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

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

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

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

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

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

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)

PC Programme Achievements 2013 Activities Targeted Achieved # administrative units for PC # people PC MDA2 (DEC + ALB) 41 14762884 10933596 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

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

Progress Towards STH Scale Up

Progress Towards STH Scale Up

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

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

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

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

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;

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

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)

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

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

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

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

# administrative units for PC Programme Plan Activities 2014 target 2015 target # administrative units for PC # people PC MDA2 (DEC + ALB) 41 14762884 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

PC Medicine Request for 2015 ALB (LF) ALB (STH) MBD DEC required 15695317 10673078 (SAC) - 39238293 in stock 10000000 in pipeline requested to WHO 10673078 (For SAC) requested to MDP (IVM) or ITI (AZI) Procured from other sources (source, # tablets and target age group) Government procurement for Pre SAC 39238293 (Government procurement, 2-70 years)

Thank you !