By Francis KOKUTSE
Buoyed by the determination to fight Neglected Tropical Diseases (NTDs), the Tanzanian government has turned to the use of Mass Drug Administration especially in schools, and Faraja Lyamuya, focal person of the country’s NTD Control Programme says it is paying off, as most of the school children have become healthier.
“Before, some of the children used to pass worms but, we have been able to bring this down through the mass drug administration and we have seen that they have become more alert in class,” Lyamuya said.
The World Health Organisation (WHO) defines NTDs as a diverse group of conditions that are mainly prevalent in tropical areas, where they thrive among people living in impoverished communities.
They are caused by a variety of pathogens including viruses, bacteria, parasites, fungi, and toxins, and are responsible for devastating health, social and economic consequences. Common NTDs include intestinal worms, lymphatic filariasis, river blindness, schistosomiasis, trachoma, and visceral leishmaniasis.
In June this year, Ibrahima Soce Fall, the Global NTD director at the WHO, said the African region is “endemic for 20 of the 21-priority neglected tropical diseases; affecting over 565 million people and comprising 35 per cent of the global disease burden.” These diseases lead to significant morbidity, including physical and visual impairments, severe malnutrition, chronic pain, disfigurement, stigma and mental health issues, and death.
To show how worrying these NTDs are, Clarer Jones Mwansasu, manager of Neglected Tropical Disease Control at Tanzania’s ministry of health, in a briefing told a group of African journalists that, about 1.7 billion people worldwide are at risk of infection, thus requiring preventive and curative interventions.
Currently, Tanzania, she said, is endemic to more than 15 of these NTDs, and it was for this reason that in 2009, an integrated NTD control program (NTDCP) was launched to target five of them.
These are Lymphatic filariasis, Onchocerciasis, Schistosomiasis, Soil transmitted Helminthiasis and Trachoma. “Initially, interventions to control NTDs were implemented as vertical programme for each individual disease,” but later “morbidity management and disability prevention, trichiasis, lymphoedema and hydrocele were included, which was backed by advocacy and sensitization on behavioural change towards control of these conditions,” Mwansasu said.
During one of these mass administration programmes at the Vikuruti Primary School in the Kibaha district, the principal, Magungu Beno, said “before the administration of the drugs, about 10 per cent of the children were absent from school. But this has improved as we have been able to change the attitude of parents on why the children need to take these drugs.”
So far, everything is pointing to the fact that Tanzania is making inroads in the fight against NTDs and has also able been able to lead the way in domestic revenue mobilisation in the face of dwindling international funding for Africa’s health sector. This is giving the grounds for some to suggest that the country has become a shinning light in this regard.
So far, the country’s effort in domestic revenue mobilisation, is receiving attention, as Peter Kivumbi, NTD programme manager for Sightsavers Tanzania says, “the country has also been successful in documenting its approach in its efforts to eliminate trachoma for instance and has documented geographical house to house coverage of how it is fighting the NTDS, which is a lesson that countries on the continent can follow.”
Kivumbi said, Tanzania is the first country to do this documentation to show how it has implemented its policies. Following this, a number of countries have shown interest in what the country has done.
Since the NTDs are not a problem for Tanzania alone, but one that Africa countries are all struggling to control, Gerald Ogodo, head of resource mobilization for Africa and Global Funds at the international charity, Uniting to Combat Neglected Tropical Diseases, gave some insights and said, Tanzania is reacting well to the low donor funding.
“Based on our country-level engagement, most countries are aware of the impact of the cost and are already positioning themselves in terms of how to adapt and respond to their existing health programmes, especially life-saving interventions, so that ongoing NTD interventions are not halted or put at risk,” he said.
Ogodo mentioned three countries Tanzania, Nigeria, and Ghana, which are responding well to the fight against NTDs and said, Mass Drug Administration programmes are being integrated into education interventions, as an efficient way of deploying scarce resources.
He however singled out Tanzania as doing so well with domestic mobilisation, because the country has met its co-financing target and is contributing $1.5 million to the International Development Association 21 (IDA 21) fund which is a World Bank’s initiative for poorest countries.
Ogodo is hopeful that, other countries will copy Tanzania in terms of meeting their own co-financing contribution to the funding bucket which will be used to sustain Lymphatic Filariasis and Onchocerciasis programmes on the continent.
He said Tanzania has finalised their IDA 21 business case and submit this to the Ministry of Finance so that they can access some of their IDA 21 allocations to support their ongoing NTD programmes.
“Another very good example in terms of Tanzania’s leadership is that recently, the country launched a comprehensive domestic resource mobilisation strategy for neglected tropical diseases. So, this gives further insights as to some of the initiatives that are being taken at the national, regional, and district levels, to mobilise resources for NTDs,” Ogodo added.
He said it was “worth noting that, despite the fact that Africa accounts for the largest NTD body in the world, we are also seeing progress from a programmatic perspective. We are seeing that at least 24 countries have eliminated at least one NTD. Togo, for instance, has eliminated four NTDs, which is something that some countries outside Africa have not even done in endemic countries.”
He also mentioned Ghana, as another African country that has eliminated three NTDs, adding that, “there are several examples in Africa where you can see progress, both from a programmatic perspective in terms of reducing or meeting NTD elimination targets, and also from the perspective of domestic resource mobilisation.”
Ogodo said the international charity, Uniting to Combat Neglected Tropical Diseases has also engaged Ghana’s Ministry of Health as one their key partners, because the country has a lot in terms of in-kind contribution towards NTD programmes in Africa, and for this reason, want to partner with the country to explore other alternative financing mechanisms to sustain the country’s NTD programmes.
He said Tanzania has been at the forefront of this and has demonstrated significant leadership in this area. In line with this, the country is reaching out to the Last Smart Fund, which was launched about three years ago, and is a platform led by the Mohammed Bin Zayed Foundation of the United Arab Emirates, together with other significant donors, including the Children Investment Fund Foundation and the Gates Foundation.
All said, the need to fight the scourge of the NTDs on Africa’s health systems is very important, because the return to investment so far, shows that it is in the interest of the countries to do so. It is estimated that, Nigeria alone stands to gain $19 billion in economic productivity by 2030, which is the elimination target date. Ethiopia, Kenya, and Rwanda are likely to secure $5 billion by eliminating just two NTDs each. All these show that it is in Africa’s interest to get it right, and this means the continent must not slack in its efforts.
What is encouraging is that the continent has not just folded its arms and looked up to the skies in the fight against NTDs. When the U.S. announced cuts in its support from the USAID, it was initially thought that this will lead to a breakdown in Africa’s health system. But judging from what Tanzania and other countries are doing to help themselves, one can only see a bright future for health administration on the continent.
