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What we’ve learned from trachoma elimination in Ghana

Sarah Bartlett, September 2018

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In August, an event was held in the Ghanaian capital, Accra, to celebrate the country eliminating blinding trachoma as a public health problem.

Ghana has made history as the first country in sub-Saharan Africa to eliminate the disease and joins Cambodia, Laos, Mexico, Morocco, Oman and Nepal in this achievement. With celebrations continuing, at Sightsavers we’re reflecting on our involvement in this milestone, what we’ve learned from the experience and the work that lies ahead.

Sightsavers’ role

Sightsavers was part of group of non-governmental organisations (NGOs) that founded the Ghana Trachoma Programme, drafting the first strategic plan to control trachoma in coordination with the National Eye Health Programme. Our support focused on training ophthalmic nurses, many of whom later became surgeons for the trachoma programme.

We came in stronger in 2010 to support programme implementation: promoting house-to-house screening to find the final people who needed surgery or antibiotic treatment, conducting the pre-validation surveillance survey in all previously known endemic districts, and helping to develop the trachoma elimination dossier – a comprehensive template that must be submitted to the World Health Organization (WHO) to validate that a country has reached its elimination targets.

The biggest lessons we learned

It’s all about the data. Countries should start gathering data for their WHO dossiers now: this includes the narrative sections, not just survey data. The dossier is much less of a burden at the final stage if it’s already in progress.
Every country must have a driver. Ministries of health and implementing partners are busy, often juggling multiple initiatives. It’s important that someone drives the process forward, keeping everyone on schedule so the ultimate goal can be reached. The ministry of health is always the lead, of course, but with permission other partners can play an important support role.
Health systems strengthening can’t be overlooked. Trachoma must be linked into the national surveillance system and any existing health management information systems so that countries can continue looking out for cases. This also involves training, to make sure health facility staff can identify the disease.
Partnerships really are key. From community health volunteers to field teams to ministry of health representatives, funders and implementing partners, you can’t take one player out of the equation and achieve the same result.

An eye health worker uses a torch while checking a man's eyes for trachoma.

What happens now?

First, it’s important to note that in Ghana the work is not over. We mentioned above that trachoma will continue to be tracked at district level in the event that new cases appear. Communication about behaviour change will also continue: for example, two previously endemic regions will continue to use trachoma messages in their posters and jingles so people keep up the good behaviours that helped us reach elimination.

On the research side, Sightsavers’ Laura Senyonjo, Dr Agatha Aboe and David Agyeman are working with the Ghana Health Service to review the trachoma surveillance strategy and assess its ability to identify potential resurgence of infection and transmission.

Looking beyond Ghana, The Gambia, Mali, and Togo are believed to be submitting their dossiers to WHO next year. Other countries, such as Malawi, are close and will be going through the two-year disease surveillance period before submitting the dossier.

Above all, success in Ghana has inspired everyone who works in neglected tropical diseases: it’s a tangible example of a country eliminating a once-endemic disease. We have a roadmap for success, and we will be following it in all the countries where we work. Congratulations to everyone involved!

“Ghana is a tangible example of a country eliminating a once-endemic disease”

Author

Sarah Bartlett
Sarah is Sightsavers’ mHealth adviser.

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