English - Global Alliance to Eliminate Lymphatic Filariasis

REPORT OF THE 6 TH GAELF MEETING, JUNE 2010
Mr Jose de la Cruz noted three types of unfamiliarity that create barriers to integrated
management of lower limb conditions. First, there is lack of familiarity with the clinical and
social tools to address these problems, for which guidelines are necessary. Second, there is
a lack of knowledge about the epidemiology of various lower limb conditions in most areas.
Third, there is a lack of familiarity with other organizations that are already addressing some
of these conditions (e.g., NGDOs working in leprosy) that can be integrated with LF
morbidity management. He suggested that NGDOs that are working in the field can provide
WHO with a map that indicates they are active, what they are doing, and with whom they
are partnering. This could be useful to WHO and to programme managers in developing a
coordinated approach.
Dr Leda Hernandez asked about the specific role of the LF programme manager in morbidity
management, and considerable discussion focused on this. Dr Lisy Rasoazanamiarana
reported that, in Madagascar, the role of the government has been to coordinate with
NGDOs to set up the programme, provide training in morbidity management for health
workers, and establish standards for patient follow-up. The NGDOs serve as an interface
between the government and the community; their covenant with the community enables
them to motivate community support for the programme and ensure adequate patient
follow-up. Patients with ADL episodes are managed within the public health system. The
Ministry of Health provides training on managing a variety of conditions of the lower limb,
including diabetes and LF.
Dr Pepe agreed, and said that integration does not necessarily require combining the
services of several NGDOs, all with separate disease mandates. Rather, a single interested
NGDO with expertise in one area can, if motivated, help to address a variety of issues and
diseases. Especially in low-income countries, flexibility is important.
Dr Brantus summarized the session by thanking the participants. He noted that the
publication of WHO treatment guidelines will represent an important step forward. He
called for developing clear strategies among interested parties, focused on integration
based in partnership. He also acknowledged that NGDOs and Ministries of Health have
different roles within a partnership, and clarity around these roles will facilitate explicit and
specific action on the part of each partner. Integration of lower limb care is just one
expression of the impulse toward greater integration of the health and medical systems
now underway in many countries.
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