**6. Global Health Agenda and** *Schistosomiasis* **control campaign in Africa**

The global health agenda can be traced to the World Health Organization and the World Health Assembly (WHA) in 1975, when the Executive Board called for an international conference to address the conspicuous inequalities in health and health services between countries [84, 85]. In the said conference WHA adopted the call to scale up efforts in drug development, proper engineering design of water management projects, and mobilization of partners for *schistosomiasis* control [86]. In the following year, in 1976, a resolution was passed on the need to consider the epidemiological aspects of the disease during the planning and implementation of water management schemes in endemic countries [23]. The resolution considered the need to implement measures to prevent the spread of *schistosomiasis* to new geographical locations [87]. In 1977, WHA specified that the central social goal of WHO was the level of "acceptable" health that would allow a "socially and economically productive life" for all people by 2000 and called on nation-states to work toward this goal [85]. To pursue this agenda, the primary health care framework was formulated at the Alma-Ata conference in 1978 [88]. The purpose of the Alma-Ata Declaration was to influence strategies, policies, and programs of national and global communities for the next two decades. The declaration emphasized the need to provide "Health for All" by adequate collaboration between biomedical and traditional sectors, in order to encourage encompasses approaches to health care that incorporated community development and community participation [85].

Oyeyemi and colleagues noted that while these efforts recorded some positive outcomes in some countries, the situations in sub-Saharan African countries were rather the same [23]. Another research confirmed the lack of interest in the *schistosomiasis* control campaign in sub-Saharan Africa as other diseases were given more priority in the region's health agenda [89]. Little or no efforts were recorded between the 1970s after the Agenda to the year 2001 when significant results were expected. For example, Oyeyemi and colleagues said there was no single record of an epidemiological study on *schistosomiasis* in some Nigerian States [23]. They, however, agreed that most of the notable *schistosomiasis* control strategies in Nigeria started in the late 2000s.

Over the years, several resolutions aimed toward improvement on *schistosomiasis* control have been made with great commitment but little or no achievement,

portraying the African countries like a dancer, dancing around in a cycle. However, there seems to be a resurgent in recent years, as the control of *schistosomiasis* and other NTDs started to have some level of awareness and taken the priority list of some African governments, international organizations, and donors among others [7]. The resurgent can be traced to the WHA 54.19 resolution on *schistosomiasis* and soil-transmitted helminths on attaining at least 75% regular treatment benchmark of all school-aged children in endemic communities by 2010, endorsed in 2001 by the WHO member states [23, 90]. But it took more than a decade for some countries to come up with a national action plan for the control of NTDs. For example, a wellorganized control implementation for the *schistosomiasis* program was only supported after the year 2010 by the Nigerian government [23]. As of January 2012, when WHO published NTDs Roadmap, it described the strategic approach to fast-track work to overcome the global impact of NTDs, targeting the period of 2012–2020 [91]. These resolutions received the overwhelming support of donors, member states, and other stakeholders who pledged their support for the WHO Roadmap and its 2020 target [51, 91], in the same 2012, the WHA 65.21 resolution on the elimination of *schistosomiasis* was endorsed [92].

Consequently, all affected regions (See, **Figure 2** and **Table 3**) are to strengthen the control interventions and surveillance and embark on *schistosomiasis* elimination where possible [19]. So, in the year 2013 WHA 66.12 resolution on NTDs, member states were to take ownership of NTDs' various control programs [49]. Then, between

#### **Figure 2.**

*Principal places affected by Schistosomiasis in Africa. Sources: MDPI [93]. Available at: https://www.mdpi. com/2414-6366/6/3/109.*

*Dancing in a Cycle: Global Health Agenda and* Schistosomiasis *Control in Africa DOI: http://dx.doi.org/10.5772/intechopen.103164*


#### **Table 3.**

*Schistosomiasis global statistics.*

the years 2015 and 2020, three time-bound goals for control of *schistosomiasis* were set by the WHO NTD Roadmap for the Mediterranean Region, Americas, Western Pacific, and sub-Saharan African countries [7, 23]. Oyeyemi and colleagues, assert that although the WHO NTDs Roadmap envisaged the potential elimination of *schistosomiasis* in some countries in the sub-Saharan region by 2020, it was certain that this feat was unachievable by the end of 2020 [23]. They assumed that conflict in the Nigerian communities might have contributed to the non-realization of the control of *schistosomiasis*. They also alluded to the COVID-19 pandemic as a possible impediment to *schistosomiasis* control implementation programs in Nigeria. The question is, would the WHO NTDs 2020 target have been realized in the absence of conflict and the current pandemic? The answer is possibly a no, going by the previous patterns of attention given to previous resolutions. It was, however, affirmed that epidemiological evidence suggests that the country has a long way to go and a new WHO NTDs Roadmap for control or elimination of *schistosomiasis* is inevitable [23], now that there is a new roadmap for 2021–2030 [52]. Following the previous pattern of late implementation, the presence of other diseases of priority such as COVID-19 and incessant conflict in Africa, are we not going to be singing the same song of a long way to go? We may need time to tell, since the new resolution just began, it may be too early to judge if it will succeed or fail.

### **7. Conclusion**

Historically *schistosomiasis* in Africa can be traced to the Egyptian mummies of the twentieth dynasty, it has spread over the continents with the highest global burden in the world. Despite several efforts brought forth to combat the disease is still categorized among the neglected tropical diseases for several reasons. It is not all affected populations that are treated during MDAs, also certain symptoms look like that of other diseases, mode of transmission also are associated with the people social and occupational activities, sometimes *schistosomiasis* is missed diagnosis and devices for the diagnosis are expensive. The high cost of logistics and the exclusion of adults and out-of-school children during mass drug administration are possible factors that promote continuous transmission of *schistosomiasis* in Africa. *Schistosomiasis* and other NTDs affect close to 2 billion people with other indirect consequences such as disability, stigma, truancy, abscond from duty, poverty, and economic loss. With all the

concerted effort of government, donors, and WHO, the MDAs is still inadequate to control *schistosomiasis* in Africa. Maybe because of the inadequate attention is given to research on the geographical distribution of schistosomiasis in other areas outside the researched areas. There is current advocacy for the use of traditional medicine as an additional effort to combat schistosomiasis in Africa. This is because several declarations and roadmap for the control and elimination program have failed, we hope that the 2030 target will be a success.
