SUMMARY OF THE MID-TERM REVIEW OF TRACHOMA ELIMINATION PROGRAMMES IN AFRICA

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1 SUMMARY OF THE MID-TERM REVIEW OF TRACHOMA ELIMINATION PROGRAMMES IN AFRICA Review conducted by Tropical Health LLP on behalf of The Queen Elizabeth Diamond Jubilee Trust and the UK Department for International Development Submitted November 2016

2 AN INDEPENDENT REVIEW OF TRACHOMA ELIMINATION PROGRAMMES SUPPORTED BY THE UK DEPARTMENT FOR INTERNATIONAL DEVELOPMENT (DFID) AND THE QUEEN ELIZABETH DIAMOND JUBILEE TRUST (THE TRUST) HAS SHOWN THAT BOTH PROGRAMMES ARE ACHIEVING SIGNIFICANT RESULTS ON AN UNPRECEDENTED SCALE. AN INDEPENDENT REVIEW OF TRA- CHOMA ELIMINATION PROGRAMMES SUPPORTED BY THE UK DEPARTMENT FOR INTERNATIONAL DEVELOPMENT (DFID) AND THE QUEEN ELIZABETH DIAMOND JUBILEE TRUST Trachoma is the world s leading infectious cause of blindness, responsible for the visual impairment of about 2.2 million people, of whom 1.2 million are irreversibly blind. It is most commonly found in poor, rural communities where people have limited access to clean water and healthcare. The World Health Organization recommends implementing the SAFE strategy for eliminating blinding trachoma: S A F E SURGERY TO CORRECT THE POSITION OF IN-TURNED EYELASHES ANTIBIOTICS DISTRIBUTION TO TREAT INFECTION FACIAL CLEANLINESS PROMOTION ENVIRONMENTAL IMPROVEMENTS TO REDUCE REINFECTION AND TO PREVENT TRANSMISSION

3 KEY FINDING: THE TRACHOMA INITIATIVES HAVE RECORDED SUCCESSES IN AREAS WHERE THE TRACHOMA COMMUNITY FACED MAJOR CHALLENGES TO DATE

4 IN 2014, THE TRUST AND DFID INITIATED TWO ALIGNED AND AMBITIOUS FIVE YEAR ( ) PROGRAMMES FOR THE ADOPTION AND SCALE-UP OF THE SAFE STRATEGY ACROSS NINE COUNTRIES IN AFRICA, WITH A TOTAL BUDGET OF 80.5 MILLION. The goal of The Trust s Trachoma Initiative is to eliminate blinding trachoma in Malawi, Kenya and Uganda and make significant advances towards elimination in Mozambique, Nigeria (Katsina State) and Tanzania. The goal of DFID s programme is to effectively deliver the SAFE strategy for trachoma elimination in Chad, Ethiopia, Tanzania and Zambia. Both programmes are being delivered by the International Coalition for Trachoma Control (ICTC), with Sightsavers acting as grant manager. A mid-term review of both programmes was commissioned in 2016 to assess progress against targets and to provide recommendations for any actions that need to be taken to ensure success.

5 BLINDING TRACHOMA 132,000 PEOPLE havereceived SIGHT-SAVING SURGERY 32 MILLON PEOPLE havereceived TREATMENT to end BLINDING TRACHOMA

6 CHAD NIGERIA ETHIOPIA UGANDA KENYA TANZANIA AREAS OF TRACHOMA WORK BY DFID AND THE TRUST IN AFRICA ZAMBIA MOZAMBIQUE KEY MALAWI TRUST SUPPORTED COUNTIRES DFID SUPPORTED COUNTIRES

7 SURGERY 41% OF THE TOTAL ESTIMATED NUMBER OF PEOPLE WHO REQUIRE SURGERY HAVE ALREADY RECEIVED IT. Both programmes have implemented a large scale-up of activities to provide surgery to all people who need it. In the first two years of the programmes, 131,708 surgery cases were managed. This means that 41% of the total estimated number of people who require surgery, in the programme locations, have already received it. At the time of this review, this is ahead of schedule. All countries, except for Katsina State in Nigeria, are on track to achieve their surgery goals by New data has predominantly shown that there are fewer people in need of surgery than initially expected.

8 SURGERY RESULTS AFTER TWO YEARS Country Number of People with Surgery Cases Managed Percentage Reduction in Surgery Backlog Target For First Two Years Achieved in First Two Years Measure of Performance Relative to Targets Chad 14,131 19% 40% 211% Kenya 30,881 54% 56% 104% Ethiopia 39,589 33% 33% 100% Malawi 2,670 53% 40% 75% Mozambique 1,179 36% 46% 128% Nigeria: Katsina State 1,628 45% 8% 18% Tanzania (DFID) 2,792 20% 11% 55% Tanzania (Trust) 1,510 17% 55% 324% Uganda 35,439 73% 85% 116% Zambia 1,889 36% 38% 106% TOTAL 131,708 36% 41% 114%

9 KEY FINDING: THE TRACHOMA PROGRAMMES HAVE PROVIDED UNPRECEDENTED TRACHOMA SURGICAL SERVICES

10 FINDINGS A lack of accurate data caused some initial challenges for the programmes. The DFID-funded Global Trachoma Mapping Project - a groundbreaking three-year disease-mapping project completed in early 2016 provided more accurate data on the number of patients requiring surgery. Using this data has enabled the programmes to be more targeted and cost-efficient. Using a combination of fixed health centres, mobile teams and surgery outreach camps has enabled a huge scale-up in surgical activities to provide treatment where it is needed. As fewer people require surgery, the costs of locating cases increases and creative strategies are required to find the last few patients who are in more remote locations. Training ophthalmic nurses and eye care workers as trachoma surgeons is building the long-term capacity of government health systems to provide treatment.

11 NEXT STEPS The programmes are focusing on providing high quality surgery by supporting surgeons, strengthening further supporting supervision, increasing the number of follow-up appointments with patients 3 6 months after the operations, and improving data gathering on success rates. Security concerns, the Ebola crisis, and a lack of mobile surgery camps have contributed to slow progress in Nigeria. On behalf of the Trust and the ICTC, Sightsavers is developing an action plan to reach surgery targets that will be owned by the state Ministry of Health.

12 ANTIBIOTICS MASS DISTRIBUTION OF ANTIBIOTICS IS SUPPORTED BY THESE PROGRAMMES IN CHAD, ETHIOPIA, KENYA, MALAWI AND ZAMBIA. DISTRIBUTION OF ANTIBIOTICS IN THE OTHER COUNTRIES IS ALREADY SUPPORTED BY OTHER ORGANISATIONS. FINDINGS Using existing community volunteers has been an effective way of mobilising communities for mass distribution of antibiotics. Good planning, and coordination with local partners, combined with post-distribution surveys and review meetings are resulting in effective implementation. NEXT STEPS The programmes will build on these successes by using lessons from each round of mass drug distribution to plan the next round. Countries will ensure that plans are in place to conduct disease surveillance activities once targets for elimination have been achieved. Using the mass drug administrations as an opportunity to identify surgery cases has been successful in Malawi, especially in areas where there are few cases left.

13 KEY FINDING: ALL COUNTRIES ACHIEVED OVER 80% COVERAGE IN THE ENDEMIC DISTRICTS... WITH A TOTAL OF MILLION PEOPLE BEING REACHED THROUGH ANTIBIOTIC DISTRIBUTION TO DATE Zul Mukhida / Sightsavers

14 NUMBER OF PEOPLE TREATED WITH ANTIBIOTICS EACH YEAR YEAR 1 YEAR 2

15 MASS DRUG ADMINISTRATION RESULTS AFTER TWO YEARS Country Number of Doses of Antibiotics Distributed Percentage of districts Achieving 80%+ Coverage Chad 3,787, % Ethiopia 13,671, % Kenya 3,837, % Malawi 8,625, % Zambia 1,936, % TOTAL 31,857, %

16 FACIAL CLEANLINESS AND ENVIRONMENTAL IMPROVEMENT EFFECTIVE FACIAL CLEANLINESS AND ENVIRONMENTAL IMPROVEMENT ACTIVITIES ARE CRITICAL FOR ACHIEVING AND SUSTAINING THE ELIMINATION OF TRACHOMA TRANSMISSION. ACTIVITIES ARE BEING SUPPORTED BY DFID AND THE TRUST IN FIVE COUNTRIES: CHAD, KENYA, MALAWI, UGANDA AND ZAMBIA. IN KENYA, MORE THAN 17,000 SCHOOLCHILDREN HAVE BEEN TAUGHT THE IMPORTANCE OF FACE WASHING TO REDUCE REINFECTION AND PREVENT TRANSMISSION OF TRACHOMA. FINDINGS The Trust and DFID trachoma programmes have been instrumental in increasing engagement with organisations focusing on water and sanitation at the global and national levels. NEXT STEPS More work is still required to secure further buy-in from the water and sanitation sector to support trachoma elimination work. The trachoma programmes are developing useful insights that would help engage the water and sanitation sector in the fight against other neglected tropical diseases.

17 KEY FINDING: THESE TWO TRACHOMA INITIATIVES ARE MAKING SIGNIFICANT CONTRIBUTIONS TO THE ATTAINMENT AND SUSTAINMENT OF GLOBAL TRACHOMA ELIMINATION GOALS Karel Prinsloo / Sightsavers

18 KEY FINDING: THE ALIGNMENT OF TWO MAJOR TRACHOMA INITIATIVES THROUGH AN COMMON INDEPENDENT OBJECTIVES, REVIEW MANAGEMENT OF TRA- STRUCTURE CHOMA ELIMINATION AND EXCELLENT PROGRAMMES COORDINATION SUPPORTED BETWEEN BY THEM UK RESULTS DEPARTMENT IN THE FOR PROGRAMMES INTERNATIONAL BEING ABLE DEVELOPMENT TO PROMOTE AND (DFID) IMPLEMENT AND THE THE QUEEN SAFE ELIZABETH STRATEGY AT AN DIAMOND UNPRECEDENTED JUBILEE TRUSTSCALE. A major strength of the programme has been its commitment to ensuring that national governments play a strong role. High-level support is crucial to ensure that the achievements of the programmes are sustainable. Both programmes need to maintain their momentum over the next three years to ensure that blinding trachoma is eliminated. The focus now begins to shift from implementing the programmes at scale, to tracking down the last few patients in need of surgery and enabling countries to prepare the necessary information required to declare themselves trachoma free. The findings from this review will be shared with the wider trachoma and neglected tropical diseases communities. This will contribute to the work of the ICTC and the WHO Alliance for the Global Elimination of Trachoma by the year 2020 (GET2020). These trachoma programmes will continue to improve the quality of data, which can now be used to support advocacy and attract resources to tackle trachoma, and other neglected tropical diseases, at both the national and global level. This summary document has been prepared by DFID, the ICTC, Sightsavers and the Trust.