Roundtable on mental health, wellbeing and person-centred approaches

This Roundtable, hosted by Africa CDC in partnership with Anesvad Foundation, CBM Global and Liverpool School of Tropical Medicine, was held on 24 January in Kigali, Rwanda directly after the International Conference on NTD Research. Thank you to Maneesh Philip (from ILEP member Effect Hope) and other ILEP member colleagues for this report for ILEP Update readers.

Aim

The aim of the Roundtable was to enable progress in addressing the intersection of mental health and wellbeing, stigma and NTDs. These are key priority areas in the new Africa CDC NTD Strategy, the WHO NTD Roadmap 2021-2030 and other strategic frameworks. In particular, the Roundtable explored concrete actions to increase investment in mental health and NTDs across different sectors, and to strengthen efficient mechanisms for allocation of funds.

Background

The Roundtable was convened in a positive context. Research has demonstrated effective integration of mental health and wellbeing considerations into support services for people living with the effects of NTDs. There is a paradigm shift in global strategic frameworks towards person-centred approaches, consideration of mental wellbeing, and integration of services across sectors that impact on the lives of people affected. However, NTD services still tend to largely focus on preventive chemotherapy or on provision of limited medical services for people affected. Some countries are starting to work across vertical programmes, for example to improve access to mental health care for people with NTDs, or to coordinate access to social interventions like livelihoods with other sectors. Welcome developments are improved collaboration between government and non-state providers, and a stronger role for organisations of people affected by NTDs.

There is now well-established consensus on what changes need to be made, and an increasing technical capacity and political commitment to implementing these changes. But if the required structural reform is to be successful, domestic and external financing are required to support scale-up of good practice examples. At present, only a tiny proportion of funding for NTDs is directed to this area of work, despite being identified as a priority in the major consensus documents. The Roundtable brings collective expertise together to consider how resources can be effectively used to support global strategic shifts towards person-centred and community-driven approaches, while maintaining momentum in reducing prevalence of NTDs.

Key points from the Roundtable

Africa CDC shared its strategy for strengthening health systems across Africa, focusing on mental health, non-communicable diseases, infectious diseases, and NTDs. Key pillars of the strategy include integration, capacity building, collaboration, research, and resource mobilization. They have three flagship programs:

• Mentorship for NTD Program Manager Leadership
• Investment Case to build stronger evidence for funding
• Integration into primary healthcare and data systems (e.g., DHIS2).

Liverpool School of Tropical Medicine (Julian Eaton) emphasized the need for integrating mental health and NTDs, highlighting evidence that people with NTDs are more likely to experience mental health issues. He stressed the importance of funding and policy support for these integration efforts, with examples like the Global Fund’s commitment to ringfence funding for mental health.

Liberia (Karsor Kollie) discussed the challenges of integrating mental health into NTDs, citing the need for leadership, advocacy, evidence around economic benefits, and sustainable financing. Liberia shared an example of successful integration through the REDRESS project (mentioned above), which highlighted the need for policy changes and resource mobilization which are now being implemented through the TRANSFORM project (integrated NTD program).

Nigeria (Gabriel Afolayan) focused on starting integration at the policy level, using the NTD Master Plan as a framework. He highlighted the need for coordination across sectors, clear strategies, tailored interventions, and training for health workers.

Anesvad Foundation (Inés Egino) has focused on a person-centered approach to skin NTDs in West Africa, integrating mental health with health systems strengthening. Anesvad’s strategy emphasizes community-based approaches, government support, capacity building, and collaboration.

END Fund suggested including mental health indicators in NTD dossiers and advocated for integrating mental health into national health sector plans.

Effect Hope (Maneesh Phillip) has supported Liberia’s NTD program since 2012 by developing an integrated approach to health systems strengthening, starting at the national policy level and extending to county, primary healthcare (PHC), and community levels. This effort evolved through various phases, now under the TRANSFORM project, which supports Liberia’s NTD Master Plans from 2016-2020 (extended to 2022) and the new Master Plan for 2023-2027. Effect Hope collaborates with partners like Anesvad Foundation and American Leprosy Missions, ensuring sustained funding for these initiatives. As part of the REDRESS project, mental health was incorporated into the new Master Plan and is included in TRANSFORM’s implementation, with a focus on training health workers at all levels. Effect Hope also partners on similar projects in other countries in Africa and Asia, studying models that improve access to care for people affected by NTDs.

Outputs and next steps

The Roundtable revealed a shared commitment to integrating mental health into NTD programs across various African countries, with emphasis on leadership, policy changes, evidence-based approaches, and sustainable funding.

The organizers will publish a report of conclusions from the Roundtable, for sharing with participants’ organisations and to encourage further engagement to raise the profile of person-centred approaches and investment in sectoral reform. The report will also be shared with key organisations such as WHO, UNECA and other UN agencies, African Union, World Bank, African Development Bank, WAHO, ECOWAS and other African regional economic blocks.

International Conference on NTD Research

This month, COR-NTD and the African Research Network for Neglected Tropical Diseases (ARNTD) hosted the second International Conference on NTD Research (InCORNTD) in Kigali, Rwanda in collaboration with the Ministry of Health. Over 500 researchers, academics, and policymakers met during the three-day conference aimed at bridging the gap between research and implementation, ensuring that knowledge translates into tangible impact in the fight against neglected tropical diseases (NTDs). You can watch highlights on the COR-NTD website and full recordings will be made available later. Thank you to Liesbeth Mieras (from ILEP member NLR) and other ILEP member colleagues for this day-by-day report on topics particularly relevant to ILEP Update readers.

Day One: 20 January

Opening remarks

There were welcomes by Pat Lammie (Director of COR-NTD), who emphasized catalysing new collaboration during the conference, and John Amuasi (Executive Director of ARNTD), who motivated participants to come up with bold ideas to put research into action to tackle NTDs.

Noella Bigirminana, Deputy Director General of the Rwanda Biomedical Centre, emphasized Rwanda’s commitment to eliminating at least four NTDs as a public health problem by 2030. She highlighted the importance of multi-sectoral collaboration and establishing essential services to achieve this ambitious goal, and overcoming the inequity related to NTDs. ‘Rwanda is committed to increasing domestic resources allocated to NTD control interventions. Investing in research is critical for generating evidence-based strategies. I call for strengthened multi-sectoral collaboration through the One Health Approach, which will not only contribute to eliminating NTDs but also help achieve the WHO NTD Roadmap targets, the Sustainable Development Goals, and other continental and global strategic objectives’.

Dr. Mosoka Papa Fallah, Deputy Director of the Africa CDC, underscored the timeliness of the conference, calling for leveraging cutting-edge technology to accelerate the elimination of NTDs. ‘We are in an era of groundbreaking scientific discoveries, from the rapid development of the COVID-19 vaccine in just 12 months to advancements like the recent discovery by Japanese scientists of pathways to regenerate teeth at any age. Yet, despite these incredible achievements, 1.2 billion people in Africa and parts of Asia suffer daily from Neglected Tropical Diseases” Dr Mosoka posed two thought-provoking questions to all concerned actors:

• Does poverty serve as an invisible magnet that attracts NTDs?
• Do NTDs persist among the poor because they are poor, disempowered, and faceless?

Through these questions he invited deeper reflection on the structural injustices, weak health systems and societal dynamics that perpetuate the burden of NTDs, including the mental health consequences.

Morning presentations

1. Health systems integration for schistosomiasis and other NTDs. Presentations focused on integrated ways to implement Mass Drug Administration (MDA) campaigns targeting children, such as MDA combined with mother and child health, including vitamin A distribution.
2. WHO research and development blueprint. This was mentioned in the October Update where we encouraged readers to sign up to participate, to maximise the number of voices contributing. The deadline has been extended. One of the driving issues is that progress towards the 2030 NTD goals is too slow, and this is related to the fact that there is relatively limited research on NTDs, compared to for example malaria. Questions posed by speaker Anthony Solomon included: Are we doing enough? Do we coordinate and collaborate enough? Are we addressing the right questions?
3. Post-validation surveillance. Abdel Direny shared PATH’s Landscaping report: Integrated surveillance planning toolkit for NTDs in post–validation or verification settings
4. iCHORDS encouraged participants to join its Community of Practice which aims to mobilize social and behavioural science into practices that meet the needs of NTD program implementers and partners, to reach the WHO 2030 NTD Roadmap targets. Services include podcasts, knowledge exchange cafes, a mentorship program, quarterly newsletters, blog posts and focus area support.

Visceral Leishmaniasis (VL)

20 million people are at risk of contracting VL; 95% of patients will die if not treated. Targeted vector control (sandflies) is lacking and new breeding sites are emerging. More positively, Bangladesh has achieved elimination of VL as a public health problem, so the challenge is how this can be achieved in East Africa. The solutions to ongoing transmission lie in innovative interdisciplinary control approaches, covering:

• Early diagnosis and treatment
• Integrated vector management
• Effective disease surveillance
• Advocacy, social mobilisation and partnership
• Research and development

Contributors to the session included DNDi – Best science for the most neglected which works with partners in low-and middle-income countries to develop treatments for various diseases. These include their Leishmaniasis East Africa Platform (LEAP). WHO has launched a new strategic framework to eliminate VL in East Africa.

The challenges for VL elimination are very similar to the challenges for leprosy control: early detection, early treatment, care, preventive measures, point of care diagnosis, training, awareness, logistics (medication), surveillance, poverty reduction. Diagnosis, treatment and care for people with skin NTDs is a pathway to stronger health systems.

The session identified these requirements for effective surveillance:

• Systematic collection and analysis of data to monitor disease and inform public action
  • Improve by digitization, training etc
• Detect outbreaks
• Monitor trends
• Promote equitable access
• Develop policies for prevention, control and elimination
• Identify new foci (eg consequences of climate change)

Day 2: 21 January

Shape the future for Skin NTD diagnosis – successes and operational challenges

This session was chaired by Kingsley Asiedu (WHO NTDs) and moderated by Liesbeth Mieras (NLR). Rapporteur was Suzan Trienekens (LRI). The full report and slides will be made available in a subsequent ILEP Update.

Sharing and developing practical tools for the integration of NTDs and mental health.

Julian Eaton, CBM Global, talked about the essential care package that is under development by the NNN DMDI (Disease Management, Disability and Inclusion) group. He stressed that treatment and care should aim to not interrupt the income of the patient and to support the patient in their daily life to the extent possible. Research priorities included prevalence and risk factors, and development and evaluation of integrated interventions.

This session continued in a subsequent side meeting. Interventions that were highlighted included:

• Better Mental Health for People with NTDs in Nigeria | Anesvad
• Strengthening people-centred health systems for people affected by severe stigmatising skin diseases in Liberia – REDRESS Liberia (see next section below)
• Guide on Basic Psychological Support for Persons Affected by Neglected Tropical Diseases (BPS-N) | NLR and InfoNTD
• The Livex project of RedAid Nigeria: LIVEX – Empowering Lives: A Landmark Dissemination Meeting on Improving Physical and Mental Wellbeing of Persons Affected by NTDs
• The ILEP-NNN Stigma Guides. Guides on Stigma and Mental Wellbeing | InfoNTD

Follow-up steps were agreed, aimed at making tools easily available and accessible, as well as flexible to enable contextualisation. An online workshop will be organized to get a bigger group together to further discuss: What is good about existing materials? What is missing? What is the best/preferred format so that tools are accessible and useable by health systems?

REDRESS

REDRESS, profiled in the August 2024 Update, is a comprehensive project in Liberia focused on severely stigmatizing skin diseases including leprosy. The very comprehensive combined REDRESS manual was presented by Rosalind McCollum (Liverpool School of Tropical Medicine) and Emerson Rogers (MOH Liberia). The manual includes not only training materials, but also pre-and post-tests and reporting tools. There is an all-condition algorithm (page 112) which is useful as a wall-chart for mid-level Health Workers. It is Liberia-specific in terms of diseases included, but it can be adapted to other contexts as well. There are multiple tools embedded in the manual as annexes, for example the Basic Psychological Support for person affected by NTDs (BPS-N), a diagnostic communication job aid, and mental health indicators within NTD case management.

Day 3: 22 January

Building sustainable financing for NTD programs: tools, challenges and collaborative solutions

The Task Force for Global Health has been working on Pathways to Sustainable NTD Elimination with the aim to empower and equip stakeholders with the tools and strategies needed to sustain the progress made in the elimination and prevention of NTDs, especially Onchocerciasis and Lymphatic Filariasis. By investing in the capabilities of national program managers, this initiative enhances advocacy efforts, bolsters the effectiveness of NTD programs, and positively impacts broader communities.

The tool can be downloaded at the link above in English and French, and Spanish and Portuguese versions will become available. There is an e-course consisting of 5 modules that you can access online. The tool helps to identify actors, including those who would normally not be thought of, to mobilize domestic resources and support the NTD programme, and to identify challenges and opportunities. Experience in Togo showed that the tool enables a full understanding of the messages that need to be drafted, and it can help engaging stakeholders. MoUs with MoH for medication supply and in-country distribution is another example. The tool also helps to understand how to present the return on investment.