Lot 1 of Ascend focuses on 11 countries in Southern and East Africa and South Asia.
ASCEND is contributing to health system strengthening and service delivery with the Ministry of Health in Bangladesh to ensure that the country meets its elimination goals for visceral leishmaniasis (VL) and lymphatic filariasis (LF). Ensuring morbidity management and disability prevention (MMDP) care to all chronic LF patients is a requirement for the validation of public health elimination by the World Health Organization. To support this, ASCEND is training healthcare providers at the district, subdistrict, and community levels on the identification, referral, and treatment of an estimated 30,000 chronic LF patients and a further 3,000 hydrocele surgery patients. To combat VL, ASCEND is training over 1,000 healthcare workers on diagnosis and treatment, while also supporting epidemiological, serological, and entomological investigations in areas that have reported cases in the last 15 years helping to ensure that no one is left behind. The programme is further supporting community sensitization activities for both LF and VL, to remove stigmas, raise awareness, and encourage preventative behaviour, self-care, and referral to health centres. In response to COVID-19, ASCEND has adapted to the challenges and launched a widely lauded and novel mHealth VL outreach service to recent VL patients, ensuring continuity of care for VL patients, while also identifying and referring suspect cases of COVID-19.
Ethiopia is endemic for all five Neglected Tropical Diseases (NTD) covered under the ASCEND Lot 1 scope. In Ethiopia, ASCEND is implementing Mass Drug Administration (MDA) coverage for all four preventive chemotherapy NTDs, as well as rolling out morbidity management and disability prevention services. To combat the spread of NTDs, the programme has a particular focus on encouraging preventative behaviour change measures, including community information and education on the importance of WASH. Supporting the national NTD integration agenda and strengthening government systems are key pillars in the programme’s approach. ASCEND avails technical expertise resources through consultants and staff seconded to the ministry and training programmes to build the capacity of the NTD programme and collaboration with in-country NTD partners on NTD sustainability analysis and planning.
Kenya is a priority country for ASCEND’s health systems strengthening agenda, to support the advancement of the sustainable delivery of NTD control and elimination activities. This includes advocacy for financial and managerial autonomy of county governments in NTD programming and technical assistance on setting up sound financial management mechanisms.
The NTD delivery activities supported by ASCEND consist of scaling up our Schistosomiasis Elimination Programme through community Mass Drug Administration in the coast region, and developing morbidity management for Lymphatic Filariasis, including tackling the backlog of Hydrocele surgeries. Through implementing partners and provision of technical support, the country teams are supporting Viseral Leismniasis diagnosis and treatment in at least 32 health facilities in six endemic countries. Hygiene promotion and behavior change communication through intensified community sensitization and coordination with WASH/NTD activities also remains a priority in Kenya.
Malawi has eight Neglected Tropical Diseases (NTDs) known to be endemic, which are a a serious impediment to socioeconomic development and quality of life in the country. The ASCEND project will focus on four of these diseases, namely: Schistosomiasis, Lymphatic Filariasis, Trachoma and Onchocerciasis. The programme is involved in delivering support through Mass Drug Administration for Onchocerciasis and Schitosomiasis, targeting over 8 million people. The ASCEND Malawi project also aims to increase the coverage of curative treatment, morbidity management and disability prevention services by providing Trichiasis surgeries in Trachoma hyperendemic districts, as well as supporting the clearance of remaining hydrocelectomy surgical cases and community-level lymphoedema management.
Mozambique is endemic for Lymphatic Filariasis (LF), Trachoma, Schistosomiasis (SCH) and Soil Transmitted Helminths (STH). The ASCEND programme is scaling up Mass Drug Administration coverage for LF and SCH throughout 2019-2021. The team are also involved in the mapping and surveillance of LF and the morbidity management of Trachoma through Trichiasis surgical outreach,as well as Lymphatic filariasis hydrocele surgery delivered through government entities. ACEND’s approach to service delivery is enabling the identification of health system gaps, allowing the in-country team to plan activities that will ensure long-term sustainability in the control and elimination of NTDs.
In Nepal, ASCEND is working with the MOHP to strengthen health supply chain systems to better tackle NTDs. Nepal is more than halfway to achieving its Lymphatic Filariasis (LF) elimination goal, and is on track for all LF-endemic districts to have stopped MDA in 2021. The programme will also support the training of health-facility workers and is anticipating conducting 3,000 hydrocele surgeries, as well as proving lymphedema management for at least 3,000 individuals.
ASCEND is supporting South Sudan through Mass Drug Administration’s (MDAs) targeting Lymphatic Filariasis (LF), Onchocerciasis, Schistosomiasis and Trachoma. The team is also providing curative treatment, morbidity management and disability prevention services. ASCEND is increasing coverage of appropriate preventive measures, including hygiene promotion, behaviour change communications and improved WASH/NTD sector coordination within the country.
Sudan is endemic for 14 NTDs, including the 5 priority diseases of ASCEND programme: Visceral Leishmaniasis, Trachoma, Onchocerciasis, Lymphatic Filariasis and Schistosomiasis. In Sudan, ASCEND is delivering Lymphatic Filariasis Mass Drug Administrations (MDA) in 60 localities, Trachoma MDAs in 11 localities and Onchocerciasis MDAs in two states. As part of these administrations, community drug distributors will be trained on mobilisation, intervention and reporting. Additionally, ASCEND is supporting the review and development of the NTD Master plan, to ensure government buy-in and the long-term sustainability of NTD control and elimination activities.
In Tanzania, ASCEND is delivering Lymphatic Filariasis Mass Drug Administrations (MDA) in five districts, and supporting Schistosomiasis MDAs in 50 districts. Teams will also be working to increase the coverage of curative treatment, morbidity management and disability prevention services by providing Trichiasis (TT) surgeries for Trachoma hyperendemic districts and hydrocele surgery and lymphedema management in 5 hyper-endemic districts. While conducting these activities, ASCEND Lot 1 plans to include system strengthening and support for the long-term sustainability of the NTD programme.
Uganda suffers from all five PC NTDs: Lymphatic Filariasis, Schistosomiasis, Soil-Transmitted Helminths, Onchocerciasis and Trachoma. To strengthen health care systems in the country, the ASCEND programme is building capacity in data management and surveillance, with a particular focus on tool integration with District Health Information Software 2 (DHIS2). ASCEND is also partnering with ACT to END to support the Ministry of Health to produce sustainability workplans and preventive plans to prioritize the scaling up of geographical coverage for Mass Drug Administrations and morbidity management and disability prevention services.
Three NTDs are endemic in Zambia, including Trachoma, Lymphatic Filariasis (LF) and Schistosomiasis (SCH). Whilst the Government of Zambia has recently created an NTD Unit within the Ministry of Health, financial constraints and visibility of the Unit have hampered its growth and functionality. ASCEND is working with the MOH to provide health system strengthening and strengthen NTD programming. Through implementing partners, ASCEND supports Mass Drug Administration for all three diseases and Morbidity Management and Disability Prevention activities for LF and Trachoma. The in-country team aim to implement ambitious COVID-19 pivot activities in Zambia, collaborating with in-country partners on COVID surveillance and Knowledge Attitude and Practice surveys.
Zanzibar is endemic for Lymphatic Filariasis (LF), Soil Transmitted Helminths (STH), Schistosomiasis, and Trachoma. The ASCEND programme in the country is aiming to work with the government and existing health bodies to increase coverage of appropriate NTD preventive measures, including hygiene promotion, behaviour change (BCC) communications and improved WASH and NTD sector coordination. The programme will maintain Mass Drug Administration (MDA) gains for Lymphatic Filariasis in all the 11 endemic districts, for Schistosomiasis in 10 districts and for Trachoma in 1 district. To strengthen health systems, ASCEND plans to support the PFM systems in order to increase the prioritisation of NTDs in national plans and budgets, while ensuring that the system is efficient.