Undeterred by Covid-19: A collaborative approach to successfully treating neglected tropical diseases in Madagascar

By Lovasoa Randriatahina, Programme Advisor for the Schistosomiasis National Control Programme, Ministry of Health Madagascar

An integrated approach to mass drug administration

In the second half of this year, Unlimit Health supported the Ministry of Health in Madagascar to conduct its annual treatment campaign for people affected by neglected tropical diseases (NTDs).

This year, for the first time, the country adopted an integrated approach to mass drug administration (MDA) in its fight against NTDs. As many of the NTDs are tackled using similar community mechanisms an integrated MDA consists of delivering multiple drugs to treat different diseases simultaneously.

Treating multiple diseases simultaneously

Lovasoa Randriatahina (photo left) Programme Advisor for the Schistosomiasis National Control Programme from the Ministry of Health, explains how it was possible.

Due to Covid-19 restrictions, the campaigns were conducted in two phases.  One in July, and the second in November. Both were a great success, thanks to the perseverance and tenacity of all partners involved. Due to the huge efforts of everyone involved at each level – the peripheral and central technical teams at the MoH as well as the support of our implementing partners, Unlimit Health, World Bank and WHO – we overcame the enormous challenges posed by the Covid-19 pandemic and were able to complete both phases of the MDA.

In the latest campaign, of the 114 districts endemic for NTDs, 106 districts were treated – 80 for schistosomiasis (SCH), 49 for soil transmitted helminths (STH) and 30 for lymphatic filariasis (LF). This integrated approach saw the collaboration of three programmes reaching 5.5 million people, with community drug distributors delivering treatment to people door to door.

Planning an MDA during Covid-19

Regular planning meetings were essential to ensure the smooth running of the campaign. The coordination and planning meetings took up approximately 60% of our time as the different programmes had to agree on each decision taken for each activity of the MDA. We encountered significant logistical challenges during the implementation period. Travel was limited across most of the island due to poor infrastructure combined with restrictions posed by the pandemic and we had to ensure Covid-safe drug distribution measures.

Despite these challenges, the programme managers continued to push forward whilst adhering to agreed plans and timeframes. In the first phase the number of Covid-19 cases reached around 500 per day, Meanwhile, during the second phase, the number of cases decreased to 31 per week. This made it much easier for community health workers (CHW) to reach and treat the target population. These CHW were trained in Covid-19 risk mitigation and equipped with the necessary PPE.  They quickly adopted effective social distancing measures to reduce the risk of transmission and reassure the communities they were treating.

Technically, this integrated treatment strategy enabled us to make important advances both in monitoring as well as preparative MDA measures. We were able to create a tool to monitor the preparation of teams at district level before the campaign, and log daily drug distribution updates at each level of the health sector.

Taking the technical and strategic advances forward

In my view, this integrated approach to the MDA was beneficial for all stakeholders in the fight against NTDs. It was very efficient in terms of resource mobilisation and a unified commitment to programme delivery and it enriched the experiences of all involved. To continue with this strategy moving forward will take a lot of preparation and commitment but I believe that the Schistosomiasis Programme Team has made some important advances in the MDA preparation and delivery.

My thanks go to Unlimit Health for the invaluable support they bring to Madagascar in the struggle against NTDs and to the entire NTD team who have worked tirelessly throughout the campaign.

I hope that someday we will live in a world without NTDs. The fight is not over yet.