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Cost-Effective Investment in Neglected Tropical Diseases in Mexico

At the end of 2011, Maria Rodriguez, who lives in the mountains in Huixtán in Chiapas, Mexico, started having such serious problems with her eyes that she could barely do her daily chores such as cooking and preparing her children for school.

Living in a remote area, she would not have been able to treat her condition if it had not been for a health worker, a brigadista in Spanish, who visits her home regularly. The health worker diagnosed Rodriguez’s pink eyes and swollen eyelids as trachoma, an infectious disease that can cause blindness if left untreated.

Rodriguez, who started taking antibiotics to treat the disease, is one of more than 132,000 people who have received health treatment through a program to combat neglected tropical diseases (NTDs), a group of little-known infectious diseases ranging from trachoma to leishmaniasis that are disabling, disfiguring, and deadly. The program is run by the Chiapas government with funding from the IDB.

NTDs occur disproportionately among poor and marginalized groups, reducing their chances of breaking the cycle of poverty. The diseases affect more than 100 million people in the Americas, mostly in poor rural communities and urban slums, and are linked to a range of social and environmental factors. In Chiapas, for example, most homes have dirt floors and lack access to potable water and sanitation. More than half of the population is illiterate. Due to these conditions, more than 300,000 people in Chiapas, mostly members of indigenous communities, are at particular risk of contracting NTDs.

The Chiapas pilot program integrates coordinated prevention and control activities for all the diseases, exploring effective ways to combine health, water supply, and sanitation interventions with other initiatives such as primary care, conditional cash transfers, housing, and preventive actions such as contagion control.

The project has also invested in public awareness campaigns to help reduce the risk of infection for the entire population of 4 million people in Chiapas. Radio shows produced in Tzotzil and Tzeltal, two main local indigenous languages; target more than 100,000 inhabitants in San Cristóbal de las Casas and surrounding municipalities. The shows depict real-life situations with information about modes of transmission, risk factors, and treatments and cures for NTDs.

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In addition, nearly 4,000 students in six public schools in endemic municipalities have participated in educational and social mobilization activities, including workshops for face and hand washing, games and theater, and the creation of educational materials using the local languages.

Given its integrated approach that incorporates measures to fight NTDs into several existing government initiatives, this program is serving as a regional pilot to facilitate the development of an NTD agenda in Latin America and the Caribbean. The experience in Chiapas is expected to provide important lessons that could help other countries develop priorities for integrated disease control, project implementation, advocacy, and resource mobilization.

The good news is that there are cheap and safe drugs to fight these diseases, making it one of the most cost-efficient public health interventions available. According to the Pan American Health Organization (PAHO), the return on the investment from controlling these diseases is estimated at 15 to 30 percent. Decreasing the incidence of NTDs improves school attendance by strengthening the health of children, protects the health of pregnant women, and improves the productivity of the workforce by preventing disabilities.

A comprehensive and cost-effective effort region-wide to take on NTDs may well have started in the hills of Chiapas.