Nigeria’s floating slum city of Makoko is separated from the gleaming high-rises of mainland Lagos by a bustling 12-kilometre overpass winding over the black-water lagoon. Look to your left while driving along the Third Mainland Bridge, one of the continent’s longest, and Makoko materialises almost as quickly as it disappears.
To glimpse the low-lying skyline of roofs wrought of wood and corrugated iron tells you of what it isn’t – of what has not happened there that should have – reminding us, for those brief moments when our attention is turned to Lagos proper, that we’re not really engaged with what happens there. Our instinct, naturally, is to look away.
Typical of the many marginal spaces on the peripheries of large cities, the streets of Makoko are disproportionately crammed with the surplus populations that result from uneven development. Collateral communities borne of poor health; too many people either crippled by disease or disheartened by joblessness.
We look away because we do not know what we can do. We would rather not see. We fall into a pattern of looking away, whether we’re in Mumbai or here in Lagos. But even after we’ve left, put a bridge or a plane ride between ourselves and the place, its people and its problems, the sense that something can be done is not as easy to leave behind.
There is an alternative to looking away. Improving the primary health system in low-income countries by tackling the treatment and health of the population rather than the individual offers a highly effective, low-cost path out of the cycle of poverty and disease.
Having a systematic focus on Africa’s high infectious disease burden can help free the continent’s peoples from poverty, so they can fully pursue their own prosperity.
Good health boosts a community’s ability to develop human capital, pursue economic activities, and attract investments. Equally, lowering the cost of doing business allows investors the freedom to put their money to work in communities where capital can offer a bridge to improved livelihoods.
A labour force prone to sickness turns into higher health care costs to employers, eating away at potential returns, and ultimately deterring investment.
Back in Makoko, many of the people you meet there and in similar communities around the country, suffer from a group of parasitic and bacterial diseases referred to as neglected tropical diseases or NTDs.
Over 1.5 billion people in the world’s poorest countries need treatment for NTDs, with Africa accounting for over 40 percent of the global NTD burden.
This high burden of disease and costs to quality of life have resulted in a two-decade gap in life expectancy between the richest and poorest countries, as well as sharp losses in productivity and school attendance among young children.
A study by Erasmus University in the Netherlands shows that meeting the WHO’s 2020 goals for the five most common NTDs in Africa would save the continent $52 billion by 2030 and avert 100 million years lost to ill-health, disability, or early death.
An approach that prioritises primary health, targeting NTDs through the mass distribution of medicines, especially to rural areas, at a cost reduced by the generosity of pharmaceutical companies that donate the needed medicines, presents a real opportunity to build that bridge out of poverty and disease to a better life.
This approach also involves collaboration between governments, health organizations and philanthropic partners with a common understanding of the link between poverty and disease. Supporting the expansion of national community health worker programs to promote primary and preventative health year-round is a key component.
In Rwanda, an NTD control program driven by the health ministry, with the initial investment from the Legatum Foundation, saw, for instance, the prevalence levels of intestinal worms, a major cause of infectious disease, decrease by over a third from 65.8 percent in 2008 down to 45.2 percent in 2014.
The Rwandan program was rooted in the principle of good epidemiology and a willingness to partner with private donors. It began with a year-long, country-wide NTD screening by the health ministry to gain a systematic understanding of the disease profile. This was followed by a mass rollout of drug distribution, paired with the upgrading of health equipment, information systems as well as training of health workers and outlay of education programs aimed at households and customised to meet their specific disease challenges.
Rwanda’s economic growth story is well-known, but less so are these details of the public health reforms and improvements supporting this growth. Rwanda, between 2010 and 2015, has successfully reduced total health expenditure as a percentage of GDP by about 2 percent. Nigeria, in comparison, has seen health expenditure remain at the same levels over the same period, meaning national budgets and those of households could not be freed for spending on schools, roads, and housing.
What can we learn from this model and how it translates to a more populous country like Nigeria and urban populations found in communities like Makoko?
We shouldn’t overstate the applicability of the Rwandan model elsewhere in Africa, as countries vary wildly in size, population, and available resources. The successes achieved in Rwanda can, however, serve as a demonstration of what is possible with dedicated and trusted partners with a common purpose.
If you can end NTDs in a country like Rwanda, however small, it can be done in progressively larger and more complex countries. For Nigeria, it may be that there are many “Rwanda’s” within the country, ready to pair private investment – perhaps even home-grown – with local implementing partners and the government to tackle NTDs.
Organisations like the END Fund are working to strengthen local health systems, deepen knowledge about NTDs, and integrate with local efforts to scale up community health worker programs. They leverage private philanthropic capital, with the knowledge that every dollar invested in NTD control produces between $27 and $42 worth of economic benefit. For business leaders and corporations, investing in ending NTDs is probably the highest and most measurable return you can make to the charitable or corporate social responsibility dollar. Not only high but quite visible and measurable.
The lesson is perhaps not to look away but to look at a little closer. Let’s see how many more success stories we can create, together.