NTDs: Lessons from Rwanda on Sustainable Ownership
By Mary Hearty
The new World Health Organization (WHO) roadmap for neglected tropical diseases (NTDs) sets out a target of 90% reduction of the number of people needing treatment for these diseases by 2030.
Over the past decade, NTDs have increasingly received more attention as a global health priority, as tremendous progress towards elimination is being made.
However, the disruption of NTD programs typically caused by the COVID-19 pandemic highlighted the need for a sustainable response to these diseases, especially in terms of country ownership.
Dr Sultani Matendechero, Head of Kenya Public Health Institute during a three-day Global Summit on NTDs organized by the END Fund emphasized on the need for African countries to start being self-reliant in order to ensure a sustainable elimination of NTDs.
“We have to think of how we are going to start replacing external funding with progressive funding in order to have a sustainable program. This will prevent us from going back to zero,” he affirmed.
Some of the sustainable strategies Dr Matendechero suggested besides government funding, include sourcing for funding from philanthropists and local organizations through corporate social responsibility.
Moreover, the WHO have long called for increased country ownership—a major area of emphasis in WHO’s new NTD roadmap—and less reliance on external donor funding for NTD programs as a means of promoting sustainability.
In Rwanda for instance, the NTD interventions have been decentralized and integrated in villages under district coordination, and the ministry of health is responsible for 100% of the operational costs.
Moreover, the interventions are context specific, focuses on community empowerment, and are integrated in the available systems like teaching program, social gatherings, and local government structures to help push further the NTDs elimination agenda.
“Initially, the implementation program was vertical, operated by ministry of health, biomedical centres and hospitals. However, we realized there are other systems that could help strengthen the implementation of mass drug administration,” Jean Bosco, Acting Director for NTD and Out-patient Department unit at the Rwanda Biomedical Center explained during the Global NTD Summit.
These include platforms at the village level like weekly social gatherings and parents evening forum, where socio-economic issues are discussed and the populations in the surrounding area meet together, were used as distribution sites and sensitization of the adult population.
“So we said why can’t we use these platforms to distribute drugs without investing any financial expense,” Bosco noted.
He further stated that they have also used teachers in the distribution of drugs to children instead of community drug distributors without extra payments, noting that integrating this in their teaching program consumes less time.
“This was very operational in 2021, where by June we achieved over 95% coverage of MDA,” he noted.
When the drugs arrive at the community level, he explained, they can be distributed to nearby schools, and once the MDA campaign is over, the remaining drugs are reported through the R-HMIS.
Rwanda also has a one health policy that commits to enhance collaboration of different actors of NTDs including stakeholders, partners working in water, sanitation and hygiene as well as agricultural sectors.
In addition, they also held maternal and child health week campaign, supported by the government and local partners.
The country has already eliminated some of the NTDs including the five skin NTDs as it is committed to eliminate NTDs as a public health problem by 2030.
“We are currently collecting evidence for WHO validation of their elimination,” he revealed.