The document discusses strengthening community health systems from the bottom up. It emphasizes empowering communities to organize and direct their own healthcare, such as through community-directed treatment of onchocerciasis with ivermectin. When communities are informed and trained, they are capable of organizing mass treatment programs with minimal outside support over the long term. Integrating multiple neglected tropical disease control programs within primary healthcare systems and involving communities maximizes effectiveness and efficiency.

1. The Community: strengthening the health system from the bottom up Dr Adrian Hopkins Director of the Mectizan Donation Programme

4. EVERYBODY’S BUSINESS STRENGTHENING HEALTH SYSTEMS TO IMPROVE HEALTH OUTCOMES WHO’S FRAMEWORK FOR ACTION

5. The six building blocks of a Health System: aims and desirable attributes

7. Onchocerciasis : Life cycle Adult filariae in nodules Microfilariae in skin Microfilariae in eyes and elsewhere in body Microfilariae ingested By black fly during bite Development of microfilariae in black fly Infective larvae in head of black fly Infective larvae injected with black fly bite Larvae develop into adults

8. Onchocerciasis and the eye 300,000 people are blind and 0.5 million visually impaired 40,000 estimated new cases of blindness per year

15. Treatment beyond the end of the road

16. And further

17. CDTI in Action in Burundi

19. Onchocerciasis Treatments Approved

20. Treatment requirements to 2020 < APOC >

22. Target P<0.001

23. RBM target P<0.001

24. RBM target P<0.001

25. RBM target P=0.014

26. RBM target P<0.001

27. APOC target P<0.001

28. Costs to the Health System District Level First Line Health Facility Level

30. Evolution of treatment with Mectizan® in the Americas 1989-2007 and Projection 2008-2015 NOTE: Projected figures from 2nd cycle of 2009-2015 are UTG(2) numbers based on 2008 treatment census data from the remaining foci under treatment in the Americas region Resolution XIV Issued Resolution XIV Expiration OEPA started

32. Global elimination programme Using combination of two drugs

34. Lymphatic Filariasis Treatments approved

40. What is needed is a strong base Communities MoH Programme Specifics Reports Data Management Decentralisation Funds flow Drug distribution to Periphery Health Districts Policy And Technical Support

41. What is needed is a strong base or more input from communities Communities MoH Programme Specifics Health Districts Policy And Technical Support

43. Thank you