1. Introduction: The strategic imperative for NTD integration

The World Health Organization’s (WHO) NTD road map defines sustainability as maintaining and expanding programme progress through: (i) strengthening national health systems, (ii) improving efficiency and equitable access to treatment and care, and (iii) mainstreaming NTDs into broader health and development agendas. It emphasizes long-term domestic financing, programmatic integration, and adaptive learning to refine strategies for sustainable impact [1–4].

Amidst a landscape of contracting donor funds and the urgent pursuit of Universal Health Coverage (UHC), the integration of NTD programs has transitioned from a pragmatic option to a strategic necessity for building resilient national health systems. This evolution presents a powerful opportunity to embed NTD control and elimination into the core of national health strategies, ensuring services are more sustainable, equitable, and effective for the communities they serve.

The fundamental rationale for integrating NTD interventions with existing health platforms is clear and compelling. By aligning with primary health care, maternal and child health weeks, and national immunization and nutrition campaigns, countries can optimize scarce resources, eliminate the inefficiencies of duplicative, siloed programs, and enhance national ownership of public health initiatives. This approach moves beyond episodic campaigns to build a foundation for continuous care, strengthening the health system as a whole and bringing essential services closer to the people who need them most.

The webinar synthesizes the rich experiences and critical lessons learned from nine African nations that are pioneering diverse pathways toward NTD integration. It presents proven models for integrated service delivery, analyzes the common enablers that facilitate success, identifies the key challenges that must be overcome, and concludes with a set of actionable recommendations for national policymakers and global health partners.

The following analysis of specific country experiences provides invaluable real-world insights into building stronger, more equitable, and more resilient health systems for all.

2. A synthesis of successful integration models and key enablers

While the goal of NTD integration is universal, the pathways to achieving it are diverse and tailored to national and local contexts. The experiences of several African nations reveal two primary, highly effective models: leveraging existing campaign-based platforms for mass reach and embedding NTD services into routine health systems for long-term sustainability. This section analyzes these primary models, highlighting the specific strategies and key enablers that have driven their success.

3. Cross-cutting benefits: Building value beyond NTD control

The value of integrating NTD services extends far beyond disease-specific outcomes. These strategies create powerful synergistic benefits that strengthen the entire health system, enhance program sustainability, and generate significant returns on investment. The evidence from across the continent demonstrates clear, quantifiable gains in efficiency, systemic capacity, and national ownership.

Financial and resource efficiency: By sharing logistics, supervision, and community mobilization efforts, integrated models achieve substantial cost savings. In Benin, integration reduced costs by 50% for onchocerciasis and an impressive 75% for SCH/STH programs. Madagascar saved over US$1.4 million in a single integrated campaign. Furthermore, Rwanda successfully mobilized 100% of its operational costs from domestic resources for STH and SCH MDA conducted through MCH week, demonstrating a clear pathway to financial sustainability.

Health system strengthening: More than a set of disparate activities, integration serves a single strategic goal: institutionalizing NTD control within the permanent structures of the primary healthcare system. The training of thousands of frontline health workers in Kenya (over 6,000) and Rwanda (over 400 in a recent pilot) creates a versatile and skilled workforce. The inclusion of NTD indicators into national data systems (HMIS/DHIS2) in Ethiopia and Kenya enhances routine disease surveillance. Concurrently, Ethiopia has integrated NTD medicines into its national supply chain, a core component of the PHC integration strategy being pursued by countries like Kenya, which is now domestically procuring essential NTD medicines [12,14,15]. These actions embed NTD control into the core functions of the health system.

Enhanced program sustainability and ownership: Moving away from partner-led vertical programs fosters greater national leadership and long-term viability. Togo’s experience confirms that integration enhances national ownership of its NTD program. This sentiment is echoed in Uganda, where officials observed that MDA activities are now more firmly embedded within the national health system rather than being perceived as externally driven initiatives.

While these benefits confirm the strategic value of integration, realizing this potential at scale requires a clear-eyed assessment and mitigation of the persistent obstacles to implementation.

4. Overcoming implementation challenges

Despite the clear benefits across countries, integrated NTD programmes are making progress but continue to face shared implementation challenges that present opportunities for strengthening. Enhanced coordination and governance are priorities in Benin, Niger [16], and Togo, while investments in the health workforce would benefit Ethiopia, Kenya, Uganda, Madagascar, Rwanda, and the United Republic of Tanzania. Sustainable financing and increased domestic resource mobilization remain important in Ethiopia, Kenya, Rwanda, and Togo. Strengthening digital tools, data systems, and logistics would further support programmes in Ethiopia, Kenya, Uganda, Rwanda, Madagascar, and Tanzania, while improved communication and targeted strategies could help address treatment acceptance and coverage gaps, particularly in Madagascar and Uganda. Remaining hurdles, far from being deterrents, provide a clear and evidence-based roadmap for the targeted policy actions and strategic investments required to scale and sustain NTD integration.

As summarized in Table 1, the countries adopted different integration approaches based on health-system capacity.

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Table 1. Summary of NTD integration strategies by country.

https://doi.org/10.1371/journal.pntd.0013628.t001

As shown in Fig 1, approaches for integrating NTD care vary across delivery platforms.

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Fig 1. Beyond silos: integrating NTD care into national health systems.

Diagram illustrating approaches for integrating NTD interventions into broader health systems: pairing with vaccination campaigns, leveraging school and community platforms, and embedding NTD services into primary healthcare. Image credit: Nadia Rozendaal.

https://doi.org/10.1371/journal.pntd.0013628.g001

5. Policy recommendations

The collective experiences of African nations demonstrate that, while complex, integration of NTD programs delivers substantial benefits for individuals, health systems, and national development. Integrated approaches reduce duplication, enable people to access multiple services in a single visit, and strengthen national ownership. Ultimately, integration is a vital pathway for amplifying public health impact and accelerating progress toward UHC.

6. Conclusion: Integration as a cornerstone of UHC

NTD integration is not merely an operational efficiency measure—it is a strategic approach that strengthens resilience, amplifies impact, and fosters national ownership. With thoughtful planning, sustained investment, and collaborative innovation, integration can accelerate progress toward UHC and health equity. The evidence is clear, the models are proven, and the time for siloed approaches has passed. Building on these lessons, stakeholders can forge pathways that eliminate neglected diseases while creating stronger, more equitable health systems for all.

Acknowledgments

We gratefully acknowledge the support of the American people through the United States Agency for International Development (USAID), whose contributions have been instrumental in advancing neglected tropical disease programmes. The USAID NTD program supported sustainability plans that were critical to multisectoral engagement and policy changes contributing to long-term sustainability.