Matshidiso Moeti When I was a child living in apartheid South Africa, I saw first-hand the pain and suffering experienced by the patients my parents cared for at their medical clinic. Patients came in and out, looking for treatment to their ailments and afflictions. I learned how constant illness and discomfort was an everyday reality for so many of our neighbours. Now a physician myself, I know that daily sickness and pain is also a reality for a billion people around the world who are affected by neglected tropical diseases (NTDs). NTDs are a group of preventable and treatable diseases that place a constant and heavy burden on the poorest, most marginalised and most isolated communities around the world. Together they cause more than150,000 deaths every year worldwide, yet even that number vastly understates their impact. By and large, NTDs are not killer diseases. Instead, over years and decades, they sap people’s strength, destroy their quality of life and eat away their savings. For many people who suffer from them, chronic fatigue, bad vision and persistent discomfort seem to be routine parts of life. Luckily, treating and preventing many NTDs is medically simple, and the vast majority of the drugs needed to do so are generously donated by pharmaceutical companies – 1.5 billion treatments were donated globally in 2015 alone. But delivering those drugs is harder than it sounds. We need better information on where people are infected or at risk, infrastructure to distribute medicine to remote areas and a system to track progress. An effort of such scale demands substantial funding and technical capacity, posing a major challenge for many African countries. Designing effective programmes is just half the battle; effective collaboration and sustainable funding for these programmes are crucial ingredients for success. Over the past few years, we’ve seen increased momentum in the fight against these debilitating diseases. In2012, a coalition of representatives from various sectors endorsed the London Declaration on Neglected Tropical Diseases, an ambitious plan to control, eliminate or eradicate 10 neglected diseases. In 2014, two dozen African countries pledged to strengthen their commitment to NTDs under the Addis Ababa Commitment on NTDs. Andin 2015, the Sustainable Development Goals made clear that tackling NTDs was essential to helping communities break free of poverty. That’s whythe World Health Organization – together with a coalition of multinational organizations –is launching the Expanded Special Project for Elimination of Neglected Tropical Diseases, or ESPEN.ESPEN has a broader mandate than its predecessor, the African Programme for Onchocerciasis (APOC), which closed in December 2015. APOC focused on one disease; ESPEN focuses on five– onchocerciasis, lymphatic filariasis, schistosomiasis, soil-transmitted helminths and trachoma –that can be controlled and eliminated through mass drug administration, the simple and cheap administration of medicine to all people living in high-risk areas. To succeed in helping these millions of people, the fight against NTDs must be led by affected countries themselves. Much of that work is already taking place through national NTD programs in partnership with public and private organizations. To help make these programs effective and sustainable, ESPEN will support countries each step of the way: it will support them as they map the burden of these diseases, deliver treatments accurately and efficiently, monitor progress and secure certification when they successfully eliminate diseases from within their borders. ESPEN will also help countries work better together and work better with their partners. ESPEN will support countries to strengthen their strategic leadership role in convening and coordinating partners support, a must-have for a successful delivery of interventions and progress towards elimination. It will create an online portal so countries can access and share information, and help the range of organizations working on NTDs to coordinate with one another and streamline their efforts. It will also advise governments on how to raise money for NTD efforts, and the best targets for spending it. This project is building on an existing global and pan-African movement to combat NTDs. APOC helped countries make enormous strides against onchocerciasis (river blindness), achieving a significant reduction in the number of people affected by this debilitating disease. ESPEN is an essential component of a broader health agenda, and the in-country systems established with its support will outlive NTDs. The recent tragic Ebola outbreak revealed the need for a stronger WHO, and I have initiated Transformation Agenda for the WHO Secretariat in the African Region to ensure that the Organization evolves to provide quality support to countries to improve and transform their health systems in a manner that is sustainable and accelerates the pace of health development in sub-Saharan Africa. ESPEN and the elimination of NTDs are both integral components of thisAgenda. Arming countries with structures to track disease and deliver services to the most remote corners of society builds stronger health systems. These systems form the basis of the infrastructure needed to respond to emergencies and ensure universal access to the entire menu of primary healthcare services – from childhood immunizations to reproductive healthcare. The tools and knowledge needed to alleviate the neglected suffering of millions of people are in our hands. I hope countries across Africa and partners will join with ESPEN totreat those afflicted by NTDs, eliminate the devastating diseases of poverty that prey on forgotten communities, and buildstronger health systems that deliver for everyone. The writer is the World Health Organization’s Regional Director for Africa.
