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Published: June 2012
In April 2012, we spoke with Eric Ottesen, Director of the Lymphatic Filariasis Support Center at the Task Force for Global Health. We believe that controlling lymphatic filariasis (LF), a parasitic disease, may be a promising area for donors (more at our report on mass drug administration for LF). We asked Dr. Ottesen about the specific opportunities for donors to support LF control. He told us that he believes there is room for more funding for two types of LF programs:1
- Mass drug administration (MDA) to prevent LF. Dr. Ottesen told us that "there are definite needs for funding of mass drug distributions" though he believes that MDA "should principally be the focus of bilateral aid agencies."2
- LF symptom management. Symptoms include hydrocele, swelling of the scrotum, and elephantiasis, swelling of the limbs. Dr. Ottesen believes there are a number of reasons to consider surgery to repair hydrocele, in particular, as a promising giving opportunity:
- Hydrocele surgery is relatively simple and inexpensive and can result in large improvements in quality of life
- Past small-scale projects have treated hydrocele successfully
- There is not enough funding to meet the need for surgeries
- Providing treatment for LF symptoms can increase compliance with mass drug administration programs because communities are motivated by immediate results
We have not reviewed the evidence for hydrocele surgery programs. Based on Dr. Ottesen's recommendation, we believe that it – along with other surgery programs such as those focused on cleft lip and palate, obstetric fistula, trachoma, cataracts, and other eye surgeries – may be a promising area.
Surgery programs are significantly more complicated than many global health programs because they require:
- Skilled labor. The need for skilled labor creates a situation where the negative or offsetting consequences of a program need to be considered. In a context with limited surgeons, donors must ask: if this surgeon were not serving the program I'm considering, what else would they be doing? Similarly, the need for skilled labor creates a potential room for more funding issue as it is possible that a program requires additional surgeons rather than additional money to perform more surgeries. Dr. Ottesen noted that hydrocele surgeries (as well as trichiasis surgery to prevent blinding trachoma) may be performed by medical students or specially-trained nurses, rather than fully trained surgeons.3
- Patient follow up. Surgeries can be dangerous and can potentially lead to complications. A successful program should be able to demonstrate that it has an effective process in place for monitoring surgical quality and patient outcomes.
Before recommending a surgery program, we would need to fully understand the factors that are required to conduct a successful program and the risks involved. We have not yet done this research, but expect to in the future.
- GiveWell. Mass administration of albendazole and ivermectin to eliminate lymphatic filariasis.
- Ottesen, Eric. Director of the Lymphatic Filariasis Support Center at the Task Force for Global Health. Email to GiveWell, June 13, 2012.
- Ottesen, Eric. Director of the Lymphatic Filariasis Support Center at the Task Force for Global Health. Phone conversation with GiveWell, April 24, 2012.
- Thomas, Gail, et al. 2009. A pilot program of mass surgery weeks for treatment of hydrocele due to lymphatic filariasis in Central Nigeria (PDF). American Journal of Tropical Medicine and Hygiene 80(3): 447-451.
Eric Ottesen, phone conversation with GiveWell, April 24, 2012.
"There are definite needs for funding of mass drug distributions, but I feel that these can and should principally be the focus of bilateral aid agencies. The things that aren't being supported sufficiently are areas such as elephantiasis management, surgeries for hydrocoele, and behavioral change. Those are areas that are terribly under-subscribed. For some humanitarian and faith-based organizations, these types of projects are particularly appealing; the funding for such activities (which also greatly enhance the effectiveness of MDAs) would most likely flow through NGOs.
With respect to support for MDAs, the UK and US governments provide more money than anyone else for NTD programs. There are certain countries, however, that are not high on any bilateral aid agendas; for example, Myanmar. Papua New Guinea, too, has a terrible LF disease burden, and while bilateral aid agencies should support them more significantly, so far they haven’t. There are also a number of small countries in Africa and elsewhere that don't have any support; MDAs could be run in a small country with 1-2 million dollars per year." Eric Ottesen, phone conversation with GiveWell, April 24, 2012.
Eric Ottesen, email to GiveWell, June 13, 2012.