Dr. Neeraj Mistry speaks at the UN ECOSOC High-Level Political Forum on July 9, 2015.

What Gets Measured Gets Counted

A man is disfigured and shunned by his community. A child is too tired and sick to go to school. A woman is blinded by an infection. These are just some of the effects of neglected tropical diseases (NTDs). There are 1.4 billion of these stories — one for each person whose life is impacted by an NTD.

We can’t tell every one of these stories, so we rely on numbers. 1.4 billion people. More than half a billion children. These numbers are our rallying cry. Statistics tell us where we are improving and where we are failing, and provide a sense of scale for problems too big to comprehend.

Fifteen years ago, the United Nations (UN) established the Millennium Development Goals (MDGs), eight international development goals that brought together the global health and development community to tackle some of mankind’s greatest challenges. The eight narrow targets “helped channel everyone’s energies — and money,” according to NPR’s Nurith Aizenman. Unfortunately, that meant issues without clear targets were left behind. NTDs were listed in the MDGs as “other diseases,” and had no specific indicator. As a result, these diseases, true to their name, have remained neglected.

When the MDGs expire at the end of 2015, they will make way for the Sustainable Development Goals (SDGs), a new set of targets that present a second chance to ensure NTDs receive the attention they deserve. Back in 2000, the process of developing the MDGs was “brilliantly simple,” Mark Malloch-Brown, a member of the original UN team that developed the MDGs, told NPR. But things are very different this time around. With the MDGs far surpassing initial expectations, all eyes are on the SDGs, and the process is far from simple.

Following years of politicking and debate, the UN Summit is expected to adopt the finalized SDGs in September, and the UN Statistical Commission plans to set official indicators in March 2016. At last count, the proposal contained 17 goals and 169 proposed targets. Though critics say the proposal’s broad scope will dilute its effectiveness, these myriad goals will level the playing field, elevating important issues that were ignored by the MDGs.

NTDs are included in Goal 3 of the proposed SDGs, which reads, “by 2030 end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases.” This explicit mention of NTDs is already an improvement over the MDGs, but what does it mean to “end the epidemic”? A clear indicator will be key to rallying support for NTD elimination.

But an initial draft of indicators presented during the March meeting of the UN Statistical Commission failed to include indicators for NTDs. As we have learned from the MDGs, “what gets measured gets counted,” said Global Network Managing Director Dr. Neeraj Mistry in remarks at the UN Economic and Social Council’s High-Level Political Forum earlier this month.

To effectively control and eliminate NTDs will require a coordinated global effort, and finding the right set of indicators will be extremely important. The NTD community strongly recommends:

90 percent reduction in the number of people requiring interventions against NTDs by 2030

Treating NTDs is extremely cost-effective and contributes greatly to the success of broader development goals. With medications already available, NTD elimination is not only possible, it’s within our grasp. And with a clear indicator, we can meet this target within the next 15 years.

Photo: Dr. Neeraj Mistry speaks at the UN ECOSOC High-Level Political Forum on July 9, 2015. 

Top News Stories

 

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Come here every month to see the most important news on NTDs!

1.  Malawi Eliminates Lymphatic Filariasis (LF) Disease – AllAfrica, June 1
2.  Jigawa Trains 650 Health Workers on Neglected Diseases – PM News Nigeria,    June 8
3.  It’s Not Just About Bad Choices – The New York times, June 13
4.  The Planet’s Children and Their Neglected Tropical Diseases– Healio, June 12
5.  WB Backs Tropical Diseases Project in Africa with $121m – Trade Arabia, June   12
6. Cannes Lions 2015: Ogilvy Bags Silver, Medulla Bags Bronze – Campaign India, June 20
7.  Nigeria: Gates Foundation to Boost Primary Healthcare in lagos – AllAfrica, June 20
8.  New Report: Investments in Neglected Tropical Diseases Are One of the Best Buys in Development – Uniting to Combat NTDs, June 24
9.  India’s Next Public Health Victory – Impatient Optimists, June 24
10. Network to Check Tropical Diseases – The Hindu, June 25

Measuring the District Health Sister of Kenema, Sierra Leone to determine the appropriate dosage of NTD medicine for her. Photo: FHI360

Down But Not Out: Sierra Leone’s NTD Program Restarts Activities as the Ebola Threat Subsides

It all started a year and a half ago in Guinea, West Africa, when in December 2013, the country reported several cases of the Ebola Virus Disease (EVD). By March 2014, the outbreak had spread to neighboring Liberia. In May, it reached also Sierra Leone, dealing a huge blow the country’s public health system, including its Neglected Tropical Diseases (NTD) program.

Sierra Leone is a poor West African country with poor health indicators. A decade earlier, a twelve-year civil war (1991-2002) had devastated the economy and almost brought the entire health care system to a standstill. Nevertheless, the country made progress in revamping its socio-economic situation after the war, and the outlook appeared optimistic. In the health arena, FHI 360 was in the forefront of assisting Sierra Leone in rebuilding its public health system. Through the USAID-funded END in Africa project, FHI 360 has supported a successful integrated NTD program since 2010 in Sierra Leone that targets 7 NTDs: lymphatic filariasis (LF), schistosomiasis (SCH), trachoma, onchocerciasis (oncho) and three soil-transmitted helminthes (STH).

Shortly after the EVD outbreak began in Sierra Leone, all public health program activities were suspended in the country, including those involving NTDs. Consequently, the NTD Program (NTDP) was unable to provide any mass NTD treatments in Sierra Leone in 2014, as the EVD outbreak had spread to all 14 districts in the country, bringing the country to a virtual stand-still.

Almost an entire year passed before the NTDP was able to resume mass NTD treatments. Even now, three of the country’s 14 districts (the Western Urban, Kambia and Port Loko districts) are still working toward containing the outbreak.[1] However, mass drug administration (MDA) for LF, Oncho, STH and SCH (baseline studies have shown that trachoma is not endemic in Sierra Leone) was successfully resumed in May 2015, on the heels of a recent nationwide malaria MDA and vaccination campaign.

Preparing for Sierra Leone’s 2015 NTD MDA

After a year-long interruption in mass treatment, Sierra Leone’s national NTDP and Helen Keller International (HKI), END in Africa’s sub-grantee in Sierra Leone, carefully planned and carried out many preparatory activities prior to embarking on the country’s 2015 NTD MDA campaign. These included conducting:

  • An NTD stakeholders meeting to plan the resumption of NTD activities in Sierra Leone (February 2015).
  • A national refresher training session for trainers in the Bo district (March 7, 2015).
  • A refresher training for peripheral health unit (PHU) district personnel (March 24 – April 4, 2015).
  • Social mobilization through radio discussions and community meetings in every community targeted for treatment in 12 provincial districts (April 2015).
  • Special advocacy and social mobilization meetings in the 3 districts that failed the last pre-transmission assessment surveys (pre-TAS) for LF conducted in 2013 (Koinadugu, Bombali and Kailahun districts). These meetings targeted paramount, section and village chiefs, people in the community, health workers and community volunteers such as community directed distributors (CDDs).
  • Advocacy and social mobilization meetings led by the district health management teams (DHMTs) under the supervision of the NTDP and partner organizations in all 12 provincial districts (May 2015).
  • Training for the CDDs, led by PHU staff supervised by DHMTs, the NTDP and partner organizations (May 2015).

 

Leading by Example to Regain Trust

As the MDA was getting underway in late May 2015, END in Africa Technical Advisor (TA) Dr. Joseph Koroma visited the community of Komende Luyama in the Kenema district, which was conducting MDA for LF, oncho and STH.

“The MDA in Komende Luyama was just getting started on the day of my visit,” Dr. Koroma said. “Only after Chief Musa Lahai, the village chief, and the village’s two community nurses took the NTD treatment, would the people in the community consent to taking the treatment themselves.” He added that three members of the district health team who had accompanied him to the village, also took the NTD treatment in front of community members to further convince people to take the treatment.

“END in Africa will continue to support HKI and the national NTDP in the process of reestablishing NTD program activities in Sierra Leone, so that the effect of the EVD on NTD control and elimination efforts will be minimal,” he said. While there’s a clear need for special social mobilization in order to convince community members to take the NTD treatment, given the country’s terrible experience with EVD, early indications are that Sierra Leone’s 2015 MDA will ultimately be considered a success.

[1]Sierra Leone cannot be declared EVD-free until every health district in the country has no new cases for at least 42 consecutive days. According to the MOH EVD situation report of June 17, 2015, 11 of Sierra Leone’s 14 health districts have not reported any new EVD cases in the past 42 days or longer. They include: Pujehun and Kailahun, with no new cases for over 6 months; Bonthe and Bo, with no new cases for over 5 months; Kenema, Kono, Tonkolili and Moyamba, with no new cases for over 3 months; and Bombali, Koinadugu and Western Rural, with no new cases in 81, 60 and 55 days, respectively. Three districts still intermittently report new EVD cases (1-3 per day): Western Urban district has gone 18 days without a new case, but Kambia and Port Loko each had 1 new confirmed case during reporting period.

Photo: Measuring the District Health Sister of Kenema, Sierra Leone to determine the appropriate dosage of NTD medicine for her. Credit: FHI360

This blog was originally published on the End Neglected Tropical Diseases in Africa blog.

3rd Progress Report on The London Declaration on Neglected Tropical Diseases Released

Uniting to Combat Neglected Tropical Diseases released its third progress report on The London Declaration on Neglected Tropical Diseases on June 25, 2015. Read the full executive summary and report. 

From the Executive Summary

In the course of human history, few public health efforts can match the scale and ambition of the endeavor to rid the world of 10 Neglected Tropical Diseases (NTDs). These efforts have accelerated over the last three years, as a diverse group of players have come together in one of the largest ever public-private partnerships to deliver the funding, drugs, and technical assistance required.

The good news is that we are beginning to see positive results from this collaboration: a growing number of endemic countries are achieving elimination goals, more people are being reached, and there is increasing national ownership of NTD programs. The political and economic gains from NTD investments make a compelling case for further investment both domestically and from donors.

Nonetheless there are challenges that threaten our ability to meet the WHO NTD Roadmap targets. Currently the supply of donated drugs exceeds our ability to reach communities and more needs to be done to scale up programs. If, as a global consortium of partners, we cannot marshal the resources required to deliver donated drugs to the communities in need, more than a billion people will remain at-risk of harm by NTDs. We need to redouble our efforts.

This third report on progress since the 2012 London Declaration on NTDs highlights important accomplishments and learnings, and identifies areas that warrant greater attention. Five principal themes have emerged within the report:

  1. Control and elimination of NTDs provide one of the strongest returns on investment in public health
  2. Leadership among endemic countries has shown a substantial increase
  3. The largest public health drug donation program in the world continues to grow
  4. Coverage is increasing, but the pace is too slow to meet key milestones
  5. National NTD programs are achieving elimination goals

 

As noted in the 2015 G7 Summit communique, “2015 is a milestone year for international cooperation and sustainable development issues”—and, the fight against NTDs is no different. We have the opportunity now, together, to reach many of the goals laid out in the WHO roadmap on NTDs and position the future elimination of these 10 NTDs as an achievable objective for this generation. Those living in extreme poverty around the world are counting on our help. Let’s not keeping them waiting.

Read the full executive summary and report.