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Sightsavers blog

Braving the odds to combat NTDs in Democratic Republic of Congo

Ndellejong Cosmas Ejong, December 2018
A group of men standing with poles used to measure people's height.

Sightsavers surveillance manager Ndellejong Cosmas Ejong explains what has already been achieved in DRC, and how we’re pushing ahead to tackle these debilitating neglected tropical diseases.

Democratic Republic of Congo (DRC) is still suffering from armed conflict, years after the Congolese civil war officially ended. It has also been deeply affected by Ebola, as well as a number of public health problems such as neglected tropical diseases (NTDs). It is thought that of the country’s population of 84 million people, about 50 million are at risk of and need treatment for NTDs, which can cause excruciating pain, disability and trap people in poverty.

In response, the United Front Against River Blindness (UFAR) and Sightsavers work in collaboration in DRC to support the Ministry of Health in the fight against NTDs. Together, we are aiming to eliminate river blindness and lymphatic filariasis (LF) and control schistosomiasis and soil-transmitted helminths (STH) in the country.

This work couldn’t happen without the support of the British public and the Department for International Development (DFID) which, through its UK Aid Match scheme in 2015, started funding river blindness and LF elimination activities. This work has been taking place in Ituri North and Katanga South projects through Sightsavers and UFAR. In 2017, funding from GiveWell was secured through Sighstavers to help address gaps in schistosomiasis and STH treatment that were identified through surveys carried out in Ituri North.

The Ituri North NTD project borders with Ituri South, which still has sporadic tribal conflict, and this instability has led to mass migration of people from the south to the north. What’s more, the few cases of Ebola detected in Tshiomia and Mandima in Ituri South (about 100km from the project area) could prevent treatments being distributed to people at risk of NTDs.  Amid these ever-changing dynamics, the valiant hearts in the communities – the volunteer community directed distributors (CDDs) – have braved the odds alongside the health workers to ensure mass distribution of treatments is not interrupted. These workers regularly receive guidance from their local authorities, the Ministry of Health and the Congolese military to ensure treatments are delivered safely.

A close-up of a hand holding Mectizan medication.

Our work in DRC

In 2017, we helped to distribute more than 3.6 million treatments to prevent debilitating neglected tropical diseases in Democratic Republic of Congo.

Sightsavers in DRC
Health experts during a monitoring visit to Aru in Ituri North.
Health experts during a monitoring visit to Aru in Ituri North. From left: Sightsavers’ Ndellejong Cosmas Ejong; Dr Leonard Lopay and Dr Josias Likwela from the Ministry of Health; and Dr Kamwasha Vincent , UFAR’s technical advisor.

What have we learned in DRC?

  • Communities are key to successfully controlling and eliminating the diseases.
    Without community acceptance, participation and ownership, eliminating these diseases is impossible. Programme uptake has improved, especially in Ituri North, because resources are being allocated annually to make sure trained community volunteers are available for drug distribution. Investments have also been made in social mobilisation and sensitisation to raise awareness of the NTD treatment programmes and their importance. This work has meant more people are treated each year within endemic communities, and the number of people refusing treatment is gradually declining each year. This indicates that the project is on the right path to elimination.
  • Quality control and assurance are vital.
    Sightsavers uses independent post-treatment coverage surveys (TCS) and quality standard assessment tools (QSAT) to assess the quality of work. Previously, both were carried out separately, but recently Sightsavers, in collaboration with UFAR and the Ministry of Health, used both tools together and found this approach was more effective. Using both tools has improved how we make and track recommendations to ensure our work is more effective. Post-treatment surveys in 2016 in Katanga South showed us that in some areas, the reported treatment coverage did not reflect reality: results revealed lesser coverage than was reported by the Ministry of Health. However, in Ituri North, the margin of error between reported and surveyed coverage was narrower. This showed us that the poor performance of one project does not necessarily affect another, even though the same implementing partner might be involved.
  • A supportive approach to field monitoring is always useful.
    Despite our projects being located in remote parts of DRC, and some having security concerns, regular visits from Sightsavers teams, alongside the Ministry of Health and UFAR, paid off. Since March 2017, at least six supervision and monitoring visits have been undertaken by Sightsavers’ programme and finance teams. This has improved technical guidance and management support, allowing prompt responses to any challenges in the field. During the 2017 drug distribution campaign, the presence of Sightsavers’ team in Aru, in Ituri North, enabled us to deal with delays in the transfer of funds, shortage of community registers and drug supply. This ensured the distribution campaign was shorter and an improvement on previous years.
  • Project review meetings allow us to appraise our performance and make operational decisions.
    These meetings with the Ministry of Health enable us to review project ownership and accountability, and identify any gaps in our performance. During the 2017 review meeting in Ituri North, a key point we learned was that health zone teams’ data analysis and interpretation skills were poor. To rectify this, we resolved to designate and train NTD data focal points in health zones during the 2018 campaign.

The road ahead is promising

These things we’ve learned give us many reasons to be hopeful about controlling and eliminating NTDs in DRC. In addition, since we began in 2016, our geographical spread has expanded: we’ve moved from 16 to 19 health zones, with three additional schistosomiasis-endemic areas added in 2017. The most recent reason to feel positive came on 5 September 2018, when the National Oncho Elimination Expert Advisory Committee (NOEEAC) was formed. The group will be vital for helping to eliminate river blindness (onchocerciasis) in DRC: it will guide the elimination work and will aim to address implementation gaps in three zones: Aru, Logo and Mahagi in Ituri North.

The Sightsavers team and I are proud to work with several organisations to deliver this vital work: UFAR, the Ministry of Health, a network of communities, donors such as GiveWell and the UK government’s Department for International Development, plus partners including RTI, the Schistosomiasis Control Initiative and the Liverpool School of Tropical Medicine. Progress is being made to combat NTDs in DRC, but there is more work to do and we must continue to work in collaboration to continue to brave the odds and achieve our goals.

More about neglected tropical diseases

Neglected tropical diseases are most prevalent in rural areas, urban slums and in conflict zones. They affect some of the world’s poorest people and can cause severe and lifelong impairment.

What are NTDs?

 

Author


name of person followed by a fullstop.Ndellejong Cosmas Ejong
Cosmas is Sightsavers’ Surveillance and M&E Manager, and is based in Cameroon.

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