Sustain The Gain: Advocating for NTD Elimination

In 2021 the World Health Organization published a roadmap targeting key 2030 milestones for eliminating and controlling NTDs. 

The 2030 target ties to the Sustainable Development Goals to improve health, reduce poverty and improve other well-being indicators. Among the proposed strategies in the 2021-2030 NTD road map is a call for a global shift to country-owned and country-financed health programs. The intent is that countries worst-affected by NTDs will take on more health initiatives previously led by external actors such as international non-governmental organizations and donors.

For nearly 40 years, The Task Force has worked to eliminate NTDs through programs such as the Mectizan Donation Program (MDP), the International Trachoma Initiative (ITI), Children Without Worms (CWW), the Neglected Tropical Diseases Support Center (NTD-SC), and the Focus Area for Compassion and Ethics (FACE). These teams have long prioritized strategies that help countries build their capacity to protect the health of their own populations.

“One of the most impactful health interventions of our time.”

Based on these experiences and in line with the focus on country-led NTD initiatives, The Task Force has been working with national health partners to augment their NTD advocacy efforts.

“The model for mass administration of drugs to fight these diseases came out of The Task Force’s MDP collaboration with Merck,” says Carol McPhillips-Tangum, a consultant working on the advocacy project. “It’s been one of the most impactful global health interventions of all time.”

Andie Tucker, Business Strategy Manager at The Task Force, noted that this success provides new opportunities, as well as unexpected challenges, which is the reason for the national advocacy focus.

“We’re approaching a horizon where these diseases are eliminated as public health problems,” says Tucker, adding that elimination or near-elimination of certain NTDs could prompt governments to redirect scarce health resources to other work, creating a space for those NTDs to roar back.

“If no one is watching the pot, the pot can boil over,” Tucker said. “Incidence of these diseases can start to rise again, but without the funding in place to fight it.”

Walter Ochieng, a health economist with U.S. CDC, cites the experiences of health officials in Belitung, Indonesia as a warning about what can happen when NTD programs end prematurely. Several years after ending mass drug administration and then surveillance for lymphatic filariasis (LF, commonly known as elephantiasis due to the swelling of limbs), the disease came back.

“Elimination of river blindness is even harder because the adult parasites live for 10-15 years,” Ochieng said. “You might think you’ve eliminated the disease and cease surveillance activities to find that the adult parasites have outlived the surveillance period. The disease bounces back, but the donors who were helping you fight the disease are long gone.”

It’s prudent to keep fighting the disease even if you don’t see hundreds of active cases, Ochieng said.

Photo courtesy of Andie Tucker
Photo courtesy of Andie Tucker

Advocacy Helps Countries Take The Lead

In October 2023, teams from Cameroon, Malawi and Togo met in Addis Ababa with Task Force representatives to develop materials to help countries use the NTD advocacy costing tool. Attendees came from different countries, with a shared goal: leveraging national health resources to keep moving forward in the fight against NTDs.

“Advocacy activities are local and specific, so we started by recruiting partners in Cameroon, Malawi and Togo to co-develop advocacy tools and resources that could work within their specific countries. Then we got together to practice using them,” said McPhillips-Tangum.

“It was very much a workshop of experiential learning,” added Tucker.

Each country team left the meeting with unique actionable steps and ideas about who they could talk to in order to move things forward. 

A critical component of the strategy is equipping advocates to present the medium-to-longer term benefits of short-term spending. 

Long before the workshops, The Task Force team working on the NTD advocacy project discussed the advantages and disadvantages of developing a costing tool that could be leveraged for advocacy.

“The idea was to develop a tool that countries could use to calculate how money spent on NTD programs today ends up reducing costs in the future,” said McPhillips-Tangum.

It turned out that the U.S. CDC was already developing such a tool. 

“The key was making it useful for people with different technical backgrounds – financial, economic and medical,” said Ochieng, who at the time was working on river blindness in Sierra Leone.

What started as a 30-tab Excel sheet was streamlined into a Python-based tool with a narrative output. Users can now input disease and population data and get clear and helpful outputs explaining how a dollar spent today on a disease like river blindness or LF will free up many more dollars in the future.

“This tool doesn’t tell anyone to ‘do this’ or ‘do that’,” Ochieng says. “It gives you information. It tells you where you can put a dollar and get 20 or 30 back.”

McPhillips-Tangum said rather than just present a costing tool and tell people they could use it, they figured a tool would be more useful — and used more — if the teams using it contributed to the development of supporting materials for advocacy.

“We didn’t call it a training, because it really wasn’t one,” McPhillips-Tangum says. “It was a workshop where groups from countries doing NTD advocacy could learn from and teach one another.”

“Our objective was to get better insight of the NTD Advocacy tool, and develop strategies for the mobilization of the local resources for NTD elimination,” said Irene Megeh Ngobe, who works with Cameroon’s public health ministry on NTDs. “The workshops included general discussions, thought-provoking debates and practical teamwork.”

Tucker said the NTD teams at Task Force and partner organizations are eager to see how NTD advocacy work evolves, as it’s critical that countries that have made enormous progress against NTDs don’t turn their attention elsewhere and lose the gains.

“I think one of the legacies of Task Force, and of Merck and our partners in the MDP is that we’ve changed the NTD game forever,” Tucker says. “No one wants to wake up tomorrow to see those diseases have come back.”

Learn more about through the online advocacy guide, Advocating for NTD Elimination: A Guide for Country Program Managers and Their Partners.

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