Drive against neglected tropical diseases

The South-East Asia region is healthier than ever. Polio has been vanquished. Maternal and neonatal tetanus has been eliminated. And after decades of struggle, the HIV, TB and malaria epidemics have been halted and reversed. They will be ended altogether in coming years.

Amid these stunning achievements, region-wide progress against neglected tropical diseases (NTDs) stands out. As the name suggests, NTDs — including leprosy, trachoma, lymphatic filariasis and kala-azar — take their most severe toll on the poor and marginalised, communities whose political influence is limited and health needs often overlooked.

Great transformation

High-level political interest has changed that dynamic. India is now yaws-free. Maldives, Sri Lanka and Thailand have eliminated lymphatic filariasis as a public health problem. Nepal is in the process of validating the elimination of trachoma as a public health problem and maintained the elimination target for kala-azar for more than three consecutive years. By the end of 2017 100 per cent of sub-districts in Bangladesh and 90 per cent of blocks in India had done the same. As a whole, the region remains responsible for the world’s largest preventive chemotherapy campaign.

Though the region has eliminated leprosy as a public health problem, the disease continues to circulate among vulnerable communities, accounting for more than 60 per cent of leprosy-caused grade two disabilities worldwide. And though several member countries have eliminated lymphatic filariasis, its burden continues to haunt communities in remote and hard-to-reach areas elsewhere. Region-wide, 53 per cent of all people require mass drug administration to stay free of the disfiguring disease. Importantly, no member country can be complacent — one of the 20 NTDs is endemic to each of them.

Nevertheless, in line with the region’s flagship priority areas, we are almost there: On a number of diseases and in a range of locations we have entered the last mile and are confronting associated challenges. The core principles of our strategy — outlined in WHO’s roadmap to overcome the impact of NTDs — should be marshalled to decisive effect.

Creative programming

First, national ownership and buy-in must continue. Stable domestic funding for national programmes is central to this outcome, as is high-level focus on key targets and accelerated progress. Region-wide, country-level commitment to addressing NTDs has for many years been impressive, and was demonstrated once again in the 2017 Jakarta Call for Action.

Second, as progress continues, member countries must ensure programming is both dynamic and flexible. That means pursuing large-scale campaigns such as mass drug administration where appropriate and strengthening NTD-related services at the primary level to secure long-term gains. It also means working creatively across sectors: Agro-engineers, for example, have much to offer in the battle against schistosomiasis. Where appropriate they should be sought out and engaged. Similarly, vector control programmes can have immediate and substantial impact on disease transmission in NTD-affected areas. That potential must be actively pursued and harnessed by programmes at the local level. It is imperative that donor funding becomes more supple, being responsive to local needs.

Finally, member countries should take full advantage of innovations in research and technology. The effective use of rapid diagnostics, for example, can facilitate swift and accurate diagnosis of a range of NTDs, at the same time as helping health workers reach large and often under-served populations. IT infrastructure should be integrated with existing surveillance systems, allowing programme managers to gather, analyse and act on real-time data.

Ensuring all communities everywhere are free of NTDs means ensuring all communities have access to health services and the benefits they provide. That will enable them to take advantage of the social and economic opportunities that define our age.

The writer is Director, WHO-South East Asia Region

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