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Director of Policy & Communications
A week ago, I had the privilege of returning to Uganda – the beautiful country in which I spent several months as a young(er) researcher working on water, sanitation and hygiene (WASH) in 2009.
At the time, the WASH sector was facing major challenges. Chronic underinvestment in infrastructure resulted in stagnating rates of access to safe water supply and sanitation services. There was little communication between the Ministry of Water and Environment and the Ministry of Health, meaning that information on lack of WASH services was not used to inform healthcare investment needs, while information on disease distribution was not used to target WASH investment. The result was predictable, with high rates of WASH-related diseases, from the immediate threat of cholera outbreaks to the long term, devastating impact of Neglected Tropical Diseases (NTDs) such as schistosomiasis. Despite ongoing mass treatment of schistosomiasis-affected populations since 2003, prevalence of the disease has not reduced significantly in some districts, and it remains endemic in 91 of the country’s 126 districts.
A decade later, many of these challenges remain. However, there is cause for optimism – and even enthusiasm – given the significant efforts made of late by the Government of Uganda, as well as the global NTDs community. Three major themes stand out:
Having been rolled out as standalone programmes for over a decade, with heavy reliance on external resources, NTD programmes are increasingly being driven by Ministries of Health as part and parcel of their national health and development plans. Dedicated expert staff lead and implement the programmes successfully and are taking charge of the way in which programmes should be planned and structured. The SCI Foundation’s own approach and values support this trend by channelling all our support directly to Ministries of Health, Uganda’s included, while avoiding the creation of a parallel system for delivering and monitoring NTD programmes.
The fact that NTDs are driven by, and can be best tackled through, multiple pathways and interventions, has been acknowledged for some time, with the first WHO NTDs Roadmap setting out five key strategies against NTDs: preventive chemotherapy, intensified case-detection and case management, vector and intermediate host control, veterinary public health at the human–animal interface, and provision of safe water, sanitation and hygiene.
The BEST framework, adopted by the NTDs NGO Network in 2016, enshrined these under four simple areas that must be addressed through all NTD programmes: Behaviour, Environment, Social inclusion and Treatment and care.
There are strong signs that the next Roadmap to 2030, which is aligned with the Sustainable Development Goals timeframe, will acknowledge these same links – this time, with explicit targets and indicators for measuring progress – much needed for engagement of other key sectors in the fight against NTDs. At country level, these frameworks have given the health sector, including in Uganda, the mandate it needs to reach out to other sectors and involve them in the fight against NTDs.
Of all cross-cutting areas, perhaps the most progress has been made on WASH in the past decade. In 2015, WHO issued a Global Strategy on WASH and NTDs, followed by the joint publication with the NNN of “WASH and Health working together: a practical guide for NTD programmes”. This step by step toolkit for partnership building and joint planning and implementation between the two communities has since been picked up by several countries. In December, Uganda became the first country to adopt the toolkit wholesale, and has wasted no time in moving this agenda ahead. I had the privilege of joining several community visits undertaken jointly by NTD and WASH sector leads to identify WASH issues that hold back progress on reducing the burden of NTDs in the country.
At SCI Foundation, we look forward to supporting these efforts as they continue, and I was struck by the level of commitment and enthusiasm for collaboration expressed by all concerned, from the high level ministry officials we spoke to, to the volunteers who work to improve conditions in their own communities.
There are reasons to hope that another decade down the line, in line with the new Roadmap, Uganda will have reached its ambition on NTDs.
Laundry at the Nile shore, Kamuli, Uganda. Simple daily activities put locals at risk of schistosomiasis. Photo: Tom Wardley