By: Dominic Haslam, Sightsavers

Trachoma is the world’s leading cause of preventable blindness and over 60 million people a year in Africa require ivermectin to prevent onchocerciasis (river blindness) from developing.  As attention is drawn to these blinding NTDs on World Sight Day, October 14^th, and following the recent MDG Summit in New York, it is another opportunity to talk about why the NTDs should be more fully included in the Millennium Development Goal (MDG) framework.

MDG 6 refers to combating “HIV/AIDS, malaria and other diseases”. Target 6a and 6b are specific to HIV/AIDS and 6c talks of malaria and “other diseases” but even the UN’s own website then only lists malaria and tuberculosis (TB) specifically under that target.

Does it matter that the NTDs aren’t included? After all, there are plenty of development programmes going on round the world that aren’t MDG-related. And there is no doubt that HIV/AIDS, malaria and tuberculosis “The Big 3” are critical health and developmental issues that need tackling at a global level. It’s also true that efforts towards MDGs 7 and 8 will have an impact on the NTDs anyway.

But the reality is, it does matter and the NTDs not being fully included within the MDG 6 targets is one of the reasons why they are neglected, despite affecting up to 1.4 billion people, being prevalent amongst the poorest and most vulnerable populations and causing a burden of disease equivalent to half that of malaria and double that of TB.

The MDGs remain one of the main frameworks within which efforts to reduce poverty at a national and international level are planned and resourced. Donors provide bilateral funding partly based around the MDG framework. Global funds have been set up to cover specific MDGs and INGOs develop funding proposals demonstrating their links to specific MDGs to improve their chances of success. The MDGs are not “the only game in town”, but they are the biggest.

So how did the MDG summit do for the NTDs? There is some good news. The outcome document of the “MDG summit” included positive references to the successes in controlling NTDs and included “renewing efforts to prevent and treat NTDs” among the specific activities required for MDG 6 to be met. This can be coupled with the US and UK governments’ significant financial commitments of recent years. So is that enough? Are the NTDs neglected no more?

Unfortunately, the reality is that we have some way to go before we can drop the “N” from the NTDs. Despite promises made by the G8, EU and the mentions in the MDG outcome document, financial commitments are not following the words. As an example, the main financial outcome of the MDG summit was the $40bn global strategy for women’s and children’s health. But read through it and you see more of the same. The occasional mention of “other diseases” but far more focus on the Big 3.

It’s a shame, a missed opportunity. I’m pretty clear that Sightsavers and others’ experience in managing NTD programs shows that when well-managed they have a significant positive impact on community health and even on other single disease programs, such as malaria.

For Sightsavers, integrated NTD programme developments have offered an excellent way to increase the impact of programmes we were already supporting in onchocerciasis and trachoma. We recognise the need to work with others and combine programs into systems.

In Nigeria, for example we’ve supported onchocerciasis and trachoma control in Zamfara State from 1996 and 2003 respectively. Building on that, we recently worked with the Federal Ministry of Health, Ahmadu Bello University and others to conduct integrated state-wide mapping and baselines for schistosomiasis and soil-transmitted helminths for co-drug treatment of the diseases. Mass treatment began in September and will cover these diseases and lymphatic filariasis.

We’ll keep working to develop and support NTD programs run within the health system and use that experience and evidence to argue that perhaps in future, maybe post 2015, we should be talking about “Building health systems which include treatment, control or elimination programs for the Big 16”.

Then perhaps the Neglected Tropical Diseases, or let’s say the Neglected 1.4 billion, won’t be neglected any more.

Dominic Haslam is Head of Government Relations and Policy Evidence at Sightsavers, has worked in the international development field for fifteen years and has been a part of Sightsavers’ move from single trachoma and onchocerciasis control programmes to an NTD focus in recent years.