By Chad MacArthur, HKI International
There is no question that mass drug administration (MDA) has had an enormous impact on disease burden but it needs to be recognized that these diseases are public health problems and our response to them needs to be through public health interventions that are beyond just preventive chemotherapy (PC). These diseases must be dealt with within a broader socio-economic development context. One of the key elements that will sustain the gains made by MDA for trachoma, soil transmitted helminths and schistosomiasis is the increased access to safe water, improved sanitation and the promotion of hygiene; commonly referred to as WASH. Integrating WASH with PC and promoting the behaviors that accompany WASH allows for a comprehensive control strategy such as trachoma has promoted for a number of years through the SAFE strategy.
The challenges that arise with integrating WASH into disease control are numerous. To be successful, integration will in most cases require new partnerships further necessitating mutually agreed upon mechanisms for coordination and collaboration. This will need to happen among various sectors at various levels. Those organizations with experience in infectious disease control generally do not have the institutional mandate or the technical expertise to effectively implement WASH programs. Similarly, WASH organizations do not always take into account disease burden in deciding where to implement their programs nor use reduction in disease prevalence as a measure of success. This dynamic can be found among international organizations, local organizations, the various Ministries in any given country and at the various levels those ministries operate within the overall governmental structure. Bringing these two groups and their respective approaches together will be critical to the success of NTD programs and will add an important dimension of WASH programs which traditionally have mostly focused on diarrheal diseases as a result criteria.
There exist a number of areas for consideration to assure the integration and potential synergy of these two sectors. A number of these points can be found in the paper WASH: The Silent Weapon against NTDs, a joint publication between WaterAid and the NTD NGDO Network. The key points for integration are:
- Talk the same language. Seek to understand how other sectors use terms such as integration and try and speak a language that is understood by all. With this in mind, the NTD sector should think of WASH as a resource necessary for the prevention, control and elimination of NTDs.
- Think about the integration of WASH and NTDs from the beginning, and embed this thinking in strategies and programs. Both sectors have a responsibility to consider how their activities do and can impact on each another. It is only through working together that the elimination of NTDs can be achieved.
- Utilize existing research and explore new research opportunities to enhance the evidence base of effective NTD prevention and control programming and its link to WASH.
- Build on foundation activities such as mapping to inform integrated program planning, implementation and sustained NTD prevention and control.
- Share information and data on the impacts of NTD and WASH interventions collected from indicators included as part of sector monitoring and evaluation frameworks. This can be via tools including country-level health information systems or the NTD Global Milestone Scorecards.
- Seek to develop sustainable programs that have a long-term vision and engage the appropriate partners and strategies to achieve and maintain the elimination of NTDs. This demands that NTD programs think about WASH and behavior change as essential ingredients. This may pose challenges to funding bodies that are used to shorter-term project cycles and strive for well-defined outcomes.
- For larger organizations operating in multiple sectors, explore the opportunities for integration between WASH and NTD programs internally, and focus efforts on scaling up good practice within national programs. If new to the area of WASH, partner with international, national and local agencies who implement high quality and sustainable WASH programs.
- Utilize existing infrastructure such as schools and community health services to implement integrated programs that address NTDs and WASH, while continuing to build capacity to manage integrated programming in other more challenging settings such as very remote communities or at the household level.
- Global partnerships such as the one established under The London Declaration on NTDs help to emphasize and draw new partners into a global commitment to fight against NTDs. Establish and emphasize WASH on the agenda of these global partnerships and encourage WASH and NTD leaders to drive the agenda. Translate achievements made at this global and organizational level to country-level programs.
- Expand communication channels between the two sectors. Encourage the inclusion of organizations from other sectors including health, WASH and education to participate in national taskforces for NTDs. Advocate for WASH in these forums, recognizing it as a foundation of health and necessary for the prevention and control of NTDs. Reinforce the communication channels by making them two-way. Represent the interests of NTDs and participate in the international, national and regional meetings of other sectors including WASH.