The recent
progress report on neglected tropical diseases confirms what all development
actors know yet few do: country ownership leads to success and sustainability.
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The progress report on NTDs shows country leadership means
greater sustainability
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In 2008, Square Mkwanda found himself in
a quandary: international pharmaceutical companies had just donated millions of
dollars worth of drugs to treat Neglected Tropical Diseases (NTDs) in his
native Malawi but the civil servant had no money to
distribute them and they were stockpiling in the ministry of health’s
warehouses. “I thought, what am I going to tell pharmaceutical companies? That
I let billions of kwachas’ [Malawi’s currency] worth of drugs expire because we
couldn’t spend just a few millions to distribute them?”
So he talked to
his minister of health and they managed to free up enough funds to distribute
the drugs in eight districts. By 2009, the distribution programme had reached
all 26 districts and was entirely funded by Malawi. Seven years on, Mkwanda,
who is the lymphatic filariasis (LF) and NTD coordinator at Malawi’s ministry
of health, proudly announced that Malawi has interrupted transmission of LF (pdf), the second country in Africa to
do so.
Leadership
like that demonstrated by Malawi was one of the key themes in thethird progress report of the London declaration on NTDs,
produced by the consortium Uniting to Combat NTDs and released at the end of
June. The report said: “Endemic countries are demonstrating strong ownership
and leadership, in variable financial, political and environmental
circumstances, to ensure their NTD programs are successful in meeting 2020
targets. Countries are achieving elimination goals, more people are being
reached, and the drug donation program for NTDs, the largest public health drug
donation program in the world, continues to grow.”
In the wake of the Ebola crisis and in
preparation for the sustainable development goals, these success stories are
important best practice examples for the global health community as it rethinks
how to effectively deliver sustainable programmes. Recognising the
opportunities for lessons learned, the World Health Organisation called the
elimination and control of NTDs a “litmus test for universal health
coverage (UHC)” – one
of the targets of the new development agenda.
Other countries
are joining Malawi to take charge of their public health initiatives.
Bangladesh, the Philippines and India are now financing 85%, 94% and 100% of
their NTD programmes respectively. Motivated by growing evidence of the impact
of NTDs on child development and productivity (and as a result on economic
growth) 26 endemic countries met in December 2014 to sign the Addis Ababa NTD Commitment,
in which they agreed to increase domestic investment for NTD programme
implementation. The Addis commitment was an initiative of Ethiopia’s minister
of health Kesetebirhan Admasu. Explaining why more governments are showing
interest in this work, Admasu said: “NTDs are not only a health agenda, but a
development agenda too, for which the poor pay the highest price.”
These country-owned programmes come in
different guises but at the heart of every successful one is an integrated,
multi-sectoral approach. Ethiopia for instance requires that every partner
working on trachoma implement the fullSAFE strategy – Surgery, Antibiotics, Facial
Hygiene, Environmental Improvements – and not just the ‘S’ or ‘A’, on which
development programmes tend to focus.
Brazil decided to include NTDs in its
national poverty reduction programme, which has other development targets such
as education, water and sanitation. Municipalities, who implement the
programme, are given free rein to tailor interventions to best suit their
circumstances (a peri-urban municipality would have different issues from an
Amazonian location for instance).
Other countries
used the single funded programme they had – onchocerciasis in Burundi’s case –
as the building block to a fully integrated, multi-disease programme. There the
ministry of health put in place a dedicated NTD team and worked with national and
international partners to build a national programme that has been immensely
successful. By end of the programme in 2011, national prevalence of schistosomiasis had been reduced from 12% to 1.4%.
Country ownership doesn’t just encourage
policymakers to come up with strategies to reach their entire populations with
health interventions but it also enables them to practice good resource
management. Mkwanda says that NTDs brought good discipline at the ministry of
health. “As with NTDs, we sit and budget. And we do not segregate diseases –
integration isn’t just for NTDs, it’s for the whole essential care package.”
The story gets
even better as countries in the global south, such as Brazil and Nigeria, are
not just coming up with their own programmes but also funding others’. Marcia de
Souza Lima, deputy director of the Global
Network for Neglected Tropical Diseases says the new funding streams will
guarantee that NTD programmes outlive traditional support (a large proportion
from philanthropic foundations) but she concedes it also makes them susceptible
to leadership change – although recent elections in Brazil and Nigeria suggest
this hasn’t been the case.
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