“Building Back Better” After COVID-19: An Opportunity to Enhance Our Programmes

The past few months have been challenging for everyone, everywhere. From missing loved ones and friends, to ill health, to economic pressure, no one has avoided the effects of the COVID-19 pandemic.

As NGOs working to tackle Neglected Tropical Diseases, we have been concerned about the short- to -long-term effects of the lockdown and the restrictions on the communities we support in sub-Saharan African countries, particularly as health systems in these countries are already overstretched.

This crisis has also provided important insights for us as individuals and within our organisation, and it is crucial we take these on board. Personally, I have learned that I need to brush up on maths to perform my home-schooling duties. As an organisation, we discovered that we can be effective even when working remotely, if we put the right measures in place. But the learning shouldn’t stop there.

Within the global health community, there is a growing momentum behind the idea that rather than return to “business as usual” once the pandemic has subsided, we should learn the lessons offered by this crisis to “build back better”.

Doing what we do, only better 
The restrictions on movement of people and goods have pulled the rug from under mass drug administration (MDA) programmes – the mainstay of Neglected Tropical Disease (NTD) programmes such as the ones we support.

Many of these happen in schools that have closed in many countries. So, what has been a highly cost-effective mechanism for treatment delivery, has been put on hold in all programme countries, with only some starting to resume activities.

As noted by others in the NTD community, this should be seen as an opportunity to consider alternative delivery mechanisms such as integrating with other mass delivery approaches like immunisation or harnessing a community directed approach where communities nominate and support other community members to deliver treatment house to house. This would enable services to continue but may also make programmes more equitable by bringing services to people rather than relying on people to seek out services.

There are also valid concerns by programme implementers about supply disruptions and escalating costs of the basic commodities required for our programmes, including the deworming drugs we help to distribute, due to scaled back manufacturing and higher air freight costs. This has made more urgent the need to manage these commodities more carefully, for instance through more precise mapping of diseases.

There is an important opportunity here not only to be more effective, but also more equitable, in the way in which these precious resources are used – for instance through more detailed mapping of where the need is and ensuring that those most in need receive treatment. It also gives us an opportunity to consider whether more ambitious targets such as quicker progress towards NTD control and elimination may be more cost effective in the long term.

It’s all about the systems 
The pandemic has stretched and burdened healthcare systems globally, including in wealthy countries. The effects are far worse, however, in low-income countries whose health systems and services were already struggling to have in place the basic foundations such as adequate financial and human resources. The crisis has shone a light on the importance of strong health systems, able to respond to current needs and resilient in the face of emerging threats.

Members of the NTDs NGO Network are already committed to health systems strengthening as a core principle, channelling all our support to Ministries of Health, and choosing not to create parallel health programmes in-country. This is not enough. For NTD programmes, funding and technical support for health systems strengthening tends to be an afterthought that is bolted on to specific healthcare programmes and fails to address the root causes of systems weakness.

We need to build on the lessons already being learned on the importance of health systems strengthening to ensure that we are embedding our disease-specific funding and technical support within existing systems, and using the evidence generated to influence policies and target resources to achieve this effectively.

One world – One Health?  
As a vet working in human health and a long-term champion of the notion that the health of people, animals and environment are interlinked, I see this moment as a unique opportunity for the global community to not only acknowledge this link, but to act on it. There are strong indications that the SARS-CoV-2 virus originated from the human-animal interface and has highlighted important gaps in research, surveillance and response, and in global health financing.  

It is my hope that the pandemic becomes a turning point in the way we conceptualise, fund and plan disease control programmes – in a way that ultimately builds a better future than the one we faced before this crisis.

Author:

• Dr. Wendy Harrison - CEO, SCI Foundation