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20 THIRD WHO REPORT ON NEGLECTED TROPICAL DISEASES *** of the financing that will be available for the post-2015 development agenda will not be foreign aid (23). They are based on the principle that NTD programmes should not be disproportionately dependent on foreign aid relative to other health programmes. In 2011, the domestic share in total expenditure on health was 71% in low-income countries, 98% in lower-middle-income countries and more than 99% in upper-middle-income countries (24). These shares are applied to the total investment targets to obtain domestic investment targets, allowing for an upward trend towards 2030 that is in line with recent trajectories in economic growth. These targets should not be interpreted as forecasts. They are intended to help endemic countries with their plans and budgets for NTD control, not to replace those plans and budgets. Investment targets are perhaps most useful in assessing the affordability to governments and national insurance schemes of universal coverage against NTDs within a longer-term perspective. They may facilitate discussions between ministries of health and other relevant ministries – especially ministries of finance. They may also help in the design of innovative financing mechanisms described in Section 2.7. Finally, investment targets may give an idea of the size of the market for innovation. While affordable, universal coverage against NTDs is not so cheap that it does not warrant further investment in new tools and approaches. 2.4.1 Population and service targets Populations targeted for coverage with prevention In the case of preventive chemotherapy for five NTDs, population targets are based on estimates of the population requiring treatment and the Roadmap’s targets for treatment coverage and duration. These targets suggest that if a high level of coverage is maintained for a number of consecutive years, populations should no longer require this intervention. Fig. 2.2 displays the minimum number of people to be targeted. Diseases are grouped based on evidence about co-endemicity and the possibility of integrated delivery of medicines for lymphatic filariasis and onchocerciasis in Africa, schistosomiasis and soil-transmitted helminthiases among school-age children, and lymphatic filariasis and soil-transmitted helminthiases outside Africa. Globally, the total number of people targeted for coverage with preventive chemotherapy for at least one NTD reaches a high of about 1.5 billion in 2017 (Fig. 2.2, panel H) and then decreases to 200 million people by 2030. In the case of vector control for Chagas disease, dengue and visceral leishmaniasis, population targets are based on estimates of the population at risk living in areas eligible for sustained vector control interventions. Targets for Chagas disease imply vector control coverage for an average of 110 million people per year over the period 2015–2030. About 2 billion people are targeted each year for coverage against the dengue vector – a relatively conservative target given recent population-at-risk estimates of between 2 and 4 billion (25). For visceral leishmaniasis, long-lasting insecticide-treated nets and indoor residual
*** INVESTING TOWARDS UNIVERSAL COVERAGE AGAINST NTDS − CHAPTER 2 21 Fig. 2.2 Number of people targeted for coverage with integrated preventive chemotherapy, selected NTDs A. LF and onchocerciasis B. LF and STH 600 100 400 50 200 0 0 C. Schistosomiasis and STH (SAC) D. Onchocerciasis (where LF is eliminated) 100 90 75 60 Millions of people 50 100 30 0 E. Schistosomiasis (adults) F. STH (where LF is eliminated) 400 300 50 200 200 G. Trachoma H. Total 150 1200 100 800 50 400 0 2015 2020 2025 2030 Year 2015 2020 2025 2030 LF, lymphatic filariasis; SAC, school-age children; STH, soil-transmitted helminthiases. Notes: The dots indicate the number of people treated in 2012; the solid lines are targets not forecasts. Targets assume integrated delivery of preventive chemotherapy for LF and onchocerciasis in Africa, schistosomiasis and STH among school-age children, and LF and STH outside Africa. Pending further evidence, they do not yet assume further integration of LF and onchocerciasis in Africa with schistosomiasis and STH.
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*** ANNEXES 179 ANNEXES
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*** ANNEXES 181 Annex 1a (cont’d)
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*** ANNEXES 183 WHA66.12 Recognizin
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*** ANNEXES 189 Annex 5. Medicines
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*** ANNEXES 191 WHO REGIONAL OFFICE
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