Identifying Sustainable Financing Opportunities for Neglected Tropical Diseases in Africa’s Emergent Economy

During the World Health Organization’s 73rd Africa Regional Committee held in Botswana, AllAfrica’s Nontobeko Mlambo spoke to Thoko Elphick-Pooley, Executive Director of Uniting to Combat Neglected Tropical Diseases (NTDs) to discuss progress made in eliminating NTDs in Africa.

Neglected Tropical Diseases affect over a billion people yet budgets for NTDs-related programmes are often limited, why do you think this is?

Thank you so much for that great question as you say, it’s quite shocking that you could have diseases that affect over a billion people and still receive such little attention and little resourcing. We were talking to ministers of health and they said the problem is prioritization. They really are neglected for a reason and that neglect is shown in the insubstantial resources that are put towards them.

How significant is the Kigali Declaration for the fight to eliminate NTDs?

The Kigali Declaration is attempting to address this issue of prioritization because prioritization of neglected tropical diseases starts with political will, there has to be a desire and the political leadership to want to end these diseases. So the Kigali Declaration is looking to mobilize the political will and the leadership of countries to prioritize these diseases. Once they are prioritized, then that will unlock financing.

What progress has been made since the signing of the Kigali Declaration on NTDs?

We have been delighted by the number of heads of states, particularly from the African continent that have endorsed the Kigali Declaration. When you think about the countries that have the highest burden such as Nigeria, you look at Tanzania and Ethiopia, these are countries that have endorsed the Kigali Declaration. So I’m really delighted that the countries that have the highest burden of NTDs have endorsed the Kigali Declaration. We are obviously thrilled with the leadership of President Paul Kagame. It takes one leader to step up and say this is a priority, and that drives action amongst other leaders. But still, it is not enough, I will completely celebrate when every single country that is affected by an NTD, all 49, on the African continent have endorsed the Kigali Declaration. So this is our call for all the countries that have not yet endorsed the Kigali declaration to do so urgently, because this is really about prioritizing the poorest people on the continent for whom the sustainable development goals were written.

We just came out of the Covid-19 pandemic which disrupted health systems across the world, how have you ensured that governments continue to prioritize the elimination of NTDs?

Sadly, NTDs were amongst the most affected services, there was a lot of service disruption as we know, across multiple health areas. Immunization was badly affected on the African continent, but also services for neglected tropical diseases. The key reason for this is that the community health workers and the technical teams that were working on neglected tropical diseases were moved over to support the Covid-19 response because they were skilled. These were scientists and technical people who had fantastic experience in dealing with infectious diseases and had to step up and provide services for Covid-19. So whilst that was happening, services for NTDs stopped, but social distancing and other Covid-19 measures had an impact. So now we are saying, we need to get back and prioritize these diseases.

Actually, there is a compelling reason why countries should prioritize the delivery of NTD services, a lot of these diseases are diseases of public health concern with a pandemic potential. If you want to be prepared for the next pandemic, you want to address existing epidemics. It is really important that attention, resources, and capacity are put into ending neglected tropical diseases. It is the right thing to do. This is a matter of equity because we’re offering services for some of the poorest people on the African continent who were severely hit by the Covid-19 pandemic, so turning attention to them and making sure that we can support an end preventable diseases that affect them is a measure of justice and as a matter of equity.

What are some of the best practices that countries like Benin and Ghana that have managed to eliminate at least one NTD and what are some of the lessons that can be learned from these countries?

This is a really good question because it all starts with a national NTD master plan, where the country says we will have a strategy. We know our direction of travel for the next five to 10 years when it comes to these diseases. In a strategy, you have a plan, you have a team of people at the county level, and you have resources being allocated in order to support those diseases. And when a country commits, it just doesn’t commit for a year, it commits for the long run until the disease is eliminated, and it also creates an enabling environment for partners to work. Of course, a lot of these diseases are supported by partners that work hand in hand with national governments for their programmes. So an enabling environment by the country for partners to work and deliver these programmes is really key alongside the country’s own resource allocation towards the disease. I think that with the elimination course, you cannot just be engaged this year, and next year you switch off you have to be in for the long haul.

Are there any policies that bind governments to push for programmes for the prevention and treatment of people affected by NTDs?

Absolutely, that is the continental framework, and the common Africa position, which has been endorsed by heads of state on the African continent. I’m very excited about the continental framework working hand in hand with the Kigali Declaration because you now have a situation where heads of states through the African Union have said, that we want to end NTDs by 2030. We didn’t have a continental framework for NTDs, we’ve had them for other diseases. We have had countries signed up to the Sustainable Development Goals targets for neglected tropical diseases, which was brilliant but at the continental level, at the African Union, the home of policy setting, and tone setting, our heads of states have said we need to end these diseases and that really, for me is the highest expression of intent that you can get on the ending of NTDs.  And so now, that needs to be backed up with allocation of resources because those policies can only be effective in as much as they say in this meeting that we are in, the WHO Regional Committee meeting, the message has been that you need to put your money where your mouth so there we have had the policy so now let’s put our money where our mouth is by actually allocating the resources.

Coming to a meeting like this, what do you usually hope to get out of it?

We have just had a side event with ministers of health called ‘Unlocking the Financing for Neglected Tropical Diseases’. We have been having a conversation with ministers of health, recognizing that the power to end these diseases lies within countries. The countries that are affected by these diseases need to be demanding action. As an international advocacy organization working on mobilizing resources, we are only as effective if the affected countries actually say we agree, that these diseases need to be ended. We were highlighting to ministers of health, the power that they have at their fingertips to unlock the various finance mechanisms for neglected tropical disease.

We know we are operating in a fiscally constrained environment. So our conversation was: how do you maximize existing financing instruments for neglected tropical diseases, such as the Global Fund, such as the Global Financing Facility for countries that are currently restructuring their debts, many of them on our African continent? How can they utilize the headroom created by more favorable interest terms to support the elimination of neglected tropical diseases? Can you imagine If a country that has successfully restructured its debt can show that with the additional money that they were able to free up, they were able to eliminate the disease? It’s practical, it’s tangible, it’s verifiable. So these were the conversations that we’re having with ministers that within the powers ministers have, what is it that they can do themselves for these diseases? And I can say that this was well received. Ministers were very agreeable to this. And they are determined to do more for entities. So maybe if we have this conversation next year, we will have a different report.

What is the next major moment for mobilizing this much-needed financing?

Well, we are excited about the 2023 Reaching the Last Mile Forum at COP28, later this year. This major event (hosted by Reaching the Last Mile, an initiative of His Highness Sheikh Mohamed bin Zayed Al Nahyan, President of the United Arab Emirates (UAE), in partnership with the Bill & Melinda Gates Foundation will feature a dedicated moment to celebrate the remarkable progress made against NTDs and announce new commitments towards disease elimination goals. Continuing in the spirit of commitment demonstrated at the Kigali Summit in 2022 and the Kigali Declaration on NTDs, the forum will provide a global platform for donors and partner countries to announce their support for elimination efforts across all NTDs. As we work collectively to achieve the goals articulated in the World Health Organization’s 2030 roadmap for NTDs, this moment will set the stage for future opportunities to catalyze new partnerships and pledges.

Is there anything you would like to add?

I think that we just need to get Africa excited about the potential of eliminating NTDs. My message is that there are very few areas of public health where we can achieve big investments in neglected tropical diseases, which is a big win for everybody. They’re a win for affected individuals. They’re a win for countries. So let’s make them a matter of African priority.

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