New Ways of Working Together: Integrating Community-Based Intervention (Round 14)

Maximizing the Benefits and Reach of Community-Based Interventions for Neglected Tropical Diseases through Integration with Other Health and Development Sectors

Opportunity: 

The World Health Organization estimated that 1.9 billion people are in need of drugs that help to prevent, control or eliminate five neglected tropical diseases (NTDs). These diseases are lymphatic filiariasis, onchocerciasis, trachoma, schistosomiasis, and soil transmitted helminthes. Over the past five years national programs with assistance from various implementing organizations have helped to distribute an average of nearly 695 million treatments of drugs annually to endemic areas through community-wide mass drug administration (MDA) efforts. Despite this impressive number, current global efforts are only reaching about thirty-seven percent of the total number of persons needing treatment. Programs will have to scale up quickly in order to achieve the 2020 targets for control and elimination, however, financial and human resources remain limited to achieve this scale. Some national programs have had success in increasing coverage as well as reducing costs through integrating programs for different NTDs previously running in parallel into one coordinated program and community outreach effort. Meanwhile, many other types of global health and development programs are accessing or attempting to access these same populations with interventions and services. Examples of these include agricultural services, malaria interventions, water, sanitation and hygiene services, and financial services for the poor. With the broad reach of the NTD programs at the community level, there may be significant opportunities to look at how this MDA platform can be used to help address a broader range of needs for these populations. Innovative pilot studies with robust evaluation metrics are needed to determine how best to integrate NTD efforts with other community-based programs that would benefit and improve participation or reach of each national program in a more efficient and economical way.

The Challenge: 

The aim of this call is to solicit innovative ideas to leverage existing MDA platforms for one or more of the five NTD drug distribution efforts (lymphatic filiariasis, onchocerciasis, trachoma, schistosomiasis, and soil transmitted helminthes) and integrate it with another community-valued or needed health intervention or agricultural service with a goal of increasing efficiency and impact. Your submission may address one or more of the following categories: 

• Integrating program elements of one or more of the 5 MDA NTDs (lymphatic filariasis, onchocerciasis, trachoma, schistosomiasis, and soil transmitted helminthes) with one or more of the following Intensive Disease Management (IDM) diseases (visceral leishmaniasis, Human African Trypanosomiasis [HAT], Guinea worm, Chagas, leprosy):Unlike the MDA NTDs which are managed through mass treatment irrespective of individual disease status, IDM NTD programs are based on identifying infected patients and providing treatment. In large part, the difference in approach is due to the dramatically lower number of persons infected by the IDM NTDs and the cost and complexity of their treatment. The challenge is finding, properly diagnosing and treating infected persons. Some programs screen large and often remote populations to find a few cases to treat which presents logistical and resources challenges to national programs.
• Integrating one or more of the 5 MDA NTDs with another NTD: National programs are burdened with the management of all endemic NTDs within their borders even if global attention and support focuses only on a smaller subset of these diseases. Determining how best to integrate resource poor NTDs into the more robust management systems of the MDA NTDs could stretch national programs' capacity to do more within existing resources.
• Integrating one or more of the 5 MDA NTDs with another community-valued or needed health intervention (Water Sanitation and Hygiene [WASH], Maternal and Child Health, Malaria, Agriculture, Micro-financing programs): Communities often have priorities and self-identified health needs other than those deemed essential by public health authorities (both local and international). Service programs which support the meeting of these community needs are often poorly funded and have limited ability to intervene across large geographic areas. Identifying opportunities for services that address community-valued needs that might be incorporated along the MDA platform could potentially result in increased participation by program recipients and reduce recipient-fatigue of multiple visits from different programs.
• Integrate MDA for the NTDs with another program in an area where MDA has not yet been established or in a difficult to access population: NTD programs have not been started in many endemic areas and opportunities may exist to leverage another community based program to establish a successful MDA program and strengthen the existing program.
• Integrate NTD MDA with malaria eradication efforts: New and renewed efforts to eradicate malaria are underway and will require infection detection and mapping of the prevalence in overlapping communities with NTD MDA. Increased reach and economic efficiencies could be obtained by integrating these efforts.

What We Are Looking For: 

Proposals must be able to do all of the following: 

• Convey a clear and testable hypothesis for how the innovation will measurably improve both sectors, program outreach, and interventions simultaneously;
• Outline a clear measurement and evaluation plan for each integrated component;
• Demonstrate that the integrated exercise results in benefits to the national program and/or community members that extend beyond coverage and the receipt of the drug;
• Describe the path to scale for the proposed integrated exercise and where it would most likely be useful; and
• Provide a clear plan for generating robust data that could be replicated and used to further increase access to health and development interventions.

Examples of what we will consider funding: 

• Integrating screening for the IDM NTDs along with MDA campaigns for NTDs as a useful option for national programs;
• Accessing hard-to-reach populations with deworming drugs by combining delivery with specific agricultural extension or veterinary services;
• Combining the screening or treatment needs of less well-resourced NTDs with the community access opportunities of MDA to increase treatment coverage;
• Integrate mapping of multiple diseases (i.e., malaria, STH, visceral leishmaniasis) with MDA to increase reach and delivery of drug treatments.

We will not consider funding for: 

• Ideas that are not directly relevant to developing countries;
• Ideas without a clearly articulated and testable hypothesis and metrics;
• Integrating efforts without a clear benefit to both programs;
• Ideas that combine the delivery of multiple drugs without evidence of safety;
• Ideas that provide only a limited or unrealistic path to scale, including those that rely on long-term financial subsidies;
• Ideas for which a relevant indicator of success cannot be demonstrated within the scope of the GCE Phase 1 award ($100,000 over 18 months);
• Ideas that address diseases other than those listed in this call;
• Strategies that focus on only one disease or intervention;
• Social or educational interventions that do not include the integration of services listed above;
• Solely infrastructure or capacity-building initiatives;
• Basic research without clear relevance to the goals of this topic.