By Romina Rodríguez Pose, independent consultant on international development and lead author for the Health Dimension case studies, Development Progress Project.
Neglected tropical diseases (NTDs) affect the poorest billion people in the world. They cause number of chronic health conditions that largely limit people’s ability to study and work and consequently have a healthy and productive life. The stigma attached to them can also lead to isolation and fear for those who suffer.
Although they have been long ignored within international and national agendas, in the last decades, there has been an increasing awareness of how NTDs can impede endemic countries from achieving public-private partnerships involving major drug donations from key pharmaceutical companies, the development of inexpensive control strategies and a growing number of donors earmarking funding for integrated NTD control.
Cambodia in Asia. In spite of their different contexts and epidemiological profiles, three drivers have emerged in both case studies:
1. Advances in the fight against NTDs have been driven by the availability of earmarked funds and donated drugs. These have been crucial for both resource-constrained countries, since most endemic countries are faced with several competing, and perhaps more urgent, health issues (such as high mortality rates for mothers and children in Sierra Leone and dengue outbreaks in Cambodia). As a counterpart, political will and local engagement to take advantage of global initiatives have been crucial in bringing NTDs within the national agenda. Both governments, through their Ministries of Health, have proactively looked for partners, secured funds and drugs donations and made important efforts to develop local capacity.
2. There is an important transitional role for development partners in providing access to strategies and guidelines on how to deal with NTDs until local capacity is fully developed. In both countries, this was achieved through bilateral, regional and global partnerships that helped build the local knowledge base for endemic countries to find their own solutions and to implement strategies according to the particular context. These dynamics between development partners and NTD programme managers have gradually led to a ‘transfer of ownership’ of the NTD programmes.
3. The integration of NTD activities within an existing government structure has been vital to set up cost-effective NTD programmes. Both countries have integrated the distribution of drugs within health and education systems. In Cambodia, given the main threat is from intestinal worms which particularly affect school-aged children, progress has been achieved by integrating the distribution of drugs into the school system and turning teachers into twice-yearly doctors/pharmacists. In Sierra Leone, given that the entire population is at risk from at least three NTDs, the main strategy involved the engagement and training of community members as drug distributors. Elected by their communities, their work is divided into catchment areas for which they are responsible, reaching the most remote corners of the country.
Despite the increasing awareness of their importance, NTDs still loom large in the cycles of poverty, ill-health and under-development that afflict too many developing countries. Yes, as Sierra Leone and Cambodia show, progress can be achieved in the most difficult contexts and with minimal resources, stressing the importance of including NTD control and elimination targets within the post-2015 sustainable development goals.
All photos by Romina Rodríguez Pose.
According to recent estimates, about 45 percent of Central America’s population is at risk for Chagas Disease –one of the 17 neglected tropical diseases recognized by the World Health Organization (WHO). However, the Japan International Cooperation Agency (JICA) has made large strides in controlling and halting the transmission of Chagas within several countries of the region.
On Thursday, May 29th, JICA members shared success stories and best practices from their 14 years of experience controlling Chagas Disease in Central America. During the event, Dr. Ken Hashimoto, JICA’s Central American Regional Advisor for Chagas, noted that the best practices developed by his team were designed to aid the broader global health community in their efforts to rid the Americas of this deadly disease.
Beginning with an overview, Dr. Hashimoto explained that Chagas disease is most-often transmitted by small insects (triatomine bugs) which frequently hide in the cracks of mud walls. This is problematic because the majority of Chagas victims are poor and live in mud houses.
Dr. Hashimoto noted that JICA’s Chagas control strategy involved a variety of activities – including surveying, training national officials and community health workers, securing financial support, raising awareness and establishing a surveillance system to prevent new outbreaks of the disease.
More specifically, Dr. Hashimoto said the control strategy consisted of an attack phase and a surveillance phase. As part of the attack phase, JICA conducted initial surveys on the scope of the problem, dispatching dozes of long-term and short-term experts and volunteers to the region. Once this initial task had been completed, the team sprayed houses in at-risk communities with insecticide. In addition, JICA members educated communities on ways to prevent the disease. Lastly, the JICA team evaluated the success of their efforts – often times needing to repeat the steps until finally halting transmission of the disease in several areas.
Why was JICA so successful? Their latest report, “Best Practices” from JICA’s Chagas Disease Control Efforts in Central America, provides insight into their best practices.
Through workshops, interviews and analysis, JICA developed 23 different best practices: 13 at the national level, 5 at the departmental level and 5 at the operational level. According to JICA, the term best practices is defined as “a set of coherent actions that generate favorable changes in sustainability, impact, and the ability to be replicated.”
Some examples of best practices at the national level include the following:
- Projecting a vision for a national plan to control Chagas
- The strategic design of national plan
- Creating a diploma course on vector borne diseases
- Applying GIS (Geographic Information Systems)
- Establishing connections between the Ministries of Health and the Ministries of Education
At the departmental level, Dr. Hashimoto notes that establishing community participation on the control efforts was important. In addition, deworming was provided at the same time that surveys were conducted to assess the burden of Chagas disease. This is because children found positive for Chagas are often not able to receive treatment for the disease because they are malnourished and will react poorly to the treatment. To help with this issue, the children are dewormed before treatment and their bodies are rid of the nutrient-sucking intestinal worms. In addition to deworming medicine, many children also need better nutrients depending on how malnourished they are.
Lastly, Dr. Hashimoto noted that strong commitment from governments were key to sustaining the program’s success long-term.
For more information and best practices from JICA’s Chagas control efforts, click here.
Shortly after Bollywood star Abhishek Bachchan Church’s Auxiliary for Social Action (CASA) is providing community-based care for patients suffering from, and the community at risk for, lymphatic filariasis (LF) and other neglected tropical diseases (NTDs). Through the work of volunteers and community health workers, the program currently serves more than 20,000 patients with LF and works in partnership with the government to support the distribution of medicine to everyone in the region to protect them from NTDs.
Abhishek met with patients who were suffering from chronic LF, and listened to their stories and experiences. They spoke of the previous hardship caused by the disease and, through the staff and services, had experienced considerable improvement in their quality of life. Yet, among many of them, there was a tangible sadness, which resulted from the stigma and ostracization caused by the disease: in a community where marriage of children is seen as a fulfillment of parenting, many of their daughters remained unmarried because suitors feared that the diseases was genetic.
LF is just one of the NTDs that can be prevented with annual medication. Once the limbs have swollen, there is no cure for LF but further disability can be prevented with proper care. CASA health workers explained and demonstrated morbidity management and disability prevention for patients with LF, which included proper washing and drying techniques, exercise massage and elevation of limbs. Abhishek was moved to join in, helping the CASA staff to wash the limbs of LF patients. Later, he took albendazole pills, one of the two medicines taken to treat and prevent early LF infection.
This visit only confirmed that there is more work to be done. While we control and eliminate these debilitating diseases, we must also improve the mental and social well-being of those suffering from NTDs. This goes beyond medicine and requires engagement of families, local community organizations, and the media and entertainment industry. With the help of organizations like CASA, and champions like Abhishek, we can take a holistic approach to addressing NTDs.
Of the 1.4 billion people in the world affected by NTDs, more than a third live in India. Global progress on NTDs hinges on India’s efforts and successes.
India is a historic leader in ending some of the most devastating diseases of our time, including smallpox and guinea worm, and most recently, polio. Now, India has the opportunity to achieve another significant public health milestone: the control and elimination of five NTDs.
By Deepanjali Jain and Anupama Tantri
Partners from multiple sectors, including development banks, play an important role in the response to control and eliminate NTDs – a point highlighted by the report, “Delivering on promises and driving progress: the second report on uniting to combat NTDs”, released in tandem with the commemoration of the second anniversary of the London Declaration on Neglected Tropical Diseases (NTDs) earlier this month. ,. In a resource-limited environment, the contributions of development banks, such as the World Bank, the African Development Bank, the Inter-American Development Bank and the Asian Development Bank, present unique and innovative models to finance national NTD programs. These models also signal the prioritization of NTDs by endemic country governments and the recognition of NTDs as a cross-cutting issue that is tied not only to health, but also to efforts to improve education, gender equity, agriculture, and water and sanitation.
The World Bank and the African Development Bank have understood this connection for decades—their investments in NTD control and elimination began in the mid-1970s with support for what eventually became the African Program for Onchocerciasis Control (APOC). Onchocerciasis, or river blindness, is a devastating disease that is endemic in 30 African countries. Easily preventable, onchocerciasis is the second leading infectious cause of blindness, just behind another NTD, trachoma. APOC, funded by several public and private donors including national governments, foundations, the private sector, the African Development Bank, and the World Bank the latter of which also manages the trust fund that pools the resources from all partnersimplements an onchocerciasis control program that reaches over 100 million people annually in Africa. Given the success of the APOC model and the overlap between onchocerciasis and lymphatic filariasis (LF), the program is now being expanded to address LF.
This past year, the World Bank committed to expanding its investment in NTDs by working with endemic countries in Africa to access $120 million in International Development Association (IDA) funds to support NTD control and elimination efforts. The investments are part of broader development efforts to address poverty in countries along the Senegal River basin by supporting fisheries, irrigation and water resources management, in addition to NTDs such as schistosomiasis. This effort has also supported NTD efforts in Madagascar, Yemen and the Sahel region.
In Asia, emerging infectious diseases and nutrition threaten the rapid economic growth and development across the region. Recognizing these links, the Pantawid Pamilyang Pilipino Program, a conditional cash transfer program launched in the Philippines with the support of the ADB and the World Bank, includes deworming of children as a condition for families to receive cash assistance, underscoring the links between health and poverty.
Recently, the ADB announced several initiatives in collaboration with the World Health Organization Western Pacific Regional Office (WPRO) that reinforce their commitment to addressing global health and communicable diseases in Asia and present an opportunity to do more on NTDs. Building on the vision of regional cooperation and leadership articulated by the Asia Pacific Leaders Malaria Alliance (APLMA), the ADB created the Regional Malaria and Other Communicable Disease Trust Fund (RMTF) that will help fund communicable disease control projects in recipient countries. ADB has also announced that they will increase their operations in the health sector to between 3 and 5 percent of their annual spending, up from 2 percent from 2008-2012, an opportunity to contribute more resources to support national NTD control and elimination programs.
Although funding for the global NTD response increased in 2013, the funding gap between current resources and those needed to reach the 2020 control and elimination goals is still US$200 million per year. Development bank programs, like those initiated and supported by the World Bank, IDB and ADB, create innovative and sustainable funding models that support endemic country initiative and bolster existing investments in NTD control and elimination programs. The ability to bring together diverse partners and encourage cross-sectoral coordination is a hallmark that is unique to these development banks and is critical to meeting the 2020 NTD control and elimination goals.