One Health Systems Strengthening: the missing link for sustainable neglected tropical disease programmes

By Carolyn Henry,  Head of Health Systems 

The World Health Organization’s (WHO) Roadmap for neglected tropical diseases (NTDs) and the Sustainability Framework call for the mainstreaming, integration, and coordination of NTD programmes. These are not new ideas, but are we truly able to deliver on them? Or are we trying to fit big ambitions into health systems that are already under pressure? As resources within health systems are stretched more than ever, the need for collaboration and efficient use of capacity is paramount. 

Like me, people working in NTDs and health systems know the theory. We talk about tailored approaches and using data to drive decisions. But in reality, due to limited resources and capacity, we’re often focused on delivery—rolling out mass drug administration (MDA) campaigns, meeting targets, and managing the day-to-day challenges that come with running complex programmes. It can feel like firefighting, with limited time and space to look at the potential in the bigger picture. This has led me to think not just about human health systems but all the systems that connect an individual’s daily life. 

The limits of linear thinking 

The six building blocks of Health Systems Strengthening (HSS) offer a solid foundation. But when applied in isolation, we risk missing the opportunity for real change. Take the example of MDA efforts across the NTDs that use preventive treatment. This approach can be more efficient in the short term, but does it change the way the health system works for the better to achieve longer-term sustainability?   

NTDs are grouped together, not because they share similar diseases, treatment programmes, diagnoses or transmission routes, but because they have been overlooked by the health system. It is time to rethink where and how care and treatment are given and to move beyond the boundaries that were created out of the past necessity of grouping together purely through being ‘neglected’.  

Applying HSS to NTDs can feel overwhelming. These diseases span, with complexity, across the health system and often compete with other diseases and health priorities for resources and capacity.  NTD programmes have been designed to be accessible to those who need them, but when delivered in isolation, they can be resource-intensive and difficult to sustain. Mainstreaming these programmes into already stretched systems without careful planning risks lowering access. 

We aim to build systems that can evolve, adapt to changing needs and be resilient to future shocks, such as a funding crisis or natural disaster.  

But are we building lasting systems or patching cracks in the surface?  

One Health Systems Strengthening 

The One Health approach—recognising the interconnected nature of human, animal, and environmental health—is often seen as adjacent to NTD efforts. In reality, it plays a central role in achieving sustainable impact. 

The One Health companion document to the NTD Roadmap highlights key principles that align closely with HSS, including communication, coordination, collaboration, and capacity building. But this is where I would like to propose that the One Health Systems Strengthening approach goes further. It encourages us to think more broadly, looking at the whole system and designing interventions that reflect the complexity of health systems and of people’s lives.  Like HSS, it takes a systems-based approach, but without being limited to the boundaries of the human health sector.  

Instead of only coordinating or integrating specific components of care such as MDA, we have the opportunity to build person-centred platforms that address a broader range of needs, including safe water, sanitation, animal-to-human disease risks, livelihoods and chronic health conditions. Achieving long-term sustainable change requires a big picture vision, one that puts people at the centre and focuses on creating a supportive, holistic environment for healthier, more resilient communities. 

The capacity conundrum 

The skills needed to work effectively on NTDs are wide-ranging—analysing data, designing context-specific interventions, and leading change. Yet too often, we expect key individuals to do all of this without additional resources, training or support, or in fact, the freedom to innovate. 

While adding capacity during specific periods of projects or interventions is helpful, it also reflects a deeper structural challenge. The current system design places unrealistic expectations on the health systems and those who work in them. 

If we are serious about building resilient and future-ready systems, we must invest not only in programme delivery, but also in the governance and organisational design that enable a new way of working. That includes strengthening capacity for dynamic strategic thinking, adaptive leadership, and cross-sector collaboration. 

Breaking silos  

Several countries have seen positive changes in disease endemicity through their disease-specific programmes. Two recent examples in which Unlimit Health was a partner included Ethiopia and Zanzibar, where the geospatial mapping highlighted a reduction of endemicity in several districts.  However, some familiar challenges remain, such as siloed programming, fragmented funding, and disconnected reporting systems. The Roadmap was designed to help move us beyond these issues.  

To truly advance, we need to commit to deeper integration—across sectors, disciplines, and delivery platforms. This means building programmes that don’t just work side by side but actively connect and reinforce one another.
Imagine a cost-effective system where families receive comprehensive care from local health workers who are not only well-trained but also equipped with the right data and context to provide effective care. This could take several forms, depending on the context, such as a geographical approach, where all services a community would need are delivered in one place by one team, clustering public health, animal health and environmental health interventions to avoid opportunity costs of access and participation. While co-creating solutions is often emphasised, true creativity cannot thrive when there is no space to think, reflect or learn. I believe that by creating these collaborative spaces, we will be advancing effective and sustainable NTD care in the future. 

Key takeaways: 

• Recognise One Health not as an add-on, but as a strategic imperative 

• Create collaboration spaces to support frontline and management staff to deliver transformation 

• Integrate programmes for resilience and sustainability rather than efficiency alone.

We are at a pivotal moment in the sustainability journey for NTD programming. I propose that One Health System Strengthening can support a more dynamic systems approach that can future-proof programmes. Now is the time to put all the knowledge, skills and experience together, and use this innovative approach to create stronger systems that are accessible and fit for purpose for all those who need to use them.  

The question isn’t whether One Health Systems Strengthening can future-proof programmes for NTDs, it’s whether we’re prepared to unlock its transformative power. Is the NTD sector truly ready to lead that change?