UK aid's support for the control and elimination of Visceral Leishmaniasis (VL) in South Asia and East Africa was a ground-breaking initiative to help countries combat this neglected tropical disease. The programme, implemented by KalaCORE, aimed 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 was 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 brought distinct and complementary skills to delivery of this programme.
The programme ran from November 2014 to March 2019. It is now closed.
KalaCORE aimed to deliver important results on tackling Visceral Leishmaniasis (VL) in South Asia and East Africa. We focused 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 aimed 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 was broadly consistent with the DFID Business Case (UKaid); however, following discussion with DFID, we 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 therefore was 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 designed our country portfolios to systematically address these challenges in ways that are tailored to specific local contexts and available resources. We prioritised investments in India, where the burden of disease is greatest. We also recognised that other important initiatives were taking place across the region at the time of KalaCORE's inception (for example, in India, CARE funded by the Bill and Melinda Gates Foundation (BMGF) to work on vector control and DFID supporting other aspects of the health sector in Bihar). We have worked 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 were reported in 2015 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 has meant that domestic vector control measures have been ineffective, and there has been considerable scope for developing new evidence-based approaches. Our main strategic focus for this region was 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 started with the emergency response covering a six-month period between January and June 2015. During this time, we also planned for longer-term input, responsive to the evolving situation of insecurity, together with DFID and other development partners.
Key challenges in this region have included 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 aimed to systematically address these challenges and build institutional capacity to support the VL response.