The COVID-19 pandemic presents some extraordinary challenges for people living with neglected tropical diseases (NTDs) and the programs which address their spread and impact in the community.

In April, the World Health Organization recommended that core elements of NTD programs – such as community- and school-based mass drug administration, training for health care workers, and community-based surveys – be postponed due to COVID-19. Their initial guidance has been followed up with two further communications on community-based health care and essential health services.

As the world grapples to cope and respond to COVID-19, it has become clear that NTD programs have a unique role to play in leveraging their networks and resources to help protect vulnerable communities during the pandemic while NTD activities are paused. Here, we will highlight one program that quickly pivoted to address COVID-19 in Liberia.

effect:hope: NTD program adaptation in Liberia during COVID-19

effect:hope is a Canadian non-governmental organization that works across different countries in Asia and Africa with partners and national NTD programs to address the causes and consequences of NTDs.

effect:hope has been working in partnership with the NTD program at the Ministry of Health in Liberia, since 2012.

Man receiving treatment for skin lesion, Liberia. Photo credit: effect:hope

Liberia is one of the poorest countries in the world with limited access to general health care, including affordable treatment for the chronic manifestations of NTDs. The effect:hope program integrates diagnosis and treatment for NTDs within the health system (called integrated case management). Critical barriers to care are minimized as community health workers are equipped with the basic knowledge to identify a person living with an NTD and refer them to a health facility for treatment, if needed.

The partnership between effect:hope and the NTD program in Liberia was active through the 2014-2016 Ebola virus epidemic in Western Africa. effect:hope developed its current approach to COVID-19, in part, from learnings from that period. A key learning during the Ebola virus epidemic was the importance of timely program adaption and support of the health system, to minimize the impact of a disease outbreak.

effect:hope’s revised approach in Liberia during the COVID-19 pandemic has two main streams:

1. Adapting current program activities to minimize disruption and risk to healthcare workers and program staff; and
2. Undertaking new activities that leverage the reach and expertise of the NTD program to support a COVID-19 response.

Under these streams, effect:hope have boosted their focus on community-based health services, recognizing that travel to healthcare facilities further away is not possible for people needing continued treatment or diagnosis. The NTD program has been raising awareness of COVID-19 within the communities it reaches; training community health workers on COVID-19 and the safe use of personal protection equipment. The communication and engagement channels used by the NTD program have been immensely valuable and have been re-purposed to increase community understanding about COVID-19.

The effort involved to pivot and adapt to COVID-19 comes at a cost. In order to include these activities, effect:hope has reprogrammed funds to ensure primary health care services and communities are equipped with the tools and information they need to respond to COVID-19. The need for additional equipment creates an additional financial burden to ensure an adequate supply of hand washing and sanitation kits and thermometers. And while movement is restricted, setting up mobile airtime and internet packages for community-based follow up of NTD patients became a necessary added expense.

What’s next?

These are challenging times for NTD programs. Predictions about the spread and impact of COVID-19 are constantly changing and the threat of COVID-19 is not likely to disappear soon. NTD programs and community health workers are trying to adapt to a ‘new normal’ which includes the risk of COVID-19. In addition, there are challenges of re-prioritized budgets, closure of facilities and the need for PPE. All these challenges are added to the pressing health needs of the community, some of which have been exacerbated by the pandemic and the cessation of regular health care provision.

Despite these many challenges, NTD programs are in a strong position to demonstrate their value in health systems strengthening more broadly during this crisis. effect:hope’s pivot in Liberia demonstrates that the tools, structures and approaches that have been built through integrated NTD programs can be leveraged to support the COVID-19 response. Through working responsively and collaboratively, NTD programs and their partners provide a unique opportunity to support countries in responding to the threat of COVID-19.

We thank effect:hope for providing the background information to this piece. Check out more information about effect:hope and the Liberia NTD program.