Neglected tropical diseases (NTDs) are a diverse group of diseases that thrive in underdeveloped areas, where basic services, such as access to water, hygiene and sanitation or care are limited. Their affects, such as disability, social exclusion and stigma, exacerbate development challenges and can keep whole communities trapped in a cycle of poverty. The control and elimination of NTDs requires cross-sectoral collaboration to respond to these cross cutting development issues that impede progress.
In 2016, in order to define how stakeholders can work together to implement cross cutting approaches, the Neglected Tropical Disease NGO Network (NNN) published The BEST framework: A comprehensive approach towards NTDs. This framework provides NTD stakeholders with a comprehensive conceptual approach for NTD programming and details the diverse cross-sectoral efforts needed to reach control, elimination and eradication targets.
BEST, an acronym for Behaviour,Environment, Social inclusion and Treatment and care, moves away from mass-treatment-focused medical approaches, such as preventive chemotherapy, and integrates the broader causes and social effects of NTDs. As a conceptual framework, BEST promotes human rights based comprehensive and inclusive NTD work that is based on cross-sectoral collaboration and an effective continuum of care from promotion to prevention, treatment, rehabilitation and care. As such it includes the cross cutting components of Water, Sanitation and Hygiene (WASH) as well as Disease Management, Disability and Inclusion (DMDI) as central to success and sustainability.
This paradigm shift requires engaging with and working holistically with a broad range of development stakeholders. It includes actively involving people affected by NTDs at all stages of programs, from conception and planning to implementation, monitoring and evaluation, and embedding cross-sectoral approaches and systems thinking into NTD work. To support this transition a range of NNN cross cutting groups, such as the WASH Working Groupand the DMDI Working Group, have been established, bringing together a diverse range of stakeholders to share experiences, develop tools and identify preferred practices for comprehensive programming.
Through the DMDI Working Group, strategies are in development to improve and mainstream the inclusion of people affected by NTDs and other marginalized groups in all work. These complement and support other stakeholders’ efforts to design participatory and inclusive programs in accordance with the BEST framework.
A key priority of the WASH Working Group is the promotion of "inclusive WASH", an approach to increase universal access and the active and meaningful participation of affected people. Inclusive WASH recognizes that marginalized and vulnerable people bring a unique insight to NTD programs and should be consulted at all stages of NTD programs to make them accessible and inclusive. People who have experienced disease, disability, stigma and social exclusion take the programs closer to the communities they are designed to benefit. This helps to ensure that infrastructure, such as hand and face washing stations and latrines are accessible and appropriate to people with disabilities.
Furthermore, because WASH activities to prevent diseases like trachoma, schistosomiasis and soil transmitted helminths are often conducted in schools, careful planning is required to ensure children with disabilities, who are often excluded from schools, can access interventions and participate in these programs.
Sharing lessons between these groups has led to a stronger understanding of the importance of social inclusion and more systematic engagement of disabled persons and women in WASH and NTD programs. Organizations seeking to use the BEST framework can learn from these experiences and engage in these platforms to increase program effectiveness.
Through the NNN cross cutting groups, key technical resources are also being developed to further support the NTD community to improve programming, policy and practices as well as other crosscutting issues incorporated in the BEST framework.
Through its task groups, the WASH Working Group has contributed to developing tools with national level program managers to support WASH and NTD integration. This includes the first global strategy on water, sanitation & hygiene for accelerating and sustaining progress on neglected tropical diseases, published by WHO in 2015. The group is also developing a WASH/NTD toolkit in collaboration with WHO, which is scheduled for publication late 2018. This toolkit supports NTD program managers and partners to work with the WASH community, build partnerships, mobilize resources, and design, implement and evaluate interventions.
Similarly, through task groups on “Indicators, Mapping and mHealth”, “Interventions”, “Mental Wellbeing and Stigma”, “Participation, Inclusion and Human Rights” and an upcoming group on “Livelihoods”, the DMDI Working Group is working on strategies and resources, such as guidelines on mental health and NTDs in collaboration with WHO. A dynamic cross-cutting NTDs, Morbidity and Disability (NMD) toolkit, which addresses the urgent need for quality data on disease complications and other aspects of disability among NTD affected persons, is available online.
The success of such cross cutting groups is evident as more stakeholders working on NTDs look to engage partners working across sectors and adopt cross cutting approaches. Over the last year, three new NNN cross cutting groups have formed, on Skin Related NTDs, Integrated Vector Control and Conflict and Humanitarian Emergency. Further information on these cross cutting issues is also being shared on infoNTD, an online portal dedicated to making cross cutting NTD resources easily available.
The importance of cross-sectoral collaboration and cross cutting approaches are also being increasingly recognized by donors who have started to specifically include details about behaviour, environment and social inclusion along with preventive chemotherapy and morbidity management in their funding requirements. For partners who are developing comprehensive and inclusive programs, this provides the opportunity to mobilize additional resources, build the evidence and enhance advocacy as the value of such holistic NTD work to broader development issues is more and more recognised.
Comprehensive and inclusive NTD programs move beyond achieving direct progress on Sustainable Development Goal 3.3, calling for an end to NTDs. Through cross-sectoral collaborations, comprehensive approaches to NTD programs will play a vital role in the achievement of other SDGs relating to poverty (SDG 1), quality education (SDG 4), gender equality (SDG 5) and clean water and sanitation (SDG 6). The BEST framework provides an important opportunity for the NTD community to leverage broader development benefits and contribute to the strengthening of health systems. This enhanced systematic engagement of affected people, cross-sectoral partners and the NNN working groups, will help to expand and forge new partnerships, develop and refine strategies to ensure that programs remain effective and efficient in reaching the world's most marginalized people.
About the authors:
Leah Wohlgemuth is Chair of the WASH Working Group and Regional Technical Advisor at Sightsavers
Professor KH Martin Kollmann is Chair of the DMDI Working Group and Senior Advisor NTDs at CBM