“This workshop has widened my scope…initially I was just looking at [immediate] targets: how do we do it, what do we do, a, b, c…without looking at the long term. [The workshop} has given me a wider scope and perspective. So now when I’m looking at one element to address a disease, I look beyond the immediate challenge.”
-- Hafez Adam Taher, Acting CPO, Internal Health Operations & Chair, ICCC, Ministry of Health
In the realm of neglected tropical disease (NTD) intervention, USAID has defined sustainability as “the national health system capacity and commitment to maintain the provision of NTD interventions at levels that will continue progression towards control or elimination of diseases in accordance with national NTD goals” (USAID NTD Program: Framework and Strategy for the Promotion of Sustainability). Ghana has seen great progress in the fight against NTDs in recent years: since 2015, Ghana successfully eliminated Guinea worm and trachoma and has also achieved significant reduction in the prevalence of onchocerciasis and lymphatic filariasis as well as reductions in the prevalence of schistosomiasis (SCH) and soil-transmitted helminths (STH) through mass drug administrations. USAID’s Act to End NTDs | West Program (Act | West) is supporting the Ghanaian NTD Program to strengthen its program operations, analyze its financial needs, and assess its current and desired state along a continuum of six sustainability outcomes (Coordination, Policy & Planning, Operational Capacity, Information Systems, Services, and Financing). Building on this momentum, the NTD Program commenced the creation of a sustainability plan that will guide the Program and its partners on the planning, implementation, and monitoring of steps taken to maintain and continue these achievements.
In line with the sustainability framework’s phased approach, the NTD Program developed key interventions and milestones for the sustainability of its programming over the next five years, with technical assistance from Act | West. In October 2021, the NTD Program hosted a four-day workshop in Accra, Ghana, which convened national level stakeholders in-person, including representatives from the Ministry of Health, Ghana Health Services, water and sanitation, education and finance sectors, as well as the Intra Country Coordination Committee (ICCC) for NTDs to contribute to sustainability plan development.
“Collaborating on NTDs helps create a well-informed health-conscious school populous who are change agents in their communities.”
--Dorcas Hushie, Program Officer, School Health Education Program, Ghana Education Service
During the workshop, participants were divided into working groups to discuss and finalize milestones, timelines, task owners and progress indicators for each sustainability outcome. Discussion was enriched by input from the representatives of various sectors involved in the fight for NTD elimination and control, who provided contextual solutions to achieve targets across the domains of sustainability and developed interventions that will respond to the current gaps and challenges in NTD programming. As NTDs cannot be defeated without intra-sector and cross-sector coordination and collaboration, participants devised activities and milestones with an approach focused on integrated efforts across schooling, medical trainings, health management information systems, social behavior change campaigns, and national-level prioritization (including financial planning and domestic resource mobilization initiatives). Galvanizing working relationships with actors—especially within the ICCC—across these efforts (e.g., health and education curriculum designers, public health and SCH/STH expert committees, finance officers, media groups) will bring the NTD Program closer to its goal of properly allocating costs and maximizing the efficiency and effectiveness of NTD intervention from national-level policymaking to district-level implementation. The groups also focused on aligning inputs into the sustainability plan with strategic activities outlined in the Ghana NTD Master Plan for 2021-2025, which aligns with the WHO 2021-2030 NTD roadmap.
Development of the sustainability plan throughout this workshop also reinforced that there remains a strong need to integrate NTD programming within all levels of health systems, especially at both strategic planning and operational levels. The Ghana NTD Program has made notable advances in mainstreaming NTDs functions into health systems, such as through embedding NTD data into national health management information systems and integrating NTD drug supplies into national supply chain operations. With this progress in mind, workshop participants also indicated that further integration in service delivery, operational capacity, and policy and planning within existing systems is critical to evolving away from siloed NTD programming. This mindset informed the interventions proposed and developed by stakeholders that provide a unique opportunity for Ghana to move towards such integrated programming.
Ghana’s initial draft sustainability plan was further defined at the end of the workshop. The next steps in the refining process will include the identification and incorporation of additional stakeholders from the ICCC, expert committees, and Ghana Heath Services who also contribute towards integrating NTD programming in additional community platforms.
Finalization and political validation by the Ministry of Health of the sustainability plan—the final steps in the plan’s development—is anticipated to happen by the end of January 2022, with plan implementation starting immediately following.
“Collaborating has helped us build our capacity in terms of planning, prioritization…it has helped us look at what are the resources, who are the collaborators, who are the stakeholders that can help us facilitate whatever we are doing.”
--Sophia Ampofo Kusi, Deputy Chief Health Planner, Ghana Health Service