By Dr Maria Rebollo Polo, ESPEN team leader at World Health Organisation, Regional Office for Africa
Of the 1.5 billion people who are affected by neglected tropical diseases (NTDs) worldwide, women and girls are disproportionately suffering. While poverty currently restricts material access to the most basic forms of healthcare which can treat these diseases, gender also plays a role in increasing a woman’s chances of contracting an NTD and limiting access to healthcare. Women need to be more visible if we are to eliminate NTDs by 2020 and a gendered perspective is crucial to understanding how this can be achieved.
The reasons for this issue are complex and cannot be isolated. In adult life, the kinds of roles that women typically perform heightens their chances of contracting an NTD. According to a 2016 report by Uniting to Combat Neglected Tropical Diseases, women and girls perform two thirds of water collection, exposing them to water-borne diseases such as schistosomiasis. This has serious consequences with one study finding that the proportion of bladder cancer linked to schistosomiasis was estimated at 28% and in areas where schistosomiasis is endemic, women are 1.5 times more likely to contract bladder cancer than men. Likewise, women are also typically the primary caregivers and are therefore far more likely to come into contact with trachoma infection. This is evident in data which shows that the infection is 2 – 3 times higher in women than in men.
Within the domestic economy too, women living in poverty tend to forego any access to healthcare that they may have on two counts. Since males are usually the providers in the family unit, money will be directed towards the health of the male provider in order to protect the family’s main source of income. Women also tend to sacrifice their own medical needs for the sake of their children’s. Consequently, the grip of poverty tightens as a mother’s health is a key determinant of her children’s future.
Improving the provision of healthcare across Africa is clearly an important priority, but to tackle challenges such as NTDs we need to ensure we equitably improve access to reach the most vulnerable populations such as women and children, and those communities most affected by poverty.
The Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN) is a World Health Organisation project which aims to eliminate the five NTDs amenable to Preventive Chemotherapy. Through this project we are building the capacity of African health leaders to best strengthen health systems and provide the quality NTD services that people in Africa deserve. Our data portal enables health ministries and stakeholders to share and exchange subnational programme NTD data and use this quality data for smarter decision-making for NTD control and elimination. This allows us to identify the most vulnerable in society to improve access to both prevention measures and treatment for those who need it.
The truth is that every person – no matter who they are, where they live, or their gender – should be able to access the quality health services that they need without facing financial hardship, so we must eliminate the out-of-pocket cost for accessing donated NTD medicines. Universal Health Coverage is therefore crucial if we want to eliminate NTDs once and for all, protecting not only women, but everyone, everywhere.
Efforts to achieve Universal Health Coverage and eliminate NTDs are mutually reinforcing. By strengthening health systems, access to NTD prevention and treatment will improve. Meanwhile, our efforts to eliminate this group of diseases ultimately can put countries on the pathway to achieving UHC, and in turn improve the health, prosperity and happiness of its citizens.
It is vital that we group together to intensify our efforts to eliminate NTDs by 2030. With this kind of synergy, we will make it possible to accelerate our mission in order to reach Africa’s entire population. No-one can be left behind.