Infectious tropical diseases such as river blindness and trachoma can be compelling targets around which to rally government and community campaigns to combat these scourges. But are these programs diverting limited resources away from basic medical and preventive care?
A new analysis suggests that although these single-disease programs can go a long way toward eliminating many common tropical diseases, such intensive campaigns can also mean that "more common health problems received little attention," the study's authors noted in the paper, published online August 17 in PLoS Neglected Tropical Diseases.
In 2007, a massive integrated treatment campaign rolled out in Mali. With support from USAID and other funding agencies as well as pharmaceutical companies, four of six drugs (ivermectin or diethylcarbamazine, praziquantel, albendazole or mebendazole, and azithromycin) were distributed to the public to combat five common diseases (lymphatic filariasis, river blindness, schistosomiasis, soil-transmitted helminthiasis and trachoma).
To assess the campaign's impact on daily health care tasks, the researchers, led by Anna Cavalli, of the Public Health Department at the Institute of Tropical Medicine in Antwerp, Belgium, assessed 16 health centers that were involved in the campaign via participant observation, interviews and document analysis.
The team found that two centers were already well-staffed and supported, and the additional mass drug distribution program did not disrupt regular health care duties. The other 14 centers, however, did not fare as well. "In more fragile health centers…additional program workload severely disturbed access to regular care, and we observed operational problems affecting the quality of mass drug distribution," Cavalli and her team noted.
And although education and training for the disease-centered programs helped staff improve delivery of the specific drugs, the initiatives did not "address other [disease] control strategies, such as curative care (e.g. eye surgery for trachoma) or sanitation," the researchers found. While in the field Cavalli and her colleagues saw many "missed opportunities for curative care," such as sick or injured children who lined up for the targeted drug distribution but who were not given the care they needed for other conditions.
As part of the master plans for these major campaigns, additional delivery and provision systems were established, but many of these operated alongside existing channels, thus straining personnel and logistic resources. "Disease-specific interventions implemented as parallel activities in fragile health services may further weaken their responsiveness to community needs," the researchers found. And "pressures to absorb donated drugs and reach short-term coverage results contributed to distract energies away from other priorities, including overall health systems strengthening."
The researchers however, don't advocate halting crucial targeted disease programs. "From a health systems perspective, the question is…not so much whether the balance of a specific [global health initiative program] is positive or negative," Cavalli and her co-authors noted. "Control of [neglected tropical diseases] in vulnerable communities is a necessity. But so is health system strengthening, in order to respond adequately to other health problems and to ensure sustainable achievements, including [neglected tropical disease] control."
Image courtesy of iStockphoto/Sean_Warren