The Role of Cultural Leaders in the Treatment and Prevention of NTDs

Jun 01, 2016

By: Sarah Marchal Murray, COO



As some of our readers are aware, the END Fund hosted a side event sanctioned by the World Economic Forum (WEF) on Africa in Kigali, Rwanda. The event spotlighted statistics released at WEF by Erasmus University which show that sub-Saharan Africa could save $52 Billion (PPP) by 2030 if the region meets the WHO’s 2020 control and elimination targets for the five most common NTDS. 

HRH
HRH Sylvia Nagginda, Queen of Buganda Kingdom in Uganda
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The event made the case for increased investments in NTD control in sub-Saharan Africa, but it also made the case for increasing another vital resource. Voices. The voices of leaders such as Her Excellency Mrs. Jeannette Kagame, First Lady of the Republic of Rwanda, and Her Royal Highness Sylvia Nagginda, Queen of Buganda Kingdom in Uganda. Below are the remarks and thoughts of HRH Sylvia, which shine an important light on how engaging traditional and cultural leaders is imperative. We are honored to have her eloquent voice champion this important message at WEF Africa and beyond.



Distinguished Participants

Ladies and Gentlemen

It is indeed a great pleasure for me to participate in this meeting today. I congratulate the END Fund for the arduous work it’s doing in the fight to end suffering and loss of lives from the Neglected Tropical Diseases or the NTDs. I would like to thank the CEO Ms. Ellen Agler for inviting me to share my thoughts on the role that traditional or cultural institutions can play in curbing and eliminating these Neglected Tropical Diseases. 

Based on that topic I will l limit my remarks to two aspects (1) what the role of culture and cultural leaders is in addressing the health challenges that exist in Africa and (2) how cultural leaders leverage positive aspects of culture and traditions to provide support to health programming and specifically for the treatment and prevention of the Neglected Tropical Diseases.

Ladies and gentlemen, while the NTDs have been wiped out in many parts of the world they still exist in most African countries. In Uganda, where I come from, with a population of 36.5 million people, the NTDs have been recognized as a public health challenge affecting almost all the 112 districts of the country, yet until recently little attention has been paid to them.

The prevalence of the NTDs in Uganda appears to be highest in the Western Rift Valley close to the shores of Lake Albert, by Lake Kyoga in the Central and at the Eastern shores of Lake Victoria.  These places, by the shores of our beautiful water bodies, attract both the rich and the poor for recreation and wealth creation activities.

Efforts are underway throughout the country to address the scourge of NTDs which, according to the Ministry of health, currently affects more than 10 million people.  The Uganda national NTD Master Plan provides a road map for Uganda to be free of NTDs by 2020 and recommits the government and partners to achieving this goal. 

Some of the efforts being undertaken involve community health workers going door-to-door administering drugs, however the limited access to safe water and proper sanitation is an impediment to these treatment efforts. 

Over half of the total population of Uganda is at risk of contracting at least one of these diseases, however, the good news is that the most common NTDs (Elephantiasis, River Blindness, Bilharzias, Intestinal worms and Trachoma) that exist in Africa can be effectively prevented and treated. 

In addition to the challenges of access, availability and demand for Health services, there is also the challenge of ‘acceptability and use’ of available health care services and products due mainly to social and cultural reasons.

 It is important to understand the social and cultural contexts of the communities served, as well as the role of local leaders, and the nature of the existing treatment systems - in order to adapt interventions to the specific realities of each context and identified needs. 

The fact that people in Uganda, as it is in other parts of Africa, belong to one of the many cultural institutions means that cultural institutions have a critical role to play in the fight against NTDs which are affecting the lives of many people within these cultural institutions.  Cultural Leaders can work with health ministries, health district offices, and community based organizations to support the provision of healthcare services in the communities.  

Since many public health decisions are primarily affected by cultural beliefs and practices, traditional or cultural leaders have the unique advantage of being able to reach out to both men and women in the various communities and effectively promote healthcare and healthcare services. 

Ladies and gentlemen, it’s important to note that today, people still naturally identify with their native culture and traditions as a source of basic identity, and as a rallying point and personification of their political, social, economic, and cultural aspirations. 

Approaching issues from a cultural vantage point appeals to the soul and senses of individuals because they feel their values are being understood and recognized by others. Appealing factors become easily believable, adoptable, and acceptable. 

In Uganda, cultural leaders are enablers and catalysts in the development process.  They leverage culture to make a difference in the lives of other people by improving their social economic wellbeing.   Cultural leaders have the authority and ability to mobilize, organize and appeal to the masses – they galvanize people for development, promote unity, and understanding among the population. Therefore, they’re very important and effective partners for development organizations, and for local and national leadership to effect positive change where it’s needed.

This approach has worked in reproductive health interventions, where for a long time, the Buganda Kingdom has supported and conducted community rallies in different parts of the country to educate, interact with and shape reproductive health behaviors of girls, boys, men and women, as well as empowering communities on self sustaining income generating interventions. 

We use the cultural voice - the voice emanating from cultural leaders of authority on development matters or the words and expressions that delineate culture as the corner stone for progress and development. 

When we address the good aspects of culture using the cultural voice it makes the information credible and easier to adopt because positive cultural voices appeal to people’s solicitous senses.  Positive culture allows us to identify with others, to have a sense of purpose, belonging and unity and to act positively. Hence people will improve their welfare, adopt healthy ways of living and become cognizant of diseases in their midst and how to prevent them. 

Within this context, I would like to make reference to my work in the field of public health – where I have used the cultural voice to support communities attain better health, education, and economic welfare.  

As Nnabagereka, over the last fifteen years, I have supported the promotion of positive culture that provides development solutions for our people in Uganda.  The Nnabagereka Development Foundation (NDF) which I founded in 2000, is the primary vehicle through which I carry out my work. It’s mission is to leverage culture to improve the quality of life of children, the youth and women in Uganda.

I have been engaged in and conducted national and grassroots advocacy campaigns for the promotion of sexual reproductive health and rights including Adolescent Reproductive health, maternal health, child health, family planning, and the prevention of HIV/AIDS and STDs. 

Furthermore, I have worked with Uganda’s National Population Council formerly (POPSEC) and United Nations Population Fund (UNFPA) and other UN Agencies like UNAIDS, UNICEF, WHO; as well as various NGOs on community health related initiatives such as Accessible Health, Communication and Education (PACE), Mama Club - an initiative of mothers living with HIV/AIDS, Campaign to End Pediatric HIV/AIDS (CEPA) in Uganda, and Hospice Africa Uganda.  I have also proudly advocated for girl child education and quality education for all. 

As part of the health advocacy campaign, a number of activities have been directed towards increasing attention on issues such as the promotion of sexual reproductive health, safe motherhood and child spacing in several districts within Uganda.  Proper hygiene, sanitation and the use of safe water are also topics of discussion. Men are also encouraged, and do participate in these campaigns and other outreach programs.

The target audience consists of people of authority in leadership positions who can play a significant role in improving the health of children, girls and women; among these are cultural, religious and educational leaders; health workers, women groups, and youth groups.

The campaigns have contributed to increased use and improved quality of safe motherhood services and family planning methods; decrease in infection of HIV/STDs, reduction in maternal deaths and increased child survival.

Today in Uganda, the number of women who are using family planning to prevent pregnancy has improved from 23% in 2001 to currently 30%; Infant Mortality rate also decreased from 74/1000 to 53/1000 in same period. Skilled attendance at birth has markedly improved with 58% of women delivering at health facilities, and Life expectancy is now 63 years from around 45 years.

The factors that have contributed to the success of  our health campaigns are premised on the trust the communities have in the voices behind the campaign; relaying understandable and accurate messages, information and providing counseling - combined with effective leadership and commitment from within Buganda Kingdom. 

In addition, the economic empowerment of women has been paramount, especially in their ability to determine which services they need and where to obtain them, a factor that can be improved by having women participate in program design and communication schemes. 

Cultural leaders hold a strong mantle for providing guidance in the fight against NTDs, especially where people affected and/or  infected with these diseases often ignorantly draw conclusions about the symptoms and signs of the diseases - alleging they’re normal or maybe witchcraft, genetics or simply bad luck. 

With the ongoing global efforts being undertaken by organizations such the END FUND to curb NTDs through treatment therapies, information, 
and communication programs in rural areas - its critical that the development community engages cultural leaders in this rather huge and demanding endeavor – to treat, prevent and ultimately eliminate NTDs from Africa.

It’s crucial to understand the cultural dynamics of any community and the way in which these will influence the acceptability, management, sustainability and ultimate success or failure of any community-directed health-care program.

In addition, given the importance of culture and people’s confidence in their cultural systems, the effort to combat the problem of NTDs, the time has come for serious considerations of incorporation proven traditional health care within our national health care systems.

Governments, development partners, and civil society organizations have the expertise and resources to design health programs that can improve and save lives, while cultural leaders have the knowledge, trust and good will of the people to contribute to the implementation and management of these programs in order to have positive lasting change where it’s needed.

I want to conclude by saying that - we can and should leverage positive aspects of culture and traditions to prevent suffering and loss of lives due NTDs.  International donor agencies, international organizations and civil society should play their part by supporting existing and the creation of new programs that integrate the positive elements of culture, and situate culture as a key framework that defines people’s choices, and use positive cultural voices to appeal to the masses – for this is a prerequisite for achieving a healthy population in the pursuit and attainment of progress and sustainable development.

Thank you for listening, God Bless you all.

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