Enlisting women in Africa’s health fight

Neglected tropical diseases (NTDs) disproportionately affect women and girls. Female genital schistosomiasis (FGS) alone causes severe pain, bleeding, and lesions in more than 16 million women and girls in Sub-Saharan Africa.

Beyond causing widespread physical suffering, NTDs have a severe long-term socioeconomic impact on millions of women and girls. Women who have been scarred or disfigured from diseases such as FGS and lymphatic filariasis are often stigmatised to the point that they are unable to marry or are abandoned by their spouses. And even though disfigurement and social stigma are not lethal conditions, they can cause or exacerbate psychological disorders and limit the opportunities women and girls have.

Since 2000, enough pharmaceuticals for five billion preventive treatments against NTDs have been donated. And many people now recognise that controlling, and eventually eliminating, NTDs will be essential for achieving the Sustainable Development Goals, which apply to such diverse areas as nutrition, education, health, water, sanitation and hygiene, and economic growth. Because the SDGs are based on the principle of “leaving no one behind,” they cannot be considered a success until they have been met everywhere, and for all people – including women and girls.

SDG 5, in particular, calls for the world to “achieve gender equality and empower all women and girls” by 2030. Gender equity applies to both sexes, but special attention is needed to improve conditions for women and girls. In Africa, women are often disenfranchised, even though they account for more than half of the continent’s population. To ensure that they are not forgotten, we need to improve our understanding of how gendered power relationships operate, and address those social dynamics head on.

Because women and girls in their childbearing years suffer disproportionately from the health and social effects of NTDs, it is critically important that they be included in any largescale health-policy interventions that are proposed. And, beyond making women the focus of NTD programmes, we should acknowledge that they will play a central role in advancing the sustainable development agenda.

We need to empower women and girls to promote and lead social-mobilisation efforts in Africa. Women are frontline partners for public-health advocates who are working to make essential medicines available across the continent. Moreover, women can help to control NTD vectors at the source, by ensuring that all members of their community are complying with anti-NTD drug distribution and treatment programmes.

Ongoing efforts to control and eliminate NTDs in Africa have made some progress. But the time has come to develop more innovative policy tools. We urgently need integrated, inter-programmatic, and inter-sectoral approaches that address NTDs’ social, economic, and etiological dynamics. And we will need the full participation of the most vulnerable communities. Without that, no programme aimed at ultimately eradicating NTDs can succeed.

This year marks the fifth anniversary of the World Health Organisation’s Roadmap to eliminate NTDs, and of the London Declaration on Neglected Tropical Diseases. It is encouraging to see that the international community is recognising not only the disproportionate burden that NTDs place on women, but also the essential role that women play in controlling and eradicating these diseases.

Now that an ever-growing international partnership has emerged, we have a unique opportunity to put an end to these debilitating diseases once and for all. In 2016, the WHO Regional Office for Africa launched the Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN), which provides African countries with technical assistance and fundraising tools to fight the five NTDs that can be preempted with preventive chemotherapy: onchocerciasis, lymphatic filariasis, schistosomiasis, soiltransmitted helminthiasis, and trachoma.

ESPEN is an effort to bring together governments, the global public-health community, and other stakeholders. Our goal is to strengthen partnerships that are designed specifically to eliminate NTDs. Toward that end, ESPEN is actively supporting national-level anti-NTD programmes that have been established to break the cycle of poverty that NTDs cause and sustain. As the WHO works toward achieving the SDGs, we will continue to foster participatory approaches that include the most vulnerable populations – especially women and girls – in the fight against disease. Ultimately, the only way to ensure long-term success is to empower those who are most affected.