Monitoring and Evaluation
As the objective of the programme is to achieve interruption of transmission, a surveillance system for lymphatic filariasis (LF) has to cover the entire country, not merely LF endemic areas. LF elimination programmes should establish surveillance that will identify foci of transmission. Efforts should be made to integrate filariasis surveillance within an integrated disease surveillance system of the country.

Filariasis (microfilaraemia, hydrocoele or elephantiasis) should be a reportable event throughout the country; a monthly report should be sent from health institutions to the district; a quarterly report from district to state or national headquarters would be adequate.   Include examination for lymphoedema or hydrocoele in population surveys for other diseases or purposes such as leprosy, family planning, school health or active guinea worm, or podoconiosis, case searches.

Screening for LF should be done during medical examinations of recruits in the uniformed services such as the military, and the police.

Random testing for filarial antigenaemia by Filaria Test Strip should be done among blood donors in non-endemic areas

Any positive report received from a facility in a LF-free area should be investigated to identify whether the report indicates indigenous transmission or an importation from a LF-endemic areas.

If the patient has migrated into the area, the health authority of the area of previous residence should be informed so that investigation for endemicity may be carried out in that area. All microfilaraemia-positive cases should be treated as described in section 5.2.1.b.

To eliminate LF, WHO recommends delivery of combinations of two medicines to entire populations at risk by mass drug administration (MDA).  This involves four steps: mapping, MDA, post-MDA surveillance and verification of elimination.

Effective monitoring and evaluation are essential to achieve the goals of LF elimination.   After MDA, according to WHO guidelines, programmes must be able to assess whether the interventions have succeeded in lowering the prevalence of infection to a level at which transmission is no longer likely to be sustainable.   To measure the ongoing levels of endemicity, prior to the first MDA, sentinel sites need to be established.

Two components of the Global Programme to Eliminate Lymphatic Filariasis: interrupting transmission and preventing morbidity and managing disability among people with the disease