Research Project

Mainstreaming NTD Campaign Interventions Into the Primary Health Care System


A mixed-methods study on the capacity and readiness of Ethiopia’s primary health care system to lead neglected tropical disease intervention campaigns.


Neglected tropical diseases (NTDs)

  • Enhancement of operational capacity is urgently needed across all levels of Ethiopia’s primary health care system.
  • Strong governance, community engagement, financing, and training for health care personnel are crucial to mainstreaming NTD interventions.
  • See all promising practices.

Key Messages

To assess the feasibility of transitioning the management of neglected tropical disease (NTD) campaigns to Ethiopia’s primary health care system, Eyu-Ethiopia, Ethiopia Ministry of Health, and the Collaborative Research and Training Center for NTDs conducted a multi-phase study of the system’s current capacity. This research involved reviewing existing practices for mainstreaming, gathering insights from stakeholders, assessing the system’s preparedness, and engaging stakeholders in developing mainstreaming strategies

Research methods included stakeholder interviews.
  • In Ethiopia, partial mainstreaming of NTD interventions is likely feasible, but full mainstreaming is unlikely to succeed, given the primary health care system’s limited capacity.
  • A policy framework is in place for mainstreaming NTD interventions.
  • At all levels, governmental involvement in Ethiopia’s NTD campaigns is minimal.
  • A lack of government funding for NTD campaign mainstreaming was the challenge most frequently cited by stakeholders.
  • Other challenges include insufficient supplies of NTD drugs, as well as poor drug management, and inadequate infrastructure for capturing and sharing data.
  • Strong management and organization at the district and facility levels are foundational to successful mainstreaming.
  • Primary health care personnel in Ethiopia expressed willingness to support the mainstreaming of NTD campaigns.



Ethiopia is among the countries most impacted by neglected tropical diseases (NTDs). The World Health Organization recently highlighted mainstreaming, which entails transitioning the management of a health campaign from an external organization to the national primary health care system, as beneficial for NTD campaigns. Thus, Ethiopia aims to transition NTD interventions to its primary health care system.

Problem or Gap

Mainstreaming is context-specific, and its implementation cannot necessarily be generalized from one setting to another. Prior to this study, minimal data were available on the Ethiopia primary health care system’s capacity to handle such a transition

Study Objectives

The objectives of this study were to:

  • Assess the operational capacity and readiness of the Ethiopia primary health care system for mainstreaming NTD interventions
  • Develop appropriate strategies to partially or fully transition NTD campaigns to the primary health care system

View the slides for detail on the research methods.

The study locations included eight regions of Ethiopia: Afar, Amhara, Gambela, Oromiya, Sidama, Somalia, SNNPR, and South West.




The findings from this study indicate that currently, Ethiopia’s primary health care system has limited capacity and readiness to fully assume management of NTD interventions. However, partial mainstreaming of NTD campaigns may be feasible.

Through a review of existing mainstreaming practices, researchers found that financing for mainstreamed campaigns is a consistent challenge across various locations. As reflected in the literature, key components for successful mainstreaming include strong governance, community engagement, dedicated funding, and adequate training for health care workers.

Dr. Teshome Gebre of the International Trachoma Initiative walks through the study’s results, lessons learned and promising practices.

Stakeholders provided the following insights on mainstreaming challenges and strategies:

  • The three most frequently reported challenges were poor drug management, inadequate documentation of data, and a lack of supportive supervision and monitoring.
  • The most commonly recommended strategies for mitigating challenges related to mainstreaming included establishing funding criteria, developing an effective drug management system, and implementing monitoring and supervision tools.

The readiness assessment component of this study revealed the following findings:

  • The Ethiopia Ministry of Health regards NTD interventions as an essential health service.
  • National policies authorizing the mainstreaming of NTD campaigns are already in place.
  • Of the health centers assessed, 32% reported delivering interventions for the NTDs that are endemic in their districts.
  • Few of the participating regions had engaged in planning for NTD interventions. Similarly, only 4% of the facilities assessed had established NTD control guidelines.
  • At all levels, government leaders are minimally involved in NTD campaigns.
  • In the 2020/21 fiscal year, 0.08% of the total domestic health care budget was allocated to NTD campaigns. At the regional, district, and facility levels, NTD interventions were not accounted for at all in budgets.
  • Difficulties obtaining NTD drugs and medical supplies were a common challenge, due primarily to shortages and poor supply chain management. For many items, availability was below 50%.
  • Most regions lacked adequate drug storage space, and about half of the participating health posts faced the same challenge. However, most health centers had sufficient space for drug storage.
  • Few health centers and health posts reported having sufficient communication equipment for sharing information.
  • 58% of participants indicated that their current data systems did not accurately capture important NTD indicators.
  • At the national, regional, and district levels, the workforce was adequate but was distributed inequitably in terms of geography and gender.
  • Approximately 25% of health center staff had received training on diagnosing NTDs and providing related interventions.
  • Most of the participants expressed positive views of mainstreaming, with 81% stating that they were willing to support such a transition.
  • However, 60% of participants cautioned that currently, only partial mainstreaming is possible due to insufficient governmental funding.
  • The average readiness score regarding mainstreaming was 7.5, which is above the threshold that denotes readiness.

Currently, the primary health care system’s capacity supports only partial mainstreaming. As one study participant shared, “the infrastructure at the health center is insufficient to providing the NTD services.”

  • A phased-out approach, through a sequence of inter-related studies that informed one another, facilitated learning and allowed the collection of robust and informative data that is anticipated to support mainstreaming efforts in Ethiopia.
  • A participatory approach, which involved stakeholders at various levels of the health system through consultative workshops, interviews, and mainstreaming strategy co-development, ensured acceptability of the results and ownership of recommendations.
  • Data collection and synthesis took a health system approach, addressing all the building blocks of the health system critical for mainstreaming.
  • This, to our knowledge, is the first study that adapted and employed the Primary Health Care Performance Initiative framework to assess the capacity/readiness of the health system for NTD campaign intervention mainstreaming, offering a blueprint for other similar studies in other settings.