Leaving no one behind in development programming

One of the main challenges in eliminating a disease is ensuring treatment reaches everyone, no matter who or where they are.

For neglected tropical diseases like trachoma, many of the millions of people affected are spread out across remote rural villages, and so this challenge is even more difficult. However, the two-year Commonwealth Fund, which closed in 2020, has shown ways to prevent those worst affected from being left behind.

Moses Chege, Sightsavers Kenya country director, who led the work in East Africa, shares how the team made this possible.

People who need trachoma treatment are often among the poorest and most marginalised in the world. They are ‘left behind’ while other parts of their countries or communities are growing economically or socially. This is often because these groups are physically hard to access; for example, nomadic communities in rural Kenya move from place to place for pastures and water, and others live in areas that aren’t safe to enter because they are prone to conflict and insecurity.

Even in communities that are better served, women, the elderly, the very poor or those with disabilities are at risk of being left behind. In some places, this can be because of a lack of knowledge about trachoma, including the misconception that it is a natural part of ageing, or because of gender inequalities, where women need permission from men to gain access to health services. We can only break the transmission of trachoma if we reach these people too.

3. Reaching as many people as possible with treatments

For MDA to work effectively, antibiotics need to reach everyone in a community or district at the recommended treatment coverage rate, which is at least 80 per cent of the population.

Careful planning, monitoring and special interventions to reach remote communities and those affected by conflict meant that we exceeded these targets in many places through our work with the Commonwealth Fund.

We achieved this by doing several things. Before we began each MDA campaign, we held detailed planning sessions with government officials, volunteer coordinators and community leaders. This meant that all groups were aware of their responsibility to proactively include marginalised community members.

For example, when people from marginalised groups couldn’t travel to receive treatment in a central location, teams established a ‘door-to-door’ service so they could receive antibiotics at home.

In addition, we created a plan to implement in conflict areas. In Northern Nigeria, for instance, because of the risks posed, mobile teams couldn’t dispense treatments by gathering large groups in central locations. Through close dialogue with community leaders, and by taking precautions when travelling, our staff and partners in Nigeria adapted their work to ensure communities could safely access services.

Extra measures are needed to ensure no one is left behind in the fight to eliminate NTDs

As part of the 2030 Agenda for Sustainable Development, 193 UN Member States pledged to “endeavour to reach the furthest behind first”. But leaving no one behind in health interventions won’t happen naturally; it needs to be confronted with well-thought-through planning and targeted interventions.

Through the extra measures put in place for the Commonwealth Fund work, together with our partners we managed to reach people who could have otherwise been left to suffer from trachoma. And reaching these people is essential if we are going to eliminate a neglected tropical disease. After all, people are neglected, not diseases.

Author

Moses Chege is Sightsavers’ Kenya country director.