Funding shortfall risks reversing gains in NTD control

Kenya has made significant progress in reducing the burden of neglected tropical diseases (NTDs) through mass drug administration, health campaigns, health education and improved water, sanitation and hygiene. This is according to the Kenya National Master Plan for the Elimination of Neglected Tropical Diseases, 2023 – 2027.

The number of people requiring interventions has fallen from 21.8 million in 2010 to 8.7 million in 2022, and elephantiasis and onchocerciasis have been nearly eliminated, notes the World Health Organization. 

However, the sustainability of these programmes is threatened by a persistent shortfall in allocated resources, which poses a significant barrier to achieving the disease-specific elimination and eradication targets outlined in the World Health Organization (WHO) 2030 NTD Roadmap. 

Irene Chami, director of programmes at the END Fund- a private philanthropic initiative dedicated to ending neglected tropical diseases - defines NTDs as a group of diseases that occur primarily in tropical and subtropical regions and are commonly referred to as poverty diseases because they affect people with very low socioeconomic status.

Mycetoma, visceral leishmaniasis and schistosomiasis are among the 18 out of 21 NTDs reported in the country. They can have devastating effects, including severe pain, disability and deformity, malnutrition, stunted growth and cognitive impairment.

"Some diseases spread because of poor water and sanitation, often due to community living conditions. If left untreated, these diseases can place a significant social and economic burden on society," she says.

Through its partners, the END Fund supports country-led programmes to control and eliminate intestinal worms, schistosomiasis, lymphatic filariasis, river blindness, trachoma and visceral leishmaniasis.

Ms Chami says the re-allocation of funds earmarked for NTDs to other emergencies has left the Kenyan government and its partners struggling to fill the financial gap, undermining intervention programmes and threatening to reverse the progress made.

"There have been efforts to prioritise NTDs, particularly at the sub-national level, where some countries have made significant efforts to allocate resources to NTDs. However, this is not enough and more needs to be done, especially in terms of prioritisation," says Ms Chami.

"Increased investment in NTD control is needed to maintain the momentum towards elimination and to protect vulnerable populations from the social and economic burden of these diseases.  Long-term commitment, especially from the government, will be critical to ensure that Kenya can meet its NTD targets and protect the health of its people," she adds.

In Kenya, the NTD programme relies heavily on external funding from development partners and other stakeholders. Expenditure data for 2016-2022 was only available for five diseases, including leishmaniasis, Lymphatic Filariasis (LF), trachoma and STH/SCH (Soil Transmitted Helminths/Schistosomiasis). 

Expenditure for STH/SCH reached over Sh1.3 billion, while expenditure for LF reached US$6.2 million. Expenditure on trachoma and leishmaniasis reached Sh3.93 billion and Sh73 million respectively. Unfortunately, Ministry of Health and county expenditure data for NTDs were not available, making it impossible to assess whether sufficient funds were raised for programme activities.

NTDs affect nearly 25 million Kenyans, with high prevalence in underserved regions straining the health system and preventing timely and adequate care for those affected. Economically, NTDs have a devastating impact as chronic disease and disability reduce labour productivity and hinder economic growth.

The WHO Global Roadmap for Neglected Tropical Diseases 2021-2030 aims to reduce the number of people needing treatment for these diseases by 90 per cent and the disability associated with them by 75 per cent. The Roadmap, endorsed by the African Regional Framework for the Control, Eradication and Elimination of Tropical and Vector-Borne Diseases, encourages governments to take the lead and commit to achieving global and national targets.

Kenya has launched a new National Master Plan 2023-2027 to guide the elimination of NTDs, which aims to break the cycle of these debilitating diseases through community-based awareness. However, the Division of Vector-Borne and Neglected Tropical Diseases faces a funding gap of Sh72,494.32 million over the five years, with the highest gap in FY 2022/23 at Sh14,918.64 million and the lowest in FY 2026/27 at Sh13,661.07 million. The significant funding gap is driven by potentially declining external funding and the increasing burden of neglected tropical diseases.

Kenya has successfully implemented two previous NTD master plans, resulting in the elimination of Guinea worm disease and the interruption of transmission of onchocerciasis and human African trypanosomiasis. It aims to achieve its NTD control and elimination targets by 2027.

Ms Chami notes that stakeholders need to come together to increase funding for research, improve health infrastructure and promote public awareness to reduce stigma.

"We need to increase investment in NTD control to sustain progress towards elimination and protect vulnerable populations from the social and economic burden of these diseases. Long-term commitment from both the government and external donors will be essential to ensure that Kenya meets its NTD targets and protects the health of its people," said Ms Chami.

Further, many people in affected areas are unaware of NTDs, how they are sprea, and the importance of treatment and prevention. This leads to low participation in treatment programmes and perpetuates stigma against those affected.

By 2020, 42 countries worldwide had eliminated at least one NTD. Kenya achieved World Health Organization (WHO) certification of Guinea worm disease elimination in 2018, and has also submitted a draft dossier to WHO for certification of human African trypanosomiasis elimination.

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