Guyana’s National Action Plan for Neglected Infectious Diseases

Objectives

Guyana’s 2022–2027 National Neglected Infectious Diseases (NID) Plan seeks an NID-free Guyana by 2030 through a quality, patient-centred programme that is comprehensive, integrated, sustainable and effective, achieves national and regional elimination where feasible, and reduces socioeconomic burden.[1]It supports universal health coverage and Sustainable Development Goal target 3.3, including the aim to end neglected tropical disease epidemics by 2030.[2]

• Align NID action with the World Health Organization Neglected Tropical Diseases Roadmap 2021–2030, Pan American Health Organization frameworks and Guyana’s National Health Vision 2030.[3][2][4]
• Address lymphatic filariasis, leprosy, Chagas disease, cutaneous and mucocutaneous leishmaniasis, and soil-transmitted helminthiasis through disease-specific elimination, control, prevention and burden-reduction measures.[5][6][7]
• Accelerate programme action, intensify cross-cutting responses to multiple diseases, and strengthen country ownership through changed operating models and culture.[2]
• Strengthen disease and vector surveillance, monitoring and evaluation, including active and passive surveillance, epidemiological and entomological reporting, mapping, laboratory confirmation and use of evidence for policy and programme decisions.[8][9]
• Mainstream prevention, diagnosis, treatment, case management, rehabilitation and psychosocial support within regional health services, with Level 2 and higher facilities intended to provide NID diagnosis and case management.[8][10]
• Improve clinical, public-health, entomological and Tropical Disease laboratory capacity, including quality control, quality assurance, standard operating procedures, modern equipment, reagents, trained personnel and external verification.[8][11][12]
• Strengthen programme management, integration, resource mobilisation, policy guidance, operational research and human-resources planning for NID elimination.[8][13][14]
• Increase public knowledge, address myths, stigma and discrimination, and support people affected by NIDs through equitable, accessible, resilient primary health services and community participation.[1][15]
• Collaborate with water, sanitation and hygiene services, rehabilitation services, maternal and child health, Amerindian Affairs, education, environmental health, local government, private providers, civil society and development partners to address social and environmental determinants.[8][15][16]

Disease goals differentiate between elimination and control. Lymphatic filariasis action aims to interrupt transmission through preventive chemotherapy, morbidity management, disability prevention, hydrocoele surgery, treatment and vector control, with effective mass drug administration coverage of at least 65% of the total population.[17]Leprosy aims for zero infection and disease, zero disability, and zero stigma and discrimination, including zero new autochthonous cases by 2028.[18]Cutaneous and mucocutaneous leishmaniasis is to be controlled rather than eliminated because of its sylvatic cycle and unknown wildlife reservoir, with targets to detect and report 85% of cases and treat 95% of reported cases.[19]Soil-transmitted helminthiasis priorities include establishing baseline prevalence and distribution evidence, designing an elimination programme, regularly treating 75% of children requiring treatment, and reducing moderate- or heavy-intensity infections below 2%.[20][21]Chagas disease priorities include reducing domestic vector infestation, preventing vector-borne, foodborne, congenital, transfusional and transplant-related transmission, and strengthening mother-to-child transmission prevention.[22][23]

Implementation

The plan adopts an integrated, decentralised delivery model in which central Ministry of Health programmes set policy, coordinate resources and strengthen specialist capacity, while regional health services embed prevention, diagnosis, treatment, surveillance, referral and follow-up in routine care.[4][8][24]Delivery is intended to use national health facilities, regional health authorities, vector-control infrastructure, laboratories, schools, maternal and child health services, rehabilitation providers and community platforms, with partners addressing capacity and resource gaps.[2][25][26]

• Establish a High-Level Commission on Elimination of NIDs, or country coordinating mechanism, to coordinate governmental, non-governmental and development-partner interventions, alongside regional NID committees responsible for regional implementation, partner coordination and advocacy.[8][24]
• Hold quarterly performance-review meetings at national and regional levels, supported by monitoring and evaluation teams, shared dashboards and reciprocal transfer of programme, logistics, financial, communication, milestone and delay information.[8][24]
• Deploy a trained surveillance officer in every region, increase entomology personnel to two per region, develop epidemiological and entomological protocols, and integrate vector surveillance with disease surveillance and vector management.[9][24]
• Make lymphatic filariasis, leishmaniasis, Chagas disease and soil-transmitted helminthiases notifiable, complementing existing leprosy notification and improving the completeness of regional reporting.[9][24]
• Train regional core teams, clinicians, laboratory staff, medicine distributors and community personnel through integrated curricula, training-of-trainers arrangements, annual refresher training and support supervision.[10][11][13]
• Develop an integrated NID unit, supported by a human-resources plan, adequate case-management space, operational research, an integrated monitoring and evaluation system and training materials suitable for hard-to-reach areas.[13][14]
• Modernise Vector and Tropical Disease laboratory capacity through documented testing packages, microscopy, skin scrapings and slit smears, enzyme-linked immunosorbent assay, polymerase chain reaction where available, biosafety, supply management and quality-assurance systems.[11][27][28]
• Implement disease-specific interventions, including mass drug administration and post-treatment surveillance for lymphatic filariasis; baseline surveys and mapped deworming for soil-transmitted helminthiasis; antenatal and maternal-child-health interventions for Chagas disease; risk-based leishmaniasis surveillance and case management; and contact screening, multidrug therapy, rehabilitation and stigma reduction for leprosy.[21][23][29]
• Coordinate water, sanitation and hygiene inspections, drainage improvements, risk-area identification, safe-water action, school and community awareness, and joint behaviour-change activities to reduce vector breeding and exposure.[15][16]

Implementation is phased through quarterly milestones from 2022 to 2027, including programme execution targets of 60% by 2024, 80% by 2025 and 100% by 2027.[13][24]Monitoring is to combine facility reporting, quarterly epidemiological and entomological reports, performance meetings, periodic six- and twelve-month reviews, patient-satisfaction assessment and operational research.[9][10]Key indicators include timely facility surveillance reports, reported NID cases, incidence, prevalence, morbidity, mortality, laboratory capacity and quality, trained staff, service availability, patient satisfaction and regional implementation of integrated surveillance.[9][10][12]

Financing arrangements are framed around proper budgeting, continuous adequate funding, resource mobilisation and integration of NID activities into national plans and health budgets.[2][8]The plan identifies costed elements to be developed, including a soil-transmitted helminthiasis programme, NID human-resources plan, Vector and Tropical Disease Laboratory design and operating budget, and five-year multimedia communication plan; the supplied material does not provide monetary allocations, a total budget or quantified funding gaps.[23][28][14][30]

Monitoring & Evaluation

The plan establishes an integrated monitoring, evaluation and surveillance approach for neglected infectious diseases, linking routine reporting, active and passive surveillance, laboratory confirmation, programme performance review and progress towards national, regional and global elimination targets.[1][9][31]It identifies persistent weaknesses in case detection, laboratory capacity, data sharing, paper-based reporting and the availability of reliable epidemiological data, particularly for Chagas disease, leishmaniasis and soil-transmitted helminthiasis.[7][25][32]

• Strengthen integrated surveillance through regional surveillance officers, trained entomology personnel, active and passive case detection, vector surveillance, improved data-management software and reciprocal data sharing between national and regional levels.[9][24]
• Make lymphatic filariasis, leishmaniasis, Chagas disease and soil-transmitted helminthiases notifiable to improve reporting and case-based surveillance.[9][24]Leprosy is the only one of the five priority diseases currently recorded as notifiable in the cited system.[7]
• Hold quarterly performance-evaluation and surveillance meetings through the High-Level Commission on Elimination of NIDs or Country Coordinating Mechanism and regional committees.[9][24][27]
• Use shared dashboards and monitoring and evaluation teams to transfer financial and programme information, including milestones, logistics, communications and implementation delays, between central and regional levels.[8]

Key cross-programme indicators include timely facility surveillance reports, reported NID cases, quarterly epidemiological reports on incidence, prevalence, morbidity and mortality, quarterly entomological reports, and the number of regions operating integrated disease surveillance.[9]The plan also tracks trained personnel, service availability, patient referrals, patient satisfaction, laboratory staffing, standard operating procedures, testing capacity, research outputs and laboratory quality-assurance performance.[10][11][12]A patient-satisfaction target of 80% and a laboratory quality-assurance pass rate of 85% are specified.[10][12]

Disease-specific monitoring includes lymphatic-filariasis drug coverage, morbidity-management and disability-prevention coverage, transmission assessment surveys and post-treatment surveillance.[33][21][34]The epidemiological drug-coverage threshold is above 65%, and reported 2021 coverage was 67.4% in Region VI, 93.0% in Region VII and 71.7% in Region X.[33][34]Soil-transmitted helminthiasis monitoring is to assess treatment coverage, infection intensity, tablet requirements, domestic financing and deworming coverage among children and women of reproductive age, supported by baseline surveys and Kato-Katz stool testing.[23][34][35]

Leishmaniasis surveillance is intended to use case reporting, incidence and density rates, risk stratification, outbreak investigation and laboratory confirmation.[35]Targets include laboratory confirmation of at least 80% of cases, treatment of at least 95% of diagnosed cases and cure of at least 80% of treated cases.[36]Leprosy monitoring covers prevalence, new and paediatric cases, grade 2 disability, contact screening, multidrug-therapy initiation and completion, reactions, nerve damage, rehabilitation needs and provision of blister packs through health facilities.[37][38][34]

For Chagas disease, monitoring priorities are national baselines and targets, updated surveillance protocols, timely information analysis and dissemination, active screening of high-risk groups, household vector surveillance and surveillance of congenital, transfusion and transplant transmission.[22][29]Blood-donor antibody results are not considered representative surveillance data because of selection bias.[39]The plan provides for periodic independent external programme assessments, but does not specify a complete evaluation timetable, reporting templates or accountability sanctions.[31][24]

Costing & Financing

The plan identifies budgeting, continuous funding and resource mobilisation as enabling requirements for neglected infectious disease elimination, but the supplied material does not provide a consolidated costed plan, total budget, allocations, quantified funding gap, financing source breakdown or economic assumptions.[8][40]Several planned activities are explicitly to be costed, including the soil-transmitted helminthiasis programme, a five-year multimedia communication plan, the Vector and Tropical Disease Laboratory and a human-resources plan for NID elimination.[23][28][14][30]

• Strengthen domestic financing for soil-transmitted helminthiasis preventive chemotherapy, including maintenance activities after elimination of morbidity and coverage for children at risk of strongyloidiasis.[34][35]
• Provide donated ivermectin, albendazole and diethylcarbamazine through the Pan American Health Organization and World Health Organization, with Pan American Health Organization funding also supporting mass drug-administration fieldwork.[33]
• Maintain donated medicines and diagnostics, including multidrug therapy supplied through the Pan American Health Organization neglected tropical disease drug-donation programme, Nifurtimox tablets and planned Chagas rapid-test kits.[41][42][40]
• Address unquantified operational constraints, including inadequate staffing, regional laboratory capacity, diagnostic equipment and reagents, transport, office and clinic space, digital systems and rehabilitation referrals.[25][43][20][44]

Broader health-system context includes health expenditure equivalent to 5.94% of the national budget in 2018 and per-capita health expenditure of 326 US dollars in 2019.[45]Prosthetic and orthotic devices and special shoes are available at patient cost, while the National Insurance Service covers up to 70% for employed persons.[44]Lack of funding has limited recent leprosy-clinic visits to Regions 8 and 9, and inadequate dedicated transport constrains fieldwork, home visits and follow-up.[46][20]