Dr. Henry Mwebesa; Director General Of Health Services, MoH

To enhance awareness and encourage all stakeholders and affected communities to invest and deliberate action on NTDs, the World Health Organisation (WHO) designated the 30th of January of every year as World NTD Day.

Today, Uganda joins the rest of the World to commemorate the day. Last year, during a similar event, the Ministry of Health launched the NTD Control Program Sustainability Plan for 2020-2025.

The main aim of this plan was to raise awareness about the importance of concerted efforts required to have a sustainable NTD program. The theme for this year is “Achieving Health Equity to end the neglect of poverty-related diseases”.

This year, the Ministry of Health will extend the commemoration beyond the actual day through the month of February.

This press release serves to raise awareness of the people of Uganda and beyond about the NTDs endemic in Uganda and the realised achievements so far.

In addition, there will be two activities:

  1. a breakfast meeting with the key stakeholders; members of Parliament and Top Management of Ministry of Health to lay strategies for a sustainable NTD program response.
  2. a community event to be held in Lira district on 25th February 2022.

Lira is one of the districts afflicted by almost all the NTDs endemic in the country and this event will serve to increase community awareness and partnership in the sustainable control of NTDs. Community compliance and buy-in is crucial for disease elimination and program sustainability.

Neglected tropical diseases (NTDs) are diseases of poverty that still threaten global health and inflict devastating human, social and economic burden on more than 1 billion people globally. NTDs are caused by various pathogens including viruses, bacteria, parasites, fungi, and poisons.

They are widespread in the world’s poorest regions, where water safety, sanitation and access to health care are substandard. These diseases are “neglected” because they are almost absent from the global and national health agenda and have very minimal or no funding.

Action against NTDs is core to the vision of universal health coverage and if not adequately managed, NTDs may hinder the realisation of the Sustainable Development Goals, hence the need to end this neglect. As guided by the World Health Assembly (WHA) endorsed – Ending the Neglect to attain Sustainable Development Goals (SDGs) – a Roadmap for the Neglected Diseases 2021-2030 to which Uganda subscribed, twenty (20) NTDs are recognised by Uganda including the Snakebite Envenoming (SBE).

The most prevalent NTDs in Uganda include River blindness, Trachoma, Lymphatic filariasis (Elephantiasis), Bilharzia, Worms, Sleeping sickness, Kala-azar and others. Management of the first five diseases is through preventive treatment (chemotherapy).

However, surgeries are performed for some individuals afflicted by trachoma and elephantiasis. Those suffering from sleeping sickness and Kala-azar are treated case by case from designated health facilities.

River blindness, Trachoma and Elephantiasis are targeted for elimination by the year 2025. Bilharzia, worms, Kala-azar and Sleeping sickness are targeted for elimination as public health problems by year 2030. Guinea worm is targeted for eradication globally and indeed Uganda already contributed to this having been certified free of Guinea worm by the World Health Organization in 2009.

Programs to control some of the NTDs in Uganda date back in the colonial time. Many of these programs were stand-alone. The Ministry of Health launched an NTD integrated Program in 2007 with support from partners.

The main interventions are mass treatment of communities living in endemic areas of the country with appropriate medicines, health education to raise awareness about NTDs, vector control, surgeries for trachoma patients and those with swollen scrotum, complication of lymphatic filariasis or elephantiasis.

Uganda is on track to free endemic communities of some of the NTDs and significant progress has been made towards realisation of the elimination targets. The key achievements so far include:

  1. River blindness: Transmission has been eliminated in 11 out of 17 foci covering over 4.8 million people who are no longer at risk. Transmission has been interrupted in 4 additional foci.
  2. Trachoma: Out of 51 endemic districts, 46 have reached the recommended low infection levels and have stopped mass treatment. Only five districts of Moroto, Nakapiripirit, Nabilatuk, Amudat and Buliisa still require treatment. These districts have been undergoing mass treatment for several years but there are persistent and repeated high infection levels. Plans are underway to enhance the intervention strategies, more so, strengthening the implementation of the SAFE (surgery, antibiotics, facial cleanliness, and environmental hygiene) by enhancing collaboration and coordination among key stakeholders.

    Uganda is currently reviewing the recommendations of the trachoma expert committee (TEC) in order to defi ne strategic ways of dealing with non-responding districts and those where trachoma has re-occurred after meeting stop-MDA thresholds.

    Trachoma surgeries have been conducted in all the 51 districts and it is projected that the target will be attained by 2025. Uganda is working closely with Kenya to have interventions to eliminate trachoma across the Uganda-Kenya border.
  3. Elephantiasis: All the 66 endemic districts have reached the elimination threshold and have stopped mass treatment. Surgeries and elephantiasis management have been done in 18 districts and this is still on-going.
  4. Bilharzia and Intestinal Worms: Bilharzia is endemic in 95 districts while Intestinal Worms are everywhere in the country. Despite the persistent challenge of high infection of both diseases over the years, substantial reduction has been realised in some districts. From recent surveys of December 2021 conducted in 38 selected districts, 41.8% have reduced infection levels, 14.3% had increased levels while 44% sustained the previous infection levels.
  5. Sleeping sickness: There are two types in Uganda, one found in West Nile (gambiense) and another in Eastern Uganda (rhodesiense). Uganda has reached WHO elimination target for gambiense type and application for verifi cation from WHO is in the process. Surveillance for both types is done in the endemic areas and cases are treated from designated health facilities.
  6. Kala-azar: The disease is reported in 9 endemic districts of Karamoja region. Whereas there was only one treatment centre at Amudat Hospital, recently interventions have been scaled up to all the nine districts. Moroto hospital has been supported to become another treatment centre in the region. So far, 160 Health facility workers from 74 facilities in 4 districts of Karenga, Abim. Kotido and Kaabong have been trained on Kala-azar diagnosis and treatment.

Uganda has also made significant progress in the following areas:

  1. Successfully mainstreamed NTDs guidance in the National COVID-19 Response on Continuity of Essential Health Services (CEHS) Pillar (2021)
  2. Developed National NTDs M&E Plan (2021)
  3. Developed and disseminated the National Sustainability Strategy for NTDs (2020 – 2025)
  4. Engaged the Uganda Parliamentary Forum on Malaria and NTDs, in collaboration with the counterparts in Tanzania (2021).
  5. Currently reviewing performance of the 2017-2022 Master Plan of Actions for NTDs with lessons learned and recommendations to update for 2022 -2026 Master Plan.
  6. Progress towards Onchocerciasis elimination as validated by the 14th Session of Uganda Onchocerciasis Elimination Expert Advisory Committee in 2021.
  7. Submitted for review and endorsement of the Dossier Documenting Elimination of Gambian Human African Trypanosmiasis as a Public Health problem in Uganda by World Health Organization, requested for guidance on post elimination surveillance.
  8. Established Schistosomiasis and Soil Transmitted Helminths (SCH/ STH) Expert Committee that guides the strategic direction, monitoring and evaluation of the SCH/STH program.

Despite the above achievements, a lot more is still desired. The main challenge is sustainability of the current achievements and scaling up of the required interventions to facilitate total elimination.

One main component of the NTD portfolio that is not adequately addressed is management of the diseases that require individual case management. For persistent NTDs, the main problem is limited access to clean water, poor sanitation and general body hygiene including regular and daily face washing. This calls for community engagement and education, provision of water sources to increase access to clean water and active participation of all stakeholders.

It is through multi-sectoral collaboration and mainstreaming that Uganda will achieve the NTD elimination goals set in the WHO roadmap of 2030.

The Ministry of Health NTD Control Program success has been made possible through financial and technical support from different partners over the years.

These include; WHO, USAID through the NTD control program, ENVISION and Act to End NTDs I East program all led by RTI International; The Carter Centre, Sightsavers, FCDO through ASCEND project, End Fund and CIFF through ARISE Project, Schistosomiasis Control Initiative Foundation (SCIF), Korean government through World vision, the Lions Clubs International Foundation and the Lions of Uganda, Children Without Worms (CWW), Merck, the Mectizan Donation Program, GSK, Johnson & Johnson and Pfizer among others.

Ministry of Health prioritizes control/ elimination of NTDs as an essential primary health care activity to ensure every Ugandan lives a high-quality life free of these debilitating diseases. Even in 2020 and 2021 amidst the COVID-19 pandemic, the NTD Program implemented mass treatment with adherence to SOPs and prevention guidelines.

We call upon all stakeholders to re-energize the movement to combat NTDs. It is our collective responsibility to end diseases that are entirely preventable through sustainable interventions.

On behalf of the Government of Uganda, I would like to register the appreciation to all our partners and stakeholders in and outside the country for the support and encouragement towards the progress made.

We call on all stakeholders including the community, relevant sectors, development partners, research, and academia, in a people centered, whole of government, whole of society approach to end the neglect to attain Sustainable Development Goals (SDGs) specially to eliminate the Neglected Tropical Diseases.

For God and my Country.

Dr. Henry Mwebesa; Director General Of Health Services, Ministry Of Health