Study finds evidence that single-disease initiatives may compromise fragile health systems in low-income countries

Aug 20 2010

Single-disease initiatives in low-income countries with fragile health systems may compromise the ability of such health systems to meet the other community needs, according to a study published Tuesday in PLoS Neglected Tropical Diseases, VaccineNewsDaily.com reports (Purlain, 8/18).

For the study, researchers analyzed how an integrated neglected tropical disease (NTD) treatment campaign in Mali, which was supported mostly by USAID, affected 16 of the health centers involved, Scientific American's "Observations" blog reports. For the NTD treatment campaign, health workers were tasked with the distribution of "four of six drugs (ivermectin or diethylcarbamazine, praziquantel, albendazole or mebendazole, and azithromycin) ... to combat five common diseases (lymphatic filariasis, river blindness, schistosomiasis, soil-transmitted helminthiasis and trachoma)," according to the blog.

To track the impact of the drug distribution campaign on daily health care tasks, the researchers evaluated "health centers that were involved in the campaign via participant observation, interviews and document analysis," the blog adds (Harmon, 8/18).

"At point of delivery, campaign-related workload severely interfered with routine care delivery which was cut down or totally interrupted during the campaign, as nurses were absent from their health centre for campaign-related activities. Only 2 of the 16 health centres, characterized by a qualified, stable and motivated workforce, were able to keep routine services running and to use the campaign as an opportunity for quality improvement," the study authors write. "While the campaign increased the availability of NTD drugs at country level, parallel systems for drug supply and evaluation requested extra efforts burdening local health systems," they add.

The authors write that "though the initiative rested at least partially on national structures, pressures to absorb donated drugs and reach short-term coverage results contributed to distract energies away from other priorities, including overall health systems strengthening" (Cavalli et al., 8/17).

Despite such challenges presented by the NTD program, the researchers "don't advocate halting crucial targeted disease programs," Scientific American notes (8/18).

"The control of NTDs in vulnerable communities is a necessity. But so is health systems strengthening, in order to respond adequately to other health problems and to ensure sustainable achievements, including of NTD control," the study authors write. "A major challenge is how to engage in disease control - NTD and other diseases - without negatively impacting on existing health systems."

"There are signs of (disease-specific initiatives) learning from experience and gradually modifying some of their processes. They also show increasing willingness to reduce fragmentation and to review processes," the authors continue. "Still the chaotic architecture for development assistance for health remains a major obstacle for health system strengthening. Progress towards effective and inclusive health systems will not result from the sum of selective ... interventions," they conclude (8/17).