“The final mile is often the most difficult one”: Launch of the third WHO report on Neglected Tropical Diseases

By Kate Hawkins, Pamoja Communications The WHO report on Neglected Tropical Diseases (NTDs) was launched yesterday with a simultaneous live feed that linked Addis Ababa and London.  Here are four issues that dominated the conversation:

  1. Money, money, money

The report outlines a business case for the control of NTDs both on cost effectiveness and equity grounds. It was suggested that meeting NTD Road Map targets for 2015-2020 requires $750 million a year (not counting vector control). Maintaining progress from 2020-2030 requires an additional $460 million a year as programmes are scaled down.  There was agreement that endemic countries will need to do more to raise the revenue required to fund this push and Baroness Northover (UK Parliamentary Under Secretary of State, Department for International Development) suggested that parliamentarians have a key role to pay in lobbying Ministries of Finance to allocate more to health budgets.

  1. NTDs as a litmus test for universal health coverage?

At the meeting we were reminded that universal health coverage is also about equity and ‘ensuring that nobody is left behind.’ In the case of NTDs this includes the poor in middle income countries.  The report describes them as a litmus test for universal health coverage, and Margaret Chan is quoted: “We are moving ahead towards achieving universal health coverage with essential health interventions for neglected tropical diseases, the ultimate expression of fairness. This will be a powerful equalizer that abolishes distinctions between the rich and the poor, the privileged and the marginalized, the young and the old, ethnic groups, and women and men.” Strong words…although presumably this will be part of a larger social and political project of tackling the norms, institutions, and structures which create and maintain such divides.

  1. Equity

Andrew Jack of the Financial Times described NTDs as conditions that effect, rural, remote, neglected, and abandoned people. They effect poorer people and because they effect physical development, educational attainment and are often disabling they can also have an impact on people’s ability to generate a livelihood. The report states, “The inclusion of an equity focus in policy-making will become more and more important the closer countries get for achieving the targets for the Roadmap. Such a focus will help justify sustained efforts in the remaining number of NTD hot spots where unit costs begin to increase just as the scale of operations begin to decrease.”

We heard little about gender at the launch, although Baroness Northover mentioned that NTDs disproportionately affect or impact upon women and girls. If this is an area you are interested in you might like to check out this review of gender and NTDs that our colleague Margaret Gyapong co-authored way back in 2005 for some background.

  1. Integration

There was consensus that collaboration is necessary if we are to make impact on NTDs. To tackle NTDs will require the health sector to work with their colleagues in water and sanitation, the environment, vector control and the veterinary sciences. A task made more tricky by climate change, urganisation, and increasing migration in many settings. It was noted that governments, the private sector, researchers, multi-lateral and bilateral donors, and non-governmental organisations all have complimentary roles to play. People were hopeful: Nigel Crisp (Chair of Sight Savers among many other roles) described the area of NTDs as ‘global solidarity actually working.’ The perennial issue of vertical versus horizontal approaches to health programming and system support raised its, now very familiar, head. Some argued that NTD programmes were a shining example of integration at its best. Others that these diseases occur in settings where there is little existing infrastructure and that there is an argument for kick starting action through vertical programmes and moving to an integrated and comprehensive approach over time. Tim Evans (World Bank) pointed to the success of Ivermectin programmes in creating community systems and structures that provide a host of other services to the poor, and poorly served. I left the meeting with the feeling that there have been many positive developments in the world of NTDs. There is much to be hopeful about and maintaining a positive sense that change is possible is important. However, I also heard talk of growing inequality, Ebola, environmental fragility, civil unrest, and conflict – all of which make real world action on NTDs all the more challenging and complicated than it at first appears.

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