Launch of Expanded Special Project for Elimination of NTDs (ESPEN), Geneva, 23rd May 2016

By Russ Stothard and Sally Theobald, COUNTDOWN consortium

This week the 69th World Health Assembly (WHA) is taking place in Geneva at the Palais des Nations, where a variety of satellite meetings are also held to discuss and define the global health agenda.

The regional office of WHO in sub-Saharan Africa – WHO-AFRO – has launched a new initiative entitled ESPEN – Expanded Special Project for Elimination of NTDs. ESPEN brings fresh focus and impetus to act on the elimination of five key neglected tropical diseases (NTDs): trachoma, lymphatic filariasis, onchocerciasis, soil-transmitted helminthiasis and schistosomiasis.

Several other diseases are currently grouped within NTDs, however it is these ‘big five’ that are primarily controlled in sub-Saharan Africa with preventive chemotherapy. The backbone of preventive chemotherapy is to provide large-scale access by routine Mass-Drug Administration (MDA) of donated medications to impoverished and often marginalised populations living with, or at risk from, these NTDs.

Such MDA campaigns are endorsed by WHA resolution 66.12 and typically springboard from the various commitments and pledges made at the London Declaration on NTDs to support national control programmes. Collectively these programmes have WHO 2020 disease control targets firmly in sight with progress also to be tracked within the sustainable development goals (SDGs).

Progress in each country is tracked by national treatment coverage statistics and the use of the NTD scorecard, now in its fourth iteration. The scorecard is important because it grades progress within each disease through a traffic light system. Some disease programmes are doing well and others less so; there are barriers and bottlenecks to operationalising control for each NTD at scale. It is against this landscape, for example, that COUNTDOWN is currently conducting its multidisciplinary implementation research in Liberia, Ghana, Nigeria and Cameroon.

Common to all diseases, nonetheless, is raising and sustaining sufficient domestic funding and resources to implement control at national levels. With a three-word slogan of ‘ownership, transparency and efficiency’, ESPEN hopes to provide technical assistance, fundraising support and collaboration between country NTD programmes and partners. This is to ensure preventive chemotherapy is both cost-effective and eminently affordable for each nation. A significant achievement of ESPEN has been raising just under 10 million USD from USAID, Bill & Melinda Gates Foundation, Endfund and The Kuwait Fund for Arab Economic Development to get progress started.

The launch was packed with a variety of distinguished international and national guests with standing room only. The health stakeholders ranged from Dr Margret Chan, the WHO Director General overseeing the ESPEN launch, to several Ministers of Health, including Professor Isaac Folorunsho Adewole from Nigeria; each participated in panel-led and open-discussions facilitated by Richard Horton, Editor of the Lancet. A short video recently filmed in Accra, Ghana also helped to frame ESPEN’s cause with interviews of Drs Julie Jacobson, Johnny Gyapong and Benido Impeuma.

The WHO-AFRO Regional Director, Dr Matshidiso Moeti outlined why ESPEN was needed to frame the opinions of other panel members. “So what is new about ESPEN?” asked Richard Horton, in his worldly-wise manner having seen other initiatives come and go with success and failure in equal measure. It is true that since the African Programme for Onchoceriasis Control (APOC) came to an end last year and there is now no major NTD programme owned and led by WHO-AFRO.

Bringing together these five NTDs under one banner is a shrewd first step towards the promotion of both cost-effectiveness and health systems strengthening. For example, it encourages programmes to share funds and reduce tensions when donor supply chains are limited. Dr Mwele Malacela, Chair of the Regional Programme Review Group, also pointed out the in-kind resources available in country such as community health workers, ready to synergise with outside support.

Perhaps less new but equally important is to highlight that preventive chemotherapy is still one of the best buys in public health, as emphasized Dr Ariel Pablos-Mendez, from USAID and Ken Gustavsen, from Merck Foundation. Simply put, the investment in NTDs in WHO-AFRO will bring forward many future health dividends, especially in populations unable to afford out-of-pocket health expenditure. Indeed, it is their right to access any intervention which forms part of the basic universal health care package as Dr Dirk Engels, WHO-Geneva, pointed out with special reference to the SDGs.

The meeting was formally closed by remarks from Dr Joseph Cabore who coined the three word slogan of ‘ownership, transparency and efficiency’.

Both Sally and I felt very privileged to attend today along with LSTM colleagues, Joan Fahy and Laura Corbridge, who played significant roles to facilitate the smooth running of this meeting behind the scenes. We also welcomed the opportunity to discuss our COUNTDOWN research with our country partners attending today and our WHO colleagues.

We look forward to supporting ESPEN from within COUNTDOWN to ensure that progress can accelerate towards WHO 2020 targets and beyond.

Find further information online about ESPEN and #beatNTDs on Twitter.

Positive experiences in multisectoral engagement for NTDs – Ghana, Cameroon, Liberia, and Nigeria

By Suzy Campbell, Corrado Minetti, Margaret Gyapong (on behalf of group B)

Across the health continuum it is vitally important to engage with all relevant stakeholders from the outset. Since the inception of COUNTDOWN this has been a priority, which culminated in exemplary examples of multi-stakeholder engagement being presented at our annual partner meeting. Our first year has focussed on defining key NTD evidence gaps and developing workplans to address these. Liaising with our stakeholders at all levels has been a critical factor in ensuring that the work which we intend to achieve within COUNTDOWN is politically and practically meaningful across all components of the NTD community. Hearing from each partner country in turn, there were some amazing similarities in approaches to multi-sectoral engagement, with the following highlights:

  • All countries have invested in inception meetings and stakeholder mapping to ensure that they are reaching all relevant stakeholders. Evidence gaps and subsequent research questions have then been defined in partnership with them
  • Our partner countries are engaging with many government ministries, including, amongst others, departments of local government, education, finance, water resources, and agriculture
  • A strong emphasis has also been placed on involvement with NTD Partners, Academic Institutions, funding agencies and Non-Government organisations at country level. These include but are not limited to World Health Organization, END, Sightsavers, the Partnership for Child Development, the Taskforce for Global Health, the media, national NTD control programmes, community drug distributors and health workers, and NTD partners in academic institutions
  • Various stakeholder meetings, scientific meetings, media events, deworming campaigns and official launches have been organised by COUNTDOWN partners, providing a strong platform upon which partners will be able to disseminate our messages throughout the NTD community.

The highlight of our recently ended Partners meeting in Accra (20th-22nd April 2016) was the rare five minute opportunity to engage with the WHO African Regional Program Review Group for Neglected Tropical Disease, key stakeholder for COUNTDOWN.

This demonstrates the hard work that each of the COUNTDOWN countries has done, with the full spectrum from local communities, to district, national and then international levels represented, and laterally, a broad primary base beyond the traditional health sector. With this engagement from the outset, our vision of achieving a holistic integrated approach to NTD implementation research is already being realised. We look forward to continuing to work with our stakeholders, and capitalising on this momentum, as we progress with our implementation research and uptake.


Photo: Dr Margaret Gyapong leading an energetic discussion with COUNTDOWN partners about the importance of multi-stakeholder engagement!

Introducing COUNTDOWN’s newest partner: UL-PIRE

At the end of 2015, DFID approved the continued inclusion of Liberia within the COUNTDOWN consortium following successful control of the Ebola epidemic. The COUNTDOWN ‘family’ were elated with this confirmation from DFID, emphasising team Liberia’s integral importance within the COUNTDOWN consortium. Given the critical focus on implementation research for COUNTDOWN and the Liberian Ministry of Health (MoH), as plans for the inception year got underway in Liberia, it was clear to the MoH that they needed to engage with a national research partner.

The MoH underwent a transparent and systematic approach to selecting a research partner that would be able to support implementation research for COUNTDOWN in Liberia. Initially, the MoH identified the core competencies that the research partner must have. These were: strengths in COUNTDOWNs core research areas (social science, health economics and evidence synthesis); good financial management capacity; and infrastructure able to support additional staff. Once core competencies had been identified, the MoH identified five possible research partners. Based on their alignment to the above criteria, these five partners were reduced to three by a team at the MoH. Members of the MoH then made site visits to each of the three remaining research partners to understand more about their work and explore synergies with the COUNTDOWN programme. Following these site visits, with the support of the LSTM programme management team, the MoH identified the most suitable implementation research partner for COUNTDOWN Liberia.

Following this detailed selection process, COUNTDOWN are delighted to introduce the University of Liberia-Pacific Institute for Research and Evaluation (UL-PIRE) as our newest implementation research partner. Fred Sosu, Research Coordinator from UL-PIRE was able to attend our recent partners annual review meeting and it was a great pleasure for all involved in the consortium to understand more about UL-PIREs work and explore in detail their involvement in the partnership. UL-PIRE has a wealth of experience in the delivery of health systems research projects as well as those that span other disciplines such as agriculture, water, sanitation and education.  Project evaluation, survey development and administration are core competence strength. With a strong focus on ethics and community engagement they provide unique and innovative perspectives from the Liberian context.

As the inception year continues within Liberia, the Liberian MoH and all other COUNTDOWN partners are very much looking forward to a long and fruitful partnership with UL-PIRE.