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.
|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.