The Government of Mali’s Ministry of Health and Social Development (Ministère de la Sante et du Développement Social – MSDS/MoH) is beginning an important new step towards neglected tropical disease (NTD) control and elimination in the country following the technical and political validation of the NTD Sustainability Plan. This five-year roadmap outlines sustainable treatment provision for endemic NTDs and surveillance activities for NTDs that have been eliminated. The Plan will further integrate these activities into national policies, planning, budgeting, and performance monitoring of the health sector. On March 14, 2023, Mali’s Minister of Health declared the NTD Sustainability Plan national policy through a momentous ceremony attended by the General Directorate of Health and Public Hygiene, the national NTD control and elimination programs, cross sectoral stakeholders, the representatives from the USAID mission, and technical and financial partners, including USAID’s Act to End Neglected Tropical Diseases | West (Act | West) program, implemented by Helen Keller Intl and World Vision in Mali. Mali is the sixth country to politically validate their Sustainability Plan where the Act | West program is active.
Mali has made major strides to develop, validate, and enact the plan into policy following the launch of USAID’s five-phase sustainability approach in 2019. Through this approach, the MoH has led an ongoing participatory process bringing together health and non-health sectors whose work is relevant to NTDs. The plan was first drafted during a workshop held November 2021 and in August 2022, the NTD Sustainability Plan was technically validated with participants from the MoH and other cross sector stakeholders. The objectives of the plan are to strengthen the cross-sectoral mechanism for NTDs, integrate NTD priorities into national policies, planning, budgeting frameworks, promote integration of NTD services into existing health and non-health service delivery platforms, and include NTD indicators into national health information systems.
The completed political validation of the Sustainability Plan is timely. After years of mass drug treatment and surveillance surveys for lymphatic filariasis, soil transmitted helminths, and trachoma, the MoH is in a good position to begin validating the elimination of these diseases. The MoH has already submitted the trachoma elimination dossier to the World Health Organization in December 2022, and it is currently under review. The MoH has also begun preparing their elimination dossier for lymphatic filariasis (LF), which is expected to be submitted in 2025. Recent surveys for soil transmitted helminths show that prevalence is low enough that STH is no longer considered a public health problem in Mali.
Few other countries in Africa have reached these achievements. To date, only four countries in Africa’s WHO region have eliminated trachoma as a public health problem, and the incomparable scale of trachoma endemicity was a major challenge in Mali, the eighth largest country in Africa by geography, and where nearly every district was endemic for the disease. For LF, only two countries in Africa have validated the elimination of the disease. Since 2021, mass treatment for LF is no longer required and only surveillance surveys and health facility assessments remain before the submission of the dossier, a significant accomplishment for a country where LF was endemic in almost every single one of the country’s 75 districts.
These impressive achievements will require a shift in NTD program management and strategy. Rather than focusing on mass treatment campaigns and impact surveillance assessments, which largely characterized the last twenty plus years of NTD activities in the country, the health system will need to be capable of identifying and managing incident cases and determining how they will be addressed by the health system. Cross sector stakeholders will need to increasingly collaborate with the health system in novel approaches to manage still-endemic NTDs and prevent reemergence of eliminated diseases.
Despite nearly unprecedented challenges such as insecurity, political instability, and high disease prevalence rates at baseline, the efforts of the MoH and NTD Programs show that it is possible to overcome these obstacles and eliminate NTDs. With the leadership of the MoH and the national NTD Program, there has been an increased focus on engaging with multisectoral stakeholders to increase collaboration and engagement for the future. The launch of the National Multisectoral Coordination Committee for the Control and Elimination of NTDs in December 2021 effectively established a governing body to convene cross sector stakeholders, which helped created the conditions needed for other sectors to contribute to NTD control and elimination targets. This will continue to raise the profile of NTDs in the country, particularly for schistosomiasis which remains a public health problem. With the validation of the Sustainability Plan, the DGSHP and MoH will begin to focus on the development of a domestic resource mobilization strategy to look at opportunities within Mali to sustainably finance NTD surveillance and prevent the recrudescence of eliminated diseases.
The combined effect of the validated Sustainability Plan amidst major progress towards NTD control and elimination achievements will set the tone for the next three years of the Act | West program, which was recently extended by USAID, allowing for continued momentum in Mali to #BeatNTDs once and for all.