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Editor’s Note: This piece was authored by Kerry Gallo, Senior Program Associate for Children Without Worms at The Task Force for Global Health. In her post, Kerry describes the added benefit that many WASH interventions have for NTD prevention and introduces a new set of tools that aims to strengthen the connection between these two sectors.

A boy in Nepal washes his face, a hygiene activity that can help prevent against infection with the blinding disease trachoma. Credit: International Trachoma Initiative

A boy in Nepal washes his face, a hygiene activity that can help prevent against infection with the blinding disease trachoma. Credit: International Trachoma Initiative

The neglected tropical diseases, or NTDs, affect more than a billion people worldwide. These diseases are entirely preventable, and WASH is essential to stopping them. Now, a new set of tools -- country-specific manuals, an e-course, and a website -- has been created to help increase the impact of WASH interventions for the control of NTDs.

The NTDs have been called ‘neglected’ because they have generally received less attention and funding than diseases such as HIV/AIDs, tuberculosis and malaria. And yet, NTDs are responsible for a huge amount of pain and suffering. People with NTDs experience a range of debilitating physical, cognitive, and social effects and the diseases generate enormous global losses in educational and economic achievement. The word ‘neglected’ also describes the populations most affected by NTDs -- they are the poorest communities in the world, many of them living in sub-Saharan Africa and Asia.

The work of the WASH sector has been critical in stopping the spread of diseases such as soil-transmitted helminths (also known as intestinal worms), trachoma, schistosomiasis, lymphatic filariasis and Guinea worm. However, as Stephanie Ogden, former WASH/NTD coordinator for the Task Force for Global Health, notes in a post for this blog in 2012, “WASH has had an underfunded and under-applauded role in ongoing NTD control strategies. A coordinated, targeted approach between the WASH and health communities is needed…real mechanisms for coordination, measurement, and monitoring must be established and supported from both sides of the sector divide.”

To help develop and strengthen these mechanisms, and to help bridge the divide between the WASH and NTD sectors, a new set of tools has been developed. These tools, comprised of a manual, e-course and dedicated website, are the result of a collaborative effort by Children Without Worms, the International Trachoma Initiative, Emory University’s Center for Global Safe Water, CARE, WaterAid and WASH Advocates, with support from the SightSavers Innovation fund.

"WASH and the NTDs - A Manual for WASH Implementers" is available in both global and country-specific versions on www.washntds.org

"WASH and the NTDs - A Manual for WASH Implementers" is available in both global and country-specific versions on www.washntds.org

“WASH and the Neglected Tropical Diseases: A Manual for WASH Implementers” (available at www.washntds.org) is a practical guide for WASH practitioners working to implement, support, and sustain WASH interventions at the country level. The manual provides WASH-implementing organizations with information on targeting  interventions to NTD-endemic communities;  engaging in and promoting collaborative monitoring for NTD-specific health outcomes; and  communicating the impact of WASH on NTDs for the purposes of advocacy and policy change. Country-specific manuals (70 different versions will be made available by April 2014), will enable WASH implementers to easily access the most relevant information, statistics, and maps about NTDs that occur in their countries of practice.

As a complement to the manual, experts from the Task Force for Global Health, Emory University’s Center for Global Safe Water, WaterAid, Improve International, and the London School of Hygiene and Tropical Medicine developed and piloted an e-course on WASH and the NTDs in late 2013. Participants from 26 WASH-related organizations working in 20 countries participated in the pilot version of the course. More WASH practitioners will have the opportunity to take the e-course and receive a certificate of completion from Emory University when the self-facilitated e-course is launched on www.washntds.org by April 2014.

The momentum behind WASH and the NTDs has only continued to grow since December 2012 when WASH and NTD experts met at a two-day WASH/NTD roundtable. At that roundtable, a common vision was developed for both sectors to strive towards -- “Disease-free communities that have adequate and equitable access to water and sanitation, and that practice good hygiene.” That vision can only be achieved through greater collaboration between the WASH and NTD sectors. The WASH/NTD toolkit can strengthen that collaboration and bring us closer to achieving our vision of a world free of disease and poverty.

For more information about WASH and the NTDs, and to download “WASH and the Neglected Tropical Diseases: A Manual for WASH Implementers,” visit www.washntds.org.

Water access and hand-washing programs in Guatemala help to reduce the transmission of diseases such as soil-transmitted helminths and trachoma. Credit: Stephanie Ogden

Water access and hand-washing programs in Guatemala help to reduce the transmission of diseases such as soil-transmitted helminths and trachoma. Credit: Stephanie Ogden

Editor’s Note: This guest post was authored by Stephanie Ogden, WASH/ NTD coordinator for Emory’s Center for Global Safe Water and the Task Force for Global Health. In it, she discusses the need for a coordinated partnership between the WASH and health communities to help control and eliminate neglected tropical diseases (NTDs). She outlines concrete measures that the WASH sector can take and provides examples of successful partnerships already under way.

Years ago, I trained women in rural and remote areas of Central America to be community visual health promoters. They knew the very basics of eye disease and visual impairments, and could offer solutions to simple problems, or referrals to expert, affordable care. But, we never thought of eye disease as related to water, sanitation, and hygiene (WASH). We never thought that encouraging families to wash their faces, or that ensuring water access and building latrines, could help to prevent blindness in one person every fifteen minutes worldwide. 

Now, at the Task Force for Global Health, I help coordinate WASH activities to control a group of diseases with tongue-twister names: soil-transmitted helminths, schistosomiasis, lymphatic filariasis and blinding trachoma. They are a diverse set of diseases that comprise a group known as the Neglected Tropical Diseases (NTDs). Together they account for nearly one billion cases of blindness, debilitating swelling of the limbs, chronic abdominal pain, malnutrition, and diminished livelihoods and well-being. Not to mention, the NTDs affect as many people with pain and suffering, lost educational opportunity, and economic loss as HIV or malaria. Many of these diseases can be treated with medicine, but they can only be prevented by improved access to water, sanitation, and hygiene.

The NTDs are diseases of poverty, and have been relatively neglected by research and large-scale political action. But, for years, the WASH sector has been working in and impacting the communities where these diseases are endemic. WASH programs have acted as a silent weapon against the NTDs, but this impact isn’t being measured. As it is, WASH has an underfunded and under-applauded role in ongoing NTD control strategies. More than just lip service, a coordinated, targeted approach between the WASH and health communities is needed to ensure long-term health gains in endemic areas. Real mechanisms for coordination, measurement, and monitoring must be established and supported from both sides of the sector divide.

Hygiene education materials in Lao PDR which depict common transmission pathways of intestinal worms. Credit: Kim Koporc

Hygiene education materials in Lao PDR which depict common transmission pathways of intestinal worms. Credit: Kim Koporc

Earlier this year, a global public-private partnership, formalized by the London Declaration on NTDs, pledged to eliminate or control 10 NTDs by 2020. In some ways, it seems like an easy win. A few pills can treat many of the current infections, and generous drug donations by companies, like Johnson & Johnson, Pfizer, and GlaxoSmithKline, have enabled countries to conduct mass drug administration (MDA) to treat infection at a national scale. But drugs do not prevent re-infection, nor do they address the underlying causes that lead to infection in the first place. The focus on NTDs must shift from treatment to a more balanced approach that includes both treatment and prevention. This is where the WASH sector is essential. After all, addressing the primary environmental factors that lead to transmission of disease, such as water access, safe excreta disposal, and hygiene, is the WASH sector’s bread and butter. While continuing its good work, the WASH sector should also push for partnership with the Health sector to measure impact beyond immediate WASH coverage. Both sectors must realize that eliminating the NTDs is a three-legged race. Treatment, through drug administration, and prevention, via WASH programs, are tied together, and one will cross the finish line only at the pace of both together.

There have been remarkable examples of joint-sector collaboration and integrated programs. The health and WASH communities continue to collaborate to eradicate guinea worm worldwide — a campaign that has been markedly successful from a disease control perspective; in twenty years, cases of guinea worm infection have dropped from 3.5 million to less than 5,000 globally. This shouldn’t be a one-off case of collaboration among sectors. We need more of this kind of joint-sector collaboration in order to reach the goal of controlling 10 NTDs by 2020. The health community and private partnerships have pledged to work together towards this goal, but the involvement of the WASH sector is indispensable. 

That is why it’s especially timely that Emory University’s Center for Global Safe Water, Children Without Worms (CWW) and the International Trachoma Initiative (ITI), have committed to a partnership that will help to encourage actionable dialogue and increased coordination between the NTD and WASH sectors. This partnership aims to call stakeholders in the WASH and NTD sectors to better understand each other, to define common indicators, explore integrated mapping and targeting, and determine further opportunities for collaboration. 

So how exactly should the WASH sector get involved? I suggest we start with the simplest measures:

  • Partner with the NTD sector to champion the role of WASH in prevention of the most common NTDs that affect more than 800 million people worldwide.
  • Hold WASH and NTD organizations jointly accountable for measuring and monitoring impact on decreasing the burden of disease.
  • Seize opportunities for integrated data collection regarding NTDs in WASH program areas.
  • Add WASH indicators to health programs, and NTD indicators to WASH programs, to help ensure the effectiveness and long-term sustainability of each.
  • Use these indicators to draw the connection between WASH programs and lowered NTD rates in annual reports and program assessments.
  • Continue to allocate resources to research and development of sustainable sanitation programs, as safe sanitation may have the greatest single impact on decreasing the burden of disease. 

The conversation about how these two sectors can work together is still in the early stages. What’s vital now is to promote dialogue and keep this momentum going. We know there is a critical link between improved WASH access and lower NTD rates, but we still have a lot to learn about how one affects the other. For example, what elements of WASH most effectively impact the transmission of diseases, like soil-transmitted helminths, schistosomiasis, and trachoma? Do all types of sanitation facilities have equal impact on reduction of these diseases? If not, which have the most impact? Collaboration, coordination, and open dialogue are important first steps in answering these questions. And ensuring partnership between the WASH and Health sectors — between treatment and effective prevention — is the only route to sustainable long-term control of disease.

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