NINETY-year-old Professor Adetokunbo Lucas, former lecturer at the Harvard School of Public Health, and front line researcher and high profile board member of the world’s most respected health agencies was one of Nigeria’s youngest professors. His commitment to the eradication of tropical infectious diseases such as guinea worm, polio, as well as the Neglected Tropical Diseases, NTDs, is legendary. In this piece, the renowned medical practitioner writes about the giant strides Nigeria is making against the menace of NTDs.
By Professor Adetokunbo Lucas
Lymphatic filariasis. Onchocerciasis. Schistosomiasis. We may not all recognize the names of these neglected tropical diseases, NTDs, but for the more than one billion people affected around the world, including roughly 800 million children, the human toll is all too familiar. Survivors of NTDs are often left permanently disabled, disfigured or blinded, and many face a lifetime of health complications.
Here in Nigeria, many of us know these diseases well. Elephantiasis and river blindness are more common in Nigeria than any other African country, and no country anywhere has more cases of schistosomiasis.
Although these diseases affect the world’s poorest and most vulnerable populations and drive people even deeper into poverty, global and national responses to NTDs have been inexcusably lax. Instead of being neglected, these devastating diseases should be at the top of health agendas in every affected country.
Nigeria has made progress in recent years, notably by eliminating guinea worm. The federal government and states have also launched community education programmes and bolstered drug distribution, which has led to improvements in the control of other NTDs, including leprosy.
Yet despite promising gains, efforts have been stalled by a persistent funding gap and imperfect national coordination that have kept the best solutions away from those who need them most.
Today, we have reason for hope. Nigeria is standing up against this scourge of terrible diseases. On 19 February, the government launched a robust and fully integrated multi-year national plan to control and eliminate 10 of the most common NTDs.
Earlier this month, more than 100 participants from Nigeria’s 36 states came together in Abuja to finalize the overall strategy and make specific plans for each state. Guided by the plan’s emphasis on mapping disease burdens, local leaders helped devise state-specific plans to determine priority locations, identify those most at risk, and most efficiently deliver treatments.
With an approved budget of N49 billion to treat more than 60 million people annually over the next five years, the national NTD plan lays the groundwork for historic progress.I am proud of my country for taking such decisive action. I am also pleased that Nigeria’s NTD plan was built with a strong spirit of partnership.
Nigeria is acting in concert with a broad group of national and global partners who are committed to sparing people from these terrible diseases. Nigeria worked with partners such as the World Health Organization, the United Kingdom’s Department for International Development, DFID, and the United States Agency for International Development, USAID, to obtain technical support and secure necessary funding. And closer to home, philanthropist General TY Danjuma has led the engagement of the private sector in the cause.
For this intensified programme, we must make good use of lessons from our past. The best outcomes are achieved when key stakeholders collaborate effectively. The public sector, including health authorities and local, state and federal governments, has developed partnerships with the private sector. Non-governmental organizations make valuable contributions through their close working relationships with local communities, and pharmaceutical companies and other commercial enterprises provide massive drug donations.
However, we need to pay more attention to the role of regular people in responding to the new programmes. The general public must be treated as partners, not passive recipients. We should make more effective use of Nigeria’s expert sociologists, political scientists, medical anthropologists and other social scientists to enhance our understanding of popular beliefs and close the gap between health workers and the communities they serve. This is our best hope of preventing the sort of disputes and misunderstandings that sometimes break out in relation to major health interventions such as polio.
A recent development points the way to closer interactions with communities. Rather than use health workers to distribute ivermectin, a drug for river blindness, a new approach was developed which involves empowering communities and enabling them to take responsibility for distributing the drug. The success of this Community Directed Treatment with Ivermectin, CDTI, has been adapted to facilitate other community-based programmes such as the mass drug treatment of schistosomiasis and the distribution of vitamin A and bed nets.
In recent years, we have witnessed a global awakening about the burden of NTDs. Just over one year ago, a group of global partners came together to launch the London Declaration on NTDs. A year later, their report cites Nigeria as a model. By setting out its national plan and by inviting support from global partners, Nigeria is taking advantage of this unique moment and setting a powerful example for other countries. I have dedicated much of my career to fighting NTDs. I have seen the effects first hand – and some days, it has been hard to look past the heartache. But today, with Nigeria on the march toward success, I am more optimistic than ever.