Funding the needs not the NTD label – what will it take?

By Wendy Harrison, Yael Velleman and Anna Georgeson

Traditionally, funding for neglected tropical diseases (NTDs) has been driven by external funders and channelled mostly through Non-Governmental Organisations (NGOs) into large-scale vertical disease control programmes. This funding model has no doubt resulted in significant health gains. However, at times it has unintentionally undermined country ownership, for example when funder priorities are not aligned with those of national programmes. This in turn puts the national health system’s ability to contribute to the achievement of universal health coverage at risk.  

Recently, the World Health Organization (WHO) Regional Committee for Africa called for greater investment in NTDs. Although this was welcomed by the global health community given the current funding challenges faced across the health and human development sectors, there is increased  recognition that the NTD funding landscape is evolving rapidly, requiring a radically different funding architecture as well as additional investment to effectively impact universal health coverage and reach the last mile in efforts to end parasitic diseases.  

At the recent NTD NGO Network’s (NNN) annual conference in Dar Es Salaam, honest discussion took place on the barriers to meeting the goals laid out in the WHO NTD 2021-30 road map  and implementing new sustainable financing approaches. A key message arising from these discussions is that as a community, we must continue to make room for honest and open discussion on NTD funding and most crucially, be guided by our endemic country partners in the process.   

Here are key themes emerging from discussions on this issue with our partners, in their own words.  

Funding in response to the needs of national programmes  

Our partner at the Kenyan Ministry of Health (MoH), Florence Wakesho, the schistosomiasis and soil-transmitted helminths focal person, emphasised the need for listening to countries’ priorities.

She said, “The financial model will change once countries’ priorities are taken into consideration. Because I believe at times partners will have their own interests that are different from what the country really needs or the gaps they really have. So, if that can be achieved that means there will be full ownership and a change of the structure because now the financing will be prioritised to country needs, which of course can lead us to reach where we really want as countries”.

At present, there is a power imbalance between national programmes, funders and international NGOs. This can result in continued misalignment of priorities, with funders and other external partners having significant leverage on shaping the health programme. An intentional change in the power balance is therefore required to shift away from a funder-led agenda to one driven by local ownership and sustainability considerations, aligning with countries’ priorities.  

“…changing the funding structure would help to prioritise those areas that are in need and yet have not been taken care of. It would be very important to have a change in the financial mechanism or framework to cater for those priority areas that have been neglected and yet they are very critical in eliminating NTDs”, said Prudence Beinamaryo, the programme manager for bilharzia and worm control, vector borne and NTDs at the Ugandan MoH.

To explain this further, Unlimit Health’s trustee, Arielle Dolegui, and past Chair of the NNN who leads the NTD policy and resource mobilisation advocacy portfolio at the Bill and Melinda Gates Foundation, added “The vertical nature of the programmes limits the visibility of NTD programme indicators with decision makers, such that for leadership at the country level, they are often not well-briefed on their own country investment. And they often don’t understand the real gap that exists to meet their programme needs”. 

Mobilising sustainable resources to support cross-cutting approaches 

Our five-year strategy was developed to reflect the three key pillars of the road map: accelerating programmatic action, intensifying cross-cutting approaches, and changing operating models to facilitate country ownership. An improved funding architecture, that responds to needs rather than to narrow disease control objectives, will enable joint planning and collaboration across sectors to maximise the impact and effectiveness of funds and resources across competing health needs.  

“Changing the funding from areas that have not been prioritised to more of multi-sectoral coordination, would mean that a number of stakeholders are brought on board and the control and prevention of these NTDs are approached in a multi-sectoral way; each sector is playing its role and that will lead us more to elimination of these NTDs”, said Prudence.  

This raises again the question of whether the NTD label itself is still helpful to achieving NTD goals and whether it results in desirable and sustainable financing structures that embed NTDs in healthcare service delivery and encourage cross-sector collaboration.  

Building trustful partnerships to evidence the value in domestic resource mobilisation 

The financing discussion isn’t just about ‘how much’ – but also about ‘how’, and ‘when’. More predictable funding support is key for improving aid effectiveness. If countries are unable to obtain information on what funding they will receive, how can they implement long-term planning that responds to gaps? The agreed international principles on aid effectiveness (national ownership, alignment, harmonisation, managing for results, mutual accountability) encourage better ways of coordination to strengthen national accountability, decision-making and financial flows – but these have not been applied consistently within NTD financing.   

As an organisation, we want to adhere to and build on these principles. In addition to aligning our strategy with the road map pillars, we‘ve put country ownership, partnership, and alignment with country needs, at the heart of our approach. Each of our strategic goals also relate to the WHO health system building blocks, including advocacy support and improvements to information systems, to ensure that our actions contribute to achieving resilient health systems. In practice, this means working directly with our MoH partners to support domestic resourcing and local health systems that deliver programmes in response to their own needs.  

If we are to meet the road map goals, it is clear the traditional funding model must evolve. But this shift towards domestic resource mobilisation is only possible by collaborating across sectors and building partnerships between MoHs, international organisations and funders, founded on trust and mutual accountability.  

It is important for us as a community not only to celebrate and protect the progress that has been made to date, while making the case for sustainable financing of NTDs. The planned meeting on domestic resource mobilisation for NTDs in Southern Africa is an exciting step in this direction. 

Arielle concludes by adding, “NTD programme funding doesn’t just lead to individual disease outcomes, they help strengthen health systems, break cycles of poverty, address inequities and restore dignities, and they bring us closer to achieving universal healthcare coverage, which is critical for understanding the shift in paradigms needed in global health financing for NTDs”. 

What we need now is a financial structure that can help deliver this impact. We must encourage open discussion on NTD funding and call on our national partners to lead the way.