Universal Health Coverage, or UHC, means that all people have access to the health services and safe and effective treatment they need without financial hardship. The global program to eliminate trachoma – a neglected tropical disease and the world’s leading infectious cause of blindness – provides a strong example of how a targeted disease program can contribute to the achievement of UHC. The program provides a wide range of essential health services, from health education to treatment, whilst simultaneously strengthening data collection and analysis, supply chain management and ensuring high-quality surgical outcomes.
Data collection and analysis
Ensuring governments have the information they need to inform their decision-making process is central to the global program. From 2012 to 2016, program partners undertook the largest infectious disease survey ever, which saw teams collect data from 2.6 million people in 29 countries to accurately identify trachoma endemicity. The Global Trachoma Mapping Project, or GTMP, funded by the UK Department for International Development and USAID, delivered a step-changing moment. It used smartphone technology to provide governments with robust standardized data so that they could effectively implement the World Health Organization’s (WHO) SAFE Strategy (surgery, antibiotics, facial cleanliness, environmental improvements) to eliminate trachoma in endemic districts.
The legacy of GTMP continues through the WHO-led Tropical Data Initiative, launched in July 2016. The initiative uses the same methodology and supports the full survey process, from planning and protocol development through to data management and analysis of the data. These initiatives are helping national programs to build their capacity and strengthen their use and analysis of data.
Supply chain management
The global program has also improved supply chain management by improving access to quality data through the Zithromax® Shipment Tracker. The web-based tracker, developed by the International Trachoma Initiative, provides real-time data for drug shipments. This gives national programs a useful tool to help effectively plan drug distributions and make adjustments when delays occur. The tracker improves communications between national programs and partners, which in turn helps to ensure drugs are delivered where and when they are needed.
Improving quality in surgical outcomes
The global program to eliminate trachoma is supporting national health authorities to eliminate trichiasis, the advanced blinding stage of trachoma, through the provision of technical guidance and training. This support has contributed to huge scale up in surgeries being performed, including a record-breaking 260,000 surgeries in 2016, increasing from 66,000 in 2011.
The program includes the use of HEAD START, an innovative training tool that allows surgeons to practice surgery techniques on a life-like surgical simulator. It provides a valuable addition to live surgery training for surgeons, who once practiced on orange rinds.
In 2016, a record-breaking 85 million people received drugs to treat trachoma infection. A strong multi-stakeholder partnership, which includes national trachoma programs, Pfizer, the International Trachoma Initiative and the International Coalition for Trachoma Control is allowing drugs to be delivered to millions without imposing any financial burden to beneficiaries.
Over 689 million treatment doses have been delivered thanks to a flexible, transparent and efficient supply chain, which includes public and private sector partners at the local, national, and international levels, right through to community health workers and volunteers who administer the treatment to individuals. The drug donation program has helped to reduce the number of people living in trachoma endemic regions from 325 million in 2011 to 182 million in 2016.
Facial cleanliness and environmental improvements
Universal health coverage not only means that people have access to treatment if they become ill, it also requires the promotion of healthy living so that people do not fall ill in the first place. The global program is supporting long-term sustainable efforts to prevent disease by promoting good health practices, such as facial cleanliness and hygiene as well as improving environmental conditions such as access to clean water and sanitation.
Water, hygiene and sanitation (WASH) activities are being increasingly integrated into national trachoma programs. This not only reduces the risk of trachoma, but a wide variety of other health issues including diarrhoea (a leading cause of death in children under five), and other neglected tropical diseases such as schistosomiasis, lymphatic filariasis and soil-transmitted helminths.
Cross-sector collaboration is an fundamental element of the global program which is building infrastructure and promoting the health practices that are necessary to prevent disease.