October 16, 2020

This interview was originally posted on the Neglected Tropical Disease NGO Network website.

Combining hand hygiene and broader water, sanitation and hygiene (WASH) interventions with NTD programs is one of the most cost-effective ways to improve public health. WASH, including hand and face washing, prevents NTDs like trachoma, soil-transmitted helminthiasis (STH), schistosomiasis and Guinea worm disease, and is needed for safe and dignified treatment and care. Hand hygiene is also effective at preventing other infectious illnesses, such as COVID-19. To commemorate Global Handwashing Day 2020, the NTD NGO Network (NNN) has committed to ensuring hand hygiene for all. It strives to support cross-sectoral political leadership, create an enabling environment, and promote sustainable and inclusive programming at scale.

Cross-sectoral partnerships are nothing new for NNN’s Vice-Chair, Arielle Dolegui. As a Technical Advisor for Health Systems Strengthening and Cross-Sector Coordination at World Vision, supporting the USAID-funded Act to End NTDs | West program, Arielle brings to the NNN a wealth of experience at the intersection of WASH, NTDs and education.

For Global Handwashing Day today, NNN WASH Working Group Chair and Director of Policy and Communications at the SCI Foundation, Yael Velleman, interviewed Arielle for her insights on the challenges and opportunities for coordinated programming, as well as the role of the NNN in driving this work forward and at scale as to realize hand hygiene for all.

As a Technical Advisor to World Vision, you’ve worked at the intersection of WASH, NTDs and education. Please tell us about your experience, and the impact you’ve seen on-the-ground from such coordinated programming.

In my role at World Vision, supporting the USAID-funded Act to End NTDs | West program, we have supported the institutionalization of cross-sector coordination of NTD programs. For example, we have supported the Ghana Health Service/National NTDP with the revamping and relaunch of their multi-sector coordination mechanism–the Intra-Country Coordinating Committee (ICCC)–to facilitate integration of NTDs into the national health systems’ priorities and policies and engage key sectors such as WASH and education for joint planning and implementation to sustain the elimination and control objectives of NTDs in Ghana. This has been a tremendous achievement on-the-ground as streamlined cross-sector collaboration remains the cornerstone strategy for effective NTD programming and a testament to country ownership and political will to move the NTD sustainability agenda forward. In Senegal, Sierra Leone, and Niger, we have also supported the Ministries of Health leadership in restructuring their multi-sectoral interventions, leveraging existing robust partnerships with the education sector while building and strengthening the nascent collaboration with the WASH sector to support both service delivery integration as well as behaviour change strategies and interventions.

The WASH UP! Initiative you lead teaches children proper hygiene practices to prevent NTDs via muppet ambassadors, Raya and Elmo. What additional innovations are needed to promote and sustain behaviour changes? How can the NNN promote such best practices?

WASH UP! is a school-based program that World Vision implements in over 11 countries in collaboration with Sesame Workshop and Ministries of Education. This program was expanded to include NTDs, specifically schistosomiasis and STH, as a pilot in Ghana and Niger. The play-based curriculum aims to promote positive WASH attitudes and behaviours among children and their school communities, including those with disabilities, with a focus on vulnerable populations. Targeted behaviours in the WASH UP! curriculum include safe water and food practices, increased latrine use, improved waste management, consistent handwashing, good personal hygiene, and kindness to all, including those who are sick and/or disabled.

World Vision has a long history of providing clean water and access to sanitation for millions of children and their families, a critical element in the prevention of NTDs. World Vision’s WASH programs focus on five key aspects: capacity building, sustainable water supplies, hygiene behaviour change, sanitation, and strengthened networks and management capacity among various stakeholders, including both government and communities. Recent projects include constructing and rehabilitating community latrines, digging wells, mobilizing communities to be declared Open Defecation Free, and promoting handwashing. In Zambia, World Vision supported the School Health and Nutrition Program, operated by the Ministry of Education in collaboration with the Ministry of Health, to leverage infrastructure and financial resources for NTD-focused health education curriculum. Other projects in Malawi and Uganda have also contributed to reduced prevalence of blinding trachoma through increased uptake of hygiene and sanitation practices and strengthened capacity in planning, coordination, and monitoring of trachoma control programs.

As for the NNN, via the WASH Working Group we are currently surveying the community of practice to identify WASH and NTD research priorities, from WASH-related determinants of NTDs to implementation research for improved coordinated programming to evaluating impacts of such joint efforts. Plans to develop a technical resource on behaviour change are also underway. These are only some of the examples of how the NNN is promoting best practices for NTD elimination and control.

Your career has focused on developing cross-sectoral partnerships, which will be critical toward achieving the goals laid out in the WHO 2030 NTD Road Map. What challenges persist for WASH and NTD coordination, and what role do you see for the NNN in helping the NTD community overcome these barriers?

While WASH is critical to NTDs, current major WASH providers are not seen as NTD players as they are not participating in NTD control or elimination activities in most countries. There is also a lack of interest in partnership due to limited funding and capacity. Across countries, barriers in effective NTD-WASH coordination and collaboration include: 1) siloed program design and insufficient joint implementation; 2) limited advocacy and communication strategies on NTDs and missed opportunities to raise awareness of NTDs and their impact on public health and economic growth among WASH partners; 3) coordination mechanisms largely driven by donor funding and priorities; and 4) limited coordination and planning with relevant partners from the WASH, education, and health promotion sectors to leverage on their existing platforms to support NTD program activities.

Fortunately, The BEST framework–Behaviour, Environment, Social inclusion and Treatment and care–launched by the NNN in 2016, provides a guide for the NTD community in terms of advocacy messaging, coordinated action and funding. In addition, the NNN and WHO toolkit released last January in English and French, provides a number of tools for WASH and NTD practitioners to work better together. As it is Global Handwashing Day, I’ll emphasize two such tools: a resource on NTD-related behaviours and a guide to understand behaviours for developing behaviour change interventions. Addressing behaviour change is core to our efforts to beat NTDs, both in terms of prevention through hand and face washing, as well as the promotion of care-seeking behaviours.

COVID-19 has been immensely disruptive to many public health programs, including delaying mass drug administration activities. At the same time, however, it has also created unprecedented momentum for WASH. How is the NNN responding to this urgent need, while also strengthening coordination with the WASH sector to ‘build back better’ toward 2030?

Last month, the NNN convened its annual conference, the theme of which was building resilient NTD programs in a changing world. COVID-19 was but one focal point at the conference, during which attendees noted the resulting challenges, but also this opportunity to ‘build back better’ against future existential threats. WASH was a thread throughout the conference, including exceptional workshop sessions on behaviour change programming and evidence-based, cross-sectoral programming. The NNN, through the annual conference and monthly WASH Working Group meetings, provides a unique knowledge-sharing and action-based platform to strengthen coordination between WASH and NTD stakeholders.

Individual NNN members have also led the way on WASH and NTD coordination in response to COVID-19. The NALA Foundation, for example, with the support of The END Fund, is scaling up its WASH efforts in NTD-endemic areas to address both NTDs and COVID-19. This has included the construction and placement of 100 handwashing stations in public areas, including healthcare facilities. Additionally, several members recently pitched the Bill and Melinda Gates Foundation and other partners at the NTDs Idea Forum–launched at our recent NNN conference–on the opportunity to integrate WASH messaging and programming with COVID-19 and NTDs efforts.

World Vision has also leveraged its NTD partnerships to provide technical assistance to Ministries of Health, such as the Ghana Health Service/Ministry of Health (MOH/GHS) and the Senegal Ministry of Health and Social Action (MSAS), on their COVID-19 responses to enhance their cross-sector collaboration with WASH Ministries. In Ghana, the MOH/GHS is working with the Ministry of Sanitation and Water Resources and the Ministry of Education on policies, strategies, and programs for the provision of safe water sources, rehabilitation of environmental sanitation facilities, and dissemination of hygiene promotion messages. For instance, the Community Water and Sanitation Agency provided free water access to all Ghanaians in rural areas for 3 months to help stem the spread of COVID-19. In Senegal, the national response coordination platform for COVID-19 is led by the Centre des Operations d’Urgence Sanitaire mandated by MSAS. Implementing partners, including World Vision, constructed and rehabilitated WASH infrastructure and sensitized community actors at healthcare facilities, Daaras, mortuaries, and households on hygiene practices to reduce COVID-19 exposure and transmission.

To mark Global Handwashing Day this year, the NNN has issued a statement reaffirming and even expanding upon its commitment to WASH. What message do you want to send to the NTD community regarding hand hygiene for all?

The NNN is committed to hand hygiene for all and WASH more broadly as to sustainably eliminate and control NTDs. Our commitment to this issue covers political leadership for cross-cutting WASH and NTD policies, budgets and coordination mechanisms; an enabling environment that fosters collaboration between our sectors and a lively exchange of experiences and best practices; and, finally, sustainable, inclusive programming at scale through our work to develop technical resources and a research agenda for behaviour change interventions. The NTD community, including and beyond the NNN, has and will continue to be an effective partner to the WASH sector; however, as we look to the next decade and the Sustainable Development Agenda, it is evident that we must identify new and better ways to work more effectively together as to fast-track progress. I call on NNN members and the wider NTD community, including NTD-endemic countries, development partners, donors and the WHO, to prioritize critical WASH investments and interventions in NTD-endemic areas, reinforce hygiene behaviours for NTDs and promote joint leadership at the local and ministerial levels toward these ends. This collaboration is needed to achieve hand hygiene for all and a generation free from NTDs by 2030.

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