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16 THIRD WHO REPORT ON NEGLECTED TROPICAL DISEASES *** 2.3 Towards targets for universal coverage against NTDs by 2030 Monitoring of UHC is increasingly focused on two discrete components of health system performance: levels of coverage with health services and financial protection, with a focus on equity (14). A joint WHO/World Bank framework for monitoring progress towards UHC (15) proposes the following targets: • By 2030, all populations, independent of household income, expenditure or wealth, place of residence or gender, have at least 80% essential health services coverage; and • By 2030, everyone has 100% financial protection from out-of-pocket payments for health services. This section considers what the SDG targets – in particular the UHC targets – imply for NTD programmes in terms of population coverage with prevention and financial risk protection against the cost of treatment and care. Existing NTD targets are in fact well aligned with UHC targets, and monitoring progress towards the former will assist in monitoring progress toward the latter. Monitoring NTDs can provide some of the detail needed to monitor the equity of UHC progress across population groups. 2.3.1 Prevention of NTDs A UHC target of 80% essential health services coverage is broadly consistent with coverage targets for the prevention of NTDs. The UHC target could be easily translated into an NTDspecific target such as: 80% coverage of the population requiring prevention of NTDs by 2030. Coverage targets for preventive chemotherapy, for example, are defined as 100% geographical coverage of endemic districts and between 65% and 85% programme or therapeutic coverage of people requiring treatment within those districts, depending on which diseases are endemic. Coverage targets for integrated preventive chemotherapy will vary among countries, but globally the target is about 80%. Progress towards these targets is reported to WHO. Baseline values for 2012 are provided in Chapter 3. Coverage targets for other major interventions for prevention of NTDs, namely vector control, veterinary public-health services and yaws eradication, are reviewed in Chapter 4. Specific targets for universal access to improved water and sanitation are expected as part of the SDGs.
*** INVESTING TOWARDS UNIVERSAL COVERAGE AGAINST NTDS − CHAPTER 2 17 It is widely recognized that coverage alone is not sufficient – coverage must be of sufficiently high quality (16). High-quality coverage means timely and consistent coverage with the full package of essential interventions. For preventive chemotherapy, low compliance (the percentage of people actually taking the medicine that has been given to them) will undermine efforts to eliminate diseases (17). However, if a sufficiently high level of coverage of sufficiently high quality is sustained for a sufficiently long period of time – between 3 and 10 years, depending on the disease – transmission will become less likely or may even be completely interrupted. Interruption is confirmed by surveys. In this sense, the quality of coverage could be assessed at least in part by the achievement of another possible NTD target: A 90% reduction in the number of people requiring prevention of NTDs by 2030. What this target means in terms of scale up followed by scale down in the number of people requiring prevention coverage is discussed in Section 2.4. Lymphatic filariasis, onchocerciasis and trachoma are targeted for elimination well before 2030, and preventive chemotherapy will only be required, with reduced frequency, in areas with schistosomiasis and soil-transmitted helminthiases. Dracunculiasis and yaws are targeted for eradication by 2015 and 2020 respectively. The scale down of prevention of multiple NTDs will no doubt be facilitated by improved living conditions, including access to improved water and sanitation. Nonetheless, a 90% reduction in populations at risk of climate-sensitive diseases, such as dengue and zoonotic diseases, may not be realistic in all countries. In some, these diseases may require prevention measures beyond 2030. 2.3.2 Treatment and care of NTDs A necessary condition for the achievement of the UHC target of 100% financial protection by 2030 is that all populations at risk are financially protected against NTDs. That is: 100% of the population at risk protected against out-of-pocket payments due to NTDs by 2030. Catastrophic health expenditure has been defined as out-of-pocket payments exceeding 10% of annual household spending or, alternatively, 40% of non-subsistence spending. Measurement of NTD-specific catastrophic expenditure is impractical in most countries given that existing survey instruments rarely collect disease-specific out-of-pocket expenditures (18). This report therefore focusses on targets related to the adoption of policies to provide an essential package of NTD services free at the point of use.
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*** ANNEXES 179 ANNEXES
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*** ANNEXES 189 Annex 5. Medicines
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*** ANNEXES 191 WHO REGIONAL OFFICE
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