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INVESTING TOWARDS UNIVERSAL COVERAGE AGAINST NTDS − CHAPTER 2
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Beyond charity
Excluding medicines, the investment target for universal coverage against NTDs
averages US$ 2.1 billion per year over the period 2015–2030. This target approaches the
US$ 2.5 billion that was spent on malaria control in 2012, but is less than the
US$ 5.1 billion that the malaria control community has estimated is required on average
each year (33,10). It is aimed at reducing a global burden of disease equivalent to about one
half of that for malaria (6,7). Investments in universal coverage against NTDs will not be
trivial – neither in their scale nor in their impact. The role of foreign donors and community
volunteers in the progress made in NTD control to 2015 is highlighted later in this chapter.
However, NTD control needs to become an integral part of national health plans and
budgets and rely less on charity if it is to achieve universal coverage.
Reliance on foreign donors and community volunteers becomes problematic when it
results in fragmented NTD projects that fail to deliver the high levels of sustained coverage
that are required to interrupt transmission. The investment target for universal coverage
against NTDs is about 10 times the US$ 200–300 million disbursed or committed by foreign
donors during 2012–2014 (34). It is unlikely that an increase of this order of magnitude can
be achieved in the current global health financing climate. Studies of the cost of preventive
chemotherapy reviewed for this chapter indicate that unpaid volunteers were used in
about 80% of sites. In studies in which the opportunity cost of their time was estimated,
it comprises 8–60% of the total. The role of community health workers will continue to
play a role in universal coverage against NTDs; but fully-scaled NTD control programmes
covering over a billion people cannot expect to recruit and retain sufficient numbers of
volunteers if other major disease programmes are offering incentives.
2.4.3 Investment targets for low- and middle-income countries
Where do most of the investments in universal coverage against neglect need to be made?
In this section, investment targets are broken down by groups of low- and middle-income
countries. Middle-income countries include both lower-middle-income and upper-middleincome
countries.
Fig. 2.5 combines investment targets for preventive chemotherapy excluding medicines,
surveillance after preventive chemotherapy, yaws eradication and vector control under
the heading of “prevention”. The investment target for prevention during 2015–2030 is
US$ 30 billion. Most of the investment in prevention is required in lower-middle-income
countries – US$ 11 billion including vector control or US$ 3.0 billion excluding it.
Investment targets decrease as diseases are eradicated, eliminated or controlled such that
the frequency of interventions can be scaled down. In upper-middle-income countries,
targets for prevention are made up almost entirely of investments in vector control.