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Political and structural factors

These factors refer to the ranking of disease control priorities within the national health policies.

Maintaining the political priority

At present, the major challenge is to ensure the sustainability of the national control programs in an epidemiological context with very low T. cruzi infection rates in the younger age groups of the populations of several countries and negligible house infestation rates.

The national programs should be adapted to the new epidemiological circumstances but should be maintained with emphasis in entomological surveillance to avoid that the government efforts, financial and otherwise, to attain the interruption of transmission, be lost. The successes accomplished in this respect should not be “punished” but maintained.

It is proposed the stratification of the risk be the central criterion to shape the required surveillance and control activities.63,64

Decentralization of control programs

Since the 1980s the traditional vertical programs for disease prevention and control are being dismantled in accordance to the current political and institutional context of health sector reforms, where the decentralization of operations may result in the risk of the activities losing priority.

The vertical programs were characterized by high specificity of activities, strict planning, and clear definition of measurable goals and investment of important financial resources.

The decentralization of programs has resulted in the lack of recognition by the local authorities of the priority given to Chagas disease control in view of more pressing needs for immediate attention.

The new institutional order requires that Chagas disease control be integrated into other services and programs and become part of a broader scheme to meet the health needs of the population. In these circumstances the integrated activities must sustain and expand the significant progress so far achieved in the interruption of transmission of Chagas disease in several countries of Latin America.

Dr. Alvaro Moncayo was secretary of the TDR Steering Committee on Chagas disease from 1979 to 1997; chief, Control of Trypanosomiasis and Leishmaniasis 1990—98; and manager of the TDR Task Force on Intervention Research on Chagas disease from 1998 to 2001 at the World Health Organization, Geneva, Switzerland. Currently he is the vice president of the Academia Nacional de Medicina, Bogota, Colombia.

Dr. Antonio Carlos Silveira was director of the Chagas Disease Division (1977—84); director of the National Epidemiology Division (1986—88); director of the Health National Foundation Operational Department (1992); coordinator of the Vector-Borne Diseases Control Coordination (1994—98) of the Ministry of Health/ Brazil and national consultant of the Pan American Health Organization/WHO. PWR-Brazil (1998—99). Doctor Silveira was deceased in 2012.

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