Lessons from the field: Restarting NTD programs in a pandemic

Neglected tropical disease (NTD) activities around the globe were halted at the onset of COVID-19 pandemic. Now, following World Health Organization (WHO) guidelines, many national governments are resuming activities worldwide.

On USAID’s Act to End NTDs | East program, our teams are continually gathering new insights as we support governments to restart NTD activities. Learning and adapting are essential when conducting NTD activities amid an ever-shifting global pandemic. Despite some distinctions, Act | East staff are seeing common trends, challenges, and best practices emerge across our supported countries in Africa, Asia, and the Americas:

1. Physical distancing is one of the most challenging COVID-19 protocols to implement during mass treatment campaigns and surveys — and solutions differ for each community. During a lymphatic filariasis (LF) survey in Indonesia, surveyors found that going door to door to collect samples attracted fewer onlookers than having people gather at a central location. On the other hand, in Uganda, LF survey teams engaged the village head and a local guide to gather participants at a fixed location, enabling surveyors to work quickly and helping to prevent crowds from gathering. In Nepal, Female Community Health Volunteers brought people to sample collection booths in small groups to support distancing.

2. Advance community engagement is more critical than ever. Government officials must engage local communities well in advance of any NTD activities to discuss how COVID-19 protocols will be followed and to give communities time to prepare. In Nepal, for example, survey teams found communication very important to inform district authorities and communities not only about the LF survey plans, but also to outline the COVID-19 precautions to be taken by the survey team and the expectations for the same cooperation with risk mitigation from the community.

3. Successful NTD activities require even closer coordination with local officials. The COVID-19 pandemic inserts more uncertainty into our operating environment. A close relationship with local officials can therefore help NTD teams adapt plans as local conditions — such as the COVID-19 case count — changes. In Uganda, district-level COVID-19 committees supported the supervision of risk mitigation practices and provided daily updates on changing COVID-19 numbers to survey teams. The strong involvement of the district health office also made the community feel more confident that the survey was safe.

4. Supervision can be done remotely. Usually, health ministry officials and Act | East staff directly supervise NTD activities to monitor progress and ensure quality. To lessen the number of external people entering communities, teams found creative ways to conduct supervision remotely. In Tanzania, health officials supervised the distribution of schistosomiasis treatment remotely using photos, texts, and calls with zonal coordinators. Many countries are also using specific COVID-19 checklists for remote supportive supervision, along with intensified trainings for district and local teams.

5. It is important to consider the unique needs of each community when planning for protection measures. In Uganda, for example, many of the communities where LF surveys were being done lacked adequate public hand washing facilities — so the team set up survey sites outside of schools and church compounds that did have facilities to use. LF survey teams in Nepal noted that more masks were needed for participants of surveys in remote communities where mask wearing is not common.

6. Populations have shifted amid the pandemic. In some communities, we found that population numbers have changed significantly due to urban to rural migration during COVID-19. In Uganda, many urban dwellers had returned to their home communities during a mass treatment campaign for onchocerciasis, which mean the teams were not prepared for the increased size of communities. Additional days of treatment had to be added to meet the community needs.