Integrating Neglected Tropical Disease Campaign
Interventions into the Primary Health Care System (INCIPS)

Date of Completion
May 2022

Funder
Health Campaign Effectiveness Coalition (HCE) at the Task Force for Global Health, USA, Atlanta

Aim
Investigate the operational capacity and readiness of the Primary Health Care (PHC) system of Ethiopia and identify acceptable and feasible strategies to transition and sustainably mainstream Neglected Tropical Diseases (NTDs) campaign interventions into the PHC system.

Background
Mainstreaming NTD interventions into national health systems is one of the strategies emphasized in the WHO roadmap for NTDs. Ethiopia aims to mainstream and integrate NTD control activities within the primary health care (PHC) system. However, a major challenge has been the dearth of evidence on how to implement the proposed mainstreamed approach in a “real-world” setting. This research project was conducted to fill this gap. It had four phases: Phase 1 was a scoping review of the literature on NTD mainstreaming; Phase 2 was a stakeholder consultative workshop on mainstreaming challenges and their strategies; Phase 3 was a health system capacity assessment across purposively selected 7 regions and 10 districts; and Phase 4: was mainstreaming strategy co-development with stakeholders

Key Findings
In a scoping review we understand that there are appropriate policies and guidelines that support mainstreaming of NTD into the Ethiopia health system: the Ethiopia Health Sector Transformation Plan II (2020/21 – 2024/25), Essential Health Services Package of Ethiopia, the Second Generation National Health Extension Programme, and the Third National NTD Strategic Plan (2021–2025). However, a major gap is in the health system capacity to support and implement these policies. The experiences from different countries indicated that adequate governance, financing, and community engagement are vital for the successful mainstreaming of NTD programs.
In two consultative workshops, 73 mainstreaming challenges on service delivery (32 [43.8%]), inputs (22 [30.1%]), system (18 [24.7%]), and outputs (1 [1.4%]) were identified. The top three most frequently cited and ranked challenges were poor data recording and reporting; poor drug management and logistics; and poor supportive supervision and monitoring. Among the 185 strategies identified in the workshops to address the mainstreaming challenges, implementing standardized budget distribution criteria, establishing an effective drug management system, and applying a standardized and integrated monitoring and supervision tool were top ranked.
There is adequate willingness and readiness of PHC workers to mainstream NTD interventions into the PHC system. There is limited involvement of government leadership in NTD governance system at all levels. In the 2020/21 fiscal year, NTD constituted only 0.08% of the total domestic expenditure for health care. Absence of budget contribution by the government, lack of drug and supplies, and poor health facility infrastructure were the top-rated mainstreaming barriers. Overall, the Ethiopia health system is not yet ready to embark on fully-fledged NTD campaign interventions mainstreaming.