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.

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