In Africa: Urgent Need for Innovative, Sustainable Funding to Combat Neglected Tropical Diseases

Gaborone — Neglected Tropical Diseases (NTDs) affect over a billion people worldwide. These diseases, like Mycetoma and African trypanosomiasis or sleeping sickness are preventable and treatable, but if untreated they can debilitate, disfigure, and kill.

Despite affecting so many people, especially in underdeveloped countries, budgets for NTD-related programs are often limited. Of the 1 billion people worldwide affected by NTDs, an estimated 40% live in 47 African countries.

“It is quite shocking that you could have diseases that affect over a billion people and still receive such little attention and resourcing. We were talking to ministers of health and they said the problem is prioritization. NTDs are really neglected for a reason and that neglect is shown in the insubstantial resources that are put towards them,” said Thoko Elphick-Pooley, the executive director at Uniting to Combat NTDs, a global advocacy organization working with over 150 partners around the world to create awareness, educate, and end NTDs.

The organization, with the WHO Africa Region and the health ministers of Comoros, Ethiopia, Senegal, South Sudan, and Zambia, discussed and identified opportunities to unlock financing for NTDs on the sidelines of the World Health Organization (WHO) Regional Meeting in Gaborone, Botswana.

Africa has made remarkable progress in the fight against NTDs. The 2023 WHO progress report found that despite disruptions brought by the Covid-19 pandemic, some countries were able to forge ahead and eliminate at least one neglected tropical disease. Benin, Gambia, Ghana, Malawi, Mali, Morocco and Togo eradicated trachoma, a disease of the eye and the leading infectious cause of blindness worldwide, while Egypt, Malawi, and Togo eradicated lymphatic filariasis, a neglected tropical disease commonly known as elephantiasis. Togo became the first African country to eliminate four neglected tropical diseases, and 42 countries have been certified free of Guinea worm.

“What we need now is to finally eliminate and eradicate these dreadful diseases which still cause an unacceptably high level of hardship among our populations. Eliminating these diseases is one of the best returns on investment available, a best buy for funding. However, this still relies mainly on donor funding which is becoming a challenging landscape to navigate against the backdrop of global economic and political instability,” said WHO Regional Director Matshidiso Moeti.

Moeti said countries affected by NTDs need to employ innovative financing solutions to protect the progress made to date, and crucially to expand elimination success to other NTDs. She gave three principles to follow in order to unlock this funding.

“First, innovative funding. Mechanisms must be catalytic. Mobilizing substantial funding from multi-cultural actors and aiming to eliminate diseases. Second, funding mechanisms must be additive. They cannot replace existing funding flows but should support integrated disease control platforms. And finally, they must be sustainable. This will require dedicated cross-sectoral collaboration and commitment to financing ambitious thinking over the long term. Governments, multilateral funding agencies, donors, and the private sector need to work together to achieve this,” she said.

The 2022 Kigali Declaration launched by Paul Kagame, president of the Republic of Rwanda, is widely seen as a sign of dedication and political will to end NTDs. The signatories of the Kigali Declaration include governments, pharmaceutical companies, donors, and NGOs, who are all committed to unlocking the global potential to end NTDs by 2030.

“The Kigali Declaration last year called for high-level commitment from governments and communities to pull together resources and action putting individuals, communities, and countries at the center of the NTD response. Political commitment translated to increased domestic resources is urgently needed to ensure transformative action in the NTD space. Traditional donor-derived grant funding is no longer reliable and needs to be complemented to eliminate NTDs,” Moeti said.

There is also an opportunity to learn from TB and malaria interventions and using health system strengthening, as well as people-centered lenses, to integrate NTDs, said Caty Sow Fall, Head of Africa and Middle East at the Global Fund For HIV/Aids, TB and Malaria (GFATM).

The African continent has for decades battled HIV/Aids and TB that have affected for a long time the social, and economic foundations of countries. One of the most important lessons learned in Africa with HIV/Aids, TB, and Malaria and during the Covid-19 pandemic is the importance of funding and data collection. Another lesson is that treatment for different diseases can be integrated into one program so that patients find all the help they need in one place and that it is easily accessible to all.

“The Global Fund strategy 2023 to 2028 calls for action to rise above disease-specific silos and towards building resilient and sustainable systems for health. And more than ever before, in a way that places, people, and communities, not diseases, are at the center of health systems to achieve universal health coverage, and while the Global Fund’s primary goal remains strengthening health systems to implement HIV, TB, and malaria, the strategy also recognizes the importance of primary health care to deliver integrated people-centered services and health outcomes,” said Fall.

NTDs and Climate Crisis

The African continent has seen a rise in diseases linked to the climate crisis, like cholera. Humid or hot temperatures can make the environment become more suitable for disease vectors to breed which can affect the fight to eliminate NTDs. The linkage between the two issues needs attention and strategic plans need to be in place if NTDs are to be eliminated by 2030 as per the Kigali Declaration.

Ibrahima Socé Fall, WHO Africa Region Director for Neglected Tropical Diseases said on December 03 at the COP28 a meeting will be hosted by UAE in partnership with Reaching the Last Mile and the Bill and Melinda Gates Foundation which will present an opportunity to talk about climate change and health while looking for solutions for NTDs.

“It will be a good opportunity for partnerships, talking cross-sectoral, and for pledging money for NTDs. We hope that we will have some high-level participation from heads of state, ministers, and all partners,” Fall said.

Elphick-Pooley said Uniting to Combat NTDs is excited about the 2023 Reaching the Last Mile Forum at COP28 which will 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.”

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