On November 7-8, 2023, Act | West held a Partners’ Meeting in Dakar, Senegal to recognize the successes and lessons learned from the past five years of USAID’s Act to End NTDs | West program and to establish the path forward for the next three years. The meeting assembled Ministry of Health delegates from the 11 Act | West countries as well Act | West consortium partners and representatives from USAID, WHO HQ, ESPEN, CDC, the GHIT Fund, Act | East, and Sightsavers. In a sign of country engagement, cabinet-level staff including the Directors General of Public Health from Ghana, Burkina Faso, Benin, Senegal, and Côte d'Ivoire as well as the Secretaries General from the Ministries of Health in Togo and in Benin were in attendance.

Several key achievements, lessons learned and observations stood out, most notably:

• Countries have made incredible strides in disease elimination. Togo eliminated lymphatic filariasis and trachoma as public health problems in 2017 and 2022, respectively. Ghana and Benin were also able to eliminate trachoma as a public health problem in 2018 and 2023, respectively, and Niger awaits official WHO verification for its dossier on onchocerciasis elimination. If verified, “Niger [will be] the first country in Africa to achieve this major milestone,” said Helen Keller International’s Yaobi Zhang. All of these remarkable eliminations were made possible through the country governments’ leadership.
• Sustainability work continues in integrating NTD services into national health care systems. Ghana has successfully added NTDs into the home visit register for community nurses. This allows the country to better monitor and categorize NTD data at the household level and refer cases to the health facility as needed. Dr. Joseph Opare, acting Program Manager for Ghana’s NTD program, noted that efforts have been made to “ensure that this pilot [initiative] is not regarded as a stand-alone project but fully integrated into the routine public health care systems.” This helps to mainstream neglected tropical diseases into Ghana’s health services. Similarly, Senegal, Benin, and Mali have worked to integrate NTDs into their respective universal health care policies and benefits packages.
• Multisectoral coordination can facilitate program success and boost sustainability. All of the countries supported by Act | West recognize the importance of cross-sector collaboration to sustainably achieve elimination and control goals. Togo has instituted and formalized a collaboration between the Ministry of Health and the Ministry of Education that includes treatment for schistosomiasis and soil-transmitted helminths, as well as NTD prevention and behavior change education in schools. Côte d’Ivoire created NTD technical working groups to operationalize multisectoral collaboration and Senegal’s sustainability work has been supported thanks to buy-in from local government and non-health sector stakeholders. The high-level panel featuring the Directors General of Public Health from Ghana and Côte d'Ivoire as well as the Secretaries General from the Ministries of Health in Togo and in Benin shared their governments’ strategies for supporting NTD programs as it mainstreams NTDs into the primary health care (PHC) structures. The integration of NTD programs and services into countries’ national health systems will enable countries to provide NTD services in a more sustainable way.

Additionally, the key recommendations and takeaways for achieving success and overcoming challenges in the last mile to disease elimination were also highlighted. Among these were:

• Cross-border coordination is essential in overcoming last mile challenges to elimination. In several countries supported by Act | West, areas of ongoing transmission persist in border districts. As such, countries like Cameroon have

  

  increased their collaboration with neighboring countries to coordinate mass drug administration (such as working with Nigeria) and achieve disease elimination. For countries like Benin, Togo, Ghana, and Niger that have already eliminated an NTD, they have initiated work to better coordinate with neighboring countries. The goal of this work is for Benin, Togo, Ghana, and Niger to maintain their elimination status and ensure that eliminated NTDs do not regain their foothold in-country.
• Countries can lead the way in innovating methods to address their specific challenges and needs. After eliminating four NTDs, Togo’s NTD program is developing an integrated surveillance plan to operationalize WHO recommendations for each eliminated disease. The hope is that this plan will help Togo better integrate NTDs surveillance into the broader national disease surveillance system and processes.

Other key recommendations from the second day included:

• Involve civil society organizations to overcome challenges.
• Use NTD data to make the case for greater financial support for NTDs to decision makers, and gain participation and boost motivation from other sectors and stakeholders.
• Improve cross-border collaboration through annual joint planning and synchronized treatment for border districts. Hotspots and persistent transmission can only be properly targeted if cross-national entities coordinate from the outset.

Over the course of the two-day meeting, countries’ presentations proved how far they have progressed since the beginning of Act | West. The lively participation and discussions also pointed to country motivation to meet 2030 road map targets set by the WHO.