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The Special Expanded Project for Elimination of Neglected Tropical Diseases

By WHO ESPEN

The World Health Organization’s Regional Office for Africa (AFRO) is poised to launch the Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN) – a new entity which prioritizes the integrated control of five  diseases in Africa. Endemic African Countries, Non-governmental development organizations, medicine donors, donorsand the World Health Organization (WHO) reached a consensus on theestablishment of ESPEN following two meetings held in April 2015 in Johannesburg and July 2015 inGeneva as the result of efforts to eliminate these diseases from the African Region.  The project brings hope to millions of people in the Region who suffer from one or more of the five diseases,which can be easily prevented through large-scale administration of medicines (also known mass drug administration-MDA) to communities at risk.WHO ESPEN image 1

Functioning as an integral part of WHO, ESPEN will ensure that the gains made over the past decades in the control of onchocerciasis (river blindness) are sustained while providing enhanced technical support for expanding large-scale administration of medicinesparticularly for lymphatic filariasis (elephantiasis).  It also sustains the monitoring, evaluation and impact assessment surveys in countries with plansto assess and advise on when to stop ‘Community Directed Treatment with Ivermectin’ (CDTI) and/or large-scale administration of medicines.  In addition, ESPEN will provide operational support to endemic countries to achieve elimination goals and targets in accordance with the Regional Strategic Plan for NTDs for the period 2014-2020.

“We want to integrate our approach and accelerate the elimination of the five high-burden NTDs in order to meet WHO’s Roadmap targets for 2020.  We can do this by creating conditions that will provide appropriate and timely technical support to countries as and when needed – and all this in a cohesive and cost-effective manner”, said Dr Matshidiso Moeti, WHO Regional Director for Africa, in her opening speech at an ESPEN consultative meeting.

Since her appointment as Regional Director for Africa in February 2015, Dr Moeti has introduced initiatives to make better health and well-being a reality for Africans. In providing her support for a lean and responsive ESPEN, Dr Moeti is reiterating WHO’s commitment to coordinate and strengthen collaboration with countries, donors and partners.

Funding

To achieve the 2020 NTD targets, ESPEN requires an annual budget of USD 10 million to support operational costs and staff salaries.   About 75 percent of the total budget will support technical and operational activities as well as monitoring and evaluation. For instance, if USD 10 million is mobilised for 2016, ESPEN will be able to reach more than 145 million people at risk in 26 countries with donated medicines.  Expected to start its operations from 1 January 2016, current funding for ESPEN is still inadequate.
Neglected tropical diseases in the WHO African Region and the future of Sustainable Development Goals
Neglected tropical diseases affect the most vulnerable and poorest populations of low and middle-income countries.Affecting more than 1 billion people worldwide, the diseases are endemic in 149 countries,40% withinthe WHO African Region.  Allthe 47 countries of the Region are endemic for at least two NTDs, andthe population at risk requiring preventive chemotherapy ranges from 123 million for Onchocerciasis to 470 million for lymphatic filariasis.

Eliminating NTDs in affected countries is more than an aspiration; it is a foundation for achieving the sustainable development goals. The SDGs provide an opportunity to address NTDs, particularly through SDG 3 which focuses on universal health coverage and ‘health for all’.  In respect to this, ESPEN advocates for a holistic approach to tackle health problems using the preventive chemotherapy, health education, improving access to safe drinking water, sanitation and hygiene (PHASE) approach.  By supporting endemic countries to complete mapping of preventive chemotherapy-NTDs; scaling of up mass drug administration to reach millions of people at risk of NTDs and harnessing all existing resources through coordination of NTD programmes, ESPEN will contribute to attaining SDGs.Lessons learnt in tackling NTDs willbe applied to achieving the sustainable development goals.The more NTD programmes reach the inaccessible, at risk communities, the wider the coverage of universal health care and improvement in their livelihood, contributing to the achievement of the sustainable development goals.  Success stories from the fight against NTDs continue to provide the motivation to strengthen operational mechanisms of its programmes including financial resources.

A Call to Action

Over the past few years and largely due to substantial economic growth, countries in the African region have increased efforts to strengthen national leadership and programmes aimed at delivering interventions to eliminate or eradicate targeted NTDs.  What is needed is greater investment of domestic resources in supporting elimination programmes.

G20 support for high-level advocacy and resource mobilisation initiatives are crucial to achieving targets set out by ESPEN.  WHO calls on the G20 leaders to include in the G20 agenda the plight of NTD sufferers and the critical role of ESPEN in achieving the 2020 NTD control and elimination targets and its contribution to the 2030 sustainable development goals.

Further information:

• In December 2013, the Joint Action Forum of the African Programme for Onchocerciasis Control (APOC) proposed to transform APOC as from January 2016. It suggested setting up a new programme (co-sponsored by WHO and the World Bank) to continue work for the elimination of onchocerciasis and lymphatic filariasis and support preventive chemotherapy co-implementation for other selected diseases.

• In October 2014 during the 148th session of the Committee of Sponsoring Agents two main donors proposed the establishment of an entirely new body with specific mandate and structure.
• In December 2014, during the 20th session of the Joint Action Forum (JAF) in Addis Ababa, Ethiopia, two major decisions were taken: (i) close APOC definitely on 31 December 2015 and (ii) establish an entirely new entity for all 5 PC diseases.

• In April 2015, a meeting of the Working Group in Johannesburg, South Africa decided to:
a.Create a ‘lean’, ‘cost-efficient’ entity that can achieve NTD Roadmap targets by 2020;
b.Ensure a smooth transition of technical support to affected countries for a period of one year.
c.Hold another round of discussions to finalize a framework for the new entity.
• The WHO organized a stakeholders’ consultative meeting in Geneva in July 2015 that finalized the framework of a new entity (ESPEN) with the aim of tackling five high-burden neglected tropical diseases through an integrated, collective approach.

NTDs and MDGs

• MDG 1: The control of Onchocerciasis regained 25 million hectares of land in the riverine area of West Africa for productive use, thus contributing to the alleviation of poverty and hunger
• MDG 2: NTD infections affect both school attendance and performance, limiting educational performance and potential.
• MDG 3: Women feature predominantly among community distributors, contributing to improved gender equality by putting their health in their hands.
• MDGs 4 and 5: By contributing to the overall improvement of the health system as well as increasing the network of community health workers, maternal and child mortality is reduced.
• MDG 6: Co implementing NTD interventions alongside others is cost effective – more for less. Addressing Schistosomiasis and hookworm will prevent anaemia in children while; preventing genito-urinary schistosomiasis will also contribute to preventing horizontal HIV/AIDS transmission.

• MDG 8: NTD partnership platforms have proven fruitful in channelling financial and technical support towards focused disease control objectives.

Extracted from the joint WHO NTD Strategy 2010 to 2014

End

For more information, please contact:
• Technical contact:
Dr Benido Impouma; Tel: +472 413 9773; Email: impoumab@who.int
• Media and Communication contacts:
Mr Winfred Oppong-Amoako, NTD Communication; Tel: + 472 413 9811; Email: oppongamoakow@who.int
Mr Collins Boakye-Agyemang, Programme Manager – Communications, + 472413 9420; Email:boakyeagyemangc@who.int

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