Category Archives: Africa

Tearing Down the Roadblocks: Another Look at Building the Resilience of Smallholder Farmers

 

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As I drove home from the Baltimore-Washington International Airport earlier this month, I could not help but notice the electronic bulletins on the I-95 and Capitol Beltway that flashed “D.C. Event Aug 4-6, expect delays.” The event, of course, referred to the first ever U.S.-Africa Leaders Summit, while the delays referred to the inevitable abundance of motorcades.

During the span of those three days, nearly 50 African heads of state gathered in Washington, D.C. for discussions with President Obama, administration officials and business leaders on a range of topics under the theme of “Investing in the Next Generation.” While we expected many roadblocks to be put up around D.C. that week, we were hoping that one major development roadblock would be pulled down during the Summit: neglected tropical diseases (NTDs).

These parasitic and bacterial infections affect 1.4 billion people living in poor and marginalized communities around the world, particularly in agricultural populations. Once infected, poor communities remain impoverished due to resulting physical and mental disabilities, including blindness, anemia, immobility, delayed cognitive development and social stigma. NTDs leave children too sick to attend school and keep adults from working. And because NTDs destroy vital social and economic capital, controlling and eliminating these diseases must be an essential element of the emerging new Africa that is increasingly seeking growth through business opportunities.

Regretfully, NTDs and the roadblock they raise against productivity and prosperity were not prioritized at the Summit (outside of a mention in USAID’s press release about its major initiatives). While we were happy to see impressive new private-sector commitments to electricity and food security, particularly to the New Alliance for Food Security and Nutrition, the omission of NTDs from those conversations and commitments signaled a missed opportunity for US-Africa relations.

For example, over the past two years, private companies, philanthropists and governments have committed an astounding $10 billion for agriculture investments in Africa through the New Alliance for Food Security and Nutrition. This initiative was launched in 2012 to build on the commitments made by G7/8 leaders to achieve sustained and inclusive agricultural growth, food security and good nutrition in the region over the next ten years.

While the New Alliance (and many other initiatives) is undeniably doing great work at strengthening the resilience of agricultural communities in Africa, fighting NTDs is an immediate and cost-effective opportunity that is available now to expand and strengthen these efforts. By working to reduce the incidence of NTDs in Africa, partners could positively impact the New Alliance’s same target areas, and more importantly, the poorest populations most affected by poor nutrition and food security.

Because Africa’s core agricultural workforce — smallholder subsistence farmers — are disproportionately affected by NTDs, the billions of dollars in agricultural investments made by governments and the private sector could be undermined if NTD control and elimination is not prioritized. In fact, smallholder farmers will be less productive and derive fewer benefits from New Alliance funding if NTDs are not addressed.

NTD infections also prevent people from enjoying the benefits of having access to a diverse, nutrient-rich diet. Roundworms, for example, compete with children for key nutrients and vitamins in order to grow. As a result, roundworm infections and other NTDs have serious consequences on a child’s growth and development, leading to micronutrient deficiencies, stunting and overall poor nutritional status.

Simply put, the New Alliance’s goals of achieving food security and good nutrition in Africa cannot be fully and sustainably achieved without addressing NTDs.

Many incredible (and highly cost-effective) victories have been won in the fight against NTDs, but greater investments are still needed to help smallholder farmers overcome the first basic roadblock to doing good business. Tackling NTDs truly helps communities invest in the next generation by offering them the opportunity to participate in their own sustainable solutions to poverty.

Watch for more information from the Global Network on the important linkages between NTDs and nutrition in the coming months!

Going Beyond Cooperation: Why it’s Critical for NTD Control and Elimination in Nigeria

 

Trachoma prevalence mapping in Katsina State by State Team of Examiner and Recorder on hand-held mobile device. Photo from RTI International.

Trachoma prevalence mapping in Katsina State by State Team of Examiner and Recorder on hand-held mobile device. Credit: RTI International.

The following guest blog post from Benjamin Nwobi, resident program advisor for RTI International and the ENVISION project in Nigeria, and Sunday Isiyaku, country director for Sightsavers in Nigeria and lead for the UNITED Project, details a new alliance aimed at strengthening Nigeria’s Neglected Tropical Disease (NTD) program and maximizing the impact of resources directed at NTD control and elimination.

If we are to succeed in reaching the World Health Organization (WHO) NTD control and elimination targets for 2020, we must focus on Nigeria – a country with one of the highest NTD burdens in the world. We therefore commend the government of Nigeria for making NTDs a priority and working with partners to implement the national integrated NTD control and elimination plans. Such efforts have contributed to the eradication of guinea worm and will surely contribute to efforts such as the Saving One Million Lives Initiative.


 

It has been one hundred years since Nigeria’s independence and while much has changed through substantial development and investments, Nigeria’s rating against the World Health Organization’s (WHO) Health-Indicators still lags; maternal and child morbidity and mortality remain high and quality and affordable health services are either lacking or not readily accessible, especially for the 70 percent of Nigerians living on less than $2 a day.

It is not surprising then that Nigeria carries one of the highest burdens of neglected tropical diseases (NTDs). These communicable diseases are inextricably linked with poverty and are prevalent in areas with poor sanitation, inadequate safe water supply and substandard housing conditions. In late March 2014, Nigeria and its partners celebrated the country receiving the WHO certification for officially eradicating Guinea worm disease. Nigeria had been the most endemic country in the world for guinea worm with over 800,000 cases documented. Scale-up efforts are now underway to achieve control and elimination of other high prevalence NTDs such as onchocerciasis, soil transmitted helminths (STH), schistosomiasis, trachoma and lymphatic filariasis (LF) by the year 2020.

An enormous task

An undertaking so ambitious requires unprecedented partnership and coordination. Nigeria is a federated country consisting of 36 states and 774 local government areas and each level of government plays a specific role in fighting NTDs. Implementing a national NTD programme that can effectively wipe out these diseases is an enormous task.

An estimated 31 million people are currently at risk for onchocerciasis across 32 states of the country. Though prevalence mapping is still underway, Nigeria is ranked third highest in the world for LF, with 63 million persons at risk, and is estimated to have one of the highest STH burdens in Africa. Trachoma is the second major cause of avoidable blindness in the northern part of Nigeria. Ongoing mapping efforts will provide more information on exactly which areas require treatment.

As Dr. Bridget Okoeguale, Director of Public Health at Nigeria’s Federal Ministry of Health so aptly expressed, “We must work as a team or we cannot go anywhere.”

Promoting standardization

This is why USAID’s ENVISION Project implemented by RTI International and the Carter Center, and DfID’s UNITED project, led by Sightsavers, are establishing a new working order to donor-driven support for the national NTD programme in Nigeria – an alliance, aimed at exploiting synergies, eliminating duplication of efforts and maximizing impact of resources directed at NTD control and elimination.

With ENVISION working primarily in central and southern Nigeria and UNITED in northern Nigeria, the alliance helps the national program to maintain consistency and promote standardization of approaches across the various states, supporting not only the integrity of programming but also management functions such as drug logistics and data reporting, playing off the respective strengths of the partner organisations.

Children in Nasarawa State, Nigeria gather to learn how samples will be collected in their school. Photo by RTI International.

Children in Nasarawa State, Nigeria gather to learn how samples will be collected in their school. Credit: RTI International

Maximizing reach and impact

Teams from ENVISION and UNITED support many of the same core programme areas in the states where they work; activities like mass drug administration and community education and sensitization. But each project also brings additional areas of support, not necessarily provided by the other project. Forming this alliance has allowed more geographic reach for this expertise than could be achieved otherwise.

RTI International has introduced a new planning tool, the NTD Tool for Integrated Planning and Costing (TIPAC) across the country, and this is now being used nationwide to improve planning and costing. RTI has also worked with the WHO to develop an integrated NTD database platform that will allow the country to store, manage, analyze and report NTD data more effectively across all states.

Sightsavers has been focusing on improving supply chain management for commodities such as drugs in its project states. The national-level component of this project supports clearing of all NTD drugs to the national Drug Storage. Again, in this case, all other states benefit from strengthened supply chain capacity and are therefore able to maximize output. They have also developed behaviour change tools and strategies that will be applied across Nigeria.

The synergies that have resulted from this close alliance bring unique benefits to Nigeria’s national NTD programme and its ability to advance towards its elimination timeline, especially when coupled with the comparative advantages for implementation achieved through the coalition of organisations working across the nation.

As we enter another century in Nigeria’s history as a country, we are hopeful that this alliance will continue to be one of the critical pillars in supporting the Nigerian Government in reducing the NTD burden. Together we will see how, when a country is committed and aid organisations and international governments synchronize and combine their efforts, ambitious goals can be achieved and the lives of Nigerians improved forever.  

How END7 Support Helps Countries across the World

 

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END7 supporters are proving success is possible; they have already helped strengthen neglected tropical disease (NTD) treatment programs in Kenya, Myanmar, Sierra Leone and Honduras. And together, we have plans to support Peru, Vietnam, Nigeria and Indonesia too!

END7 donations go a long way, especially since 100 percent of donations made go directly to NTD treatment programs in Asia, Africa and Latin America and the Caribbean, the regions with the largest NTD burdens.

This money helps train the community health workers that deliver the NTD medicine to communities, fund educational materials that teach kids how to prevent NTDs, support the delivery of NTD medicine to remote areas, provide clean water to communities and strengthen these country’s abilities to help their own people who suffer daily from NTDs.

These parasitic and bacterial diseases infect 1.4 billion people worldwide, causing unnecessary suffering and trapping families in poverty.

Dedicated partners, including ministries of health and education, governments, regional institutions like the Pan American Health Organization and many NGOs – including the Global Network and its END7 campaign – work hard to support countries around the world that are plagued by NTDs. seventy-four countries in Africa, Asia and Latin America have already developed plans to control and eliminate NTDs. But often these countries lack the money or resources necessary to carry out their plans year after year.

Together, we’re making real progress. Because of the dedicated support of people like you, girls like Pwint Yamone-Thin are healthy, active and free of NTDs; Kids like Neema and Fatuma Kahindi have a brighter future.

See the projects END7 donations supported and the impact they’re are making on the lives of those who needlessly suffer from NTDs.

While we’ve done so much together, we must continue to support those suffering from NTDs. By donating to END7 today, you’ll ensure that more children around the world live happy and healthy lives. Your support means that governments around the world can continue to provide NTD treatment to their most vulnerable populations – and end NTDs once and for all. Donate now.

Nigeria Champions Integrated Approach to NTDs at the World Health Assembly

 

Photo credit: U.S. Mission Geneva / Eric Bridiers

By Helen Hamilton, on behalf of the UK Coalition against NTDs

The first six months of 2014 have 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.

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.

UKCNTD WHA attendees (3)

Creidt: Yael Vellemen, Wateraid

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 $200 million 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.

Download “The Power of Integration: A report from the WHA 2014”.

The UK Coalition against Neglected Tropical Diseases is a collaborative effort by UK organisation that are actively engaged in NTD research and implementation and in advocating for effective and sustainable NTD control programmes.

Find out more about them at www.ntd-coalition.org and follow them on Twitter @UK_NTD. This post also appears on the UK Coalition against NTDs blog.