Integrated NTD-prevention and control interventions into health systems of endemic countries has shown to be successful over the past 20 years. Integration of control interventions into health systems makes programs sustainable, improves on coverage, and reduces costs. Where control interventions depend on routine services being instituted and maintained in a long-term perspective, elimination activities however are time limited, often intensive, targeted and organized in restricted programs with campaign elements as prominent features. Elimination programs have therefore been considered as unsustainable activities that compromise the development of the health system.
Recently in Trachoma endemic villages in Egypt, an intervention based on community-based eye health education with door-to-door screening, and improvements in the clinical capacity of eye care providers (mainly surgery services) has been conducted successfully. The intervention was designed to increase access for patients with trachomatous trichiasis and acceptance of surgery, particularly for females, as well as improve quality of care. Prior to the intervention, the trachomatous trichiasis surgical coverage was 22.7% (38.9% males, 16.7% females). Identified barriers to utilize surgery included fear for (outcome) surgery, too expensive, not necessary, and not able to go (time and transport) to the surgery services. After the intervention, the surgical coverage had increased to 68% (81.5% males, 60% females) and the prevalence of trichiasis was significantly lower. The combination of community health education, door-to-door screening and clinical capacity building has seemed to be successful, however the persistent gap between males and females still needs more research.