Operationalizing elimination goals with a national strategy

Related program: Advocacy and policy

Example: DRC National Strategic Plan for human African trypanosomiasis elimination

The five-year National Strategic Plan aligns elimination goals and employs tools to screen, test, and treat for sleeping sickness in some of the most remote parts of the country.

The need

In January 2012, a group of leaders from endemic countries, funders, pharmaceutical companies, and nongovernmental organizations came together to sign the London Declaration on Neglected Tropical Diseases. Inspired by the World Health Organization’s 2012 road map to drastically reduce the global impact of neglected tropical diseases (NTDs), they committed to control, eliminate, or eradicate ten NTDs by 2020.

Galvanized by this pledge, the government of the Democratic Republic of the Congo (DRC) needed a policy framework, a strategy, to guide its efforts to eliminate an NTD that had long plagued the country: Human African trypanosomiasis (HAT, also known as sleeping sickness). Transmitted by the bite of the tsetse fly, HAT is usually fatal if not treated. Nearly 85 percent of cases occur in the DRC. Thus, eliminating the disease in the country would pave the way for elimination worldwide.

When assessing the HAT situation in the country, one thing became clear to the Ministry of Health: the need to have a singular national policy that clearly outlines specific ways in which the country can eliminate the disease.

The policy

In preparation for drafting the policy, the Ministry of Health conducted landscaping of HAT endemic provinces to gather information about current HAT cases, elimination efforts, and barriers to elimination. Upon completion of this landscaping, the Ministry of Health, PATH, and other national and international partners came together to reflect on the current situation and determine the approaches needed to achieve elimination. The accompanying written strategy was spearheaded by PNLTHA (Programme National de Lutte contre la Trypanosomiase Humaine Africaine)—the national program for the control of HAT—in consultation with partners.

Following the completion of the written strategy, PNLTHA officially launched the five-year HAT National Strategic Plan in 2018. The strategy put into effect the use of tools including rapid diagnostic tests, improved treatment, and innovative insecticide-treated traps to control tsetse flies, alongside an awareness-raising campaign, use of digital technology to help find and confirm new cases, and “mini-mobile teams” going door-to-door in remote provinces to screen for the disease. It also ensures these interventions are funded and prioritized at the national and local levels, ensuring that diagnostics, control methods, and new drugs are incorporated into governing policy documents so they can be rolled out to at-risk areas. Key to the strategy is stopping transmission, which requires treating people during the first phase of the disease, when it’s much harder to diagnose and is often confused with other diseases, like malaria.

Understanding the importance of not only writing the policy, but properly implementing it, the Ministry of Health used the first National Day of HAT—an annual recognition to celebrate the DRC’s progress toward elimination of the disease and emphasize the government’s commitment to eliminating HAT by 2020—as an occasion to announce the Strategic Plan . The Ministry of Health used the anniversary of the London Declaration on NTDs as a hook for declaring a National Day of HAT, and in doing so connected the national and global NTD elimination priorities.

At the end of 2018 the DRC held national elections, voting into power a new Minister of Health. With a new Minister of Health comes new priorities, and the HAT National Strategic Plan 2018 was updated in 2019 to reflect these changing priorities and progress toward elimination.

The impact

The alignment of the HAT elimination vision and creation of one national policy is a tremendous step toward eliminating HAT in the DRC. Ministry of Health data from January 2019 show that the number of cases of HAT in the DRC continue to decline, one indication of the positive impact of the Strategic Plan.

Since its launch, HAT endemic provinces have been using the Strategic Plan as a benchmark to raise political will for HAT elimination. This has resulted in the creation of provincial-level policies for resource allocation.

Following national elections, in early 2019 the National Strategic Plan for HAT was adapted to fit the national health development plan under the new administration. Although the basis of the policy remains the same, the process speaks to its ability to easily adapt to new government priorities.

Today, the HAT National Strategic Plan continues to employ tools to screen, test, and treat for HAT, and is updated to include new drugs and technologies as they become available. A new all-oral drug, fexinidazole, was registered in the DRC in late 2018 and has since been added to the Strategic Plan for the treatment of HAT stage-1 and stage-2.

Considerations for application

Following the success of DRC’s National Strategic Plan for HAT, other endemic countries can follow the DRC’s lead in creating a national strategy to employ similar methods to fit with their geographies.

Additionally, other HAT endemic provinces within DRC can use the HAT National Strategic Plan to raise political will for the creation of and as an outline for implementing provincial-level HAT policies.

Policy text

National Strategic Plan for human African trypanosomiasis elimination

Additional resources