Development and validation of a framework to improve neglected tropical diseases surveillance and response at the sub-national level in Kenya

Background Assessment of surveillance and response system functions focusing on notifiable diseases has widely been documented in literature. However, there is limited focus on diseases targeted for elimination or eradication, particularly preventive chemotherapy neglected tropical diseases (PC-NTDs). There are limited strategies to guide strengthening of surveillance and response system functions concerning PC-NTDs. The aim of this study was to develop and validate a framework to improve surveillance and response to PC-NTDs at the sub-national level in Kenya. Methods Framework development adopted a multi-phased approach. The first phase involved a systematic literature review of surveillance assessment studies conducted in Africa to derive generalised recommendations. The second phase utilised primary data surveys to identify disease- specific recommendations to improve PC-NTDs surveillance in Kenya. The third phase utilised a Delphi survey to assess stakeholders’ consensus on feasible recommendations. The fourth phase drew critical lessons from existing conceptual frameworks. The final validated framework was based on resolutions and inputs from concerned stakeholders. Results Framework components constituted inputs with the first domain combining surveillance tools, equipment and infrastructure while the second domain combined financial, technical and logistical support. Processes were categorised into four sub-domains with activities for strengthening existing surveillance tools, surveillance core, support and attribute functions. The intended results phase comprised of ten distinct outputs with the anticipated outcomes categorised into three sub domains. Lastly, the overall impact alluded to reduced disease burden, halted disease transmission and reduced costs for implementing treatment interventions to achieve PC-NTDs control and elimination. Conclusion In view of the mixed methodological approach used to develop the framework coupled with further inputs and consensus among concerned stakeholders, the validated framework appears to be relevant in guiding decisions by policy makers to strengthen the existing surveillance and response system functions towards achieving PC-NTDs elimination. Author summary Neglected tropical diseases (NTDs) affect marginalised and underserved populations with sub- national levels providing first contact healthcare services to the afflicted communities. NTDs amenable to chemoprophylaxis are primarily controlled through mass treatment interventions. However, identification of disease transmission hotspots requires strengthened health information systems (HIS) to inform targeted public health action and response. Using a multi-phased approach, we developed and validated a framework, which provided a logical approach for guiding actions to strengthen surveillance system functions in view of NTDs. Framework development involved undertaking a systematic literature review to retrieve generalised recommendations for improving surveillance system functions within the African context, conducting primary data surveys to identify disease-specific recommendations on improving surveillance system core, support and attribute functions regarding NTDs and determining feasibility for implementing recommended actions at the sub-national levels. A review of relevant conceptual frameworks provided information underpinning overall framework development. The study identified framework component interlinkages to achieve the desired results of reduced costs for implementing treatment interventions, halted disease transmission and reduced disease burden. Overall, the framework provides a logical approach for strengthening HIS at sub-national levels in NTD endemic regions, considering stakeholders’ perspectives and the available resources to achieve the ultimate goal of disease elimination.