The
first six months of 2014 has already seen a number of milestones reached for
the international neglected tropical disease (NTD) community, including the
successful NTD-focused side event at the 67th World Health Assembly (WHA) in May and the
celebration of progress made on eliminating river blindness by the African
Programme for Onchocerciasis Control at the
World Bank.
A running theme throughout the discussions
at these events has been the importance of taking an integrated approach to
eliminating a number of NTDs by the end of the decade.
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| UKCNTD's Dr Wendy Harrison. Image courtesy of US Mission |
But what does ‘an integrated approach’ mean in practice? It may
mean integration of disease specific interventions into broader public health
systems, across different groups of diseases, or integration across sectors. Integration
is not just another buzzword, but a real approach to effectively controlling this
group of diseases. Both evidence and common sense tell us that we cannot
expect to achieve and sustain our NTD control and elimination goals unless we also
tackle the underlying causes – namely the provision of safe water, sanitation
and hygiene facilities (WASH) and health
care access - and do so in a joined-up way.
One example where integration is yielding results is in Nigeria. As a country with one of the heaviest burdens
of NTDs globally, and one which has successfully launched its ‘NTD masterplan’
(a multi-year national plan to control and eliminate several NTDs under the London
Declaration), it offers a wealth of valuable insights. The WHA side event in May, which was hosted
by the Nigerian government and supported by the UK Coalition against NTDs, south-south sharing
of learning was central to the discussion.
Nigeria’s
Minister of Health, Professor Onyebuchi
Chukwa, and the Director of Public Health, Dr Bridget Okoeguale, highlighted
what they see as the foundation of success in combating these diseases: building
stronger health systems, equipped to deliver and sustain effective control
programmes alongside interventions grounded in a public health approach. To
this end, Dr Okoeguale highlighted that Nigeria is working to embed NTD care
within primary health care structures to bring together preventive and curative
care. She called on the NTD and WASH sectors to work together across
departments responsible for Environment, Water, Education, Housing and Media.
This
is certainly an approach supported through the Nigerian NTD elimination
programme led by Sightsavers, where both local
government and global donors such as the UK government aid agency, DFID, have committed funds
to control several NTDs. The success of this
programme rides on all parties collaborating under a united goal and sharing
knowledge and resources. The programme is designed to support the strengthening
of the Nigerian health system alongside delivering targeted interventions to
eliminate NTDs.
During
the WHA event, this approach was supported by both the World Health
Organization and international donors, including representatives from DFID and USAID,
who
emphasised the investments being made into WASH programmes in NTD endemic
countries. Dr Wendy
Harrison, Chair of the UK Coalition against NTDs reiterated the importance
of cross-sectoral collaboration to meet the WHO
2020 roadmap goals and the need to embed and standardise monitoring of the
impact of NTD programmes on health systems.
All parties at the event were in clear agreement that
cross-sectoral integration is vital and that without access to safe effective
WASH and health services, NTD elimination will not be possible. However, whether or not this happens
will depend on the level of political will, leadership and resources dedicated
to achieving our goals in a sustainable way. As the recent announcement of £39m by the British Government to help support the
elimination of trachoma in highly endemic countries in sub-Saharan Africa
reminds us, NTDs have never been as well supported or as prominent on the
global health agenda. However there still remains a global $200million per year
funding gap that needs to be addressed if we are to meet the ambitious goals of
control and elimination as laid out in the 2012 London Declaration.
We
need to make sure that we leverage these global commitments and this momentum
to achieve our goals in a way that builds systems to provide safe and effective
WASH and health services, and delivers on our commitment to control and eliminate
these diseases in a sustainable way.
