International Coalition for Trachoma Control

This year on Universal Health Coverage Day (12 December) we reflect on almost a year since the start of the COVID-19 pandemic, which has emphasized the critical need for robust and resilient health systems that protect health for all. Universal health coverage (UHC) means that all people and communities receive the quality health services they need, without financial hardship and this blog reflects on the ways in which investments in trachoma and neglected tropical diseases (NTDs) can support a global vision of health for all. 

Trachoma, the world’s leading infectious cause of blindness, affects the world’s most remote and marginalised communities. People affected by trachoma often have limited access to essential infrastructure, including clean water and sanitation and formal health services, which allows trachoma and other neglected tropical diseases to thrive.

Global commitments to the achievement of UHC, through the Sustainable Development Goals, have provided a platform to advocate for people affected by trachoma and ensure that no one is left behind. Furthermore, it has provided an opportunity for trachoma programmes to directly contribute to the achievement of UHC by improving the resilience and sustainability of health systems.

Trachoma programs contribute to the achievement of UHC in several ways. In many settings, trachoma interventions are embedded into routine eye health services to ensure that incident cases of trachomatous trichiasis (TT), the late blinding stage of trachoma, can be identified and managed after trachoma programs end. 

For example, in Mali, the national trachoma program is integrated into the national eye health program (Program National de Santé Oculaire-PNSO). Surgeries are performed by medical assistants in ophthalmology or by technicians specializing in ophthalmology, who are trained through the Institut d’ophtalmologie tropical de l’Afrique and the Institut National de Formation en Sciences de la Sante. The integration of surgical interventions into the national eye health service helps to maintain the quality of TT management, with the Institut d’ophtalmologie tropical de l’Afrique including a specific surgery module on TT and providing supervision to those practicing surgery. 

Building the capacity of health workers is critical to achieve UHC. Through innovations such as the TT Tracker, launched in 2019, surgeons, assistants and supervisors are able to collect and analyze information about surgical outcomes and performance, and to determine when and where follow-up appointments are required. This improves the efficiency and effectiveness of programs by allowing supervisors to monitor activities, improve data quality, and identify health workers that require additional training to provide quality care. The TT Tracker was developed to support surgical interventions for trachoma but has since been adapted to other eye health issues like cataract correction surgeries, and in 2021 will be adapted for other NTDs, including the treatment of hydrocele for people with lymphatic filariasis.

In the World Health Organization (WHO) Region of the Americas, national programs are increasingly integrating trachoma interventions into broader health care packages, to improve the health of some of the region’s most remote and hard to reach communities, including indigenous populations living in the Amazonian Basin.  

In Colombia, the Ministry of Health has integrated trachoma interventions into primary health care for hard-to-reach populations. This includes the integration of mass drug administration with vector-borne disease platforms to bring treatment for trachoma and soil-transmitted helminthiases with integrated vector control management actions to communities also affected by this group of diseases, such as malaria, leishmaniasis and arboviruses. These actions are funded by the health system through resources allocated by the national government for public health interventions at the local level, and actions are implemented by health care workers that are paid by the health system and use their local capacities. 

Similarly, in Venezuela, health services are integrated to service hard to reach communities and provide trachoma rapid assessments while identifying and treating malaria cases, providing vaccinations for children and adults, and ophthalmologic screening of eye diseases. This integrated delivery of health services is conducted with Ministry of Health resources, including health workers at the local level, medicines, and rapid tests.

In September 2020, Myanmar became the 10^th country to be validated by WHO for eliminating trachoma as a public health problem. In order to sustain progress, Myanmar has taken several steps to ensure the sustainability of elimination. Most notably, trachoma is integrated into its National Eye Health Plan 2017–2021, which aligns with the Global Strategy for Prevention of Avoidable Blindness (VISION 2020) and the WHO Universal Eye Health Global Action Plan 2014–2019, which aimed to coordinate eye-care services and advance the country towards UHC. This is now supported by the focus on integrated people centred eye care, guided by the 2019 published WHO World Report on Vision.

The integration of NTD interventions into routine health services is critical to sustain progress towards trachoma and ensure that health systems are equipped to respond to new cases efficiently and effectively. To support this, the International Coalition for Trachoma Control has developed three transition toolkits for program managers and implementing partners to support the transition of SAFE (surgery, antibiotics, facial cleanliness and environmental improvement) interventions from elimination efforts to routine public services.

The COVID-19 pandemic has demonstrated the importance of strong, resilient health systems that reach all segments of society. Trachoma programs have an opportunity to contribute to the achievement of UHC and help to ensure that health systems are equipped to tackle any health challenges, from COVID-19 to non-communicable diseases and beyond. This Universal Health Coverage Day, we call on all NTD stakeholders to redouble efforts in support of the partnerships and multi-sectoral collaborations needed to achieve the WHO road map of NTDs 2021-2030 and the Sustainable Development Goals target towards UHC to provide a healthy future for all.