Exploring the Challenges, Barriers and Opportunities for Neglected Tropical Disease Programmes of Conflict-affected Countries in sub-Saharan Africa: A Qualitative Investigation

Background Insecurity and conflict threaten achievement of global Neglected Tropical Disease (NTD) targets. Identifying conflict-associated challenges, and strategies to mitigate them, can inform NTD programmatic decision-making. Methods In-depth interviews were conducted with key stakeholders, including NTD programme managers and implementing partners, to explore their experiences of implementing NTD programmes in conflict-affected regions in sub-Saharan Africa. Study 1 focused on Nigeria and Study 2 on multiple countries. Thematic analysis was used to identify and extract key themes. Results Fourteen participants (7 participants per study) from six countries and several NTD programmes reported an array of complex challenges, which were categorised into three common programme-specific activity themes (implementation, community engagement, sustainability) and five external influencing themes (access to areas, water and sanitation, hygiene, inclusivity, stakeholder partnering, financial resources). Several sub-themes (e.g. surveillance, community education), unique challenges (e.g., displaced populations, access for women) and potential solutions (e.g., innovation, collaboration) were reported. Conclusion There are many complex interacting factors that hinder NTD programmes in conflict-affected NTD-endemic areas. The scale and breadth of the common and unique challenges and potential solutions require more investigation to enable the development of a practical framework to support programmes in the efforts to meet global NTD control, elimination and eradication goals.