"No universal methodology"
There is no universal methodology to control human African trypanosomiasis. Control and surveillance of the disease includes active and passive case finding, diagnosis, treatment, patient follow-up, vector control and control of animal reservoir. These are performed at different levels and intensity, depending on epidemiological situation, local and national capacity and environment.
Control and surveillance can be implemented by the health system using mobile teams or fixed posts or both, whereas coordination can be centralized or decentralized, vertical or integrated in the existing health services.
The elaboration of a control and surveillance system must take into consideration the epidemiological status and the form of the disease, gambiense or rhodesiense. Financial availability, local needs and constraints are also fundamental elements in planning. In addition, geographic, climatic, sociologic and demographic factors as well as problems associated with security and accessibility, staff availability and competence, as well as the structure and performance of health care system must be considered.
Each of these aspects will define the method and approach of the programme. There is no “standard” scheme for surveillance and control. Each situation must be assessed and analyzed separately to develop appropriate strategies and meet local needs.
WHO approach to efficient and effective surveillance and control operations consists in helping national programmes assess local conditions, identify available techniques and methodologies, help design appropriate structures, develop adapted strategies and implement capacity building activities. Assistance is brought through consultation, training and logistics support.
Success of control and surveillance stumbles on a number of factors:
- the disease occurs mostly in rural-difficult-to-access areas, south of the Sahara and is distributed over wide areas where poverty, social instability, insecurity and weak health systems are predominant;
- the complexity of current tools to combat the disease require technical and medical staff with strong competence and experience, which usually impedes implementation of control activities by primary health services;
- the disease competes with pandemic diseases and is consigned to a low health priority, receiving little support from health policy makers and donors.