By: Alanna Shaikh

Last week I mentioned briefly that poverty is a major factor in the spread of NTDs. It’s not the only non-medical factor that contributes to the damage done by NTDs. One thing that’s rarely mentioned in relation to NTDS – but matters a lot – is governance. Rule of law, effective government, and transparency are important to the fight against NTDs. You don’t get those from a mass drug administration, unfortunately.

Effective government starts with health system strength – having enough trained personnel, sufficient infrastructure, good data, and enough money to provide health care and support health. But the effective government needed to support health programs goes beyond the health sector. You need to be able to collect taxes or manage donor money to fund all services, including health. And you need a Ministry of Finance capable of moving the money in ways that work.

Corruption is another major issue. How much money is lost to the health sector – or the government at large – because of corruption? Government support to social services and health is lost when money goes to blinged-out private jets or overseas bank accounts. Corruption within the health sector is a problem, too. A 1997 health services survey in Uganda found that “If system leakage could be halted or slowed, indications are that health care effectiveness and efficiency could increase by 30-50%.” As one author points out, that’s a bigger impact than vaccines, which are pretty much the gold standard for high-impact health interventions.

Then there’s rule of law. Connecting rule of law to neglected tropical diseases sounds vaguely like a mad lib gone horribly wrong, but it’s actually surprisingly direct. On physical protection level, you can’t do a mass drug administration if it’s not safe for your health workers to travel into rural areas. Example: visceral leishmaniasis is endemic in Somalia. Somalia is also where the last smallpox case happened. Do you think we could eradicate smallpox now?

Rule of law also matters in ways that don’t relate to physical safety. Manufacturing or procuring NTD drugs requires a sophisticated business environment. That means the ability to draft and respect a contract, provide a line of credit if needed, and transmit non-cash payments from one party to another. You need to pay able to pay your health workers, and have them trust that you will continue to pay them. If there is a problem with a contract or payment, you need people to be able to resolve it within the justice system, not with violence. (Somalia again: I heard of a situation where two local NGOs got into a shoot-out because one group had received funding to commemorate International AIDS day and the other felt it had been unfairly awarded.)

None of these governance issues are easily resolved, but they can’t be ignored either. All the drugs and the funding in the world won’t help if you can’t get the drugs where they need to go, or don’t have the people you need to distribute them.

Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.’ The views and opinions expressed by guest bloggers are not neccesarily the views and opinions of the Global Network.