Feb 26, 2015
By: Warren Lancaster, Senior Vice President, Programs
I have just returned from the biannual World Health Organization Regional Program Review Group (RPRG) for Africa meeting in Brazzaville, Congo, to which the END Fund has Observer status. The RPRG is a group of leading experts in the field of neglected tropical diseases (NTDs) and in particular the 5 diseases that are eligible for preventative chemotherapy treatment (PCT) using the donated drugs that are distributed once or twice a year through mass drug administration (MDA).
What struck me again is how complex a simple health intervention can be. Broadly, we tend in the NTD sector to paint a simple picture of schoolteachers or village volunteers administering tablets to their students or fellow villagers. The tablets are donated by the international pharmaceutical companies and so delivering treatment is both simple, extraordinarily cheap, and done on a grand scale.
But behind the scenes is a complex mosaic of disease mapping, at-risk population identification, integrated treatment protocols, end-to-end supply chain logistics, coverage surveys and perhaps the most demanding, the determination of when the job is complete.
This is the remit of the RPRG. By the end of 2015 the goal is to have mapped Africa for NTDs. So the RPRG is tasked to review progress against this goal; do we know exactly where these diseases are most prevalent and how many people are infected and with one or multiple diseases? How many people and in what locations should people be tested to give the best representation of infection to be distilled and then visually represented on country maps so we know precisely where to work? We do not want to treat people who are not infected nor miss people who are.
But the numbers of people infected in Africa is colossal. Hundreds of millions of tablets need to be manufactured by different pharmaceutical companies on different continents, consolidated and delivered to more than 40 African countries in good time to then be transported to local communities just-in-time for the MDA window after the rainy season ends. The RPRG listens to the supply chain experiences of country program managers and interprets this at a pan-African level to the suppliers and other partners.
Although donated, these medicines have a very substantial cost to the manufacturer plus a significant investment in last-mile delivery, which is underwritten jointly by African governments and supporting agencies like the END Fund. Donors require reports on impact of their donations. If these medicines do not reach a high enough proportion of the infected population the effectiveness on the burden of disease in the community is diminished. So the RPRG has to assess the data collected by the various ministries of health in countries about population coverage and determine when or if populations are free of disease and treatment can be discontinued. Specific epidemiological information about the diseases and entomological data about the vectors of diseases transmission has to be collected and analyzed to inform these decisions. This too is brought to the RPRG.
My reflection on observing the deliberations of the RPRG on a myriad of information and data from multiple countries about five different diseases that can be treated simultaneously at low cost, guaranteeing high value for money – is that it is simply complex.