Tackling NTDs: A look at the future of control and elimination

As evaluators working on WASH (water, sanitation and hygiene) and NTDs (neglected tropical diseases), it is only right that we mark World NTD Day and take time to recognise the enormous progress being made in the eradication of NTDs and the progress yet to be made.

Itad is involved in evaluation of two of the world’s largest NTD eradication programmes – Accelerate and ASCEND – and, while these projects are in their nascent stages, it is important that we reflect on the importance of NTDs as a public health issue.

WASH for prevention and treatment

Safe water, good sanitation and hygiene conditions are essential tools in the fight against NTDs. They play a critical role in both the prevention and treatment of diseases, such as trachoma and dengue. The incredible success fighting the guinea-worm disease– on track to be only the second human disease to be eradicated – demonstrates the impact providing access to safe drinking water has on NTD prevalence.

The latest WHO evaluations emphasised that mass drug administration alone cannot lead to the elimination of NTDs. Progress needs to be made on strengthening the implementation of a full armoury of tools; including WASH interventions, integrated response systems and the prevention of new infections.

WASH interventions only work if they are effective. New water points must be used by communities and repaired when they break down. Hygiene programmes must lead to lasting behaviour change, rather than holding out hope that bars of soap will solve the problem.

Itad’s work on WASH involves understanding and measuring knotty problems, such as whether or not sanitation facilities are used and the extent to which hygiene practices have changed. We are also currently evaluating the extent to which WASH programmes lead to health impacts, including what needs to be done to ensure that cross-sectoral collaboration is part of programmes from the design stage onwards.

Building integrated approaches

How can this process be better facilitated? Integration and data are important here. Traditionally, approaches to tackling NTDs have been siloed, running as independent isolated public health campaigns, separate from the broader health system. While WHO strategies place explicit focus on facial cleanliness and environmental cleanliness (for example the F and E in the SAFE strategy) these efforts are often not well aligned with WASH investments in other sectors. To remedy this, current investments in NTDs have been focusing explicitly on promoting integration, both by supporting an integrated government approach to tackling NTDs, but also by supporting national and global data platforms that will coordinate data across sectors to support national policy makers.

If this can be achieved it will leave a legacy of stronger health systems and global integration, as well as the eradication of diseases that affect 1.5 billion people globally. Working at the heart of this effort, we hope our evaluation of Accelerate and ASCEND can draw out learning and insights to help lessen the burden of disease and strengthen health systems to better respond to NTDs.

Fergal Turner and Ben Harris, January 2020