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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 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.  

USAID Awards New Flagship Project “Envision” for Neglected Tropical Diseases

In 2006, USAID launched its first-ever integrated program to target the control and elimination of neglected tropical diseases (NTDs). Managed by NTD Control Program is one of the first global efforts to integrate existing disease-specific treatment programs for the control and elimination of seven NTDs. Its five years proven track record has demonstrated that such programs can be successfully scaled up to achieve national-scale coverage of all at-risk individuals, an approach that is leading to the successful control and elimination of the targeted diseases.

Since the launch of USAID’s NTD Control Program in 2006, more than 447 million NTD treatments have been provided to more than 82 million people.Pfizer to the countries in which USAID is supporting implementation of NTD control.

To add to this success, World Vision.

Under Envision, NTD control and elimination will continue to be supported by USAID and will expand in priority countries to further the development of evidence-based policies and standards globally. Envision will assist USAID and the Bureau for Global Health in supporting NTD-endemic countries to scale up control efforts to reduce the burden of the big seven NTDs.

Stayed tuned to End the Neglect, as we will feature more about this exciting new development at USAID.

Ownership of Treatment Efforts for NTDs in Mali

Community drug distributors in Cinzana, Mali prepare for mass drug distribution. Photo ©HKI.

As it takes a village to raise a child, it takes a community to control and eliminate NTDs. In Mali’s Segou Region resides Cinzana, a town made of 39 villages with 15,000 inhabitants with a high number of NTD cases. NTD Control Program. Beginning in 2007, the Program partnered with the country’s Ministry of Health to distribute drugs and treatment to control NTDs. In Cinzana, distribution is conducted by a community group comprised of volunteers. Effective delivery of drugs to each infected individual can pose as a lofty endeavor. Limited resources and poor road infrastructures act as barriers to getting drugs to individuals in the outskirts of Cinzana, and becomes an even greater obstacle during the rainy seasons.

Despite these challenges, the NTD Control Program has been highly successful. By the end of 2009, the entire area of Cinzana received treatment. Much of this success is attributed to the community’s willingness to participate and be a part of the Program’s activities. Volunteers quickly recognized that effective distribution could only be reached if there was a large number of community drug distributors (CDDs). Thus, one of Cinzana’s economic interest groups, the Association of Community Health (ASACO), garnered the support of 200 much needed CDDs. In addition to the increase of CDDs, ASACO along with Mali’s government also provided more resources conducive to effective disease control such as notebooks, pens, and dosing poles, which are wooden tools used to identify the correct drug dosage for each individual.

Through community involvement and participation, Cinzana was able to reach 100% geographic coverage rates. Cinzana pledges to continue its diligence and dedication to the work of the NTD Control Program, working toward reaching goals and controlling NTDs.

To do your part in controlling and eliminating NTDs, please visit the Global Network website to get involved.

Support for NTD control in Mali is provided by USAID through a grant to