December, 2014

Terms of Reference: School-Age Children (SAC) Working Group, STH Coalition

  1. Context

Approximately 875 million children are at risk of soil-transmitted helminths (STH) infections,adversely affecting their health, education and long-term livelihoods potential.[1]Periodic deworming of infected children has been shown to improve physical growth and nutritional status; improve learning and school attendance; enhance long-term economic earning potential; and have “collateral benefits” such as decreased levels of STH in family members who were not treated for worms.Despite the availability of safe and effective donated drugs, only 32.6% of at-risk children between the ages of 1 and 14 years were covered in 2012.[2]The welcome announcement of an infusion of $120M additional dollars into STH control in April 2014 provides a window of opportunity to vastly accelerate scaling treatment. However, even with additional resources, the WHO goal to treat 75% of at-risk children by 2020 is in peril unless strategic, coordinated action is taken to deploy those resources effectively to treat children.

The STH Coalition, a newly formed group of diverse partners recognizing the value of STH control that is committed to progress accelerating treatment coverage, formed the SAC Working Group in 2014 to focus explicitly on increasing treatment coverage for children between the ages of 5 and 14. This ToR is intended to guide Working Group activities and be a tool for measuring progress and enhancing accountability.

  1. Objectives

The STH Coalition defined the following objective for the SAC Working Group:

  • Increase drug coverage of and impact on school-age children primarily through school-based deworming programs

In the Working Group meeting on November 17th, participants raised the question of refocusing as a school-based working group as opposed to being a school-age children working group and the confirmed its intention to remain focused on school-age children. While the priority delivery platform for this age group will continue to be the school-based platform, participants felt that the group should prioritize this target population rather than the platform to a) be aligned with WHO targets for treatment (75% of school-age children by 2020), b) to reduce the risk of overlap with the preschool-age working group and c) consider non school-based platforms for some of the sub-workstreams of this group.

The SAC Working Group will have the near-term goal of identifying the plan required tosupport thescale up of high coverage, cost-effective national treatment programs, particularly through school-based deworming, to achieve the NTD Roadmaptarget of 75% coverage by 2020.[3] Implementation of this plan will require commitment from individual members of the Working Group, as well as country governments, to ensure that this plan translates into increased coverage and impact.

  1. Working Group Approach

The SAC Working Group, as an entity, willprioritize the following three focus areas in 2015to achieve the goal of increasing treatment coverage on SAC predominantly through school-based deworming programs. Success metrics for each sub-workstream are listed underneath the descriptions.

  1. Determining current barriers and specific tactics that could be funded to scale up treatment for school-age children nationally in the 7 highest at-risk SAC population countries: Scaling treatment nationally to the 7 highest at-risk SAC population countries[4] could have a truly profound effect on the treatment gap. Each high burden country has a unique set of barriers to scaling treatment that would benefit from different tactics that could accelerate filling the gap. This sub-workstreamwill develop a snapshot of the current status of treatment in each target country, the most pervasive barriers to treatment,a funding gap analysis, and country-specific tactics to scale deworming nationally. This sub-workstreamwill rely on both secondary research from the WHO and other sources and primary interviews with government officials and local partners to complete the snapshot. Subsequently, organizations could be identified internal and external to the working group to partner with country governments to support implementation of the country-specific tactics necessary to scale treatment.
  2. Year 1 success metrics:
  3. At least 7 country snapshots (current state of deworming at scale, barriers, funding gap analysis, and tactics) completed
  4. Point persons / organizations identified to support the tactics in each of the 7 countries
  1. Identifying best-practice cross-sector policy / governance approaches to treat school-age children: Due to the cross-sector nature of deworming, it is often neglected in policies or risks redundancy across several Ministry policies and governance structures. For example, a Ministry of Education may have a school health and nutrition policy that promotes deworming while a Ministry of Health may also have a deworming strategy within its NTD plans and policies. Coordination across ministries, therefore, is essential but does not happen enough. This sub-workstream will focus on identifying effective governance structures and policies currently in place and subsequently share these findings to help governments understand potential options for how to set up effective deworming policies and governance structures.
  2. Year 1 success metrics:
  3. At least three case studies of highly effective cross-sector policies / governance structures overseeing deworming completed
  4. Lessons learned and ingredients for success in coordination documented
  5. Plan for dissemination completed
  1. Collecting and documenting case studies in innovative programmatic approaches to treat SAC at scale: Treatment programs targeting school-age children are not one-size-fits-all; a number of different approaches have seen recent success in various geographies, for example integration with the Weekly Iron and Folic Acid Supplementation program in some Indian states. While innovations for mass deworming programs are proliferating, they are not being sufficiently shared with NGO partners and governments who could benefit from their learning. This sub-workstream will focus on identifying at least three case studies of different innovative mechanisms for scaling mass deworming and sharing the cases widely.
  2. Year 1 success metrics:
  3. At least three case studies completed of innovative mechanisms for scaling mass deworming
  4. Plan for dissemination completed

These sub-workstreams will work in parallel throughout the year. Once this Terms of Reference is agreed upon among the Working Group members, a clear workplan with timelines and milestones will be developed. At the end of the year in November 2015, the group will decide what would be most useful foryear 2 of the Working Group.

  1. Commitment from Members

As co-chair of this Working Group, Evidence Action will hire and fund a consultant who will conduct the research associated with the outlined sub-workstreams and producing the written deliverables described above, working in collaboration with Working Group members and with oversight from the co-chairs. Members will be engaged to support research if they so choose, be interviewed about their expertise, provide feedback on a regular basis and approve all documents as coming from the SAC Working Group, without the need for a significant resource investment.[5]

All working group members are invited to:

  • Contribute their expertise through participating in at least one of the three sub-workstreams
  • Be interviewed for one or all of the sub-workstreams
  • Share their contacts and documents that are relevant to the sub-workstreams
  • Attend quarterly meetings where deliverables are discussed
  • Participate in bi-monthly meetings to provide feedback on progress and content

Evidence Action and the Global Partnership for Education, as co-chairs of the working group, will play the role of guiding the research, synthesizing findings, facilitating meetings and writing up the documents.

  1. Communications Approach and Meetings Cadence

Quarterly Working Group meetings will be held to discuss specific content-related items; additionally, more frequent bilateral discussions will occur as-needed to advance the deliverables.

Every other month:

  • Members will be asked for their feedback on in-process documents in one-on-one sessions with the co-chairs of the working group.

Quarterly:

  • Group will provide feedback on specific deliverables

1

[1]WHO, “Soil-Transmitted Helminthiases: Number of Children Treated in 2012,” Weekly Epidemiological Record / Health Section of the Secretariat of the League of Nations 89, no. 13 (March 28, 2014): 133–40.

[2]Ibid.

[3] Working towards achievement of the 75% coverage target for preschool-age children is being led by a separate workstream under the STH Coalition.

[4]This list will be discussed and confirmed in the next Working Group meeting.

[5] As country-specific tactics are identified, it is anticipated that some members of the SAC Working Group would be well-positioned to provide support for scaling treatment in high burden countries; however this work would be undertaken outside the scope of the Working Group.