From childhood affliction to national action: Dr Wyckliff Omondi’s journey in combatting NTDs in Kenya

Earlier this year, the Kenya Ministry of Health intensified its efforts against Neglected Tropical Diseases (NTDs) with the launch of a five-year (2023-2027) Masterplan to put these diseases that are affecting Kenya’s development high on the country’s advocacy and development agenda. Kenya has demonstrated success in the fight against NTDs, including the elimination of Guinea Worm Disease (2018) and the interruption of transmission of Onchocerciasis (river blindness) and Human African Trypanosomiasis (sleeping sickness). This Masterplan aims to further advance NTDs control and elimination in the country.

In tandem with the Masterplan’s development, the Ministry adopted the NTDs Scorecard for Accountability and Action in 2022. This scorecard, aligned with the objectives of the new Masterplan, encompasses key performance indicators to enhance program interventions using real-time data.

To ensure ownership and accountability across all stakeholder levels, the Ministry, supported by the African Leaders Malaria Alliance (ALMA), have rolled out NTD scorecard decentralisation efforts. Beginning with the Coastal region earlier this year, the Ministry extended its decentralisation to Western Kenya in May, reaching nine subregions. Upcoming plans include expansion to Kenya’s Great Rift later in the month.

Along the sidelines of the Western Kenya decentralisation mission, we caught up with Dr Wyckliff Omondi, Head of Vector Borne and Neglected Tropical Diseases at Kenya’s Ministry of Health. In an insightful conversation, we delve into his personal and professional journey in combating NTDs as well as Kenya’s on-going efforts in this critical area of public health.

Tell us about your role at the Kenya Ministry of Health.

I currently lead the Vector Borne and Neglected Tropical Diseases department at the Ministry of Health in Kenya. My responsibility revolves around driving the country towards interventions aimed at controlling and eliminating prevalent vector-borne diseases and NTDs.

Have you had any personal encounters with vector borne and neglected tropical diseases, and how has that influenced your work in this field?

Absolutely. Growing up in the Lake region, I witnessed firsthand the impact of diseases like malaria and bilharzia/Schistosomiasis.

Personally, I have been affected by both diseases multiple times, so I understand the challenges. At the community level, Bilharzia, was prevalent. People would experience symptoms like bloody urine. It is interesting that it was such a common phenomenon that people thought it was normal and worse, some type of rite of passage especially in youth.

When I later joined campus, these experiences shaped my academic pursuits when I was invited to read for a BSc in General Sciences, leading me to focus on botany and zoology, and later parasitology, and entomology. Since then, my goal has been to contribute to the health and well-being of communities like the ones I saw growing up.

Fast forward to today, how is Kenya fairing in its fight against NTDs?

While we lack data on the prevalence of some NTDs in the country, Kenya has made some remarkable progress over the last few years.

In 2018, Kenya achieved certification for elimination of Guinea worm as a public health problem, a significant milestone in our battle against NTDs, and very much in line with the World Health Organization (WHO) 2021-2030 roadmap which targets the elimination of at least one NTD in 100 countries by 2030.

To further align with this target, we recently rolled out the 2023 – 2027 NTD Masterplan which targets the elimination of four NTDs. This proactive approach means that we are aiming to surpasss the targets set by the WHO.

In terms of progress against specific diseases, I must note that, sleeping sickness once widespread in the Western region, is now on the verge of elimination. We submitted dossiers to the WHO in the past year and are now working towards validation. Similarly, we are working to be verified free of Onchocerciasis/ river blindness, with international and national experts guiding our interventions towards this milestone.

For Lymphatic Filariasis (elephantiasis), we have stopped mass drug administrations (MDAs) and moved towards surveillance to prevent resurgence.

We have also significantly reduced the provision of MDAs for blinding trachoma, now focusing on just five implementation units within the cross-border areas shared with South Sudan, Ethiopia, Uganda, and Tanzania. We are optimistic that synchronised MDAs will yield positive results. If all goes according to plan, we aim to achieve validation as free of blinding trachoma by 2028.

We are also expanding our mapping efforts for Soil Transmitted Helminths (parasitic worms) and Bilharzia. Currently, we have mapped 15 counties and secured funding to upscale this to the remaining 32 counties. With this initiative, we anticipate having a comprehensive map of disease prevalence by next year.

Leishmaniasis also remains under our keen eye. While its burden is not yet known, we have observed its expansion from traditionally eight regions/ counties to around twelve now on account of mobility.

Generally, we are working on around 12 out of the 21 WHO recognised NTDs, which for me is laudable against the broader set of conditions which are within this portfolio.

Kenya is evidently making progress, congratulations. What factors do you believe have contributed to this positive momentum?

There are several factors contributing to this.

One is the increase in global goodwill in terms of awareness and advocacy for NTDs. This has attracted financial support for addressing priority NTDs and accelerating their elimination.

Secondly, there is an increasing sense of ownership from the government, both at the national and subnational levels.

And of course, when implementing interventions, the community plays a crucial role, otherwise our interventions would be as good as dead. So, I must say that apart from partners and the government, the community also has played a crucial role in terms of the progress we are making.

I must also note that we are now seeing technological advancements and innovation in healthcare products which are accelerating our efforts.

For example, in the case of Lymphatic Filariasis a therapy introduced in 2002 required a minimum of five years of treatment. However, in 2018, it was discovered that additional medication could reduce the treatment duration to just two years. Kenya embraced this approach, accelerating elimination efforts in endemic areas.

What challenges persist in Kenya’s NTD control and elimination efforts?

The biggest challenge emerges from the fact that most NTDs are not fatal. As such, they often receive less attention and priority, both from individuals and governments. People tend to only seek medical help when they feel severely ill, and since many NTDs have mild symptoms, they often go unnoticed and untreated. This lack of awareness and neglect starts at the personal level and extends to the leadership level.

As a result, there is a mismatch between the burden of NTDs and the allocation of resources to combat them. While some priority NTDs receive donor support, local investment remains limited. Additionally, efforts to improve complementary measures such as clean water and sanitation services and promotion of behavior change are still lagging.

At the same time, the lack of adequate health products persists, with certain diseases lacking essential medicines and vaccines. This leaves individuals affected by these diseases without viable treatment options. On a global scale, pharmaceutical companies are disincentivised to develop vaccines or medications for diseases that are not financially lucrative, leading to neglect of these critical health needs.

At the country level is a concerning shortage of skilled workforce to tackle NTDs. This scarcity of technical expertise strains our ability to effectively fight these diseases at the national level.

How has Kenya’s experience with the NTDs scorecard evolved and what role do you foresee it playing in addressing some of the country’s challenges moving forward?

The scorecard is a useful tool for tracking progress in priority NTDs areas, at both programmatic and leadership levels. Since we developed it in 2022, it has facilitated monitoring and helped us focus on areas needing attention, prompting reviews and follow-up actions.

This year, we initiated its rollout to subnational levels, starting in the coastal region in the first quarter, followed by Western Kenya today, and later this month, the great rift region. This is where majority of the implementation work takes place, hence full-scale adoption at this level will give us a fuller and broader view of how we are performing as a country.

One of the other key things we are looking forward to is to see how we can leverage it to mobilise domestic resources. Of course, we appreciate the donor support but it is not enough to tackle all of our needs and priorities. The fact that it is discussed at the head of state level, as well is very promising, we are optimistic that the NTDs scorecard will help us gain attention even at that level and drive action to move the NTDs program forward.

Given the chance, what would be on Kenya’s NTD-program wish-list?

That is a very difficult question to answer because the wish list is very huge!

However, from a national perspective, it would be worth re-examining at the program’s structure. The program, despite handling a portfolio of 21 distinct conditions and diseases has a significantly under-resourced human capacity. Strengthening this capacity and establishing fully dedicated departments at the subnational level to address NTDs would be extremely essential in effectively tackling the broad spectrum of NTDs we face as a country.

Most importantly, resourcing remains critical for the program. So, another wish would be to see an increase in resource allocation for NTDs, at national and subregional both levels to further complement external aid.