Neglected tropical diseases (NTDs) are a diverse set of 20 debilitating infectious diseases which affect more than 1 billion people worldwide. The most affected communities are the most impoverished, marginalised and rural communities in countries where the diseases are endemic. According to WHO, NTDs contribute to nearly 19 million disability-adjusted life years. It is estimated that more than 1.7 billion people require treatment for at least one NTD, every year. Over one third of people affected by NTDs live in Africa.
Launched in 2011, the ALMA Scorecard for Accountability and Action implements a monitoring, accountability and action mechanism to track progress, identify bottlenecks and facilitate appropriate action through the ALMA Scorecard for Accountability and Action. To further enhance leadership in ending NTDs in Africa, African leaders requested the inclusion of an NTD indicator in the ALMA Scorecard for Accountability and Action in 2017. Following consultations with partners, the indicator selected was the NTD coverage Index, an indicator that tracks progress in the coverage of drugs distributed for the five NTDs amenable to preventive chemotherapy (PC-NTDs: trachoma, lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths). Data for the indicator are routinely reported by countries to WHO. Indicator performance categories (“on track”, “progress but more effort needed” and “not on track”) are aligned to the WHO NTD Roadmap overall coverage target for the five NTDs eligible for preventive chemotherapy.
How it works
The scorecard accountability tool is produced quarterly by the ALMA Secretariat. It has three complementary components:
The scorecard, which displays country-level performance against key malaria, neglected tropical diseases (NTDs) and reproductive, maternal, newborn, child and adolescent health (RMNCAH) indicators for 46 malaria-endemic countries in Africa highlighting successes and shortfalls in performance. The scorecard currently tracks one NTD tracer indicator, the NTD coverage index. This index is the geometric mean of the reported coverage rates for the five diseases amenable to preventive treatment.
Country quarterly reports which provide a summary of performance for each country and document and track recommended actions to address identified bottlenecks. ALMA works with NTD partners, including WHO ESPEN and Uniting to Combat NTDs, to craft tailored and specific NTD recommended actions, which are then incorporated into country quarterly reports, highlighting essential actions required to drive action and impact for NTDs, where performance is not on track. Subsequently, progress in addressing the recommended actions related to the NTD composite indicator are tracked on a quarterly basis and the NTD coverage index is updated on an annual basis and shared with countries in the ALMA quarterly scorecard.
The inclusion of the NTD indicator into the ALMA scorecard for accountability and action has increased visibility of NTDs at country level and led to impactful action.
In Kenya, the scorecard has facilitated a review of country performance in supply chain, service delivery and Mass Drug Administration (MDA) coverage and has helped to identify bottlenecks and gaps. For example, the findng of low coverage of trachoma MDA led to the integration of trachoma into the national NTD programme, and also into the existing supply chain arrangement for NTD drugs. Additionally, the scorecard review led to an increase of the MDA budget from US$ 170,000 in 2015 to over US$ 1,000,000 in 2019 and stimulated the developed the Kenya Breaking Transmission Strategy for STH, Schistosomiasis, lymphatic filariasis (LF) and Trachoma (2019-2023).
“The ALMA scorecard is a great platform for advocacy and to enhance the visibility of NTDs by senior management. The addition of the NTD indicator also made Ministry senior management realize NTDs have international attention and aware of the private sector involvement with drug donations.”
NTD Programme Manager, Kenya
In Rwanda, the review of the scorecard revealed a low NTD Coverage index, due to failure to undertake MDA because of lack of funds. The following actions were taken to address the low coverage: finalization of the NTD Master plan; improved partner coordination and collaboration and support to the NTD programme for MDA; integration of deworming into routine activities at district level; inclusion of NTD indicators in district action plans, with a standing budget allocation; and inclusion of NTD indicators in DHIS-2. The NTD programme also mobilized funds to map mycetoma and scabies and the country committed an additional US$ 500,000 to improve the supply chain and MDA distribution.
In Botswana the inclusion of the NTD index indicator in the ALMA Scorecard has enabled quarterly updates to senior leadership at the Ministry of Health where programmatic and other gaps are highlighted. Botswana’s First Lady has added NTDs to her list of priority issues and the government has pledged more funding for NTDs.
“It has been useful to have a mechanism to give quarterly updates and highlight gaps to leaders. The recommended actions were implemented and helped to improve where gaps have been identified. The First Lady has now added NTDs to her list of issues she supports. Before 2017, she hadn’t heard of Schistosomiasis.”
NTD Programme Manager, Bostwana
In 2018, Burundi’s NTD indicator was ‘red’ in the ALMA scorecard. A bottleneck analysis revealed that no MDA for trachoma had been conducted due to lack of data on the prevalence of this disease. In collaboration with country partners, a trachoma survey was conducted and one district was found to be endemic and in need of MDA. The MDA for trachoma was then conducted leading to a coverage exceeding 95%.
In some cases, the ALMA scorecard was also able to increase visibility of programmes performing well.
Malawi was identified as the country with the second highest NTD coverage in Africa and this created an opportunity to raise awareness and advocate for NTDs at the highest levels in the country. Additionally, an article on the ALMA Scorecard was published in a national newspaper, further increasing NTD visibility to leadership and the general public.
Country feedback indicates that the inclusion of the NTD indicator in the ALMA scorecard for accountability and action has significantly increased the visibility of NTDs at country level. Countries have noted that following up on the recommended actions has helped countries by increasing the attention of senior leadership to NTDs. This has included increased resource allocations from both government and partners.
The impact of the inclusion of the NTD indicator in the ALMA scorecard has stimulated interest in the development of NTD scorecard tools at country level. As of September 2021, 8 countries have developed national scorecard management tools for NTDs.