Trachoma, the world’s leading infectious cause of blindness, disproportionately affects the world’s most remote and marginalized communities. Trachoma thrives in areas with insufficient clean water and sanitation and is exacerbated when communities have limited access to health care services. This is particularly common among nomadic and pastoralist communities whose livelihoods are dependent on traveling to find water and grazing for their animals and other hard to reach populations, including refugees.
Significant progress has been made towards the global elimination of trachoma in recent years. Since 2002, the number of people at risk of trachoma has reduced by 91% from 1.5 billion to 136.9 million as of May 2020. Although ten countries have been validated for eliminating trachoma as a public health problem, multiple countries face obstacles to achieving elimination as a result cross-border transmission.
In Eastern Africa, cross-border collaboration is of particular importance due to the large number of ethnically diverse nomadic groups, such as the Turkana, who travel between Ethiopia, Kenya, Uganda and South Sudan with their animals for pasture. This makes it difficult for health ministries to collect accurate data, implement interventions, train village health workers and implement surveillance systems as large portions of the community might not be available at the time of the activity. Most of these communities are not known by the health system because of the nature of their social and cultural dynamics.
In order to ensure that ethnic groups like the Turkana are not left behind, in 2019, the Ministry of Health Uganda launched its ‘strategic plan for cross-border activities for NTD control and elimination in Uganda: 2019-2023’. The strategic plan provides a framework for effective collaboration for improved service coverage for trachoma, onchocerciasis, schistosomiasis and soil-transmitted helminths among nomadic populations and across borders. It provides key performance indicators for cross-border collaboration and will improve reporting on key areas of partnerships, including synchronization of activities, resource mobilization, and human resources to support different elements of the program.
If countries are to achieve elimination and targets set in in the Sustainable Development Goals and the WHO NTD road map, a population centred approach is needed to ensure access to the most remote, marginalised and hard to reach populations so that we truly leave no one behind.
In particular, the plan highlights the importance of coordinating NTD interventions and surveillance with health ministries in neighboring countries to ensure that all people at risk can access interventions and are accurately captured in NTD surveillance mechanisms. This includes synchronizing activities like mass drug administration to ensure mobile populations are identified and treated on either side of the border.
To ensure the effectiveness of programs, USAID’s Act to End NTDs | East program and the UK Foreign Commonwealth and Development Office funded Ascend program have been supporting governments in the region to work with nomadic communities to deliver people-centered health programs. This means ensuring that all materials can be accessed in the appropriate languages and that communities are properly sensitized to the interventions. In many situations, nomadic communities have had limited engagement with health services and the success of programs requires the targeted community to understand and accept the interventions being implemented.
Uganda’s new strategic plan for cross-border NTD activities showcases endemic country leadership and ownership of not only program activities, but also the essential learnings and experiences that can be shared through South to South cooperation and beyond. Cross-border meetings between Uganda, South Sudan and Kenya, with support from USAID, have fostered ongoing discussions around serving mobile communities.
Alongside increased country ownership of programs, the draft World Health Organization road map for neglected tropical diseases 2021-2030 also emphasizes the importance of cross-sectoral and cross-ministerial partnerships. In order to truly leave no one behind, it is critical that health ministries work with water and agricultural ministries in addition to implementing partners to improve access to water, sanitation and hygiene interventions, and make the environmental improvements needed to reduce transmission and sustain progress.
Uganda’s strategic plan recognizes that regionally coordinated NTD control and elimination activities targeting mobile populations crossing international borders are largely beyond the scope of a single country program. If countries are to achieve elimination and targets set in in the Sustainable Development Goals and the WHO NTD road map, a population-centered approach is needed to ensure access to the most remote, marginalized and hard to reach populations so that we truly leave no one behind.