How can we make Universal Health Coverage truly universal? Equity, gender, disability, and NTDs

By Russell Stothard and Kate Hawkins

Equity is a weak spot in Neglected Tropical Disease (NTD) policy and practice; often aspired to but rarely realised. At the recent COR-NTDs meeting we hosted a session which brought together experts who have been struggling to address equity issues with regard to overlooked and under-prioritised populations. It provided examples of current work on equity and NTDs from multilateral, bilateral, national and community level perspectives. The objectives of the session were: (1) To explore how equity is being addressed in relation to NTDs at different levels of the health system; and (2) To identify key research questions for equity and NTD programming and make recommendations for equity and NTDs policies and programmes.

The session began with a presentation by Margaret Gyapong who provided case studies on Onchocerciasis and schistosomiasis that highlighted inequity in access to treatment and morbidity management. A panel including Charles MacKenzie (LSTM) who chaired the session, Samantha Page (LSTM), Camilla Ducker (DFID), and Elizabeth El-Hassan (SightSavers) provided expert reflection on the issues.

What issues came up?

Small group work enabled us to get detailed feedback on research priorities and areas where there are evidence gaps.

Community and District levels: Participants felt that more research was needed into the social benefits of disease control (for example, less stigmatization in key groups, improved family planning and reproductive health).There were also concerns that there is little formal documentation of resources among Community Drug Distributors – a group that has a great deal of potential to act on equity and the social determinants of health.  There were felt to be gaps in our understanding of gender-specific issues in the need and delivery of interventions. For example, the way that current programmes for schistosomiasis and soil transmitted helminths mostly target school aged children meaning that particular groups – such as adults and children who do not attend school – fail to benefit from them.

National level: Participants mentioned weaknesses within current methods of data collection, and that transgender issues were of growing importance. The need for gender-specific messaging within health interventions was recognized and that there is a need to test alternative programme strategies to maximize programmatic impact among people of all genders. More clarity is needed on exactly what data is collected and harmonization with other interventions for example on Malaria and HIV may be needed. Participants wondered whether all the data included in the NTD master plans took account of gender related issues for example, sex disaggregated data on community drug distributors. How these master plans relate to broader health strategies and plans was considered to be important as was how Ministries of Gender and the Family understood and supported work on NTDs.

International level: Participants felt that there could be more clarity on the use of Preventive Chemotherapy medicines in pregnancy and antenatal care. More could be done to elaborate what universal health coverage might look like in relation to the Preventive Chemotherapy amenable NTDs and understanding and aligning the reporting indicators that national governments will use. More could be done to understand how gender and other inequities potentially act as a barrier to treatment and perhaps this could be the topic of a systematic review.

We are thankful to all participants for engaging so thoroughly and we look forward to continuing this discussion and taking forward some of the suggestions.

Photo courtesy of the World Bank.

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