UK aid's support for the control and elimination of Visceral Leishmaniasis (VL) in South Asia and East Africa is a ground-breaking initiative to help countries combat this neglected tropical disease. The programme, implemented by KalaCORE, aims to reduce the economic and health impact of VL in three countries in South Asia (India, Bangladesh, Nepal) and three countries in East Africa (Ethiopia, Sudan, South Sudan).
The KalaCORE consortium has been formed from four organisations: Drugs for Neglected Diseases Initiative (DNDi); Mott MacDonald; the London School of Hygiene and Tropical Medicine (LSHTM) and Médecins Sans Frontières (MSF). Each of these organisations brings distinct and complementary skills to delivery of this programme.
KalaCORE aims to deliver important results on tackling Visceral Leishmaniasis (VL) in South Asia and East Africa. We focus on reducing the health and economic impact of VL by supporting progress towards elimination in South Asia and building stronger capacity for an effective VL response in East Africa.
All aspects of the KalaCORE activities aim to provide sustainable results, particularly by strengthening national programmes’ capacity for effective control and elimination after the end of UK aid's support.
The KalaCORE logframe
The logframe provides the underpinning structure for the whole project and ties together impact, outcomes and outputs. The design of the various Activities is aligned with the Impact of the logframe and the Outcome of successful implementation.
Country work plans
During the first 6-month inception period we conducted in-depth consultations with government (including national and state VL authorities) and non-governmental stakeholders, formed alliances with principal partners and established a presence within key coordinating structures. The overall design is broadly consistent with the DFID Business Case (UKaid); however, following discussion with DFID, we have balanced the allocation of resources to each region to optimise programme impact, reduce risk and maximise value for money.
There has been good progress towards VL elimination as a public health problem in the South Asia region – indeed Nepal has already reached the elimination target. Our strategic focus is therefore to support South Asian countries in keeping transmission levels low so that the target can be achieved and maintained. However, common challenges remain. Based on intensive stakeholder dialogue, we have designed our country portfolios to systematically address these challenges in ways that are tailored to specific local contexts and available resources. We have prioritised investments in India, where the burden of disease is greatest. We recognise that other important initiatives are taking place across the region (for example, in India, CARE is being funded by the Bill and Melinda Gates Foundation (BMGF) to work on vector control and DFID is supporting other aspects of the health sector in Bihar). We work in ways that are collaborative, complementary and support the institutional strengthening of national VL authorities.
 Elimination as a public health problem is defined as less than 1 case per 10,000 population. This is a WHO definition, accepted by Bangladesh, India and Nepal in their national VL strategies.
In Ethiopia and South Sudan, more cases have been reported this year than at the same time last year, indicating that the 5-10 year epidemic curve may be on the rise in the region. Weak national health infrastructures, mass displacements of non-immune populations, and the HIV pandemic are also fuelling VL outbreaks. The distinct sandfly entomology of the region means that domestic vector control measures are ineffective, and there is considerable scope for developing new evidence-based approaches. Our main strategic focus for this region is to treat as many patients as possible (including those with access challenges, such as displaced persons, migrant labour), and to pilot and help scale up vector control methods. In South Sudan, our support for the emergency response is for a six-month period. During this time, we plan for a longer-term input that is responsive to the evolving situation, in dialogue with DFID and other development partners.
Key challenges in this region include shortfalls in drugs, diagnostics and therapeutic food at treatment centres; poor infrastructure and service access by at-risk groups; inadequate VL mapping and surveillance; and knowledge gaps relating to VL transmission. Our country portfolios aim to systematically address these challenges and build institutional capacity to support the VL response.