Dr. Nastu Sharma is the Country Lead for the ASCEND programme in Nepal. There, 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.
What is your specific involvement in the ASCEND programme?
As the programme Country Lead for Nepal, I engage the Nepalese government to identify areas where ASCEND can deliver support and translate this into plans and programmes. I also coordinate the allocation of resources with the ASCEND team in the region, Crown Agents HQ, other NTD partners and the Nepal Ministry of Health. Lastly, I provide oversight of the implementation of ASCEND programmes in-country, ensuring that resources reach the intended beneficiaries of the programme, namely poor and marginalized people.
What most excites you about the work we are carrying out under the ASCEND programme and what are your hopes for what it can achieve?
ASCEND is a very adaptive and flexible global programme, and I consider myself to be very fortunate to have been involved right from inception. In Nepal, we support the elimination of three NTDs: Visceral Leishmaniasis, Lymphatic Filariasis and Trachoma. We focus on five outputs: Health system strengthening, disease prevention, control, diagnosis and treatment. We also include activities aimed at strengthening gender equality, social inclusion, community sensitization and advocacy, and ensure the programme uses globally standardized tools and evidence in its implementation.
Our programme in Nepal has had achievements already, such as securing Parliament’s recognition of the programme, which in turn raises awareness of the importance of NTD investment across society. Similarly, the role the secondees from the ASCEND programme play in the provinces helps support the government’s ambitions to devolve decision making and service delivery to the lowest levels of administration and ensures that households are directly benefitted by the programme.
I am thrilled to be part of the global effort to combat NTDs as I would like to give back as much as I can to those who will benefit from my expertise and experience.
Do you think enough is being done to tackle NTDs globally? If not, what could be done to improve the situation?
There are still many unfinished tasks needed to tackle NTDs globally. NTDs are currently disproportionately affecting the world’s poorest and most marginalized populations. The biggest challenge is to incorporate activities to control and eliminate NTDs into the general health system and ensure access to and use of NTD prevention and treatment services by target groups.
Another challenge is the mobilization of resources for an increasing list of NTDs; Governments need to increase their provision of assets to control and eliminate NTDs which are prevalent in their countries. Also, donors and other global NTD partners need to work closely with those governments to create integrated health systems for service delivery. They need to focus on strengthening existing health systems to make them more robust and responsive. In addition, current investments in NTDs need to increase significantly for the purpose of knowledge creation and evidence generation, operational research, and the improvement of clinical and preventive pathways.
What do you think the impact will be on NTD programmes such as ASCEND from the COVID-19 pandemic and how could they react?
I think the impact is going to be manifold for NTD programmes and activities.
One of the immediate impacts of the COVID-19 pandemic will be in the uncertainty of continuity of services, such as mass drug administration, care and support to people affected by NTDs, evidence generation, and social mobilization. Therefore, there is a serious need to consider an extension to ASCEND’s lifetime in order not to lose momentum. Most of ASCENDs interventions require close contact with targeted people in remote and rural areas where WASH conditions are poor and general awareness of viruses and NTDs are low. Ensuring social distancing and maintaining hygiene and sanitation conditions while delivering ASCEND activities remains a challenge. Putting measures in place to overcome and mitigate these challenges is likely to increase the cost per activity. For example, working closely with the government and the rural communities, the ASCEND Programme in Nepal ensures personal protective and safety measures to prevent COVID infection while carrying out basic NTD services in the rural and remote areas.
Lastly, is there a moment of your career that you are particularly proud of?
When I received the message in March 2019 that the ASCEND Lot-1 had been awarded to the Consortium led by Crown Agents, I was filled with joy and happiness. I felt proud because, as the Country Lead, this put me in the perfect position to support the Nepal government and the ASCEND consortium partners to design the ASCEND programme for Nepal. I knew that ASCEND would benefit all parties involved and, above all, help meet the last mile gaps to eliminate Visceral Leishmaniasis and Lymphatic filariasis from Nepal.