As the work to finalize the indicators for the sustainable development goals progresses and countries start to work on their implementation strategies and national action plans, it is high time to reflect on what opportunities the new framework presents for raising the profile of neglected tropical diseases such as trachoma.
The sustainable development goals - a vision for transformational change
In September 2015, the UN General Assembly adopted the sustainable development goals to stimulate action over the next 15 years in areas of critical importance for humanity and the planet. These 17 goals and their 169 targets don’t just aim to complete the work of the millennium development goals but envision transformational change in all countries and globally to end poverty, protect the planet and ensure prosperity. They integrate all three dimensions of sustainable development – the economic, social and environmental – and are built on the important commitment to leave no one behind.
While the outcome document of the 2010 UN Summit on the Millennium Development Goals did include some reference to progress on controlling neglected tropical diseases, the annual global progress reports did not. This reflects the absence of these diseases in the targets and indicators, which were not included in any of the three health-related goals – to reduce child mortality rates (4), improve maternal health (5) and combat HIV/AIDS, malaria and other diseases (6).
Tracking progress on neglected tropical diseases in the sustainable development goals
With the sustainable development goals, there has been a shift to just one goal on health. However this goal, goal 3 – Ensure healthy lives and promote well-being for all at all stages – is comprehensive and goes much beyond the aspiration for health included in the millennium development goals. Among the 13 targets in this goal, explicit mention is made to neglected tropical diseases in target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
The initial indicators proposed to measure progress did not include a target on neglected tropical diseases, but advocacy by the community successfully ensured the inclusion of a neglected tropical diseases-specific global indicator which has now been agreed for inclusion as: Number of people requiring interventions against neglected tropical diseases.
In the meta-data sheet, a document that details exactly what data will be collected, we can see that the indicator collects both data on preventive chemotherapy and provides the opportunity to include trichiasis surgery in a section called ‘Number of new cases requiring individual treatments for other neglected tropical diseases’.
There are a number of other health targets with strong links to neglected tropical diseases, including targets on universal health coverage (3.8) and on the health workforce in developing countries (3.c), though they don’t explicitly mention neglected tropical diseases – and it’s unlikely that the indicators will include specific references (the indicators for universal health coverage are still under discussion and not yet agreed).
Programs tackling poverty, food security, nutrition and inclusive education… are the litmus test for whether the political commitment of leaving no one behind is put into practice
There are certainly other sustainable development goals which are pivotal to achieving progress on neglected tropical diseases such as goal 6, Ensure availability and sustainable management of water and sanitation for all. The 1 billion people affected by these diseases frequently lack access to programs tackling poverty, food security, nutrition and inclusive education. Without their inclusion, goals 1, 2 and 4 will not be achieved. They are the litmus test for whether the political commitment of leaving no one behind is put into practice.
The opportunities - accelerating political commitments
With the scale up of the work on neglected tropical diseases and trachoma in particular, there are fantastic achievements and successes to share. Supporting governments to put these into their global reporting provides politicians and policy makers with the opportunity to demonstrate good progress on the global development agenda. Their explicit mentioning in the health goal and the specific global indicator are a perfect starting point.
Advocating for inclusion of trachoma-related targets and indicators in endemic countries needs to start now
Perhaps even more importantly, the goals offer the opportunity to increase commitment to neglected tropical disease policies, interventions and programs at the national level. Each country is required to develop a national strategy for the implementation with national targets and indicators, taking into account different national realities, capacities and levels of development. How a national strategy is developed and what issues are prioritized will vary from country to country. Accordingly, advocating for inclusion of trachoma-related targets and indicators in endemic countries needs to start now. Partners could work to call for:
- the setting of a trachoma-specific target under target 3.3
- the inclusion of cost-coverage for trichiasis surgery to promote universal health coverage (target 3.8)
- the setting of a target for qualified trichiasis surgeons under target 3.c
- the scale up of water, sanitation and hygiene interventions in trachoma-endemic areas under goal 6
- access for trachoma-blind and vision impaired people to rehabilitative services (as part of universal health coverage) and their access to support schemes (social protection, target 1.3), amongst others.
Another opportunity exists to influence the voluntary country reports for the national reviews. These are presented at the UN High Level Political Forum and the first reviews will already taking place in July. The theme of the 2016 forum is ‘leave no one behind’ and the thematic priority is on poverty eradication in conjunction with five goals, including the goals on poverty and water. Among the first countries which have volunteered for the national reviews this July are Madagascar, Sierra Leone and Uganda, all of which are affected by neglected tropical diseases. Though the health goal is not part of the thematic priority this time, these countries may already work on more comprehensive national strategies. A mention of trachoma and neglected tropical diseases in their review report – related to ‘leave no one behind’, poverty and water and sanitation - will definitely help to keep them on the global agenda.