Dar es Salaam, Tanzania — Africa is at the center of the global problem of neglected tropical diseases  (NTDs). The continent carries about – 40 % of the worldwide NTD burden, impacting over 500 million people. Twenty of the 21 NTDs identified by the World Health Organization are found in Africa, with many countries facing several NTDs simultaneously. More than three-quarters of African nations are co-endemic for at least five NTDs. Lymphatic filariasis (elephantiasis), onchocerciasis (river blindness), soil-transmitted helminthiasis (hookworm, whipworm, roundworm), schistosomiasis (bilharzia), and trachoma make up around 90% of the continent’s NTD burden.
Despite this significant challenge, progress is speeding up in the fight against NTDs in Africa.
As of August 2025, twenty-four African countries have eliminated at least one NTD, and several have successfully addressed multiple diseases. This progress shows strong political support for the AU Common African Position and Continental Framework on the Control and Elimination of NTDs and the WHO NTD Roadmap.
Yet the fight is far from over.
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Historically, NTDs have been severely underfunded. The recent cuts in official development assistance (ODA) have worsened the situation. This disruption affects NTD services and interventions, including mass drug administration campaigns, impacting millions of people. It puts decades of investment and progress at risk. Without ongoing funding, millions may lose access to essential services, and hard-earned achievements could be undone.
For example, the termination of the USAID-funded Act EAST and Act WEST Programs threatens the already limited funding for NTDs in a shrinking global health financing environment, while the risk is higher and more pronounced due to several health and non-health issues competing for limited resources. NTDs are at risk of being further neglected due to a lack of dedicated funding mechanisms, unlike those available for HIV/AIDs, TB, and malaria. The need for African country leaders to demonstrate strong dedication and leadership, as well as the global health community, in the fight against NTDs cannot be overemphasised, as without NTD elimination, we cannot achieve Universal Health Coverage (UHC) or meet the Sustainable Development Goals (SDGs).
Not investing in NTDs puts the health system at risk.
Failing to invest in NTDs carries significant social and economic consequences. Investing in NTDs offers tangible, high-impact wins, as many are preventable and treatable, leading to significant health and economic benefits. Conversely, failing to invest perpetuates inequality and poverty, negatively impacting vulnerable communities, keeping generations trapped in sickness, disability, and poverty. The consequences include reduced productivity and income, higher out-of-pocket healthcare costs, in turn making people poorer, increased stigmatization and marginalization, and a negative impact on human development, as demonstrated by the inability of the affected population to achieve higher levels of educational attainment
Lack of investment in NTDs puts significant achievements in the fight against these diseases at risk. This also threatens the broader health system.
Domestic resource mobilization provides predictable, reliable, and sustained financing essential for building resilient health systems over the medium and long term. African countries can explore alternative financing mechanisms, such as expanding the tax base, introducing targeted health taxes, or allocating a portion of tobacco or sugar taxes to support national NTD programmes.
According to Uniting to Combat NTDs, countries should work to improve sustainability and resource mobilization strategies. This includes embedding NTDs in national health budgets with dedicated budgetary allocations. In addition, NTD interventions should be integrated into other interventions, such as education and nutrition, in order to maximize available resources for maximum health outcomes.
To keep control, maintain NTD service delivery and interventions, prevent the return of diseases, strengthen health systems, develop new tools, and address the disease’s economic and social burdens, sustained investment is required. In the absence of adequate funding for NTDs, service delivery and disease prevention and control will be compromised, putting additional pressure on already stressed health systems. This could increase the number of people in need of interventions and at risk for NTDs, as well as the reemergence of NTDs that had been eliminated due to insufficient funding for surveillance and control. Reduced funding also threatens access to care and poorer health outcomes among populations affected by NTDs.
NTD programmes are recognized among the most cost-effective initiatives in global health.
To leave no one behind, African governments should prioritise NTDs by mainstreaming NTD services into routine health systems as a cost-saving measure and for efficiency and effectiveness. For example, mass drug administration (MDA) can be embedded into existing community health outreach and school-based programs. Through investment in a robust data system to guide data-driven decision making and strengthen surveillance, and by addressing social determinants of health such as access to clean water, sanitation, and education, to effectively prioritize NTDs.
Yet, progress is evident.
Strong political will and commitment from the African government, along with high-level support for global policy frameworks and tools like the Kigali Declaration on NTDs, the African Union’s Common African Position on NTDs, the Continental Framework on NTDs, Agenda 2063, and the WHO Roadmap on NTDs, not only increases the visibility of NTDs, which helps draw funding, but also elevates NTDs as a priority for development. A major component of maintaining NTD focus and attracting funding is advocating for NTDs at global and regional forums, and working with organizations like WHO and Uniting to Combat NTDs helps maintain focus on NTDs and attract funding.
In addition, regional collaboration was leveraged to access funding from regional funding avenues such as the African Development Bank. Regional workshops and platforms can facilitate cross-country learning, technical assistance, and shared resource mobilization strategies. Community engagement and partnerships, such as public-private partnerships, have successfully helped with resource mobilization. For example, accepting drug donations ensures that drugs for NTDs are available and provides a great return on investment.
NTDs affect the underserved and vulnerable populations. According to Uniting to Combat NTDs, funds raised for NTD programs will help vulnerable and marginalized groups. This includes lowering out-of-pocket costs for treatment and care. Governments should strengthen primary healthcare delivery, which is often the first point of contact for the poor and vulnerable, most affected by NTDs, especially in relation to morbidity management. Funding research and innovation to enhance diagnosis, treatment, and service delivery for NTDs will advance elimination strategies and aid the sustainability of gains.
NTDs are among the most neglected diseases, and as such, including them in broader health systems strengthening interventions should enhance access to care for vulnerable populations. For example, including treatment for NTDs in National Health Insurance Schemes would greatly improve access to care for affected individuals.
The path to innovation
According to the  Drugs for Neglected Diseases initiative  (DNDi), investment in research and development is crucial to advancing diagnostics, treatments, and preventive measures. Continued investment in R&D for NTDs is crucial, but this is threatened even more than usual in the current funding landscape, which stands to reverse progress made. Adaptive and innovative financing models, including public-private partnerships, regional and domestic resource mobilization, and strategic alliances that place endemic country governments and patients at the centre of the innovation ecosystem, will bolster R&D advancements and ensure sustainable, equitable access to health tools for communities affected by NTDs.
DNDi reports that many existing NTD treatments require complex administration, such as injections or lengthy hospital stays. While progress has been made, there is still a critical need for new drug compounds and patient-friendly formulations that are safe and effective for vulnerable groups, including children and pregnant and lactating women. Another major issue is the lack of simple and affordable diagnostic tests that can be used in rural or remote areas at the primary healthcare level.
Current diagnostic methods for NTDs tend to be complicated and need specialized equipment, which leads to delays and misdiagnosis. DNDi calls for the urgent need for quick and accurate tests to identify diseases in the field. Many NTDs lack effective vaccines – which may take decades to develop. Early-stage research is essential to identifying and progressing promising vaccine candidates to fill this gap.  Uniting to Combat NTDs also points out that R&D should include an access pathway to commodities at conception, so that products are feasible and accessible to the populations at risk.
Strain on Africa’s fragile health systems and deepen inequality.
The African region carries around 40% of the global burden of neglected tropical diseases (NTDs), affecting over 500 million people. This adds considerable strain to already overburdened health systems. Most of the burden falls on primary health care (PHC) systems, which are weak and underfunded. The WHO, in a statement during its  75th Regional Committee meeting, said that without strengthening PHC systems, reaching Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs) will remain out of reach.
In the absence of functional PHC systems, vulnerable and marginalized populations, who are most affected by NTDs, are most likely to remain untreated, perpetuating the cycle of illness and poverty. The effects of NTDs may cause disability, resulting in a rise in long-term care costs, a decrease in economic productivity, increasing poverty, and placing a strain on public health services.
The elimination of NTDs can, however, reinforce universal health coverage and improve the resilience of the health system as a whole.
Technological tools are also improving coordination and planning.
The Africa CDC’s digital micro-planning portal, endorsed by 50 AU Member States, enables countries to track resources, identify gaps, and coordinate multi-sectoral efforts across sectors and partners. This innovative platform, developed with inputs from Member States, World Health Organization (WHO), The END Fund, and other technical partners, will track resource utilisation, advocate for sustainable financing and domestic resource mobilisation, and drive Africa-owned solutions to end these diseases of poverty by 2030.
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The tool creates a chance to identify the overall financial resources needed to combat NTDs on the continent, as well as contributions from endemic countries and gaps. This robust process supports efforts to mobilize resources for NTDs. To speed up NTD elimination, this new approach to micro-planning will connect country and regional planning, streamline resource mobilization, and improve budget efficiency, reducing duplication and maximizing impact. This effort comes at a time when global funding is declining, which demonstrates the need for homegrown solutions to diseases like trachoma, intestinal worms, and river blindness, which affect over 500 million Africans.
The progress made by African nations in the fight against NTDs offers hope.
The significant progress made against NTDs cannot be overlooked. As of August 2025, 57 countries globally have eliminated at least one NTD. Yet, with a shrinking health financing landscape, greater emphasis is being placed on domestic resource mobilization (DRM) as a means of bridging existing financing for NTDs in endemic countries.
Looking toward 2030, several factors inspire hope for NTD elimination. The increased domestic resource mobilization, growing political will, technological advancements, progress in research and development, and integration into health systems are further positive drivers that can help many endemic countries move closer to elimination targets. The greatest concern, however, lies in insufficient and unpredictable funding as a major concern in the fight against NTDs. Without sustained investment, hard-won gains risk being reversed, and progress toward elimination and eradication could stall. The impact of climate change, conflicts, and persistent poverty equally threatens progress in the elimination of these diseases.
Chironda was in Tanzania as part of a workshop and field visits hosted by Sightsavers and Tanzania’s Ministry of Health, in collaboration with other partners, including Uniting to Combat Neglected Tropical Diseases, a global advocacy organisation that exists to end NTDs by mobilising resources. This article also incorporates insights from Uniting to Combat Neglected Tropical Diseases’ experts in global health and NTD advocacy, as well as contributions from DNDi on research and development priorities.
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