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32 THIRD WHO REPORT ON NEGLECTED TROPICAL DISEASES
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2.5 Towards an investment case for NTDs within universal
health coverage
In the context of UHC reform, “countries should primarily first expand coverage for
low-income groups, rural populations, and other groups disadvantaged in terms of service
coverage, health, or both” (35). This “progressive universalism” signals a commitment to
include the least well-off from the very beginning of the path towards UHC. WHO has
outlined a three-step process:
1) categorize services into priority classes;
2) first expand coverage for high-priority services to everyone; and
3) while doing so, ensure that disadvantaged groups are not left behind.
Evidence-based categorization of services into priority classes (step 1) has typically relied
on studies of effectiveness and cost–effectiveness. In the context of priority-setting for UHC,
multi-criteria approaches are being advanced that recognize that societies are not interested
only in the costs and effects of a given intervention at the country level; they are interested
also in the distribution across population groups – in particular socioeconomic groups – of
those costs and effects.
2.5.1 The investment case based on cost−effectiveness
The literature on the cost-of-illness, cost–benefit and cost–effectiveness of NTDs and their
control is cited in Chapter 4 of this report. The results, usually specific to a setting, need to
be assessed to determine whether they are “generalizable” – meaning that similar results
are expected in other settings. Only then can they inform priority-setting at the country,
regional or global level. The last major attempt to synthesize the available evidence on cost–
effectiveness and prioritize NTD and other infectious disease interventions at the global
level was in 2006, in the second edition of the Disease Control Priorities Project. Of note
also is the effort in 2012 to bring together the economic evidence in favour of a One Health
approach to human and animal health, including the neglected zoonotic diseases (36).
Interventions for NTD control were among the most cost–effective interventions
assessed by the Disease Control Priorities Project (second edition). Since then, their cost
to national health systems has been further decreased by the donation of medicines by the
pharmaceutical industry. New tools and strategies, such as vaccine development for dengue
and single-dose azithromycin treatment for yaws, warrant an update of the investment case.