Partnership and progress – building systems to achieve neglected tropical disease elimination

Huge progress has been made in the past four years in the fight against neglected tropical diseases, but the NTD community has a daunting challenge ahead if it is to meet elimination targets. What can be done to combat this?

The Uniting to Combat NTDs report Reaching the Unreached- Fourth progress report of the London Declaration on Neglected TropicalDiseases released today centres on partnership and progress.

It reflects what has been achieved and what’s worked, as well as underlining areas the NTD community must focus on to continue to deliver progress.

We know that addressing these diseases can unlock major reductions in health inequality and pave the way to better health for the world’s poorest people. 

By joining forces to fight NTDs, partners have come together to make huge strides in the four years since the London Declaration was signed and the successes, highlighted in the UTC report launched today are truly extraordinary: 

• We are reaching more people than ever with much needed treatments - in 2015 alone 2.4 billion tablets were donated, leading to 1.5 billion treatments.
• Our understanding of the disease burdens grows stronger with each disease and country that is mapped – most notably we have now mapped the world for trachoma in the largest infectious disease mapping project ever undertaken, with 2.6 million people examined with WHO-standardised Global Trachoma Mapping project methodologies in 29 countries (representing a population of 224 million). 
• We’ve seen global political acknowledgement of NTDs with their inclusion for the first time in and international development framework under Sustainable Development Goal 3 on good health and well-being. 
• In 18 of 37 countries endemic for LF MDA has been stopped and we’re now into a post-MDA surveillance phase. 

Yet despite these staggering achievements, if we continue along the current trajectory we’ll struggle to reach global targets to eliminate these horrendous, painful and often debilitating diseases.

The London Declaration recognises the importance of advancing research and development for the next generation of interventions for NTDs. As we approach elimination for some NTDs we will need more sensitive technologies to diagnose the last few cases. Having a full arsenal of tools including drugs, diagnostics and vaccines, to complement existing treatment will be critical in the drive to achieve elimination.

The question is: what can be done to safeguard the huge gains we have made to date and address the barriers that stand between meeting our targets?

In 2012 Margaret Chan, Director General of the WHO, noted that, "If adequate sustainable capacity is not built into national health plans and strategy, it is unlikely that such a large number of endemic countries will simultaneously be able to scale up their programmes."

It is well recognised that strengthened health systems are vital to maximising the impact of current and future investments in NTDs. But addressing this challenge in practical terms is tough. 

Strengthening national systems

In many countries ravaged by NTDs national systems struggle to support the delivery of donated treatment or to reach communities with surgical interventions or hygiene promotion and behaviour change services. They face understaffing, inadequate resources and must contend with challenges such as migration and a paucity of services in rural areas.

Elimination requires broader system strengthening alongside new treatments and data collection, yet understanding the complex interactions of targeted NTD programmes and opportunities to engage with efforts to build health systems is exceedingly challenging.

Responding to the Sustainable Development Goals

To truly respond and contribute to the achievement of the Sustainable Development Goals we will need to continue this evolution and focus on new areas, including: equity in service delivery; building surveillance systems that will deliver and endure; and embedding actions to address the social and environmental risk factors that allow these diseases to flourish in the first place.

Staying ahead of the game

Health system strengthening within an NTD context is vital to address systems barriers to achieving elimination and to support scale-up of services and sustain progress. To stay ahead of the game in driving progress we need to agree and pursue clear pathways to health system strengthening.

The NTD community needs to continue to contribute to efforts to strengthen systems to create the right environment to achieve the elimination of NTDs and ensure that those systems are strong enough to sustain elimination.