People often talk about international development in terms of north-south cooperation, or developed countries supporting developing countries. While developed countries play an important role in the elimination of poverty and disease, it is becoming increasingly clear that we cannot eliminate poverty-related diseases like trachoma without strong collaboration among the affected countries themselves, particularly in situations where migration is common across shared borders.
In East Africa, migration and cross-border movement have presented many challenges to trachoma and neglected tropical diseases (NTD) control and elimination programs. International borders are often unmarked and consequently unrecognized by communities. This is particularly common among pastoralist groups, such as the Maasai or Ateker people, who live in border areas in Kenya and Tanzania or Uganda and Kenya. Pastoralist groups often share similarities in languages, cultural practices and ethnicity, which can result in cross-border marriages, business partnerships and other opportunities that can increase travel across borders. This complicates efforts by health authorities to accurately identify and locate at-risk populations, making it difficult to reach these people with important interventions such as drug distributions or surgical outreach campaigns.
In other cases, natural disasters, famine or conflict have caused the mass migration of millions of people into areas that do not have adequate health infrastructure to support them. This has resulted in populations introducing diseases to areas where they did not previously exist or, in other cases, populations have entered trachoma endemic regions that did not have the infrastructure to support them.
One thing that has become clear from these meetings is that in order for each country to reach elimination, we must think about health programs at the regional level as well as the national level.
To identify and resolve common issues presented by population displacement and migration, program managers of seven East African countries now attend regular partnership meetings with a broad range of other stakeholders including NGOs and donors. They work together to identify crucial problems, map out known migrant routes and to align intervention strategies to tailor relevant interventions to internally displaced and migratory populations.
So far, there have been some encouraging outcomes. After the meeting in August last year, the Ministry of Health in Kenya began coordinating its trachoma-related surgeries and drug distributions in border areas with Uganda and South Sudan, home to the Karamojong, Turkana and Toposa ethnic groups. Together, the countries ensured that drug distributions and surgery campaigns were carried out at the same time. This meant that migratory groups could access interventions no matter what side of the border they were at the time of the campaigns. The Cross-border Partnership meeting has also led to talks between the Ministry of Health South Sudan and the Sudan NTD team to help coordinate treatments of South Sudanese refugee populations in secure areas along the border of Sudan. These are just two inspiring and important examples of what working in partnership has achieved.
Following the success of East-Africa's cross-border partnership, NTD/Trachoma program managers in the Southern Africa region have established a similar cross border partnership. At their first meeting in July this year, they looked at how to increase participation among migrant communities in trachoma elimination programs. Tanzania, Mozambique , Malawi, Zambia and Zimbabwe are now working together to update their data collection tools to allow for smooth flow of information and exchange when it comes to treating non-nationals. The results of these early collaborative efforts are eagerly awaited.
So, what are the lessons learned? One thing that has become clear from these meetings is that in order for each country to reach elimination, we must think about health programs at the regional level as well as the national level. The regional partnership meetings are already showing great results, allowing national program managers and district-level health managers to learn from each other, build relationships, share challenges, and engage across borders in joint planning and program delivery. This is essential to ensure that mobile populations living in border regions and remote settlements receive the treatment they need and that all countries reach elimination targets with no one left behind.
The East and Southern Africa Trachoma/NTD Cross-border Partnership meetings are supported by the International Trachoma Initiative.