Cover photo: Member of the Masai community in Arusha, Tanzania, taking preventive chemotherapy during a Mass Drug Administration event in June 2016.
Photo credit: Fay Venegas.
Neglected tropical diseases (NTDs) are 18 communicable diseases identified by the World Health Organization (WHO) which affect an estimated 1.7 billion people globally, mostly in low- and middle-income countries. The impact of NTDs on communities is devastating, often resulting in life-long physical pain, social stigmatization, abuse, and even death. They are disproportionately prevalent in poor populations without adequate sanitation, and impact significantly on maternal and child health and education; on global and national economic output, and on progress towards global development goals. Individuals in endemic regions are often afflicted with more than one NTD at the same time, with children being most vulnerable to infections. In recognizing that long-term sustainable development and improved health outcomes cannot be fully achieved without simultaneously addressing NTDs, Sustainable Development Goal 3 has a specific target to eliminate NTDs by 2030.
Guided by local epidemiology, the most common and debilitating NTDs can be prevented, or even eradicated, with safe, inexpensive treatment, known as preventive chemotherapy. In Tanzania, which is large and geographically diverse, the NTD Control Programme (NTDCP) works with local communities and sub-national health management teams to plan and implement a large-scale community-based delivery approach—known as mass drug administration (MDA) campaigns—for the most common NTDs, namely soil-transmitted helminths, schistosomiasis, lymphatic filariasis, onchocerciasis, and trachoma.
The NTD MDA program in Tanzania relies on a vast network of more than 67,000 frontline health workers, district pharmacists, community drug distributors, volunteers, and teachers, reaching the entire population of 50 million people with 55 million NTD treatments in 2015. NTD medicines are collected from a designated center and administered from house to house, or by setting up drug distribution points such as schools, markets, fairs and other public spaces. However, the supply chain of NTD medicines experiences significant bottlenecks and challenges during MDA campaigns, largely stemming from a lack of training and guidelines for health workers who deliver these campaigns. This has resulted in inadequate quantification, inaccurate data collection and forecasting, poor storage and administration of medicines, and significant wastage of resources.
In light of these challenges, the ADP has worked closely with Tanzania’s NTDCP and the Pharmaceutical Services Unit to strengthen the understanding of methodologies and tools for managing the supply chain logistics of NTD medicines during MDA campaigns. In particular, overseeing this activity arethe Monduli District Commissioner, Mr. Francis Mitti; the Tanzania NTD Control Program Manager, Dr. Upendo Mwingira; and the WHO representative, Dr.Antonio Montresor.
The ADP held stakeholder consultations with representatives of relevant government departments and community-level personnel to identify key gaps and prioritize areas of support. The ADP also facilitated technical consultations with key experts from the WHO and other global institutions in identifying best practices for managing the medicines and other health commodities related to NTD MDA campaigns. A key outcome from these discussions was a set of new guidelines that specifically target the main health actors responsible for implementing NTD MDA campaigns: community drug distributors, frontline health workers (which include health centre and dispensary personnel), and district pharmacists.
These guidelines are important for documenting best-practice procedures on managing and tracking the flow of NTD medicines before, during, and after an MDA campaign. The guidelines have been published as booklets and distributed to all relevant personnel for easy reference. Furthermore, based on these guidelines, the ADP has developed training curricula tailored to each of the relevant groups of health actors. The ADP supported the use of these materials to train 21 national-level master trainers in 2015, and who will conduct cascade training to a further 3,000 personnel in 2016. The booklets and training curricula have been translated to Swahili and approved by the Ministry of Health, and have been integrated into the NTD MDA logistics management training program, the rollout of which is being supported by the ADP.
In the long term, a stronger, more efficient and more reliable supply chain of NTD medicines can ensure availability, reduce wastage of medicines, and improve the effectiveness of MDA campaigns, resulting in dramatic impact on the health of Tanzanians, particularly mothers and children. This will also prepare the health system for future introduction and scale-up of new NTD medicines coming through the pipeline, such as the paediatric formulation of praziquantel to treat schistosomiasis that is currently being developed by a research consortium supported by the GHIT Fund.
Fay Venegas is Senior Procurement Officer at PATH.