Challenges, barriers and opportunities for neglected tropical disease programs of conflict-affected African countries

BACKGROUND: Insecurity and conflict threaten achievement of global neglected tropical disease (NTD) targets. Identifying conflict-associated challenges and mitigation strategies can inform NTD programmatic decision-making. METHODS: In-depth interviews were conducted with key stakeholders to explore their experiences of implementing NTD programs in conflict-affected regions in sub-Saharan Africa. Study 1 included a variety of stakeholders in Nigeria and study 2 included the NTD program managers from multiple countries. Thematic analysis was used to identify and extract key themes. RESULTS: Fourteen participants (seven participants per study) from six countries and several NTD programs reported an array of complex challenges that were categorised into three common program-specific activity themes (implementation, community engagement, sustainability) and five common external influencing themes (access to areas; water, sanitation and hygiene; inclusivity; stakeholder partnering; financial resources). Study 1 included a unique theme for solutions. Several common subthemes (surveillance, community education, displaced populations, access for women) and unique study 1 subthemes were reported. CONCLUSIONS: Many complex interacting factors hinder NTD programs 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 programs in achieving the global NTD goals of 2030.