and managerial role in addressing NTDs to achieving universal healthcare and the Sustainable Development Goals [3]. Significant achievements toward elimination and control of these diseases are being made and recorded. In this achievement, the resources and funds are provided by different stakeholders; it is notably that non-national governance pledges a high fraction of the support [4]. For ownership and sustainability of interventions against NTDs, it need endemic countries to planning and financing activities and programs to be fully incorporated into health system, national agenda and service delivery structures [5]. The World Health Organization (WHO) has developed a sustainability framework [6] that calls for endemic countries to develop and implement their own country strategic and sustainability planning for NTDs [7].

Background

NTDs are known to debilitate, deform, blind, and kill sizeable proportions of the Tanzanian population [8]. These diseases include some of protozoans, Bacterial, Helminthes and Viral infections for example, Lymphatic Filariasis (LF), Onchocerciasis, Schistosomiasis, Soil Transmitted Helminths (STH), Trachoma, and have been confirmed to be endemic in Tanzania [9].

The focus of NTD Programme-Tanzania- had been on the main 5 Preventive Chemotherapy (PC) (LF, STH, schistosomiasis, trachoma, and onchocerciasis). 5-PC against NTDs reached a geographical coverage of 100% countrywide from 2016 (meaning, Mass Drug Administration (MDA), is provided in all endemic district councils requiring MDA). LF, Onchocerciasis, Trachoma, Schistosomiasis and STH are targeted for elimination, thus, striving to reach the criteria to stop MDA implementation across all endemic councils. Targets for preventive chemotherapy treatment were met in 2018 while in 2019 only two targets (Onchocerciasis and Trachoma) were met. The reason behind for not meeting these targets was lack of fund to support some of the Mass Drug Administration activities. Therefore, Ministry of Health through NTD Control Programme (NTDCP) in Tanzania struggle developed a country Sustainability Plan 2021-2026 for NTDs [9].

Review

Tanzania has developed a current strategic master plan (2021-2026) for NTDs [9]. However, evaluation of implementation a previous NTDs master plan (2012 to 2017), it shows that Tanzania made significant progress towards combating NTDs. The overall prevalence of highly endemic diseases has gone down and the number of endemic districts that need treatment is also going down. The government through health policy 2007 is committed to efficiently prevent and manage the NTDs and dedicated to; (i) Promote public awareness on NTDs, (ii) Increase access to care for people already affected with NTD morbidity, (iii) Enhance NTD management systems, monitoring and evaluation and (iv) Strengthen operational research and surveillance capacity for early detection of NTDs and any recrudescence. A number of successes have been achieved to collaborative effort of local communities, government, partners and implementing team. Some of these successes include; attainment of full (100%) geographical coverage for MDA in all councils (Table 1); MDA for onchocerciasis reached full coverage by 2009, for LF in 2014 and for STH and SCH in 2015/16. Over 42 million people were reached with treatments of Ivermectin, Albendazole, Praziquantel and Zithromax and Scaling down of MDA for LF and trachoma: For Lymphatic Filariasis the country scaled down from the previous 120 endemic districts that needed MDA to 24 (80% reduction) in 2019 and for Trachoma the country scaled down from the previous 71 districts that needed MDA to 6 (92% reduction) districts that needed MDA in 2019.

The Tanzania Sustainability Plan (2021–2026) for NTDs builds on the achievements gained and interventions implemented in order to integrate them into current health system structure through Government commitment to Universal Health Coverage by maintain the gains and interventions of the Neglected Tropical Diseases is among a few key priorities [10]. The sustainability plan identifies four broad objectives that will be the focus of achievement in the next five years. These are; (i) Improve NTD services, both at the facility and community level (ii) Strengthening the availability and quality of NTD data to improve decision making (iii) Integrate NTD planning into wider health systems planning/coordination structure and (iv) Increase Domestic financing of NTD intervention to at least 60% by 2026 [10].

The Sustainability Plan highlights the preconditions necessary to subsequent results of integrating the NTD interventions into the essential health package and provided in routine bases. The document also envisions the commitment of the government financing the NTD interventions at least 60% by 2026. This will go hand in hand with capacitating the healthcare system through improvement of health facility infrastructure, installation of diagnostics equipment and ICT, strengthening the health facilities and LGAs with NTD bottom-up quantification and planning into CCHP following the planning reforms of bottom-up planning. The need for proper training and orientation to the health service providers and Community Health Workers / Community Drug Distributors will be conducted as well as engaging community trusted bodies, civil society organizations, NGOs to promote and address the Gender and social inclusion issues to increase the uptake of Mass Drug Administration to the specific groups of drop out pupils’/street children who could not take drugs because of different cultural or gender barriers [10].

Conclusion

The development, dissemination, and implementation of this sustainability plan in Tanzania and other NTD endemic countries will mobilize internal resources and sustainability in control and elimination of these diseases. Also of note, will be a major contribution to poverty alleviation and attainment of the Sustainable Development Goals (SDGs) [11]: Erasing lifelong debilitating NTDs overcomes poverty (SDG1) and hunger (SDG2), ensure healthy lives and promote well-being for all at all ages (SDG3), improve education (SDG4) and economic growth (SDG8) and serve as tracers for equity and universal access.

The successful implementation of the sustainability plan will highly depend on continuous commitments and collaborative efforts of key stakeholders from government sector, non-governmental sector, and development partners. Creating demand to improve utilization by clients including individuals, households and community will be a crucial part of measuring success of implementation.