Sierra Leone’s National Neglected Tropical Diseases Program (NNTDP) politically validated and launched their neglected tropical disease (NTD) Sustainability Plan, a five-year roadmap to mainstream NTDs into routine health service platforms, national policies, and national budgets on May 18, 2023. The Plan will build on the country’s achievements to control and eliminate NTDs through a unique approach which includes non-traditional stakeholders, who are instrumental frontline health service providers in areas where there are systemic barriers to reaching health facilities. Their inclusion is key to strengthening sustainable NTD treatment in the country as part of an overarching strategy that aligns with the latest health policies and universal health care targets in the country.
“This plan will strengthen and integrate NTD services into the country’s national health system to a level that propels progress toward disease elimination and/or control in accordance with national health goals. Practically, it will ensure that all NTDs activities are well coordinated, and resources are utilized effectively and efficiently to deliver life-saving interventions to all communities where NTD activities are and will be implemented”, Dr. Mustapha Kabba, Deputy Chief Medical Officer for Clinical Services in the Ministry of Health, and Sanitation (MoHS) explained.
Before the United States Agency for International Development (USAID) support began in Sierra Leone, onchocerciasis (OV), schistosomiasis (SCH), soil transmitted helminths (STH), and lymphatic filariasis (LF) were widespread and found in every district in the country. After years of mass drug treatment delivered by thousands of trained community drug distributors, there are few districts left that require mass treatment for these diseases. Most noteworthy is the remarkable progress to eliminate LF, with only one district still requiring mass treatment. The NNTDP expects that 2023 is the last year the district will need treatment, positioning the country to reach full elimination by 2027 with support from USAID’s Act to End NTDs | West program, led by FHI 360 in partnership with Helen Keller Intl. In addition to mass treatment, the NNTDP has undertaken several initiatives to strengthen and integrate NTD activities into the overall health system. For example, the NNTDP increased data management capacity by integrating key mass treatment indicators into the District Health Information System (DHIS2) and providing training to key district level. The NNTDP also participates in the Partners Network Forum, a multisectoral platform launched in 2019 to coordinate NTD activities across all sectors in the country. These advances signal the shift from mass treatment and surveillance for NTDs to a health system strengthening approach where the local health systems must be able to take ownership over the process to identify, manage, and treat incident NTD cases. In Sierra Leone, this system will rely on nontraditional stakeholders to achieve their universal health coverage targets and to align the health system with the latest policies. To do so, the sustainability plan will guide domestic resource mobilization to finance the system, integrate SCH/STH into school health curriculums, and strength the Partners Network Forum to implement and monitor the plan.
Long-time partner to Sierra Leone’s MoHS, USAID’s Acting Director of Health in Sierra Leone, Dayo Spencer-Walter emphasized the importance of sustainability, "This is a very critical piece of the puzzle. For Sierra Leone to continue the path of elimination and control of neglected tropical diseases, the sustainability needs to be thought through and planned for,” Dayo Spencer-Walter said.
Sierra Leone’s NNTDP has taken a unique approach to counter the many challenges that undermined progress to eliminate NTDs, including the erosion of public trust in health services following the Ebola epidemic from 2014-2016. To better understand the communities, they were trying to reach, the NNTDP conducted rapid assessments and community listening activities. Through these activities, the NNTDP learned to engage more with existing networks such as traditional healers, religious leaders, and civil society organizations who could build trust in NTD services and promote community ownership, with the added benefit that service delivery platforms that leverage relations with nontraditional stakeholders ensure that the health system reaches everyone and improves trust between health service providers and the communities they work with.
These learnings were reflected in the development and subsequent validation of the Sustainability Plan, which was politically validated and launched following almost four years of sensitization, analyses, convening, drafting, and review by a variety of health and non-health stakeholders. The Plan was first developed during a workshop in 2021, aligning with the other significant developments in policy integration and alignment, including the NTD Master Plan (2021 -2025), National Health Sector Strategy (2021 - 2025), and Universal Health Care (UHC) policy. The NNTDP participated and presented the Plan at the Sierra Leone National Health Summit in 2022, where it was lauded by the MoHS for prioritizing locally driven health solutions and equitable health services. The theme of the event was transforming healthcare delivery towards universal health coverage.
Like other countries where NTDs are endemic, living conditions in rural Sierra Leone directly reflect community health and wellbeing. Access to clean, potable water, and toilets is extremely important for reducing the incidence of NTDs such as SCH and STH and protects against water-borne and water-related illnesses. Proper education, nutrition, and access to health services are also critical for holistically promoting good health. For this reason, the validation of the Sustainability Plan is a major milestone for the NNTDP and MoHS to ensure all sectors in the country are engaged in the mainstreaming of NTD and health services amidst the other health policy advancements in the country, and the anticipated elimination of these diseases.
During the validation event, Shawn Baker, Chief Programs Officer at Helen Keller Intl reflected on this progress, noting, “I had the great fortune of spending the last few days prior to the Sustainability Plan launch, visiting people and communities affected by NTDs and the front-line health workers here in Sierra Leone, who have been fighting these diseases. Nothing makes the success of the two decades of efforts more concrete than their stories, and they also make clear what the next steps are. So, as we gather here to launch this sustainability plan for the elimination of neglected tropical diseases, their experiences make very real what we are committed to sustaining... Victory over these diseases is truly at hand”.