RTI International: Eliminating lymphatic filariasis in Nepal

For many years, Nepal has been working to eliminate lymphatic filariasis, a disabling and stigmatizing neglected tropical disease (NTD) spread by mosquitoes. While symptoms can be managed, those who suffer from elephantiasis, cannot be cured. That is why the Government of Nepal is championing efforts to eliminate the disease from the country. USAID has been contributing to Nepal’s efforts to fight neglected tropical diseases, including lymphatic filariasis, since 2009. From mapping the burden of disease, to supporting government-led treatment campaigns, implementing surveys to track progress, and strengthening local capacity to respond, the work continues to ensure the disease is eliminated for good. USAID’s Act to End NTDs | East, which is implemented by RTI International, is a global effort assisting governments to eliminate NTDs, in Nepal, and around the world. The good news is that safe, effective medicines exist to help prevent lymphatic filariasis—and they are donated free of charge to governments working to eliminate the disease. Over the past decade, the Government of Nepal has worked to ensure these medicines reach all those that need them. By providing these preventive medicines for multiple years to whole communities, Nepalis are closer to being free from this devastating disease. However, effectively reaching all Nepalis with these medicines is no small job. 

Alongside the government, USAID’s Act to End NTDs | East has supported significant and innovative efforts to ensure all Nepalis are treated, including through targeted efforts such as partnering with youth, journalists and health professionals, and by reaching minority groups often missed by health services. 

Raising awareness in schools Nepal’s growing youth population plays a significant role in society and can inform and educate their communities about health activities, including the importance of participation in treatment campaigns for lymphatic filariasis. To this end, Nepal launched a school awareness program with support from USAID’s Act to End NTDs | East to engage and equip youth as community ambassadors. Across seven districts, approximately 100,000 youth have been engaged in this successful school awareness effort, helping to reach youth and their families with annual treatments to eliminate lymphatic filariasis in Nepal.  Partnering with journalists Knowledge can be a powerful tool by helping individuals to understand the disease and raising people’s awareness, interest, and demand for preventive medicines. In an effort to overcome misinformation and increase public awareness about national treatment campaigns, USAID’s Act to End NTD | East has organized interactions with Nepali journalists to make sure they have the resources and information they need to report on lymphatic filariasis and the national efforts to eliminate the disease. These sessions include sharing data on progress across districts, information on budgetary issues for interventions, expected side effects and management plans put in place to address any health concerns following treatment with ample time allocated for questions and clarifications. These efforts have helped in reducing rumors and increased participation in lymphatic filariasis treatment campaigns. Improving uptake of treatment by all Nepalis Over the last few years, with support from USAID’s Act to End NTDs | East, the Government of Nepal has been working to determine which Nepalis are not getting the treatment they need. A gender equity and social inclusion analysis conducted in Dang, Banke, and Kapilvastu confirmed that there are challenges faced by different communities causing them to either miss or refuse treatment. Detailed results are currently being used by national, provincial and district officials, with support from USAID’s Act to End NTDs| East, to develop plans to adapt treatment campaigns to the needs of these communities, including people of certain religious and ethnic groups and young women who face mobility restrictions, by engaging men to achieve better treatment results in the challenging geographic areas in the coming years. A Nepal free from lymphatic filariasis Despite some challenges, Nepal has made tremendous progress toward eliminating lymphatic filariasis, with more than 18m Nepalis no longer requiring treatment across the country, thanks to the success of these interventions to date. The massive task to distribute treatment is driven by strong government leadership, the commitment of municipalities in planning and financing treatment campaigns for their populations, and the diligent efforts of health workers and female community health volunteers in planning and mobilizing people for treatment and sharing other important health information.  Nepal has made incredible progress to date, but the work is not over. Currently, treatment continues for 10m Nepalis still at risk of lymphatic filariasis—ensuring that treatment campaigns reach these people effectively will be a key step to securing a healthy and productive future free from lymphatic filariasis. USAID’s Act to End NTDs | East program continues to support the government to conduct surveys to measure progress—these results show where adaptations and improvements are needed, as well as the areas that are having successes in eliminating the disease.  Nepal has proven that it is capable of eliminating a neglected tropical disease before and can do it again. In April 2018, the World Health Organization validated Nepal’s elimination of trachoma as a public health problem. Through the leadership of the Government of Nepal and the Nepal Netra Jyoti Sangh (NNJS), and with support from partners like USAID and Research Triangle Institute (RTI) International, Nepal achieved an incredible success in eliminating trachoma as a public health problem. Nepal was the sixth country globally to eliminate trachoma, and the first in WHO’s Southeast Asia Region. As we move forward, we must work together to eliminate this disease for good. This will require adaptive and targeted strategies to ensure that all those at risk receive treatment and continued efforts to monitor and track progress. Together we can achieve a Nepal free from lymphatic filariasis – we can and we are making Nepal better.