Women outside clinic in Gashora, Rwanda. Photo: Lindsay Wheeler
It’s hard to argue against the fact that there are many global health interventions that can go a long way toward the control and elimination of many neglected tropical diseases (NTDs). Global health initiatives have become an intrinsic part of international aid policy.
At a low financial cost, single disease campaigns in various countries like Rwanda, Burundi, Mali and Sierra Leone for instance, have seen success in deworming children and treating patients for schistosomiasis, onchocerciasis, and trachoma.
However, a recent study conducted in Mali by the Antwerp Institute of Tropical Medicine and published in the journal PLoS Neglected Tropical Diseases found that single disease campaigns while beneficial, weakened the overall health care system and interfered with routine healthcare delivery and provision systems.
The Antwerp team examined 16 healthcare centers in Mali that were involved in a large-scale integrated treatment campaign funded by USAID and a number of pharmaceutical companies in order to tackle lymphatic filariasis, river blindness, schistosomiasis, soil-transmitted helminthiasis and trachoma.
They found that of the 16 centers, only two were sufficiently staffed and supported and were able to conduct normal duties during the drug distribution campaign. The other 14 centers faced enormous operational problems. People were getting treated for specific NTDs, but healthcare for their other ailments were not being tended to.
According to the authors, “Several informants also criticized the high priority given to targeted diseases, while more common health problems received little attention; they worried about the campaign mobilising energy and diverting staff’s attention from routine care delivery.”
The authors also found that while training and education helped staff improve specific drug delivery, it did address other disease control strategies, such as sanitation and curative care.
Overall, the authors contend that mass drug administration for NTDs is still crucial and a positive global health initiative, however they stress that health system strengthening must be improved.
“Health system strengthening should rely on country-specific development plans aligned with national policy, and requires a comprehensive approach across diseases and health problems and coordination among GHIs…..Progress towards effective and inclusive health systems will not result from the sum of selective GHI interventions.”
The treatment of NTDs in countries that suffer from a high disease burden is a necessity, there is no argument here. However we cannot overlook how global health initiatives impact and disrupt existing health systems.
