Reaching the Last Mile Fund is advancing health equity in Africa

Neglected tropical diseases affect more than a billion people. They contribute significantly to poverty and inequality but remain largely invisible in the global health agenda.

I’ve been working in the health sector for decades, with a focus on eliminating neglected tropical diseases (NTDs), and I’ve witnessed the lack of funding and research devoted to these conditions. This neglect is one of the most persistent injustices in global health. It has significantly hindered our progress towards reaching the last mile and eliminating these preventable diseases.

At Sightsavers, we’re proud to be involved in several international partnerships that aim to meet the funding gap and combat NTDs. This includes the Reaching the Last Mile Fund (RLMF), an ambitious programme that is speeding up the elimination of two neglected tropical diseases (onchocerciasis and lymphatic filariasis) across most of Africa.

One of the biggest challenges for any health programme is accessing and providing treatment to remote or marginalised groups of people. In our work, we prioritise reaching these groups, so that everyone has an equal chance at a life free from disease.

Empowering communities to lead the fight

One of RLMF’s key aims is to support mass drug treatment campaigns to protect people against onchocerciasis and lymphatic filariasis, two NTDs that cause skin damage and chronic disability. Lymphatic filariasis can lead to severe disfigurement, while onchocerciasis can cause permanent blindness.

Over the past year, Sightsavers has worked with health ministries and partners to deliver more than 56 million treatments across Guinea-Bissau, Liberia, Nigeria and the Democratic Republic of Congo. Wherever we work, we make sure communities themselves take a leading role.

Through ‘micro-planning’ sessions, we support local people to decide the best ways to reach marginalised groups – including people with disabilities, women and girls, and people living in insecure areas or remote settlements – to make sure no one is left behind.

People with disabilities

People with disabilities often face huge challenges in accessing treatment. It is difficult for them to travel to schools, clinics or town squares where drugs are being distributed, and information about drug treatment campaigns is often inaccessible.

To overcome these challenges, we encourage communities to include people with disabilities in their micro-planning sessions. This has led to new approaches in some areas – for example, volunteers will often travel house-to-house with treatments so that no one is missed.

Tackling stigma and strengthening health systems

We also help governments to treat people who are living with the long-term effects of lymphatic filariasis. This includes people with lymphedema, which may cause severely swollen limbs, and men with hydrocele (a painfully swollen scrotum).

People with these complications often experience significant barriers in accessing treatment and securing a livelihood, which negatively impacts their quality of life. Sightsavers addresses this through the Eliminating Lymphatic Filariasis in Africa (ELFA) initiative, which is part of RLMF and is funded by UK international development.

The burden of stigmatisation

It is possible to reduce the swelling and discomfort of hydrocele with a simple surgical operation. But men with the condition are often exposed to stigma and discrimination from other members of their community, leaving them reluctant to talk about their condition and seek treatment.

Through the ELFA initiative, we’re finding ways to break this stigma. This often involves educating communities and dispelling any myths and superstitions around lymphatic filariasis.

We also engage female community members, recognising that they often act as caregivers, and have a vital role to play in encouraging men to seek care. We’re aware that many men only talk to their wives about their condition, so we hope that women can play a role in persuading their husbands to agree to have surgery.

The need for stronger health systems

Sightsavers also works with national governments to ensure that health systems can provide hydrocele surgery to men who need it.

We train surgeons in new techniques and support them to pass on their knowledge to other doctors in their local areas. We also help health ministries to assess surgical facilities and make sure they’re meeting the right standards. This helps countries to provide health care on a more equal basis for those patients who are living in rural and remote areas.

Why do we put so much emphasis on inclusive health programmes? Because we’ve seen that providing equal access to health care can bring benefits that go far beyond disease elimination. This can help more children to stay in school, more adults to earn a living, and can improve productivity on a global basis.

I’m proud to say that through programmes like RLMF, we’re contributing to achieving this future for people around the world.