A call to action for universal health coverage: Why we need to address gender inequities in the neglected tropical diseases community

Abstract

The UN's Sustainable Development Goals (SDGs) and pledge to leave no one behind have raised the importance of ensuring equitable health outcomes and healthcare delivery. Multisectoral approaches to tackling neglected tropical diseases (NTDs), including prevention, diagnosis, treatment, and healthcare, have had a limited focus on gender. Yet, gender roles and relations shape vulnerability to NTDs, access to prevention and treatment, and experience of living with NTDs [1]. Understanding the similarities and differences of disease vulnerability and experience between genders can support NTD actors to deliver equitable prevention, diagnosis, and treatment services. The NTD community, including researchers and practitioners, needs to better understand these dynamics and take action to advance gender equality, meet the NTD roadmap 2020 goals, and contribute towards the SDGs and universal health coverage (UHC). The UHC movement is advocating for clear action to address the gender determinants of health. This viewpoint synthesizes evidence from a discussion paper [2] developed by the UN Development Programme (UNDP) and TDR (Special Programme for Research and Training in Tropical Diseases sponsored by UNICEF, UNDP, World Bank, and WHO) in partnership with the Liverpool School of Tropical Medicine to support governments and nongovernment organizations to understand how to recognize and address gender inequities within NTD programs and improve delivery through gender analysis. Gender refers to the socially constructed roles, behaviors, activities, attributes, and opportunities that any society considers appropriate for men and women, boys and girls, and people with nonbinary identities [3, 4]. Gender, sex, and their intersections with other social determinants of health shape peoples' vulnerability to and experience of multiple NTDs and their ability to access care and treatment [3, 5]. This can be complex and will vary between diseases, contexts, and other social and demographic factors such as age. Fig 1 highlights differences in disability-adjusted life years (DALYS) from different NTDs by age and sex from the Global Burden of Disease (GBD) Study [6]. By examining how gender shapes who is infected with NTDs, who accesses preventive medicines, who is diagnosed and treated, who is exposed or vulnerable to NTDs, and how and whose behavior is risk prone or risk averse, inequities can be better understood, challenged, and addressed.

Achieving equity in UHC interventions: who is left behind by neglected tropical disease programmes in Cameroon?

“…We highlight here the case of schistosomiasis where women in their reproductive years spend more than 25% of their time pregnant or lactating [13,33]. With the irregularities existing in the distribution of praziquantel to pregnant or lactating women, these women are constantly missed [13,34]. A clear treatment strategy must be developed for pregnant women and girls of reproductive age [35] as their participation in MDA, though prescribed by the WHO, remains an issue in most implementing programs [33,36].…”

Vector-borne diseases in pregnancy

“…156,157 Addressing these diseases has immeasurable benefits, not just to the health of individuals but on a societal level to the prosperity of emerging nations, and economic and social issues like gender inequality. 158,159 Chagas disease Chagas disease (CD), also known as Trypanosoma cruzii, is a protozoal infection of Central and South America and is recognised as one of the NTDs with the biggest impact on human mortality and quality of life with 500,000 reported DALYs (disability-adjusted life years). The primary mode of transmission is a bite from the reduviid bug, subclasses Triatima infestans and Rhodnius prolixans being the most common vectors in South and Central America, respectively.…”

“… 156 , 157 Addressing these diseases has immeasurable benefits, not just to the health of individuals but on a societal level to the prosperity of emerging nations, and economic and social issues like gender inequality. 158 , 159 …”

Keeping communities at the centre of efforts to eliminate lymphatic filariasis: learning from the past to reach a future free of lymphatic filariasis

“…To uncover potential inequities in MDA and to refine and tailor awareness and outreach activities more effectively, the LF community must first heed increased calls for the collection and use of gender-disaggregated data in MDA programmes. 56–58 Furthermore, gender-based analysis needs to be incorporated into the planning and execution of MDA for LF elimination as well as in the care and management of chronic manifestations of the disease. 57 Gender analysis is also recommended to understand the differential burdens and experiences that CDDs face in their work.…”