Progress and challenges in measuring the health systems impact of elimination and eradication programs: The example of lymphatic filariasis

The impetus to achieve the Millennium Development Goals, the availability of new sources of funds like the GFATM, and the activities of seven ongoing global disease elimination and eradication programs have called renewed attention to the fragility of health systems of countries where the burden of poverty and disease is greatest. Concern is growing, and large disease-specific programs are under scrutiny to show how or whether they affect health systems in tangible and measurable ways. Preliminary efforts have been made to elucidate and quantify the effects these programs have had on health systems in developing countries, but important methodological challenges remain. This paper reviews lessons learned from previous elimination and eradication programs, and then focuses on the efforts of the Global Program to Eliminate Lymphatic Filariasis to develop and test a tool national LF programs can use to measure the impact program activities have on the health system. Structured around the definition and conceptualization of health systems described in the World Health Report 2000, the tool consists of 25 indicators designed to elucidate the impact that LF program elements have on the four functions of the health system. Data for each indicator were gathered from field locations in three LF endemic countries and analyzed using a standard set of criteria. Analysis criteria included availability of data, significance of the observed phenomenon, sensitivity and specificity, and interpretation of results. Four indicators were determined to have strong potential to measure LF program effects on health systems. While more research is needed, these results demonstrate that it is possible to devise tools that can monitor the health systems impact of specific programs. Such tools can improve our ability to assess health systems effects as they occur, help programs avoid negative effects, and extend program benefits beyond disease control to strengthened health systems.