International Coalition for Trachoma Control

Indigenous peoples often have distinct social, cultural, economic and political practices from the societies in which they live. Many indigenous communities maintain traditional languages and have strong cultural links to territories and surrounding natural resources. While there is no formal definition for indigenous peoples, these characteristics along with a resolve to maintain and reproduce their ancestral environments and systems are common.

Although indigenous communities vary drastically in their social, cultural, economic and political practices, many indigenous communities share common problems related to the realization of their human rights and ability to access essential services. This is particularly true when it comes to accessing health care services for neglected tropical diseases (NTDs), such as trachoma, the world's leading infectious cause of blindness.

Indigenous communities, such as the Karamajong, Pokot and Turkana in East Africa, are disproportionately affected by trachoma because of poor access to clean water, sanitation and hygiene. These communities live in remote areas and must travel long distances to reach health facilities. Language barriers between indigenous populations and healthcare workers can further exacerbate challenges, as many indigenous people cannot understand the medical advice they receive.

Outreach programs to provide antibiotics and surgery for trachoma are also complicated by cross-border migration. In some cases, indigenous communities live in or travel through hard to reach mountainous grazing lands, which makes delivering interventions difficult. Similarly, because of migratory practices, following up cases can be challenging and requires strong knowledge of common travel routes. Many indigenous communities have also been known to travel through insecure and conflict prone areas, have mistrust of government authorities, or have traditional beliefs regarding treatments and the causes of illnesses, which can all decrease participation in outreach programs.

Beginning in 2015, as part of an effort to eliminate trachoma with no one left behind, ministries of health, donors and implementing partners started the East Africa Trachoma/NTD Cross-Border Partnership. Stakeholders in the partnership meet annually to develop solutions to regional challenges, including those unique challenges faced by indigenous, tribal and nomadic communities. By bringing together senior ministry of health officials from Eritrea, Ethiopia, Kenya, South Sudan, Sudan, Tanzania and Uganda, valuable discussions are undertaken to plan joint policies and mechanisms for delivering services for these hard-to-reach populations.

In its almost four-year history, this cross-border partnership has supported numerous examples of collaboration. During the most recent meeting in July 2018 in Mombasa, Kenya, the ministries of health from Kenya and Uganda planned synchronized mass drug administration campaigns so that people will be treated at the same time on both sides of the border. This ensures people who have crossed the border at the time of the campaign can still access essential medicines.

With support from the county medical representatives of Karamajong, Pokot and Turkana, Kenya and Uganda also began planning joint radio talk shows to educate communities on how to prevent trachoma and to inform them about upcoming outreach campaigns delivering treatments. Ugandan officials discussed plans to participate at cultural festivals in order to address specific cross-border migratory groups. Uganda also announced plans to share surgery schedules and information, education and communication (IEC) materials with the Kenyan Ministry of Health so that culturally-appropriate messages reach the communities they were designed to benefit.

Cross-border collaboration between Kenya and Uganda provides important lessons for other countries that require a regional approach to trachoma elimination. For decades, the border between Kenya and Uganda has been affected by conflict, with cross-border cattle raids between the Karamajong, Pokot and Turkana being common. However, with support from government disarmament and peace building programs, violence has steadily declined. Now, through the East Africa NTD/Trachoma Cross-Border Partnership, these formerly hostile communities share medical supplies, training and expertise.

Other prominent examples of cross-border collaboration conducted during these meetings include the Ugandan Ministry of Health working with the South Sudanese Ministry of Health and International Coalition for Trachoma Control members* to develop Karamajong and Toposa specific health education materials that are appropriate to the target population. The work, funded by The Queen Elizabeth Diamond Jubilee Trust, takes an approach that "one size does not fit all" when it comes to education materials and that national level materials can be ostracizing for communities whose cultural practices and beliefs are not always compatible with the national identity. This is especially true for minority or marginalized populations.

The East Africa Trachoma/NTD Cross Border Partnership has been an important platform to identify challenges and mobilize resources needed to resolve them. Addressing common challenges together is beneficial for all stakeholders. By approaching trachoma elimination at the regional level, countries are reducing the burden of trachoma effectively and efficiently with no one left behind. Partners attending the meeting have been able to increase the delivery and uptake of surgeries and antibiotic treatments and countries are increasingly recognizing the need for further investment and greater collaboration to scale up water, sanitation and hygiene programs so transmission is prevented and gains are sustained. The East Africa Trachoma/NTD Cross Border Partnership is a model example of South-South Cooperation and what can be achieved when partners work together towards a common goal.

*Karamajong and Toposa specific health education materials were developed by the Ugandan Ministry of Health working with the South Sudanese Ministry of Health with support from The Carter Center and Johns Hopkins University.

This blog was written by Gilbert Baayenda, National Program Officer for Trachoma Control, Ministry of Health Uganda