Health: Neglected Tropical Diseases

Earl of Sandwich Excerpts

Wednesday 30th January 2013 Lords Chamber

[The Earl of Sandwich]

My Lords, I thank my noble friend because I know that water fleas, snails, blackfly and many other deadly insects and parasites are still infecting millions with NTDs such as trypanosomiasis and onchocerciasis. “Trips” and “oncho” became part of my vocabulary when I joined Christian Aid 40 years ago. Remembering the WHO mass-spraying campaigns in west Africa at that time, I now feel disappointment that we always seemed to be on the point of eliminating oncho but never quite succeeded.

Agencies specialising in this field have long had the target of “clean water for all”. Water is given a green light in the MDGs but this remains an enormous task —the UN says that 783 million are still using traditional drinking water supplies and one of the most successful agencies, WaterAid, now has 27 country programmes, which last year provided 1.6 million people with safe water and 1.9 million with sanitation. Oxfam and CARE have also been prominent in this field. Coming from the background of the voluntary sector, people like me can sound quite glib in describing the needs of the poorest people—all they have to do is boil their water, wash their hands and follow the advice of the nearest health centre. However, life of course is a little more complicated: the advice may be 50 or more miles away; tradition and culture dominate; and the worms and flies may be too numerous. Education is vital. Water and sanitation must be complemented with child-focused health education that promotes lifelong healthy behaviour.

I have some scepticism about the donations offered by pharmaceutical companies and the doctors they direct, and even control, in developing countries, which undoubtedly gives them a PR advantage. I am also aware of the ill effects of overprescription, which leads to dangerous dependence and painful withdrawal. I remember how subsidiaries of well known pharmaceutical companies in countries such as Bangladesh bought doctors and tyrannised village clinics that did not comply with them. I nevertheless congratulate these companies, and the charities that are contributing to this important campaign. We know that more than 700 million people have been treated for seven diseases and that the numbers treated for soil-transmitted worms have quadrupled in one year, which is nothing but impressive.

Just after DfID announced its fivefold increase in support for the NTD programme—which is to be warmly welcomed, alongside the US contribution—the Lancet asked, a year ago, whether increased funding for neglected tropical diseases really made poverty history. It pointed out the risks of undermining healthcare systems and of relying on volunteers, the gaps in the knowledge of combination drugs, and the limits in the evidence base for these drugs. Mass campaigns, although necessary to meet the MDGs, can at the same time take staff away from fragile healthcare administrations.

I have consulted Save the Children, which of course is well aware of the importance of tackling the NTDs with major campaigns. However, its key message is that, as the communities affected are often those excluded from health services, any work to ensure sustainable access to NTD prevention and control interventions should always be integrated with the strengthening of comprehensive health systems for sustainable change. Does the Minister agree with that and will she ask DfID to ensure that health workers who get involved in these interventions are always adequately remunerated, trained and motivated to support them as part of a package of essential services?