No public health programme has ever expanded as quickly as the Global Programme to Eliminate Lymphatic Filariasis (GPELF). Governments in endemic regions increasingly view the programme as a tangible way to address poverty and improve health. As a result, annual treatments have jumped rapidly, up from 25 million in 12 countries in 2000 to over 250 million in 39 countries in 2004.
Despite the rapid progress of the global effort to eliminate lymphatic filariasis, much remains to be doneBy the end of 2005, all countries where LF exists are expected to finish mapping to identify endemic areas. Following mapping, Ministries of Health in each country develop a national elimination programme to provide annual mass drug administration, as well as to alleviate suffering of infected individuals through hygiene and surgery. Although the Global Alliance has generous donors and strong partners, the programme still has many needs. In fact, there are a number of countries in Africa and Asia that have already completed mapping and are poised to initiate a programme, but cannot do so for lack of funding. Even in countries with established LF programmes, there is the annual challenge of securing funds for the costs associated with MDA, as well as morbidity programmes targeted at alleviating suffering of infected individuals. In addition, the Global Alliance also hopes to secure funds for in-country capacity-building for programme managers for fundraising training and workshops to explore alternative funding sources such as debt relief and funds for programme integration.
The following is a list of specific needs in order for the Global Programme to meet its goal of eliminating LF by 2020:
Country Specific Needs: Since MDA must occur for at least five consecutive years, even if the first few years are funded, a national LF Elimination Programme may have subsequent funding needs related to MDA. These needs may include social mobilization costs, training for community volunteers, food and travel allowance for the volunteers, and monitoring and evaluation activities. The Global Alliance estimates that MDA costs between $ 0.03 and $ 1.00 per person per year depending on the country. As the MDA costs are closely linked with the use of human resources, MDA tends to be more expensive in countries with more developed economies.
Fundraising Training for In-Country Programme Managers: As each endemic country initiates an LF Elimination Programme, the local programme managers receive fundraising training to learn how to access local funding sources. Ultimately, this investment will lead to more sustainable and effective national elimination programmes. Such training costs are between $5,000 and $8,000 per country. The annual need depends on the number of countries both ready to initiate a programme and interested in training.
LF Regional Support Centre in Africa: Established in 2005, the LF Regional Support Centre is located at the Noguchi Institute in Accra, Ghana. The Centre provides technical, programmatic, and advocacy support to LF Elimination Programmes, as well as other LF-related disease programmes in Africa. The annual budget for the LF Regional Support Centre is $215,000.
Mapping Costs: Before a country can begin an LF Elimination Programme, local health officials must map the country to determine where LF is endemic and decide on the geographic areas (implementation units or IUs) where the programme will take place. IUs can run the gamut in size from village, district, country, or other unit depending on the specific needs of the country. Once the IU is defined, the health officials sample up to 250 individuals within each IU using finger-prick blood tests to determine the level of filarial infection. If 1% or more of the population tests positive, then the area is considered endemic and will require mass drug administration. The cost for mapping a country typically runs in the $20,000 to $40,000 range depending on the number of IUs in the country. At present, 15 African countries remain unmapped.
Regional Programme Review Group (RPRG): On an annual basis, the six Regional Programme Review Groups, comprised of representatives from WHO, other Global Alliance partners and the respective region, meet to discuss the implementation of the global elimination strategy within the regional context. While the global strategy serves as a framework, each region and country make modifications based on their circumstances. Typically, the LF programme managers from a region meet at the same time as the RPRGs. These meetings are critically important to the success of LF elimination since they provide a unique opportunity for the program managers to exchange experiences, learn and teach "best practices", and recognize their essential role in ensuring the success of the Regional and Global Programme activities. The annual cost of the RPRG meetings ranges between $20,000 and $40,000 per region.