“In everything we do [in health], it is necessary to consider the sustainability...to maintain the successes and face new challenges.” -  Deputy Director of Disease Control, Dr. Moussa Mintou Koné

When mass treatment programs for neglected tropical diseases (NTDs) first started in Mali in the 2000s, nearly the entire country was endemic for these diseases, particularly trachoma and lymphatic filariasis. In some regions, almost half the population of children aged 1 – 9 were infected with active trachoma, whereas lymphatic filariasis rates were almost as high as 20 percent in regions such as Sikasso and Mopti. Thanks to the tireless efforts of the Mali Directorate General for Public Health and Hygiene (DGSHP) and NTD programs, Mali has stopped mass treatment against trachoma and lymphatic filariasis and are preparing their respective elimination dossiers for submission to the World Health Organization in 2025.  In the latest survey for soil transmitted helminths (STH), it was determined that there is a very low prevalence, and treatment is no longer required and is no longer considered a public health problem. Furthermore, Mali completed the stop survey for mass treatment of onchocerciasis in 2021. The DGSHP and national NTD program’s success in overcoming these persistent challenges has positioned Mali as a leader in the region, demonstrating that the elimination and control of these diseases is possible, leading to healthier and happier communities.

Mali’s advanced progress in the control and elimination of NTDs is being incorporated into the country’s new NTD Sustainability Plan, a five-year roadmap that outlines sustainable treatment delivery for schistosomiasis and surveillance activities for eliminated NTDs. The DGHSP convened health officials and cross sector leaders from November 8-11, 2021, with support from the USAID-funded Act to End NTDs | West (Act | West) program, to develop this plan.

The development of the Sustainability Plan comes at a time when Mali continues to draw closer to elimination targets for trachoma, lymphatic filariasis, onchocerciasis, soil transmitted helminths and the control of schistosomiasis, all preventable diseases with the potential to cause lifelong hardship and disability as well as stigma and discrimination within communities. These diseases most heavily impact impoverished communities living without access to adequate sanitation and health services, therefore, they can have significant health and economic impacts on vulnerable populations.

These achievements were no small feat.  Mali has faced nearly unprecedentedchallenges with security, political instability, and a high burden of these diseases prior to the start of mass treatment programs.  With support from USAID since 2007 and with Helen Keller International as implementing partner, the DGSHP and national NTD programs constantly innovated and adapted their approaches to address the evolving challenges of the implementing environment, developing solutions to access seemingly unreachable areas. These successes have positioned the DGHSP to focus on the sustainability of their efforts.

As Mali progresses towards these major milestones, the development of the Sustainability Plan is a key next step in identifying how the country will incorporate activities to ensure the eliminated diseases do not rebound while also ensuring services for schistosomiasis are still available and managed by the government, so that targeted communities can continue to receive treatment when needed.  The Plan is aligned with the priorities set out in the World Health Organization roadmap for NTDs, which aims to achieve the elimination and control of NTDs by 2030. Areas that the Plan will prioritize include the mainstreaming of surveillance activities into the national health system, cross-sectoral coordination, and improving the capacity of health workers to treat NTD morbidities.

The DGSHP also brought together representatives from WASH, education, malaria, nutrition, veterinary sectors, and implementing partners. The inclusion of these cross-sectoral stakeholders reinforced the importance of collaboration by promoting prevention and stop transmission through other sectors that address the socioeconomic or environmental factors that contribute to NTDs, such as WASH and vector control. Some current examples of notable achievements in mainstreaming NTDs include the development of learning modules on lymphatic filariasis that are included in health worker curricula and the integration of mass treatment campaigns for NTDs with vaccination campaigns in insecure areas.

“The Sustainability Plan will maintain the gains that we have made in NTDs in its implementation and will benefit the population of Mali to ensure there is not a resurgence of disease” - Dr. Mahamadou Traore, National SCH and STH Program Coordinator

The Mali Sustainability Plan will reinforce country ownership, identify cross-sector priorities for NTDs, and strengthen the overall health system to deliver and sustain NTD program advancements. It will mark a significant transition point for Mali, in which their extensive efforts will shift from disease elimination to an integrated and sustainable control and surveillance system.  The development of the Sustainability Plan is a major milestone that positions Mali as an exemplar in West Africa, paving a path towards a world without the neglect of poverty-related diseases.