Analysis of policies and practices for administrative oversight of integrated NTD control programs

The World Health Organization’s (WHO) endorsement of integration as a strategy to tackle NTDs has led to many countries seeking to integrate one or more of their NTD control programs. However, no standard guidelines yet exist to support this process. Moreover, most of the emphasis to date has been on operational integration at the local, program implementation level, such as co-distribution of chemoprophylaxis. Much less attention has been paid to the organizational and administrative changes that must also be considered when integrating disease control programs, particularly to ensure smooth coordination and long-term sustainability of the effort.

CGHSS conducted a landscape analysis of national efforts to integrate NTD control efforts, across the 25 countries we identified–through a quantitative scoring method—as having the highest burden of NTDs. We reviewed the administrative management of integration, for those countries which had started integrating their NTD control, in order to identify pathways and approaches that had been used. We supplemented our literature review with key informant interviews from stakeholders in six countries, to validate our findings and also gather additional insights into obstacles and opportunities for integration, based on their country’s experience with integration.

We observed substantial heterogeneity in the kinds of approaches countries have taken towards integration, highlighting the adaptability and flexibility of integrated approaches to match the specific country context. However, the most common integrated approach was to combine NTDs that rely on preventive chemotherapy for control; another common combination was leprosy with other bacterial diseases, including tuberculosis. Less common, despite the potential opportunities, were integrated approaches that combined NTDs with health services (such as WASH or pre-natal care) or based on mode of transmission (such as through integrated vector management). Such approaches may have high potential for advancing NTD control in the future, provided barriers—which include internal administrative obstacles as well as external pressures, such as donor preferences and priorities—can be successfully overcome.

Future work in this area will consist of additional research into the policies guiding disease integration from a health systems and administrative oversight perspective, including opportunities for developing guidelines to assist countries in identifying best practices to apply when considering integrating their own NTD control programs.