Department of Parasitology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.
Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.
PLoS Negl Trop Dis. 2018 May 10;12(5):e0006472. doi: 10.1371/journal.pntd.0006472. eCollection 2018 May.
Sri Lanka was acknowledged to have eliminated lymphatic filariasis (LF) as a public health problem in 2016, largely due to its success in Mass Drug Administration (MDA) to interrupt disease transmission. Analysis of the Strengths, Weaknesses, Opportunities and Threats (SWOT) of the national Morbidity Management and Disability Prevention (MMDP) program, the other pillar of the LF control program, was carried out with the objective of evaluating it and providing recommendations to optimize the use of available resources.
A situation analysis of the MMDP activities provided by the state health sector was carried out using published records, in-depth interviews with key informants of the Anti Filariasis Campaign, site-visits to filariasis clinics with informal discussions with clinic workforce and personal communications to identify strengths and weaknesses; and opportunities to overcome weaknesses and perceived threats to the program were explored. The principal strength of the MMDP program was the filariasis clinics operational in most endemic districts of Sri Lanka, providing free health care and health education to clinic attendees. The weaknesses identified were the low accessibility of clinics, incomplete coverage of the endemic region and lack of facilities for rehabilitation. The perceived threats were diversion of staff and resources for control of other vector-borne infections, under-utilization of clinics and non-compliance with recommended treatment. Enhanced high level commitment for MMDP, wider publicity and referral systems, integration of MMDP with other disease management services and collaboration with welfare organizations and research groups were identified as opportunities to overcome weaknesses and challenges.
The recommended basic package of MMDP was functional in most of the LF-endemic region. The highlighted weaknesses and challenges, unless addressed, may threaten program sustainability. The identified opportunities for improvement of the programme could ensure better attainment of the goal of the MMDP program, namely access to basic care for all affected by lymphatic filarial disease.
斯里兰卡在 2016 年被公认为已消除淋巴丝虫病（LF）这一公共卫生问题，这主要归功于其在大规模药物治疗（MDA）方面的成功，从而阻断了疾病的传播。对国家发病率管理和残疾预防（MMDP）项目（LF 控制项目的另一个支柱）的优势、劣势、机遇和威胁（SWOT）进行了分析，目的是对其进行评估，并提供建议以优化现有资源的利用。
利用国家卫生部门提供的 MMDP 活动的情况分析，通过查阅已发表的记录、对反丝虫病运动的主要知情人进行深入访谈、对丝虫病诊所进行实地考察，与诊所工作人员进行非正式讨论，并与个人进行沟通，以确定优势和劣势；并探讨了克服该方案的劣势和潜在威胁的机会。MMDP 方案的主要优势是斯里兰卡大多数流行地区都设有丝虫病诊所，为诊所就诊者提供免费的医疗保健和健康教育。确定的劣势是诊所的可及性低、流行地区的覆盖不完全以及缺乏康复设施。感知到的威胁是为控制其他媒介传播感染而转移工作人员和资源、诊所未得到充分利用以及不遵守建议的治疗方案。增强对 MMDP 的高级别承诺、更广泛的宣传和转诊系统、将 MMDP 与其他疾病管理服务相结合以及与福利组织和研究团体合作，被确定为克服劣势和挑战的机会。
MMDP 的推荐基本套餐在大多数 LF 流行地区都能发挥作用。除非解决所强调的劣势和挑战，否则可能会威胁到方案的可持续性。确定的改进方案的机会可以确保更好地实现 MMDP 方案的目标，即所有受淋巴丝虫病影响的人都能获得基本的护理。
