Road to Kigali – Gender and integrated approaches to disease elimination
Co-convened by the Global Institute for Disease Elimination (GLIDE) and Reaching the Last Mile
GLIDE and Reaching the Last Mile co-hosted a GLIDE Labs roundtable discussion on International Women’s Day at EXPO 2020 to discuss opportunities to integrate efforts to eliminate malaria and neglected tropical diseases (NTDs), with a focus on the gender dimensions. The event brought together an intimate group of global health and development experts to initiate a Chatham House-style conversation ahead of the first Summit on Malaria and NTDs in Kigali, Rwanda, to be held in the margins of the Commonwealth Heads of Government Meeting in June 2022.
The conversation began by highlighting that preventable infectious diseases such as malaria and NTDs have a profound impact on women and girls that is not always considered when planning and implementing health programmes. Women and girls are often at a higher risk of exposure to these diseases due to activities associated with gendered roles, such as water collection and laundry. They can experience amplified social stigma, isolation, and depression. Some NTDs expose women to other health conditions, including HIV, anemia, and pregnancy/childbirth complications. The visible symptoms of NTDs like lymphatic filariasis may result in women facing greater social and economic stigma and marginalisation. Understanding and accounting for the gender dimensions of malaria and NTDs is an essential component of effective and sustainable disease elimination. This also means involving men and boys for truly gender-transformative approaches that challenge long-held gender norms and stereotypes.
While many of the necessary tools and technologies exist to eliminate malaria and NTDs, challenges in their implementation persist. In order to successfully roll out tried and tested tools, stakeholders must consider the social and cultural dimensions issues that affect health providers, people living with the diseases, and their larger communities. It is critical to engage all members of a community to ensure that solutions are sustainable and effective.
Health education and information dissemination, clinical care and other health issues are frequently managed in siloes – but people experience health issues in parallel and holistically. A case in point: some NTDs and malaria have common vectors, and while the malaria elimination community advocates for usage of bed nets, the NTDs community often does not refer to bed nets in their prevention messaging. Simple shifts in messaging could help improve community awareness and uptake of bed nets, leading to better health outcomes.
The World Health Organization has called for increased efforts to integrate health programmes. The upcoming Summit on Malaria and NTDs in Kigali (23 June 2022) will provide an opportunity for advocates to improve integration messaging and identify interventions that can meet people where they are and how they live. When considering the potential for integration between two or more programmes, stakeholders need to ensure that the rationale for the integration is justified and that the efforts will result in improved outcomes for all health programmes involved. Countries need to identify which elements of their programmes it would make sense to integrate, within their local context, and meaningfully involve the communities and people living with and affected by the diseases in the planning, development, implementation and evaluation phases of the move towards integrated services.
Throughout the discussion, participants acknowledged that while the COVID-19 pandemic brought global health to the forefront of the public’s conscious, its impacts on disease elimination and eradication goals for malaria and NTDs are yet to be fully understood. During the initial, acute phase of the pandemic, the essential role that community health workers (CHWs), the majority of whom are women, play in primary health care delivery was clear. With their established ‘health credit’ in the communities, CHWs were able to respond quickly and effectively to identify and report COVID symptoms, inform the public about prevention, and to facilitate access and referral to formal health care and treatment where possible. CHWs have the trust of the people they are working with and are key actors in disseminating information and influencing healthy behavior change.
While the pandemic has helped the general public understand how health goes beyond borders, it has also heightened longstanding inequalities, such as gender and poverty. In many countries, already stretched resources for existing health initiatives were reallocated to the pandemic response. As a result, routine NTD programmes find themselves even more underfunded and more neglected than ever. Many in global health will turn to private sector actors, who are often asked for financial contributions to fill the funding gap, but their partnership could be more strategic. Multi-sectoral partnerships can help amplify and bring clarity to messaging for health interventions, support monitoring and evaluation of health campaigns, and connect national policy discussions to programme implementation. Identifying the mutually beneficial aspects of public-private partnerships could help these kinds of partnerships be more effective for all.
More resources are needed to banish NTDs and malaria from the world and consign them to the history books. Yet, disease elimination requires more than financial resources. It needs the voices of champions to elevate the profile of the diseases both in affected communities and globally to help people understand the importance of elimination and eradication. A clear vision with messaging and stories that capture people’s hearts can have long-lasting impact. The malaria community, with their strong advocacy campaigns and resonant messaging have, in the past, been asked to expand their platforms to include additional diseases. While the narrative built around malaria could be an arrowhead to break through and tell a broader disease elimination story including NTDs, there has been some reluctance to widen the net. Although the potential benefits of an integrated campaign are attractive, there is a risk that an integrated approach will dilute messages and reduce the impact and effectiveness of the campaigns.
As advocates look ahead to the Kigali Summit on Malaria and NTDs, participants agreed that the Summit provides an opportunity for the communities to come together and make the clear case for investment and integrated action for disease elimination, remind the world that billions of people are still affected by malaria and NTDs, and to argue that elimination is achievable. Identifying opportunities where integration makes sense – where there are shared vectors, potential joint messaging, and improved services – could help advance elimination efforts for both malaria and NTDs.
GLIDE and partners concluded by confirming a shared commitment to continuing the conversation and exploring the how, when, and why of integrated solutions to malaria and NTDs in the lead up to the Kigali Summit on Malaria and NTDs and beyond.