1. Progress Report: National LF and STH Programme in Nepal
Dr Babu Ram Marasini
PM & RPRG Meeting, SEARO
Jakarta, Indonesia
23-26 September, 2014

2. Country Profile Total population: 27,311,978
Geography: Three ecological zone: Mountain, Hills and Plain
Administrative division
Development regions: 5
Zones: 14
Districts:75
Mid western region
Eastern region
Central region
Western region
Far western region

3. Health Administration and Service Delivery
Central Level
Regional level
District and Community level

4. Background: LF Mapping: 2001, 2005 & 2012 Average prevalence: 13%
Endemic districts (IUs): 61
Parasite: W. Bancrofti
Vector: C. Quinquifasciatus
Year MDA started: 2003
Geographical coverage achieved in 2013
By 2014, MDA stopped in 20 IUs.
DOLPA
MUGU
JUMLA
KAILALI
BARDIYA
HUMLA
DOTI
SURKHET
NAWAL
PARASI
KAPIL-
BASTU
RUPAN-
DEHI
DANG
BANKE
ACHHAM
KALIKOT
JHAA
MORANG
SIRAHA
SAPTARI
DARCHULA
BAJHANG
BAITADI
DADEL-
DHURA
KANCHAN-
PUR
BAJURA
PARSA
BARA
RAUT-
AHAT
DHA
NUSA
MAHO-
TARI
SUNSARI
SARLAHI
DHADING
MAKAWAN-
CHITWAN
KASKI B A G L U N
TANAHU
PALPA
SYANGJA
PARBAT
ARGHAK
HACHI
GULMI
UDAYAPUR
SINDHULI
ILAM
BHOJ- P C H E T R
DHAN-
KUTA
TAPLEJUNG M
OKHAL-
DHUNGA
TERHA-
THUM
KHOTANG
LALIT
KATHM
SULUK-
HUMBU
DOLAKHA
SANKHUWA-
SABA
NUWAKOT
SINDHU-
PALCHOK
KAVRE
RASUWA
LAMJUNG
GORKHA
PYUT-
HAN
ROLPA
SALYAN
MYAGDI
DAILEKH
JAJARKOT
RUKUM
MUSTANG
MANANG
LF Endemicity and MDA Status: 2014
MDA stopped (20 Districts)
Two round completed (10 districts)
Non endemic districts (14)
Five rounds completed (10 Districts)
Four rounds completed (10 Districts)
Three rounds completed (10 Districts)
Continuation after 6 rounds (1 district)
Index

5. LF Elimination Programme: Key Milestones
Step 1: Mapping
Step 2: MDA Implementation
Step 3: Surveillance
Pre TAS in 16 and remapping in 3 IUs
MDA stopped in 15 IUs, TAS1 in 5 IUs, Pre TAs in 10 IUs
MDA stopped in
5 IUs
Mapping
2003
2011
2013
2001/2005
2010/2011
2012
2014
MDA rolled out to all endemic districts; TAS in 16 districts
MDA initiated in 1 IU & then scaled up in subsequent years
TAS in 5 IUs

6. National Programme Overview
Indicator LF
STH
Year of inception of the national programme
2001
2000
Target date for elimination
2020
Name of administrative unit for implementation of PC
District
Total # administrative units requiring PC at the start of the programme 61 75
Total population requiring PC in the country
25 million
10,384,014

7. PC Programme and Financing
Contributors to the 2013/2014 programme costs (and rough estimate of contributions by each):
Contributor
Funding (US$)
National government
1.7 million (for LF)
Sub-national government -
Internal donors (___)
External donors (USAID)
1.5 million (for LF)
Others (WHO)
LF: 803,510 (Albendazole and TA)
STH: 100,000 (Albendazole)

8. PC Programme Achievements 2013
Activities
Targeted
Achieved
# administrative units for PC
# people PC
MDA2 (DEC + ALB) 41
T3 (ALB/MBD) for STH 1st round 34
T3 (ALB/MBD) for STH 2nd round 75
Indicator
Targeted
Achieved
M&E
Total # sentinel and spot check sites surveyed (LF)
Total # sentinel sites surveyed (STH) 4
Total # IUs where stopping-MDA TAS implemented (LF) 16
Total # IUs which passed TAS and stopped MDA (LF) 15
Total # IUs where surveillance TAS implemented (LF)
MMDP
# IUs where hydrocele surgeries performed 5 3
# IUs where lymphedema and ADLA management provided

9. Progress Towards LF Elimination
Started MDA
≥5 MDA rounds
Surveillance
MMDP access
𝟔𝟏 IUs
𝟑𝟏 IUs
𝟐𝟏 IUs
𝟔 IUs

10. Progress Towards STH Scale Up

11. Progress Towards STH Scale Up

12. PC Coverage, 2013
PC type
No. of districts IUs (districts) receiving PC
No. of districts IUs (districts) with reported coverage above target*
No. of districts IUs (districts) where coverage was verified**
MDA2 (DEC + ALB) 41 35 21
T3 (ALB/MBD) for STH 1st round 34
T3 (ALB/MBD) for STH 2nd round 75
* 65% for LF and 75% for STH
** reported coverage was verified by coverage survey or similar independent activity

13. Impacts of MDA in Sentinel Sites (LF)
# SS/SC sites
Sentinel Sites
<1% mf
≥1% mf
Spot Check sites
Baseline Survey 24 37 10 1
Latest surveys (post-MDA) -
Note: All reports not available

14. PC Monitoring and Evaluation
Post MDA coverage survey
Transmission assessment survey (TAS)
Pre-transmission assessment survey
Monitoring during PC implementation (MDA)
SAE protocol
Detection: training to volunteers on possible SAEs and reporting/self reporting,
Management: Programme provides free treatment of SAEs
Reporting: number of and types of SAEs

15. LF Transmission Assessment Survey to Stop MDA
Progress to date in assessing transmission
Number
# administrative units currently eligible for surveys to stop mass treatment
0 (10 in 2015)
# administrative units where surveys to stop mass treatment were conducted 21
# administrative units where criteria was passed and mass treatment stopped 20
Integrated assessment of STH considered? Yes

16. LF Transmission Assessment: Forecasting
Year
Number of IUs to be covered
TAS1 TAS2 TAS3
Total number of EUs
ICT/LF ST Required*
2014 - 5 2
3500
2015 10
8000
2016 16
5+7
20000
2017
10+14
5+7+2
22,500
2018
5+5
16,000
2019 7
12,000
2020
5+7+5
28,000
Insert into map:
-planned, not done
-needed, not planned
-not warranted
*sum of the total sample size required for each EU assessed;

17. MDA Status, TAS and Post MDA Survey Plan
Note: No colour significance. Resource identified till 2016.

18. Integrated Vector Management (LF)
No LF specific IVM activities
LLIN distribution (malaria programme)
Space spraying/indoor residual spraying for malaria and Kala-azar
IEC/BCC/awareness
Monitoring and evaluation are done by specific programme (eg: LLIN coverage survey, vector survey, LLIN durability study etc)

19. LF- MMDP – Strategy LF National policy exist? Yes
Organizational placement within the government (who is responsible?)
Epidemiology and Disease Control Division at the central level
How integrated with the health service?
Service is provided through integrated health service
Training of service providers conducted (by who? How frequent?)
Has been planned for 2014 (In two hospitals and 3 PHCCs/districts)
Patient mobilization and registration (by who? How?)
District health system

20. LF- MMDP – Monitoring and Evaluation
Describe how MMDP services are currently monitored and reported to the national programme
Districts and regional health directorate implement and monitor the MMDP activities (eg surgery camps)
Reported directly to programme and HMIS
How is “access” determined?
MMDP activities are organized in health facilities and communities based on the morbidity/case loads
Is there any quality assessment of provided services?
Monitoring during implementation

21. Best Practices
Multi-sectoral involvement ( mobilization of school teachers and local leaders)
Media mobilization
School health and nutrition week

22. Challenges and Issues LF Urban coverage Post MDA surveillance
Morbidity management
Low lying river valleys
STH
Monitoring
Achieving and sustaining coverage
Reaching non-enrolled school children

24. # administrative units for PC
Programme Plan
Activities
2014 target
2015 target
# administrative units for PC
# people PC
MDA2 (DEC + ALB) 41
15,981,384
T3 (ALB/MBD) for STH 1st round
T3 (ALB/MBD) for STH 2nd round
Activities
2014 Target
2015 Target
M&E
# districts/IUs where coverage surveys are planned for any PC diseases 21 22
# IUs where pre-TAS sentinel site and spot checks planned (LF) 10
# IUs where TAS for stopping MDA is planned (LF) -
# IUs where STH survey integrated with LF TAS planned
# IUs where MMDP is to be evaluated (LF)
# IUs where surveillance activities are to be carried out (LF) 5 20
MMDP
# IUs where MMDP services newly initiated (LF) 3
IVM
# IUs where IVM coordinated to target LF vectors

25. PC Medicine Request for 2015
ALB (LF)
ALB (STH)
MBD
DEC
required
(SAC) -
in stock
in pipeline
requested to WHO
(For SAC)
requested to
MDP (IVM) or ITI (AZI)
Procured from other sources
(source, # tablets and target age group)
Government procurement for Pre SAC
(Government procurement, 2-70 years)

26. Thank you !