Table 3.

Major challenges facing national programmes in developing and sustaining their lymphatic filariasis MMDP activities

Issue	Factors	Notes
Locating patients	LF patients are often reluctant to be identified	Important to provide community-wide information about the clinical care available for LF patients
Estimating the number of LF cases	Diagnosis depends on only clinical signs and symptoms that are limited in specificity	There is currently no confirmatory laboratory test for LF clinical disease
Sustainable supply of needed materials	LF patients often cannot afford the material of access (e.g. antifungal creams)	Requires continuing donations from external agencies
Funding for MMDP activities	Variable international funding for specific MMDP activities	Important to maintain advocacy and positive results to funding agencies and the wider community
Management issues	LF programmes often focus on MDA rather than MMDP	Important to explain the need for MMDP to national programmes
The need for sustained MMDP	Overworked NTD programmes	Must be addressed during LF programme planning
Patient access to care facilities	Transport difficulties and distances from healthcare centres	Important to train local healthcare workers to support patients
Achieving 100% geographic coverage with MPC	This is major challenge for many countries and requires special attention as programmes move to UHC	Many countries have only managed to implement MMDP activities in small demonstration projects rather than at scale over an extended period of time