Kabatereine Narcis

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Kabatereine Narcis
AFRICAN SCI CAPACITY BUILDING ADVISOR BASED IN
UGANDA

• NEED FOR IMPROVING IN-COUNTRY CAPACITY FOR BETTER
  DELIVERY.

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Some of my roles

• As SCI Capacity building advisor and as a member
  of WHO/Geneva WG for Capacity building, I
  participate in
• Identifying existing efforts and gaps in CS and
  Prioritize needs in order to accelerate rate of
  scale up of country programmes,
• I participate in training consultants who train
  country staff,
• I train country staff as SCI Capacity building
  Advisor or on behalf of WHO.
• Examples of existing CS courses include
• NTD Programme Managers Course
• ME course
• Working on district managers training course
• As a Member of WHO/RPRG, reviewing progress of
  country NTD Programmes and advise on way forward.

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According to WHO targets By June 2015, Mapping
of PC-NTDs should be completed in all
countries.Elimination should be achieved by 2020
WHY IN-COUNTRY CAPACITY BUILDING?
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According to existing data on global preventive
chemotherapy,

• Approximately additional 350 million people per
  year must be reached by 2015
• Requiring global rate of
  
  8 to 10
  million new treatments
  
  per month
• This is not being reached at
• The current treatment rate.

Current and projected proportion of people
(2008-2020) receiving PC for at least one disease
among LF, SCH and STH out of the estimated number
of people requiring PC (excluding India and
Bangladesh)
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Mapping gaps at Country and District levels
PC NTDs Countries with Mapping gaps Number () of districts to be mapped
LF 17 655 (14)
ONCHO 12 374 (9)
SCH 22 972 (20)
STH 24 1,031 (21)
TRA 19 1,690 (40)
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PC NTD Mapping Status
Schistosomiasis
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THEMATIC AREAS FOR CAPACITY STRENGTHENING FOR
PREVENTIVE CHEMOTHERAPY
"Sunflower concept"
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Other Areas that urgently require capacity
building include

• Epidemiological survey skills
• Financial management skills
• Social science skills
• Training of health workers on health centre based
  disease management

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For Elimination, We need more sensitive
diagnostic tools

• Eg. Kato Katz method for S.mansoni diagnosis is
  not adequately sensitive
• CCA has been shown to be more sensitive in a
  multi-country SCORE study.
• Uganda and Rwanda are currently re reassessing
  schistosomiasis distribution using CCA
• and capacity building is needed to scale-up use
  of CCA for re-evaluation in elimination phase in
  many other countries.
• .
• CCA can be used as an RDT to improve facility
  based schistosomiasis managemen.

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CAPACIITY BUILDING NEEDED FOR MONITORING IN MOST
COUNTRIES

• Coverage monitoring
• Geographical coverage
• Epidemiological coverage
• Programme coverage

• Impact monitoring
• Prevalence and intensity of infection
• Micro/macro haematuria stool
• Anaemia
• Growth
• Clinical complications
• Educational achievement
• Cost-effectiveness

• Process monitoring
• Drug procurement and management
• Monitoring of side-effects
• Quality of drug distribution
• Training of teachers and CDDs
• Health education
• Political and financial support
• Advocacy and publicity
• Inter-sectoral collaboration, e.g. WASH

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ULTRASOUND Clinical examination of
schistosomiasis

• Ultrasound examination
• WHO guidelines
• portable machine Aloka SSD-500

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Training in integrated vector management(IVM)

• Vector identification
• Pesticide handling and management
• Insecticide applications
• Environmental Impact assessment
• Insecticide resistance management
• testing impact of pesticide applications etc..

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Timely data retrieval and reporting

• Timely data retrieval from the field is a
  problem due to inadequate logistics or demand for
  incentives by volunteer drug distributors.
• However, some electronic tools eg smart phones
  have been tested and they work and such training
  is important.

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Way Forward considering sustainability

• There is need to
• shift from disease-specific to intervention-specif
  ic approaches
• It is important to synergize control efforts with
  existing health systems
• especially with successful in country disease
  control channels eg, ITN.
• Strengthen partnership and NTD coordination at
  National and district levels,
• Strengthen health facility based disease
  management.
• Capacity building needed at country level for all
  these issues.

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SOME RECENT IN-COUNTRY CAPACITY BULDING
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Malawi Over 40 Technicians trained and they have
completed Schisto / STH Map.
Mapping done By the trained Local Techncians
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Rwanda 64 technicians recently trained and are
re-mapping using both CCA and Kato Katz to
produce a map for elimination phase.
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IN ETHIOPIA 175 technicians trained and mapped
500 Woredas including 2790 schools
575 2790
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Coverage validation surveys to evaluate accuracy
of reported coverage
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Main Challenge

• To promote country ownership
• even when CS gap exists,
• it may not be attended to
• until the country feels it as a priority.
• Hence CS scale-up rate is slow.

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Thank you