Thirty years ago, I attended primary school in Rwanda. My family had no access to health care, and many days I never made it to school. In wrenching pain due to intestinal parasites, I would lay down on the roadside until I could stand again. I cannot count the number of times I missed tests and risked suspension. Two months prior to Covid-19 pandemic, I visited public schools in three countries, including my old elementary school in Rwanda. I was stunned to see children laying on the ground in abdominal pain. I could easily spot those with malnutrition. Just as I had many years ago, these children were suffering from neglected tropical diseases (NTDs). Talking with their teachers, it was clear that they did not know what to do to help their students. Neither had they interacted with staff at local health facilities—a reflection of the wide gap between the health and educational systems. Now, closing that gap offers the best hope for these young people and the best opportunity for countries to break the vicious cycle in which NTDs fuel poverty and undermine education. Since the pandemic was first declared, governments have prioritized fighting Covid-19 across all levels of the health system. Countries reallocated resources to strengthen pandemic response teams and ensure provision of essential supplies. In the process, efforts to tackle NTDs were ended or fell to the bottom of countries’ to-do-lists. Close to half of Africa’s current population is under 18, and school-aged youth are the population group most affected by NTDs. As the child population grows to reach an anticipated 1 billion by 2055, and many NTDs remain unchecked, new solutions are urgently needed. It is estimated that NTDs infect over 1.5 billion people, or 24 per cent of the world’s population. In Africa, intestinal worms are the most common NTDs among children. Untreated NTDs lead to cognitive impairment and developmental disabilities, and severe forms can cause malnutrition and death. While it costs less than 50 cents to treat the top five NTDs per person for an entire year, 89 million children in Sub-Saharan Africa are infected by NTDs. To be sure, in the past decade African countries have made significant investments in health education and in fighting NTDs through improving access to clean water and sanitation and to deworming. And then came COVID and progress stopped. The World Health Organisation (WHO) has now established a guideline on NTD active case‐finding and treatment in the context of Covid-19. While this guidance is crucial, the lack of available health staff makes it impossible to carry out. A global net shortage of 15 million health workers is predicted by 2030. Africa alone will need an additional 4.2 million health workers to meet minimum global standards for frontline skilled health personnel by 2030. This shortage of doctors, nurses and health clinics in Sub-Saharan Africa means that disease goes undiagnosed and untreated. School nurses or other health workers are rare at Africa’s public schools, while teachers feel confused in the presence of students who are sick or in pain. However, there is a solution, and that is to train teachers and students in the basics of NTD detection and treatment, and equip them as a powerful new cadre of community health workers. Africa’s youth are frequently proclaimed as the force and hope for the future. Such proclamations are empty as long as there is no tangible way to protect their health and that of their communities. Since the Alma Ata Declaration in 1978, countries have established and used community-based health workers (CHWs) to ensure access to primary care services and to combat diseases. Among their many accomplishments, CHWs in Africa have been pivotal to treating HIV and improving malaria control. Building on such successes, teachers and youth should be trained as CHWs. They would be able to apply their health know-how in real time. For example, homework could include thorough detection of danger signs and treatment of NTDs among family and friends. Schools should be positioned to deliver public health messages and NTD treatment kits. To realize these changes, countries will need to establish joint coordination between health and education at all levels, from the community to central ministries. It will require dedicated resources to adapt curriculums and train teachers. The return on investment will be significant. Every year, NTDs cause a loss of 17 million healthy life years. In the long run, the integration of health education and basic health care delivery with Africa’s educational systems would save billions of dollars and millions of lives. In Sub-Saharan Africa, where over 50 per cent of the population live on less than US$1.25 per day, the price of doing nothing is staggering. Many of my childhood friends did not live to graduate, others have spent their lives in poverty, hoping for a better day for their children. If countries act now to train and equip teachers as extended CHWs, they can eliminate NTDs in the span of a lifetime and build a generation of educated young people and healthy communities. The author is the deputy chief medical officer at Partners In Health, assistant professor of global health at University of Global Health Equity, Lecturer at Harvard University and Aspen New Voices Fellow.
