From Vientiane to Phnom Penh (and Beyond): What We've Learned About Documenting NTD Success

In the many end-of-year roundups of annual global health achievements, you may have seen that Laos and Cambodia have both recently eliminated trachoma, a neglected tropical disease (NTD) which can lead to blindness. In a national celebration last week, Ambassador Rena Bitter, U.S. Ambassador to Laos, offered her congratulations to the government of Laos on "achieving this wonderful milestone—eliminating trachoma as an endemic threat."

For Laos and Cambodia, this milestone signifies that future generations will be protected from a blinding disease, and resources that would have gone toward treating new infections can be used elsewhere. In a global sense, validation of these countries—only the fourth and fifth countries to achieve trachoma elimination worldwide—provides important evidence that elimination is possible.  

For my team, this is also special, as we have supported the ministries of health in both countries to develop their elimination dossiers, the official documentation required for achieving validation from the World Health Organization (WHO) of trachoma elimination as a public health problem. This is the sought-after WHO stamp of approval. It’s a wonderful achievement and deserving of international recognition.

I’ve personally devoted more than 10 years of my career to NTD control and elimination. In my current role on the ENVISION project, USAID’s flagship for NTD control and elimination, I have the pleasure of seeing the incredible results in near real-time, as countries complete disease mapping, reach critical points where treatments are no longer needed, and continue to survey areas to ensure the gains are lasting.

It is incredibly exciting to see the progress towards elimination. Laos and Cambodia are early in a long list of countries on the horizon; they are among those countries paving the way, giving hope, and helping the global community learn from the process.

Around the world, we are working to consolidate the achievements and successes of ENVISION-supported countries into elimination dossiers. Since 2014, we have supported Ministries of Health to compile data, strategize how to fill remaining gaps, and begin drafting narrative sections. Over the next 18 months, we will be supporting dossier preparation in 16 countries for lymphatic filariasis and 14 countries for trachoma. 

Some of these countries are still several years from achieving elimination. Why start so early? Our experience has taught us that the time to prepare for elimination is now.

Here are a few things we've learned thus far:

• Start early: In our efforts, we’ve found you can never start country dossiers too soon. The process of gathering, reviewing, and cleaning historical data – sometimes dating back more than 20 years - can be cumbersome. Perhaps more importantly, if gaps are found, national programs need time to fill them.
• Double back: We've found that sometimes additional work is needed, especially where new guidance is available or where mapping results have been unclear. The earlier the national program starts to think through the process, the sooner it can double back and take the necessary measures to clarify or gather more data in these districts.
• Think long-term: The dossier preparation process has been incredibly useful for long-term planning for surveys and surveillance efforts. Countries have used this process to map out the way forward and to plan for the resources required after elimination is achieved.
• Allocate resources: Preparing a dossier requires resources. Think of it like the dissertation of the national NTD program efforts—it needs a champion and will require time and effort to carry the process through to completion.
• Involve WHO: In Laos and Cambodia, early preparation allowed national programs to get feedback from WHO prior to official submission. In our experience, receiving WHO guidance early helped ensure the final product included the quality data needed to get programs across the finish line. It also helped WHO to plan for their review and approval process.  
• Be holistic: Remember that elimination of both lymphatic filariasis and trachoma requires national programs to address aspects of morbidity and disability. Early preparation of the dossier can be a good reminder of all the elements required. The process may also help garner the political will to start or advance those activities.

I've been profoundly moved by the amount of work that has made these draft dossiers possible. Not just the documents themselves, but the years of national NTD program efforts that they capture and represent. The progress from the initial 'proof of concept' for NTD control and elimination, to where we stand today, is remarkable. 

My sincerest congratulations to Laos and Cambodia on the elimination of trachoma.  I look forward to working with many ENVISION-supported countries in the days and months to come, to consolidate their successes and continue dossier preparations.