Noella Bigirimana

Neglected tropical diseases (NTDs), a group of poverty-related infectious diseases, affect 1 out of 2 people in Africa, and 1.5 billion people globally. These diseases are highly debilitating, can cause life-long disability and cost billions of dollars in developing countries. Many people have never heard of these diseases despite their human and economic costs.

Another astonishing part – the infection routes are preventable, $17 billion worth of medicines have been committed by the pharmaceutical industry, between 2012 and 2020, and key interventions such as mass drug administration (MDA) are known to be effective. And yet, these diseases prevail among top causes of medical consultations and school absenteeism in affected countries. How can we connect the dots to see the end of NTDs in our lifetime?

The most affected populations live in poverty and lack adequate water sources and sanitation, putting them in close contact with infectious vectors. A report launched recently by the END Fund shows that the numbers are compelling. Over 1.5 billion people require treatment for intestinal worms, nearly 200 million suffer from river blindness and 856 million people are affected by lymphatic filariasis – one of the most painful and stigmatized diseases in the world.

The numbers are also undeniable as there are huge returns on investment. It costs less than $0.50 per year to treat someone with NTD medicines, and every dollar invested in NTD control and elimination results in $27 to $42 of economic benefit. Even more compelling, if the WHO’s 2020 goals for NTDs are met, Africa could save $52 billion by 2030 if the most prevalent NTDs are eliminated.

Countries like Rwanda have made impressive strides in reducing the prevalence and incidence of NTDs. These countries have shown what is possible with strong partnerships and high-impact initiatives. To maintain the progress toward elimination, however, requires a focus on developing key partnerships and strategies. Beyond maintaining critical interventions like MDA and education around water, proper sanitation and hygiene, below are 5 key strategies to keep in mind:

1. Sustainable solutions come from communities : affected populations understand constraints that impede prevention and control, and their active participation should be a priority for partners looking to close the gap in eliminating NTDs. Although this is not a new concept, efforts to empower these communities must be front and center and any sustainable strategy should align with their unique perspective. This implies developing strategies from within, with community members as implementers and not just recipients of programs. It is also important to include strategies for those already affected by lifelong disability due to NTDs leading to severe limitations to a productive livelihood and stigmatization.
2. Identify positive deviance in behavior change : NTDs are closely linked to hygienic practices and can be avoided through hand-washing, wearing proper footwear, and using latrines. These positive practices are often known across communities, but their adoption is not always straightforward. An example is that building latrines does not guarantee that the community will use them. In some instances, open defecation – a major infection route for NTDs – has continued even after latrines are introduced in the community. In this context, it is crucial to identify positive deviance – households or communities that have been able to eliminate NTDs despite having similar challenges – and facilitate cross-learning.
3. Economic development as a powerful incentive: fighting NTDs is a road to economic development, and the latter can be a driver for the fight against NTDs. A part of promoting behavior change could be linked with social and economic incentives. For instance, if a community can significantly increase and sustain the number of people with access to latrines, adequate water sources and hygienic practices, could that be translated into advantages towards getting out of poverty? Here, one could even posit that an impact bond model could be developed with an incentive mechanism linking investment in health to actual economic gains. It could start at  the village level with socially-minded investors ready to scale up these incentives while maintaining focus on results – avoiding re-infections and achieving elimination of NTDs.
4. Women as strategic partners: NTDs disproportionately affect girls and women which makes them key beneficiaries. However, women are also strategic partners in the front-line, to encourage compliance in treatment, advocate at the household-level to promote social mobilization efforts to fight NTDs. These efforts can also be aligned with other related programs such as early childhood development (ECD) activities to impact children – a group highly vulnerable to NTDs – from an early age.
5. Community health workers (CHW) as linkage: CHW are involved in providing treatment, carrying out surveillance and in health promotion. Their involvement facilitates complementarity with various other interventions and avoids any perceived silos. This is particularly important since there is co-endemicity among diseases within the same individual or target groups. Many countries have well established networks of CHWs that promote control and treatment of various diseases at  the community level. In Rwanda, 3 CHWs are embedded in each village to follow assigned households daily, and it has undoubtedly contributed to overall increase in health outcomes. Building the knowledge and capacity of community health workers to tackle NTDs leads to a more sustainable delivery channel, rather than a vertical approach.

Currently, major players in the fight against NTDs such as Ministries of Health, the World Health Organization and the Bill & Melinda Gates Foundation are considering ways to further tackle remaining challenges.

A recent END Fund roundtable provided a platform to start exploring different ways to approach the issues. Sessions that bring together government institutions, private sector, philanthropy, academia and NGOs embedded in the community are great first steps.

The tools to eliminate NTDs are in place, but with the end targets in mind, are we connecting the dots?