03/02/22

Partnerships key to fighting diseases of the poor

Somali region drought response
A nurse measures a child's arm circumference with a pediatric MUAC (Mid-Upper Arm Circumference) bracelet. Copyright: UNICEF Ethiopia/2022/Mulugeta Ayene, CC BY-NC-ND 2.0

Speed read

  • The Kigali Declaration launched last week aims to help tackle neglected tropical diseases
  • Partnership and country ownership form a key focus of the declaration
  • The declaration could give a voice to those who have too long been affected by NTDS

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Partnership and country ownership are key to fighting neglected tropical diseases, writes Gail Davey.

Neglected tropical diseases (NTDs) are a group of chronic infectious diseases that affect people in many low- and middle-income countries.

Although they are preventable and often treatable, knowledge of NTDs within healthcare systems is limited yet many people worldwide suffer extensive pain, disfigurement and disability as well as discrimination and social stigma that contribute to the poverty cycle in affected areas.

The Kigali Declaration, launched last week (27 January), is the political brawn behind the strategic brains of the World Health Organization’s NTD Roadmap 2021-30. It is a significant document, with commitments by governments, industry and NGO partners to deliver ambitious targets on a host of diseases, which affect an estimated one billion people globally.

Principles of partnership and ownership

Right at its heart are the principles of partnership and country ownership. These principles have driven the exhaustive process of consultations with national governments, mayors and local government leaders, intergovernmental bodies, pharmaceutical companies, NGOs, research institutions, youth and more under the ‘Uniting to Combat NTDs’ banner.

“Rwanda, whose capital city give the Declaration its name, ranks high among NTD-affected countries in Africa for its progress against intestinal worms.”

Gail Davey, Brighton and Sussex Medical School in England

These same principles will continue to drive the implementation of the commitments that were pledged last week.

Unsurprisingly, the launch of the Kigali Declaration – intended to be linked to the 26th Commonwealth Heads of Government Meeting – has twice been delayed by COVID-19. At last the moment came and the Kigali Declaration was launched virtually with a stream of events and engagements to amplify and embed the commitments. But virtual events are by definition remote, and can seem disengaged from realities on the ground.

This is why my colleagues and I are in Kigali this week, at the invitation of the Government of Rwanda, which is at the forefront of efforts to tackle NTDs in Africa. We will then run a series of training workshops with our partners in Rwanda, Ethiopia and Sudan, one way that our NIHR-funded partnerships on NTDs are bringing the ‘remote’ to life.

Rwanda, whose capital city gave the Declaration its name, ranks high among NTD-affected countries in Africa for its progress against intestinal worms, river blindness, and bilharzia.

We hosted a real-life event on 30 January in Kigali with Rwanda’s minister of health and the University of Rwanda, as well as UK health leaders and others in Africa, to highlight our successful partnerships and progress on tackling a debilitating neglected tropical disease known as podoconiosis.

This progressive leg swelling condition affects people in every Rwandan district, reducing productivity and causing great suffering through the stigma it attracts. It is a significant public health problem across East Africa, and Rwanda has shown important leadership in ‘owning’ the condition and planning for its elimination. Given the size of the country and the strength of its health system, it could be the first country to eliminate podoconiosis.

Understanding partnerships on neglected diseases

For the past five years, our NIHR Global Health Research Unit on NTDs at Brighton and Sussex Medical School  has also been working with our partners in Rwanda’s much larger northern neighbours —  Ethiopia and Sudan —  to study the diagnosis, prevention and treatment of podoconiosis and other NTDs that cause leg swellings, and debilitating skin infections such as leprosy and scabies.

“While partnership is implicit to this work, we realised it should not be taken for granted.”

Gail Davey, Brighton and Sussex Medical School in England

While partnership is implicit to this work, we realised it should not be taken for granted. We have explicitly examined the partnership process and propose an academic partnership maturity model based on the capability approach — itself borrowed from development science. We would encourage other groupings formed in the wake of the Kigali Declaration to use a similar approach. Better understanding of the level of maturity of partnerships within and across countries will enable more realistic and value-driven engagement.

Our mostly biomedical Global Health Research Unit is complemented by a parallel programme, the Social Sciences for Severe Stigmatising Skin Conditions (5S) Foundation, also funded by NIHR and addressing the same NTDs in the same three countries, but from a predominantly medical anthropology perspective.

New funding against skin diseases

We are also delighted that NIHR will fund Phase 2 of the Global Health Research Unit on NTDs. This will enable a further five years’ research and action on podoconiosis, mycetoma (a chronic skin infection caused by bacteria and fungi found in soil and water) and scabies in partnership with institutions in Ethiopia, Sudan and Rwanda, with partners including the University of Rwanda and the Rwanda Biomedical Centre.

Twelve research projects will focus on the causes of disease, geospatial mapping, diagnostics and drug development, and understanding how interventions can be implemented in real world settings.

The Global Health Research Unit and 5S Foundation can directly support country ownership, as we are in Rwanda. The event in Rwanda and the Kigali Declaration will enable the Rwanda Biomedical Centre to showcase its work against NTDs and, vitally, give a voice to those affected by them who have too long been voiceless.

 Gail Davey, a professor of global health epidemiology at Brighton and Sussex Medical School in England, is co-director of the UK National Institute of Health Research’s Global Health Research Unit on Neglected Tropical Diseases Phase 1, and a leading authority on stigmatising skin diseases. She can be reached at [email protected]

This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.