The Role of Health Systems in the Control of Neglected Tropical Diseases in Sub-Saharan Africa

Abstract

Neglected tropical diseases (NTDs) mostly affect populations with low socioeconomic status and limited access to health care. The opportunity to combat NTDs is now available, facilitated by increasing partnerships and availability of effective drugs. However, weak health systems (HSs) in NTD endemic areas pose a challenge to delivery of interventions at adequate levels to at-risk populations. To effectively reach target populations with NTD treatment, weak HS challenges must be addressed by fixing specific weaknesses in the HS building blocks – service delivery, health workforce, information, medical products and technologies, financing, and leadership and governance. The building blocks, however, should be tackled with a systems thinking approach to have the best impact. The role of volunteers – community drug distributors (CDDs) – in achieving adequate treatment coverage during mass drug administration (MDA) for NTDs cannot be overemphasised. They serve to extend health service beyond the reach of the formal HS and also contribute to the low cost of drug delivery to target populations; hence demotivating factors that reduce their commitment must be addressed to sustain the gains made so far. CDDs have acceptability challenges in urban areas; however the proposed use of low-cadre community health workers in urban settings must be explored. Commitment by pharmaceuticals and donors to support for NTDs must be accompanied by increased HS investment by governments in SSA to improve weak HS. Current medicines for preventive chemotherapy in NTD control are effective microfilaricides. The development of effective macrofilaricides will not only shorten the number of MDAs required to eliminate lymphatic filariasis and onchocerciasis but also significantly reduce cost. Quality and timeliness of data in NTD control programmes are affected by the literacy levels of CDDs and the largely paper-based system used to collect the data. While the CDD literacy levels will be difficult to alter in the short term, the use of electronic data collection tools and systems can be explored to address the shortfalls listed. Control of NTDs requires also inputs such as potable water and basic sanitation facilities that often do not fall directly under the ministries of health. To effectively control NTDs means building good inter-sectorial coordination mechanisms that work beyond ad hoc meetings of inter-ministerial agencies whose outcome has no policy implications.