Tag Archives: neglected tropical diseases

Harnessing the power of WASH in the fight against NTDs by Yael Velleman

While in Uganda last week, I had the unique opportunity to sit down with the Ugandan Ministry of Health’s National Program Officer for Trachoma Control, Gilbert Baayenda.

Gilbert Baayenda

Trachoma is a devastating bacterial infection and the world’s leading infectious cause of blindness. It is one of 20 Neglected Tropical Diseases (NTDs) that cause extreme pain, disability and even death. Yet NTDs are preventable. They are diseases of poverty and marginalization that affect over one billion people across 149 countries globally.

Access to safe water, sanitation and hygiene (WASH) is essential for the prevention, treatment and care of NTDs. Recognizing this, the World Health Organization (WHO) and the NTD NGO Network (NNN) developed, “WASH and health working together: A ‘how-to’ guide for Neglected Tropical Disease programmes,” the first step-by-step guide for building successful WASH and NTD partnerships.

Since its launch last year on what is now World NTD Day, the toolkit has been utilized in a number of countries across sub-Saharan Africa and Asia, including Uganda. As the lead on collaboration with the WASH sector on behalf of Uganda’s National NTD Control Program, Gilbert has championed greater coordination between WASH and NTD partners, and is now in the process of adapting the innovative WHO and NNN toolkit to meet national and district-level needs.

What motivates you, as a healthcare professional, to be a WASH champion?

GB: I have lived and worked at the community and sub-national level for about 15 years and have seen what it means to have access to water and sanitation. I’ve worked in nomadic communities where WASH is non-existent – where there is no safe water, no latrine, no hygiene facilities, and water is scarce. Even where we believe that access is relatively good, we hear communities complain that there is only one water source and they must travel far to access it.

What motivates me is the decisions we make and their impact on the community. If even one family that currently has difficulties in access can say that the WASH problem has been resolved, then I would be relieved. If we solve half of the cases of disease within the next couple of years, I would be motivated to scale up to as many homes as we can get to.

What challenges have you faced in addressing WASH and NTDs?

GB: One challenge is that service providers, as well as communities, are not aware of the connection between WASH and NTDs. We must get the message out that without improvement in WASH, we may not be able to sustain the gains we have made in the fight against NTDs.

This is clear when you compare progress on trachoma and schistosomiasis; while we have eliminated trachoma in most endemic districts, we have seen progress on schistosomiasis reversed despite added treatment. The only way we can address this is if we improve WASH.  

In terms of achieving this improvement, we are challenged by natural disasters such as floods, poor soil conditions that make latrine construction difficult, and long distances to water sources. When we conduct health education, we try to emphasise the vital role of WASH.

Getting all the players to sit at the same table and view themselves as part of one WASH community instead of medical, engineering, NGO, social science or hydrology specialists, and initiating collaboration, has been a challenge. Another challenge is that Uganda has a decentralised government system, so whatever we do at the national level has to also reach all 126 districts if we want to make an impact.

Coordination of the collaboration itself is also a challenge as it is important to ensure that one sector does not appear to dominate the others – we’ve therefore tried our best to get everyone together and this is expected to improve as the concept of WASH and NTD collaboration gets more buy in.

How have you begun to overcome these challenges and improve cross-sectoral coordination?

GB: We decided to adopt the WASH and NTDs toolkit [“WASH and health working together”] and customise it to the Ugandan context. We have held meetings at the national level and we would like to hold specific WASH and NTDs meetings with district officials in which we can explain the toolkit and the expected results, to get them to appreciate that collaboration and partnership with WASH stakeholders and relevant ministries is vital. WASH is a very big challenge and we cannot do it alone.

What difference can collaboration make?

GB: Even if we come up with one innovation that can ensure coverage in fishing communities, which are right on the water, yet they have no access to safe water, that will be a huge success. If the communities that are very far from the water source can benefit from innovation to resolve this problem, I would be proud to have been a part of this effort.

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About the author:
Yael Velleman is the Director of Policy & Communications at SCI Foundation, and co-chairs the NNN WASH Working Group

Can a toolkit make a difference to WASH and NTDs collaboration?

Yael Velleman, WASH Working Group Co-Chair, Neglected Tropical Disease NGO Network, Director of Policy and Communications, SCI Foundation

Leah Wohlgemuth, WASH Working Group Co-Chair, Neglected Tropical Disease NGO Network, Technical Adviser, Sightsavers

One year on from the launch of the first-ever practical guide on WASH and NTDs collaboration, the co-chairs of the NNN WASH Working Group reflect on its impact

A year ago today, Dr. Mwele Malecela, WHO Director for the Department of Control of NTDs, unveiled the first-ever step-by-step guide for building NTD and water, sanitation and hygiene (WASH) partnerships to a crowded auditorium at the London Centre for Neglected Tropical Disease (NTD) Research.

WASH and health working together: A ‘how-to’ guide for Neglected Tropical Disease programmes” is the culmination of more than two years of collaboration between the World Health Organization and the NTD NGO Network (NNN), incorporating real-life program perspectives and tools to improve coordination between the NTD and WASH communities. On this inaugural World NTD Day, the toolkit is celebrating its one-year anniversary and the significant headway made since its launch.

2019 saw a burst of activities to disseminate the toolkit far and wide; it was translated into French and Spanish, transformed into an interactive online version, and featured in two webinars for the NTD and WASH communities. Blogs by WaterAid and the NNN highlighted the mutual benefits of the toolkit to the WASH and NTDs communities, and the toolkit was highlighted in a USAID Water Currents issue on the importance of WASH and NTD integration.

Interviews with The Carter Center’s Kelly Callahan, Director of the Trachoma Control Program, and Dr. Wondu Alemayehu, Technical Advisor at The Fred Hollows Foundation, demonstrated the value of the resource in the eyes of those who have worked towards NTD control and elimination for many years.

The toolkit also made a splash at a number of WASH and global health convenings, with workshops delivered at Stockholm’s World Water Week, UNC’s Water and Health Conference, and the 10th Annual NNN Conference.

More importantly, however, the approach set out in the toolkit was implemented in a number of countries. Inspired by this resource, the Ethiopian Ministry of Health, which was also a major contributor to the toolkit’s content, developed a national framework to guide all government and non-government stakeholders on resourcing, planning and monitoring joint interventions, along with a woreda-level WASH and NTDs coordination toolkit.

Various tools including the situation analysis protocol and planning workshop were also utilized in Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Guinea, Kenya, Liberia, Niger, Nigeria, Senegal, Tanzania, Zambia and Zimbabwe.

More recently, the Government of Uganda formally adopted the toolkit as a whole and has begun a process of coordination, and adaptation of the toolkit to the national and local context.

The toolkit has also informed the design of WASH activities with the UK Aid funded Ascend programme in West and Central Africa, including coordination structures and joint planning processes.

As we look ahead to 2020—with the anticipated launch of the 2030 Global NTD Roadmap and complementary Global Strategy on WASH and NTDs, as well as renewed commitments to be made in Kigali this summer—nothing is clearer: cross-sector collaboration is essential to sustainably beating NTDs.

This World NTD Day, we’ll celebrate the progress made in 2019 following the launch of “WASH and health working together”, but know that as a global community, we still have much to do to build successful partnerships.

This will mean taking collaboration to the next level, by convening and supporting capacity building initiatives at the regional and national level, by supporting the development of country and local tools, and by documenting the use of the tools to ensure that the toolkit is continuously enhanced to achieve the ultimate aim: end the scourge of NTDs by 2030.

Crossing the Finish Line:  Sustaining Behavior Change for the Prevention and Elimination of NTDs

Crossing the Finish Line:  Sustaining Behavior Change for the Prevention and Elimination of NTDs

By the NNN WASH Working Group

Access to water, sanitation and hygiene (WASH) is a fundamental human right. Improvements in health and increasing life expectancy across much of the world can be attributed to investments that improve environmental conditions and healthy behaviors.

However, inequities in accessing services mean that many of the world’s poorest and most vulnerable communities still lack sustained access to WASH infrastructure of sufficient quality.


Shelmel Terefa, a school teacher, demonstrates face washing to students at his school in Aware-Golje village in the North Shewa Zone, Oromia, Ethiopia. Photo credit: Michael Amendolia/The Fred Hollows Foundation

This leads to ill-health, including neglected tropical diseases (NTDs), which exacerbate social and economic challenges and can trap entire communities in a cycle of poverty and marginalization.

The presence of NTDs is an indicator of the need to improve access to WASH. Many NTDs, such as trachoma, soil transmitted helminths and schistosomiasis, are preventable through practicing the same behaviors, such as reducing open defecation, maintaining sanitation facilities, and hand and face washing with soap.

Other NTDs require WASH access to treat the symptoms caused by the disease, such as personal hygiene to reduce the occurrence of acute attacks in people with lymphedema due to lymphatic filariasis.

Continue reading

WASH & Neglected Tropical Diseases: Water Currents, May 7, 2019

The U.S. Government Global Water Strategy identifies poor hygiene and the lack of adequate water and sanitation as a leading cause of disease and death worldwide and a contributor to the spread of many neglected tropical diseases (NTDs).

The World Health Organization (WHO) WASH and NTD global strategy (2015–2020) emphasizes the urgent need to focus efforts on the provision of safe water, sanitation, and hygiene (WASH) to eliminate NTDs. Despite the urgency, according to the WHO strategy, WASH and NTDs have received little attention. ntds

This issue features new NTD toolkits from the WHO and the International Coalition for Trachoma Control (ICTC), as well as news from USAID’s NTD Program, studies and reports with overviews on WASH and NTDs, and recently published updates on schistosomiasis, soil-transmitted helminths, and trachoma. It also includes links to some earlier but key WASH and NTD reports.

We would like to thank staff from Global Water 2020 for reviewing and providing content for this issue, as well as the International Coalition for Trachoma ControlSchistosomiasis Control Initiative, and SightSavers for providing content.

Taking Action to End NTDsUSAID Neglected Tropical Diseases Program, February 2019. Last year USAID announced a combined $500 million investment for two new five-year flagship awards that will lead the Agency’s next generation of NTD programming.

WASH and Health Working Together: A ‘How-To’ Guide for Neglected Tropical Disease ProgrammesWHO; NNN, January 2019. This toolkit provides step-by-step guidance to NTD program managers and partners on how to engage and work collaboratively with the WASH community to improve delivery of WASH services to underserved populations affected by NTDs. It includes a series of tools to help build multisectoral partnerships and design, implement, and evaluate interventions. The WHO also hosted a recent webinar on the toolkit and Facebook Live Q&A.

Transition Planning for Facial Cleanliness and Environmental Improvement. ICTC, April 2019. This toolkit for transition planning is one of three planning documents ICTC recommends for program managers and implementing partners to support transition from elimination efforts to routine public services.

NTD General
Fact Sheets on the Five Main WASH-Related NTDsWHO, March and April 2019. TrachomaSchistosomiasis, and Soil-Transmitted Helminth Infections (roundworm, whipworm, hookworm). These updated online resources provide a snapshot of each disease with information on prevalence, transmission, and strategies for control.

Read the complete issue.

Water Currents, June 5, 2017 – WASH & Neglected Tropical Diseases

Water Currents, June 5, 2017 – WASH & Neglected Tropical Diseases

Publications and Videos watercurrents

Integrating Neglected Tropical Diseases in Global Health and Development: Fourth WHO Report on Neglected Tropical Diseases. WHO, April 2017. This report discusses the significant progress made in reducing the health burdens caused by NTDS. These achievements result from the implementation of five WHO-recommended interventions: preventive chemotherapy; innovative and intensified disease management; vector ecology and management; veterinary public health services; and the provision of safe water, sanitation, and hygiene. An Executive Summary of the report is also available.

Sanitation for All: The Global Opportunity to Increase Transgenerational Health Gains and Better Understand the Link between NCDs and NTDs. Tropical Diseases, Travel Medicine and Vaccines, April 2017. This study takes a look at how the global “sanitation for all” goal will address the dual burden of NTDs and non-communicable diseases (NCDs). This qualitative review of the literature is an attempt to document the health effects of inadequate sanitation and further understand the link between sanitation and NTDs and sanitation and NCDs.

Nearly 400 Million People Are at Higher Risk of Schistosomiasis Because Dams Block the Migration of Snail-Eating River Prawns. Philosophical Transactions of the Royal Society B, April 2017. This study estimates that one-third to one-half of the global population at risk of schistosomiasis could benefit from restoration of native prawns. Because dams block prawn migrations, results suggest that their removal contributes to the sharp increase of schistosomiasis after damming, and points to prawn restoration as an ecological solution for reducing human disease.

Global Urbanization and the Neglected Tropical Diseases. PLoS Neglected Tropical Diseases, February 2017. Increasing urbanization in both developing and developed countries could promote the emergence of a new set of NTDs. While an important feature of NTDs is their disproportionate impact on populations living in rural poverty, selected diseases primarily affect the poor in urban settings. Poor urban planning, unchecked growth, and inadequate public health measures further complicate urban areas’ abilities to meet the Sustainable Development Goal targets.

World Health Organization NTD Fact Sheets. In April 2017, WHO published NTD Fact Sheets on Foodborne Trematodiases, Trachoma, Dengue, Chikungunya, and Leishmaniasis. Additional NTD fact sheets are available on the WHO NTD web page.

Lessons learned from WASH and NTD projects

wash-combat-ntd-150pxWater, sanitation and hygiene (WASH) are essential for preventing and managing diseases including neglected tropical diseases (NTD) which affect over 1 billion people among the poorest communities.

Closer coordination of WASH and NTD programmes is needed to ensure WASH services are reaching the most vulnerable populations. Many WASH and NTD actors have started to work together on the planning and implementation of their projects and have documented their experiences and lessons learnt.

The World Health Organization (WHO) has published a paper that draws on examples from eighteen countries to summarise emerging successes and challenges. Several examples relate to WASH in Schools projects. Two case studies are highlighted: the Lao PDR and Cambodia CL-SWASH initiative and the CARE Integrated WASH and NTDs Programme in Ethiopia.

WHO, 2017. Water, sanitation and hygiene to combat neglected tropical diseases : initial lessons from project implementation. Geneva, Switzerland: World Health Organization. 6 p. WHO reference number: WHO/FWC/WSH/17.02. Available at: www.who.int/water_sanitation_health/publications/wash-to-combat-neglected-tropical-diseases/en/


To End Neglected Tropical Diseases, Start With The Basics Of Clean Water And Sanitation For The World’s Poorest

To End Neglected Tropical Diseases, Start With The Basics Of Clean Water And Sanitation For The World’s Poorest. Huffington Post, April 26, 2017.

Despite ‘unprecedented progress’ further gains depend on water and sanitation, says the World Health Organization 


Itai Nakoru, 87, from Adengei village, Nakapiripirit District, Karamoja region, Uganda is examined to see if she is fit for eye surgery to treat her trachoma

87-year-old Itai Nakoru, opens her eyes slowly so the doctor can examine them. She’s in excruciating pain because every time she blinks, her eyelashes scratch her corneas.

For the last six years, my eyes have been itching so much, this year, my left eye totally lost sight,” she explains.Itai lives in Uganda’s northeastern Karamoja region. She’s being examined by a doctor to determine if she can have surgery to treat her trichiasis, which is a result of repeated trachoma infection.

This eye disease is caused by the bacterium Chlamydia trachomatis and leads to inflammation, scarring the inside of the eyelid. The eyelids eventually turn inwards causing the eyelashes to scratch the cornea.

Trachoma is the leading cause of preventable blindness in the world, affecting almost two million people globally. In this region of Uganda, trachoma rates are the highest in the country, largely because the area is hot and dusty and sanitation is poor, making it a perfect breeding ground for bacteria.

Read the complete article.

Water, Sanitation and Hygiene for sustainable Neglected Tropical Disease control

Water, Sanitation and Hygiene for sustainable Neglected Tropical Disease control. by Anouk Gouvras, BugBitten Blog, November 18, 2016.

The International Society for Neglected Tropical Diseases (ISNTD) hosted a meeting exploring aspects of Water, Sanitation and Hygiene (WASH) on NTD control; ISNTD Water. Below I have highlighted some of the NTD and WASH aspects that were presented and discussed at the meeting.

Currently the majority of Neglected Tropical Disease (NTDs) control programs center around chemotherapy to treat and prevent disease. However two documents from the WHO; the 2012 WHO roadmap and more recently the report on NTDs and Water, sanitation and hygiene (WASH),  highlight the need for WASH integration to achieve sustainable NTD control and elimination. The International Society for NTDs hosted a meeting exploring aspects of WASH and NTDs; ISNTD Water.

Neglected Tropical Diseases

NTDs is a term given to a diverse group of 17 infectious diseases that are highly prevalent in tropical and subtropical countries, that thrive in poverty stricken areas with low or no access to sanitation and clean water infrastructure, cause huge damage to public health and socio-economic development and yet still receive little global attention. Together they infect over 1.4 billion people world wide and the majority are caused by protozoan or helminth infections. They are the diseases of neglected people of low income countries and of poor communities living in richer countries.

Read the complete article.


Water, sanitation and hygiene for accelerating and sustaining progress on neglected tropical diseases: a new Global Strategy 2015–20

Water, sanitation and hygiene for accelerating and sustaining progress on neglected tropical diseases: a new Global Strategy 2015–20Int. Health (2016) 8 (suppl 1): i19-i21.
doi: 10.1093/inthealth/ihv073.

Authors: Sophie Boisson, Dirk Engels, et al.

Neglected tropical diseases (NTDs) affect over 1 billion people. Safe water, sanitation and hygiene (WASH) contribute to prevention and management of most NTDs. Linking WASH and NTD interventions has potential to impact on multiple NTDs and can help secure sustainable and equitable progress towards universal access to WASH.

The need to address the determinants of NTDs has been acknowledged. In response, WHO has published a new Global Strategy: ‘Water, Sanitation and Hygiene for accelerating and sustaining progress on Neglected Tropical Diseases’.

The Strategy focuses on cross-cutting actions that benefit disease control and care efforts, and strengthen health systems. Implementation of the strategy and the accompanying action plan can help ensure that the health and development agenda leaves no one behind.

WASH & NTDs Webinar – WASHing Away Diseases, Two Hands at a Time

Published on Feb 22, 2016

The Global Public-Private Partnership for Handwashing (PPPHW) co-hosted this webinar with the USAID WASHplus project to discuss the importance of integrating water, sanitation, and hygiene to combat neglected tropical diseases, and to address the need for new approaches for multi-sector initiatives to promote equity, poverty alleviation, health, and well-being.