Category Archives: Global Health

Untouched: How 284 Liberian Communities Remained Ebola-Free

By Piet deVries, Senior WASH Advisor, Global Communities


A community hand washing station in Liberia. Credit: Global Communities

Everything changed with Ebola.

For four years, Global Communities had been busy creating access to safe sanitation for communities in Liberia, helping to fight the spread of disease and improve health outcomes. Utilizing Community-Led Total Sanitation, we were making consistent progress, beginning work through the USAID-funded Improved Water, Sanitation and Hygiene (IWASH) program in 2010 in the three Liberian counties of Nimba, Lofa and Bong. Our program gained the support of the national government, and we worked with them to develop their sanitation strategy to improve the health of rural communities across the country. By early 2014, we had helped 284 communities become “open defecation-free” and were working with more communities.

Suddenly we and our partners in the Liberian County Health Teams and the Ministry of Health found ourselves at the center of a maelstrom. To combat Ebola, we scaled up our community engagement work, training community leaders who were already working to prevent open-defecation in how to provide information about Ebola prevention. As the epidemic swelled, our community engagement approach shifted again, focusing on acceptance of vital services like dead body management, and eventually, health screenings. In just a few months, our work scaled up from three to all 15 Liberian counties.

It was during this time that we received reports of an astonishing statistic. All 284 open defecation-free communities were reporting that they were also Ebola-free — despite being located in some of the regions hardest hit by the virus.

Was there a link between being open defecation-free and Ebola-free? Or between our program’s process and Ebola resistance?

Earlier this year, we employed two independent public health consultants to conduct research into the informal reports we had received. They came back with extraordinary findings. Focusing their research on 551 households in Lofa County, they established with a representative sample that the communities that had reached open defecation-free status were indeed Ebola-free.

They also found that communities that had only started the Community-Led Total Sanitation process — but not reached full open defecation-free status — were 17 times less likely to experience a single case of Ebola. This suggests a statistically significant correlation between our work to become open defecation-free and being Ebola-free.

Still, it would be wrong to assume that these findings mean that simply becoming open defecation-free stops Ebola. Rather, they suggest that people who had been exposed to the program’s education were far more likely to develop healthier behaviors and practices that lead to Ebola resistance — especially when led by a member of their own community.

Perhaps most encouraging, these behavior changes don’t just defend against Ebola. By utilizing CLTS, individuals can help prevent a variety of water, insect-borne and diarrheal diseases, including many neglected tropical diseases. In addition, such methods are inexpensive; in Liberia, incentives of only $130 per community can result in far better sanitation practices. Make household latrines, hand washing facilities, garbage pits and dish racks available, and you have a safe, hygienic and resilient community.

Disease spreads at the community level, and only by engaging with the community to create sustainable change can we hope to control and eliminate many of the diseases that are so prevalent in the developing world. CLTS does just that, and any focus on water and sanitation must recognize the importance of empowering communities to make wise decisions to help improve their health.

The Intersections of Poverty, Handwashing and Neglected Tropical Diseases

Sabha and her friends drink water and wash their hands from a village well in Ghorahuan Village, Bihar State, India

Sabha and her friends drink water and wash their hands from a village well in Ghorahuan Village, Bihar State, India

Today marks the 7th Global Handwashing Day. This year’s Global Handwashing Day is a particularly important one for neglected tropical diseases (NTDs). Just two months ago, the World Health Organization (WHO) launched a global strategy to better integrate water, sanitation and hygiene (WASH) services — including handwashing education and access to handwashing facilities — with other public health interventions to eliminate and eradicate NTDs by 2020. The strategy aims to provide evidence-based guidance on effective ways for WASH and NTDs groups to collaborate to meet common goals.

Improved WASH is one of five interventions recommended by the WHO roadmap for the fight against NTDs. Access to clean water, handwashing facilities, proper waste management and good hygiene practices are critical to preventing NTDs from spreading. This is especially important for trachoma, the world’s leading cause of preventable blindness of infectious origin.

Approximately 232 million people are at risk of trachoma, and it is estimated to be responsible for the visual impairment of about 1.8 million people. A bacterial infection of the eyelid, trachoma is a highly contagious disease that can cause blindness if left untreated. It is spread by the eye, nose or throat secretions of an infected individual. These secretions are commonly spread by hands — as well as flies and shared facial cloths or tissues. Washing and other hygiene measures are critical to the success of trachoma interventions.

WASH and NTDs are both significant challenges to global development. WHO estimates that 1.9 billion people across 149 countries are at risk of at least one NTD, with many people at risk of suffering more than one. Likewise, 2.4 billion of the world’s population lacks access to adequate sanitation, while 1 billion people practice open defecation and 663 million do not have access to improved sources of drinking water. Both impacting the most impoverished communities, there is a significant overlap in the communities where NTDs are endemic and in which WASH resources are limited.

Notably, the strategy calls on endemic countries and partners to, “include, where possible, WASH indicators to contribute to success on NTD targets, and NTD indicators to contribute to success on WASH targets within the national frameworks for reporting progress against SDGs [Sustainable Development Goals].” NTD stakeholders have also recommended an NTD indicator to monitor progress on the SDGs. Because of the close links between poverty, the prevalence of parasitic diseases and access to WASH, measuring progress against NTDs provides insight into how effectively the global community is progressing towards ensuring equitable access to clean drinking water, improved sanitation and proper hygiene — and ultimately eradicating extreme poverty.

You can join the effort by asking your country’s representative to the United Nations to support and promote the inclusion of a global NTD indicator in the SDGs.

TAKE ACTION: Make NTDs count in the SDGs, send a message.


A Call to Compassion and Unity

Dr. Ariel Pablos-Mendez speaks at A Call to Compassion

Dr. Ariel Pablos-Mendez speaks at A Call to Compassion

Over the past nine years, USAID’s Neglected Tropical Disease (NTD) Program has delivered more than 1.3 billion treatments to nearly 600 million people across 32 countries. USAID’s work with NTDs is a shining example of the power of public-private partnerships to leverage existing resources that stretch the impact of U.S. foreign aid dollars. In the FY 2015 budget, Congress funded USAID’s NTD Program at $100 million, demonstrating continued U.S. leadership in global health.

Ahead of Pope Francis’ historic address to the U.S. Congress this Thursday, the Global Network was pleased to host an event celebrating the bipartisan commitment of the U.S. government in the fight against NTDs. The reception, “A Call to Compassion: Spotlight on NTDs,” sought to build further support for the NTD cause among Members of Congress, the Administration, the broader policy community, private sector partners and lay leaders in the Catholic Church.

Rep. Chris Smith speaks at A Call to Compassion

Rep. Chris Smith speaks at A Call to Compassion

We were thrilled to welcome Rep.Chris Smith (R-NJ) to speak, along with Reverend Thomas Streit, C.S.C., the Founder of the University of Notre Dame’s Haiti Program, Dr. Ariel Pablos-Méndez, Assistant Administrator for Global Health and Child and Maternal Survival Coordinator at USAID and Dr. Leonard Friedland, Vice President and Director of Scientific Affairs and Public Health for Vaccines in North America at GlaxoSmithKline (GSK). Reverend Pat Conroy, S.J., Chaplain of the U.S. House of Representatives, concluded the program with a benediction.

We also appreciated the support of our co-sponsors: RTI International, FHI 360, the Catholic Health Association of the United States, GSK, University of Notre Dame’s Eck Institute of Global Health and Advocates for Development Assistance, as well as the coordination received from the Congressional Caucus on Malaria and NTDs — co-chaired by Rep. Ander Crenshaw (R-FL) and Rep. Gregory Meeks (D-NY) — and the Congressional Global Health Caucus — co-chaired by Rep. David Reichert (R-WA) and Rep. Betty McCollum (D-MN).

Saint DamienSaint Damien of Molokai was a great source of inspiration for the event. St. Damien dedicated the last sixteen years of his life to caring for those with leprosy on the island of Molokai, Hawaii. He eventually succumbed to the disease in 1889 and was canonized in 2009 by Pope Benedict XVI. Leprosy is one of 17 NTDs targeted for control or elimination by the World Health Organization.

More than 1.4 billion of the world’s poorest people suffer from NTDs, including 500 million children. These diseases perpetuate poverty by causing blindness, malnutrition, anemia and disfigurement — preventing children from attending school and parents from going to work. Treatment for these diseases can cost as little as 50 cents per person, per year.

Guests at the reception learn about NTDs

Guests at the reception learn about NTDs

Inspired by Pope Francis’ call for Catholic communities to “become islands of mercy in a vast sea of indifference,” a historic conference will be held at the Vatican in May 2016. Sponsored by the Pontifical Council for Health Care Workers, the entity that coordinates and promotes the health care work undertaken by the Catholic Church, the conference will focus on “diseases of solidarity” – both rare and neglected tropical diseases. The Global Network is honored to be serving as the official planning partner for the NTD stream of the conference.

NTDs are a pervasive issue, threatening the health of one-fifth of the world’s population. It is a problem that cannot be tackled by one sector working alone. As Pope Benedict XVI said, “Saint Damien teaches us to choose the good fight, not those that lead to division, but those that gather us together in unity.” To see the end of these diseases requires the commitment of politicians, organizations, students, administrators, faith leaders, health care workers — all of us. We are grateful to welcome new partners to the NTD elimination effort and to find new sources of inspiration to sustain this fight.

The Global NGO Deworming Inventory: Taking Stock of Progress against NTDs

Child receiving treatment CameroonAccording to the World Health Organization (WHO), an estimated 873 million children are at risk of soil-transmitted helminths (STH), including roundworm, hookworm and whipworm. In children, STH infections can lead to malnutrition, anemia and stunting. In both adults and children, they can cause fatigue, intense abdominal pain and chronic diarrhea. In severe cases they can even cause bowel obstruction, rectal prolapse and appendicitis.

To improve health and development in infected communities and reduce the prevalence of neglected tropical diseases (NTDs), WHO aims to control STH and schistosomiasis by 2020. Meeting this goal requires regularly deworming at minimum 75 percent of the preschool-age and school-age children who are at risk of STH or schistosomiasis. To ensure such an ambitious global goal is met, it is paramount that ministries of health, WHO and non-governmental organizations (NGOs) coordinate and share data.

WHO operates the Preventive Chemotherapy and Transmission Control (PCT) Databank, which tracks the number of children given PCT for STH, schistosomiasis and three other NTDs. The databank is populated largely by information reported by ministries of health and helps policymakers and implementers understand where deworming programs are active and where more interventions are needed to meet the WHO target of controlling STH and schistosomiasis by 2020.

However, gaps in the PCT Databank have become apparent. The 2013 STH preschool treatment data was recently revised when supplementary data was submitted by UNICEF. This data caused a 104 percent increase in the recorded number of preschool-age children treated for STH. Clearly, better coordination is needed to ensure the global community meets 2020 goals.

To facilitate better coordination among WHO, ministries of health and NGOs, the Global NGO Deworming Inventory collects data from NGOs administering deworming treatments for STH and schistosomiasis. The data are compiled into a single database with disease-specific information by Children Without Worms (CWW).

After the data are compiled, WHO will merge the CWW database with national program data provided by ministries of health to the PCT Databank. This effort will make deworming dollars go even further by strengthening program monitoring and leading to an efficient use of resources. Ultimately, it will be an important step in controlling STH and schistosomiasis.

You can learn more about the Global NGO Deworming Inventory — and implementers can submit their data — at