**4.5 Strengthening of partnership**

368 Current Topics in Tropical Medicine

parasites were eradicated in Okinawa. In contrary, lack of ambitious control is remarkable in Sub-Saharan Africa where many countries have passive attitude, waiting for partners to decide and to tell them what to do. African governments should develop more positive and ambitious approach for the control of NTDs, and donors and agencies beyond disease endemic countries—the agents of aid to developing countries—will need to accept that countries must have ownership of their health systems and total control over decisions

In order reach the target set by WHA for the different NTDs, there is a need to accelerate the extent of treatment. The extension of regular deworming coverage as a public health intervention to reach all individuals at risk remains a challenge. There is also a challenge to tackle the big countries such as Nigeria, Democratic Republic of Congo, Ethiopia and Tanzania which count for 60% of at risk population not covered by preventive chemotherapy yet. In the context of multi-disease integrated control, the current tendency in sub-Saharan Africa is to integrate helminth control within the community-directed interventions, taking advantages of the long experience and gains of onchocerciasis and LF control programmes through the establishment of community-directed treatment with ivermectin (CDTI) in all countries supported by the African Programme for Onchocerciasis Control – APOC (Sékétéli et al., 2002; Amazigo et al., 2002). Yet, in the majority of countries, STHs are more widely distributed than both onchocerciasis and LF. Therefore, the challenge will be to extend MDA coverage in those areas where CDTI does not exist. Countries should thus act cautiously and anticipate to avoid to neglect STH and schistosomiasis control in those endemic areas. School-based deworming is probably the simple, cost-effective and best sustainable way to expand coverage of children. With more schools than clinics, and more teachers than health workers, the existing and extensive education infrastructure provides the most efficient way to reach the highest number of school-age children and to reach the WHO target of covering at least 75% of all school-aged children in need. The recent increases of donated anthelminthic medicines by Merck KGaA (praziquantel), Johnson & Johnson (mebendazole) and GlaxoSmithKline (albendazole) constitute a real

To roll back the NTDs, it is necessary to continue and maintain the implementation of control activities during very long period. The programme should be long-term, and financial and implementation plans should be made accordingly. This would avoid one of the major errors of the past where most of the programmes were supported by short-term external funds and stopped immediately when funds ceased. To ensure sustainability, countries should, from the beginning, envisage strategies to: (1) keep the momentum, interest and enthusiasm for the control of the diseases; (2) organize and finance in a sustained way the distribution of drugs to those who need them; (3) mobilize funding for operational costs for drug distribution, health education materials, baseline data collection, monitoring and evaluation, etc.; (4) ensure the availability and affordability of the drugs at community level in endemic areas; (5) integrate programme activities within the existing health structures and networks; and (6) strengthen the health system and national capacity at all levels, especially in the peripheral and remote areas which manage the greater number of communities and infected persons. One of the key questions is how to guarantee the

continuation of control after the decline or interruption of external funds.

about the health of their people.

boost towards the achievement of this goal.

**4.4 Sustainability** 

**4.3 Scale up of control** 

An efficient control requires multisector collaboration and multilateral funding. No single organization can hope to achieve this goal alone. School-aged children are the target group for schistosomiasis and STH, so the collaboration between the Ministry of Health and the Ministry of Education should be reinforced. The target group for the different filarial infections is the entire population and the control strategy is based on community-directed interventions, which requires ownership by the communities and strong partnership with NGOs. Overall, partnership with other government departments and NGOs concerned with water supply, sanitation and development projects should be developed and reinforced.
