23 June 2022
By Yacine Djibo, founder and executive director of Speak Up Africa, a nonprofit based in Dakar, Senegal, focused on public health and development in Africa.
“…In a globalized world, you cannot live in isolation; all the problems and solutions are interconnected …”Kailash Satyarthi, Nobel Peace Prize winner
Health challenges, like many others cannot be addressed in isolation because they are complex and interlinked, not only in themselves but with social and economic problems. Throughout my career in Global Health, I have seen that we often focus efforts on individual disease approaches. Yet, there is much to be gained from a multi-disease approach. The notion that health challenges can be addressed in separate silos can no longer be entertained.
Let’s take malaria and Neglected Tropical Diseases (NTDs). Both diseases have been with us for too long with debilitating and devastating effects. Despite good progress in scaling up interventions and novel tools, billions of people around the world continue to suffer and die from both diseases – which are entirely preventable and treatable.
Neglected tropical diseases (NTDs) are a diverse group of 20 conditions affecting 1.5 billion people. 39% of the burden is in Africa, with 79% of African countries being co-endemic for at least 5 NTDs. Africa also carries the heaviest malaria burden, accounting for approximately 95% of all malaria cases and 96% of all deaths in 2020. About 80% of deaths in the region are among children under five years of age. We lose one child every two minutes to malaria.
The challenge is how to make better progress on tackling malaria and NTDs together. The answers require integrating the tools for detection and elimination. Multi-disease approaches are known to work; they also encourage significant efficiencies, value for money and cost rationalization in the healthcare system. And when we think of healthcare systems across the continent – systems in which the share of global health expenditure is less than 1% while accounting for 25% of the world’s disease burden – taking a multi-disease approach seems logical. Furthermore, reducing the risk of both diseases transmission can be achieved through an integrated approach, “One health” supporting human, animal and environmental development.
The great news is that this solution is within reach. Health experts acknowledge that opportunities exist for integration or convergence of malaria and NTD interventions. Therefore, the Kigali Summit on Malaria and Neglected Tropical Diseases (NTDs), which takes place alongside the 26th Commonwealth Heads of Government Meeting (CHOGM) in Rwanda this week, presents a defining moment to secure political support and investment in integrating malaria and NTDs programs, as well as broader healthcare and cross-sectoral programmes.
Using this summit to firm up existing commitments and provide a framework for endemic countries to work from will be crucial. Enhanced integration of malaria and NTDs programs across sectors will unlock the potential of a safer, healthier, more equitable world for everyone.
Senegal, my home country, has made efforts to integrate malaria and NTDs. To improve the effectiveness and efficiency of implementing disease control interventions, Senegal has integrated NTDs and malaria data collection and review. The National Neglected Tropical Disease Control Program (NNTDCP) integrated the quarterly reviews organised by the National Malaria Control Programme (NMCP) with all health districts and medical regions. Its success lies in the government’s political will to progressively integrate malaria-NTD data and to put in place an official endorsement and formal agreement for the integration of these services.
Ownership of the project at the ministry level is done through an agreement at the central and decentralized levels. And the commitment of technicians and partners in the sector to carry out the objectives to achieve the integrated review at the national level. When we bring people and resources together, a new opportunity for empowerment and ownership emerges, which makes the Senegal case study different.
Senegal’s malaria-NTD project is already scaling up by integrating the efforts planned for malaria, NTDs and tuberculosis. Lessons learned from this integration have led to the reflection on the development of integrated vector control and mass campaigns implemented by the programmes (Mass Drug Distribution and Chemoprevention of Seasonal Malaria).
While the Kigali Summit is an opportunity to discuss how to turn this broad set of commitments into sustainable action, we must also ensure adequate funding to continue tackling these diseases. We must ensure the Global Fund is fully replenished with a minimum of 18 billion USD. With this funding, it is projected that countries and partners can reduce malaria deaths by 62%. National governments also need to do more by strengthening the financial sustainability of malaria and NTD programmes to improve the long-term management and elimination of these diseases. And finally, we need to be more inclusive in identifying, implementing, monitoring and evaluating NTD and malaria projects and programs, considering gender aspects and the specific needs of all of the population, people with reduced mobility, women, men, young people, senior citizens. This can be done by effectively implementing primary health care in all endemic countries.
Diseases do not respect national borders, so countries must work together to control and eliminate infectious health threats like malaria and NTDs. Regional Economic communities should ensure effective cross borders interventions. We must all work together because effective collaboration is critical to scaling up interventions. Many endemic countries are developing and implementing country-specific programmes to end malaria and NTDs.
The March to Kigali campaign is a multi-country approach that brought together like-minded civil society organizations in the lead up to the Kigali Summit to push for more action on NTDs and malaria. The more than 300 signatures from across civil society, private sector, media organisations and individuals is evident of the commitment to leave no one behind in the pursuit to integrate malaria and NTD programs and to secure funding to eliminate these entirely preventable and treatable diseases.