Community-based-rehabilitation: empowering rural Sub-Saharan African communities to tackle NTD-related disabilities.

 

Neglected tropical diseases and their related disabilities in rural Sub-Saharan Africa

Neglected tropical diseases (NTDs) are a category of twenty tropical infections that affect more than 1 billion people worldwide who reside in poor and low-resource communities.  According to the World Health Organisation estimates, Africa  accounts for 40% of the worldwide NTDs burden, disproportionately affecting rural communities. Poverty is a major determinant of NTDs in Sub-Saharan Africa (SSA), where over 73% of the population lives on less than US$2 per day. Although mostly preventable and treatable, NTDs can result in disabling and disfiguring problems that negatively impact the quality of life, as the link between NTDs and disability has been brought to light. It is not surprising that NTDs contribute to discrimination, stigma, and social exclusion as they are more likely to result in (chronic) disabilities and morbidity than mortality. One study in rural Nigeria found that persons with Lymphatic Filariasis experienced different forms of stigma and discrimination, affecting their wellbeing, relationships, work and participation in community life. Traditionally, people with NTD-related disabilities have been isolated and marginalized from their communities. However, in recent years, there has been a growing emphasis on community-based rehabilitation (CBR) as a way to empower rural SSA communities to tackle NTDs-related disabilities.

Rural settings in sub-Saharan Africa (rural SSA) often lack sufficient access to healthcare services and consequently bear a disproportionate burden of NTDs. Besides the healthcare challenges they face, these areas suffer from isolation due to distance and are characterized by limited resources, economic instability, and inadequate infrastructure. Despite these obstacles, rural communities in SSA display remarkable strengths and capabilities essential for addressing these challenges and achieving sustainable development. Recognizing their potential is crucial, taking into account the diversity and unique characteristics of each community within rural SSA. While generalizations are made in this article to emphasize the importance of employing Community Based Rehabilitation (CBR) approaches throughout the region, it is vital to acknowledge that each rural SSA community possesses its own context and distinct qualities.

Community-based rehabilitation strategies and current implementation to address disabilities caused by NTDs in rural SSA.

According to the World Health Organisation, CBR, is defined as “a strategy within general community development for the rehabilitation, equalization of opportunities, and social inclusion of all people with disabilities”. Thus, people with NTD-related disabilities, their families and communities, as well as concerned organizations, must work together to implement CBR.

CBR programs for NTDs have been implemented in various regions across the globe, especially in sub-Saharan Africa and provide numerous benefits. The Mind-Skin-Link Project by the Christian Blind Mission in Nigeria holistically ensured access to mental health services for people with NTDs. This was achieved through the training and supervision of volunteers and community healthcare workers to identify mental health issues and support people living with NTDs. This support also includes health education campaigns to raise awareness about NTDs prevention and promote early treatment. In Ethiopia, the Vision Community-based Rehabilitation Association (VCBRA) established early intervention programs that improved the health, education, and livelihood of community members with disabilities, including those from NTDs. Capacity-building workshops and activities, including home management of lymphatic filariasis for affected people in the Upper West Region of Ghana, resulted in significant improvements in self-care. These CBR programmes were aimed at promoting the dignity and rights of people with NTD-related disabilities, reducing stigmatization and promoting social inclusion.

As communities have various assets and capacities that must be recognized, utilized, and developed even further, hence, CBR is a great approach to ensuring community participation and sustainability by promoting the creation of local solutions for local problems.

Fostering CBR for NTD-related disabilities in rural SSA; challenges and evidence-based recommendations

Community-based rehabilitation is crucial for the effective management of NTD-related disabilities, particularly in resource-limited settings. Assessing existing approaches to the management of the disabilities caused by NTDs will help identify gaps in current community-based rehabilitation approaches, enabling the improvement of current techniques and the introduction of more advanced strategies.

Fostering CBR approaches for disabilities associated with NTD in rural SSA can be challenging. The two main challenges facing the usage of CBR services for NTD-related disabilities as seen in a rural setting in Africa are limited healthcare resources and a shortage of health workers with the skills and training needed to care for affected patients and also implement CBR techniques for NTD-related disabilities.

To tackle these barriers, various strategies must be employed. Firstly, stigma must be addressed by raising awareness about NTDs and related disabilities to encourage affected persons to seek care openly without fear or shame. Additionally, it is crucial to adequately train and upskill community healthcare workers. Furthermore, CBR services for NTD-related disabilities must be made accessible and affordable considering that affected persons live in rural settings plagued by poverty. By implementing these measures, CBR for NTD-related disabilities can be highly effective in rural SSA.

The 2021–2030 NTD roadmap along with the inclusion of NTDS in the SDGs offer immense opportunities for governments, policy makers, organizations and relevant stakeholders towards collaborating with people affected by NTD- related disabilities to prioritize and address tackle NTDs across rural SSA, through the achievement of Universal health coverage and a commitment to leave no one behind.

 

About the Authors: Archibong Bassey (MPH) is a dedicated Public Health Professional with a wealth of experience spanning five years working with local and international organizations across a wide range of health and development-related issues aimed at achieving health equity and sustainable development. He was a recent commonwealth scholar at the University of Warwick, United Kingdom, where he earned his Master’s degree in Public Health (MPH).

Nsikakabasi George (MPH) is a Public Health Practitioner with over 4 years of cross-cutting experience across Health Policy and Management, Epidemiology, Health Financing, and Global Public Health, working with local and international organizations which target sustainable development. He works as the Program Manager for the ZeroNOMA Initiative, an organization pushing for the eradication of Noma and NTDs in Africa.

Usoro Akpan is a young, passionate public health researcher with expertise in NTDs and a focus on improving the wellbeing of marginalized communities affected by these diseases in Africa. As an assistant lecturer of Applied Epidemiology of Infectious Diseases at Arthur Jarvis University in Nigeria, he is dedicated to addressing the complex challenges associated with NTDs and advancing public health.

Competing interests: None

Handling Editor: Neha Faruqui

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