EP 168: Michael Ofire, Neglected No More: African Solutions for NTDs

Half the world lives at risk of at least one neglected tropical disease, yet these illnesses remain underfunded, misunderstood, and hidden behind stigma. 

Our host, Anne Chisa, speaks with public health practitioner Michael Ofire to unpack what “neglect” really means, how NTDs entrench poverty and how policy, primary care, and community action can break the cycle. 

Michael Ofire shares practical wins, funding ideas, and a hopeful path to 2030 through African-led research and partnerships.

Chapters

• 0:00 Framing The Global NTD Burden
• 2:11 Meet Michael And His Work
• 3:22 What Makes A Disease Neglected
• 6:57 The Human Cost In Kenya And Africa
• 11:08 Barriers And Lessons From History
• 15:59 Policy Shifts And Primary Care In Kenya
• 20:14 Community Success And Reduced Stigma
• 23:26 SDG 2030, Debt Swaps, And Partnerships
• 27:32 What Listeners And Young Scientists Can Do
• 31:07 Hope, Progress, And Closing

Transcript

SPEAKER_01: 0:00

The global population is almost approaching two billion and out of which at least fifty percent are um at risk of at least one neglected because this is after communities often affecting diseases that are disabled, stigmatized, and often go unnoticed.

SPEAKER_00: 0:44

These are neglected topical diseases, otherwise known as NPDs. These are illnesses that affect more than one billion people globally, most of them right here in our continent. MTDs disproportionately impact the world's poorest and most marginalized communities. In Africa, these diseases continue to perpetuate cycles of poverty, disability, stigma, and limited economic opportunity. However, these diseases receive minimal attention, research funding, or innovation. In 2025, the Drugs for Neglected Disease Initiative reminded the world that science and collaboration can end neglect. They called for renewed investment, innovation, and partnerships to eliminate entities. The recent elimination of sleeping sickness as a public health problem in Guinea stands as living proof that progress is possible when political will, research, and coordinated strategic action come together. And that's what this episode is all about, illustrating the lived realities of communities affected by entities, the obstacles of progress, and the promise of African-led research, innovation, and advocacy. As you might all know, I'm your host, Anne Cheesa, and this is the fourth episode of our Rooted in Health series, a partnership in collaboration with Global Health Strategies, where we bring you the stories behind the science and the people driving change in the public health. Today I'm joined by Michael Offiri, a public health practitioner and a program manager for Entity's Emirates Health Africa. Michael has spent years bridging epidemiology, community engagement, and policy, reminding us that science means little if it doesn't reach those who are most affected. Stay with us as we look at some of the work that he's involved in. Hello, Michael. Welcome to the show.

SPEAKER_01: 3:03

Thank you very much. Um thank you for inviting me.

SPEAKER_00: 3:10

Sure. It is such a pleasure to have you on the show and to get to know more about you and the work that you do. So before we get things started, could you briefly introduce yourself for our audiences who are listening?

SPEAKER_01: 3:22

Yeah, um, thank you very much, and um I work for AMRA Health Africa um in Kenya, and um my main focus of work is on neglected tropical diseases, um, where we work with the government of Kenya um towards um addressing or rather uh the journey to eliminating um some of the priority neglected tropical diseases, um, that includes uh black fever, scientifically known as visceral eishmaniasis, um elephantasis, um, intestinal worms, um, and belhasia. And um out of all these, I've just mentioned four, but in Kenya we have 17 neglectotropical diseases. But largely in the world, uh, the World Health Organization has classified 21 neglectropical diseases, and in Africa, um at least 20 of them um have been documented to be present in the African continent. And of course, with other colleagues within with in other African countries coordinated by the um WHO Africa Regional Office, um, all of us focusing on supporting various countries to eliminate various neglected tropical diseases.

SPEAKER_00: 4:42

Fantastic. Thank you for that overview about you and also the work that you do. Um, the topic of conversation today is neglected tropical diseases, or in short, NTDs. But for someone who's listening, um, you've you've given us what does that actually mean? What are neglected diseases? Why are they neglected and why have they been classified into their own um category as opposed to all the other diseases that we are familiar with?

SPEAKER_01: 5:08

Um thank you very much, Anne. So um neglected tropical diseases are classified as neglected. One just be because of the first name, the neglect. Um they're largely given little attention um um in the global health um sphere. They are largely underfunded, um, they mostly affect um the poor. Most of them are chronic. It takes lengthy duration for someone to manifest the symptoms. And um, they are not diseases that you know, most of the policymakers from where they sit, uh, they don't perceive to be at risk of these diseases because of, you know, the access to uh you know better health services, um, access to interventions like you know, uh proper housing, ETC that kind of help prevent them from the risks of uh getting some of these neglectropical diseases. And that's where they're really uh given little attention um uh within the global health space. And that's why they are called neglectrotropical diseases, and the tropical part is because they are found within the tropical region of the world. Um, for those that remember their geography classes, we have the tropic of cancer and the tropic of Capricorn. So there are various, you know, in the world. If you go back to the world map, you'll see areas where um the tropical region lies. So Africa is part of it, and of course, we have the Indian subcontinent, we also have the South American region that lies within the uh tropical regions of the world.

SPEAKER_00: 6:55

That's pretty interesting. Um, for an ordinary family in Kenya specifically, who, for example, Amref works with um what what does this what does this burden of NTDs actually look like?

SPEAKER_01: 7:10

I'll maybe just paint a picture. Um the global population is almost approaching 2 billion, and out of which at least 50 percent are um at risk of at least one neglected tropical disease. Uh when we narrow down to um our African continent, we actually contribute to 40% of um the global burden of neglected tropical diseases. So if you were to do a calculation out of a billion people, we have at least 400 million people in Africa that um are at risk of at least one neglectropical diseases. And of course, this varies by country uh based on the in-country population. Um, in the Kenya, the population is almost approaching um 60 million, and out of which approximately 50% of that population is at risk of um one neglectropical diseases. And uh, as I had only mentioned, um these diseases, in as much as they are predominantly found within the poorest or the poorest, um, we still have pockets within the urban areas, uh, you know, the urban poor, even the urban rich that um kind of have have uh rather still suffer from some of these um conditions. They are largely deliberating, uh they will lead to psychosocial um uh distress, psychosocial issues, they will exacerbate the cycle of poverty because treating them is a bit expensive. And as I'd mentioned, some of them lead to permanent and long lifelong disability, like um elephantasis, where which lead to deformities either in on the leg or uh the arms, and over time leads to uh lifelong disability, and some of course are very fatal, like um visceral echemaniasis. Um, if left untreated, 95 percent at least of the cases will end up dying. And um, you know, some will lead to you know uh like schistosomyasis that will maybe affect children, it will affect their neurological uh development and affect their academic performance uh for women, it will affect their reproductive area within the when they are uh they develop into female genital schistosomias, and at times this is confused with um cervical cancer, misdiagnosed, and uh the uh it breaks families because of they are unable to um have that physical contact uh for married couples, and at times these are some of the things that kind of break families. So the impact of neglected tropical diseases is huge because it not only affects the economy, it affects social lives, it affects livelihoods, it's a it affects uh you know the development of children, and with that they're unable to catch up with um children that either in developed nations or within their countries that are privileged. So it kind of helped to expand the iniquity uh you know that is experienced within the communities that suffer from some of these diseases.

SPEAKER_00: 10:43

This is so heartbreaking. I mean, just hearing you explain um these effects. And I'm also learning, and I'm sure even some of our listeners are learning, the type of impact um that it has at a social economic level as well. And we've seen, and you've mentioned already, that um, you know, these entities are persisting. Um, and I'm sure there's been a lot of effort in the past. But uh what are some of the biggest barriers that are holding um Africa back, specifically um in really having targeted um or rather, yeah, targeted um efforts or real having like breakthroughs in treating these um diseases?

SPEAKER_01: 11:33

First of all, before I talk about the barriers, I'd like to really celebrate Africa due to um its rich diversity. Uh we have people uh practicing different cultures, um we have communities and countries that you know um have minerals, some have are oil producing, some the economic uh the main um economic income is on agriculture, ETC. So Africa is a very rich continent. And just going back to history, um, the first African country to actually gain independence was um Ghana around 1957, but earlier on, Liberia, um which um moved from colonial rule around 1847. So, give or take, uh it would be right to say maybe it's the first African state that was freed from colonial rule, and just looking at other countries um that are already classified as uh first world countries like Singapore and Malaysia, um, between 1959 and 1965 is when they gained their independence, China around 1949. So essentially, most of these countries they are as old as African um nations or countries, but they also used to suffer from neglected tropical diseases if you dig deep in history. But there's something that they did differently that um African countries um can try and learn from to address uh the barriers that still hold Africa's progress towards addressing um entities. One is the issue around um iniquity in development, because as I indicated, these are diseases of the poor, and the best way to get people or communities out of poverty is through economic development, ensuring education, um, access to markets for their products, minimizing uh the conflict that we see in most African countries, ensuring the security for people to be able to do business, to be able to do agriculture, work in uh you know mining, um, you know, farms, ETC. And all this, once we try and um improve the economic lives of um Africans, then over time, an educated community will tend to learn and understand what are the reasons of some of their health conditions, including the neglected tropical diseases. Um, at the systemic level, um our leaders, um and as we can see, most African countries right now, we can see citizens are really calling for accountability and wanting to elect uh patriotic leaders to kind of lead them. And so there's need to prioritize uh you know health systems and not uh you know look at health as um an expenditure, but our leaders need to view it as a public good so that kind of they are able to um invest in resilient um health systems and largely looking at the primary healthcare level where uh you know services can easily be accessed by communities and in the principle of universal health coverage. So once they do that, then you know, certain systems or other interventions like social behavior change, communication, uh, you know, them understanding the need to change um their way of life that is putting them at risk of some of these neglected tropical diseases will be addressed at that level when African governments kind of invest in health, strengthening health systems and prioritizing it, and looking at health as an econom a public good that is also a catalyst for economic development because a Sikh population is unable to engage in meaningful uh economic productive activity. Lastly, is around um over reliance of external funding uh for our health systems in Africa. Um most of our governments, um, beyond uh you know, salaries and the hardware, which is building hospitals, um, you know, there's really very uh little to no investment when it comes to equipping, ensuring human resources that are fit for purpose are recruited, and as well as the software which is around educating masses around their health, uh, because the lack of knowledge is not uh you know uh something that we can capitalize on, that it's the problem. But um the educated that are sitting in governments at the apex of leadership, how can they use their knowledge and skills to try and sensitize uh their populace within their various countries? And I think if Africa tries to address all that, then it is going to accelerate the progress towards addressing um the still high burden of neglectropical diseases.

SPEAKER_00: 17:21

Just to further pull the string on the idea of the type of leadership um that Africa needs, you did mention that one of the key factors is that we really focus on uh uh global fund, I mean global partnerships or funding, external funding not coming from Africa. But um what are some of the work that um African leaderships or African governments, you can speak specifically to um your local context in Kenya. Um how are they coming together to actually change the way we tackle these entities?

SPEAKER_01: 17:59

Just looking at um uh what is happening right now, um there's the whole idea around looking at health holistically as a public good. And with the current government um in Kenya, we're seeing them focused more on um health promotion and preventive um uh care. And um, with this, uh we're seeing them looking at strengthening primary health care and deliberately focusing on how they're able to kind of sustain um health financing by kind of um taxing uh you know uh those that are working and are higher up uh the economic chain to be able to ensure access to health services to the entire populace, ensuring health equity, and this is strengthened through um social health um insurance. So um that is what is happening, and in as much as um it's progressive because uh unemployment rate is still a bit high, not only in Kenya, but um it's a challenge that most African governments are grappling with. But uh, you know, the shift that we're seeing in terms of looking at health as a public good in Kenya and where uh you know the those that are working are taxed more, similar to what the Obamacare used to do, so that they're able to ensure access to health services for the marginalized uh population and at the primary healthcare level. I think the shift for me is something that is um a bit interesting uh to see how then that can kind of build resilient primary healthcare systems where you know um health promotion can be done, preventive health services, and for those that require curative health services can also still access health facilities at that level.

SPEAKER_00: 20:10

That's really encouraging that there is that work in the ground. And I want to ask further on this what are some of the breakthrough stories or uh community success stories that you have seen in your own work with AMRIF that's um that kind of gives you hope that something is working and the work that you do is having um impact and meaning?

SPEAKER_01: 20:36

Thank you very much. So um, impact is um what I think all of us in the global health and public health space um focus on, just trying to see uh whatever policies, whatever investments uh we have, how then does it create the impact at that lower level or at the individual or household level? And some of the successes we've seen is, for instance, a disease like elephantis that will kind of affect the males around the scrotal region. Um, you know, they will develop a condition uh known as a hydrocell. And most of the time, um, people associate this to so many other factors. Uh, there are a lot of myths and misconceptions around it. They'll probably think it's uh, you know, uh taking the local broom or uh witchcraft, ETC, but over time, through constant engagement, uh community engagement, we've seen like males that have this condition coming out and seeking care and treatment, which is uh provided through um a surgical intervention. And most of them are able to go back to their communities, go back to their families, uh, reunite with their families because some of them, because they're of their conditions, you could see families breaking, uh, you know, uh because some think their, you know, the husband or their dad has been bewitched, and so they're running away from the witchcraft, not interfering with them. And so when a simple surgical procedure is done and uh, you know, their condition is restored uh to back to normal and they reunite with their families, uh, you know, that is something that is very interesting. And you see them now, you know, fighting stigma and being able to go back into their communities and engage in meaningful economic activities. And even some of them having more children, which you know um is something that they always think when you have a swollen scroll region, then you know, you're unable to get children. So once we see some of those successful stories, those are some of the things that you know kind of um um satisfy some of us that are in the business of um addressing neglected tropical diseases within our respective communities.

SPEAKER_00: 23:02

That's absolutely brilliant. And um, it really um, you know, puts a smile on my face just listening to that story. So this really gives me um so much hope, and I'm really excited that the work that you're doing is having such wonderful impact um on the community. And, you know, I wanted us to maybe then take it back to a broader context, right? As we're speaking on successes, um, we're fast approaching 2030 uh with the SDGs that some say uh we might not be able to meet the targets as it's pretty close. But for you personally, what does success look like for you in this field at a global level as we're linking it to the SDG goals, uh, specifically for some of the health targets?

SPEAKER_01: 23:54

Just looking at the height of COVID around 2020, 2020, 2021, it appeared like 2030 was far off, but right now uh we are made into the current decade and um only five years to um 2030. Yet COVID came at the beginning of the current decade, which you know disrupted um various health systems, and beyond that, the economy, and there was a lot of disruptions. And um, we even saw countries that had the most developed um public health systems, you know, being vulnerable. And that raises the question, uh, you know, African countries that still have very fragile health systems, uh, that still require a bit more of investment. You know, uh what does that mean as we look towards the uh you know, achieving the 2030 goals, the Millennium Development Goals, and the um SDGs. And uh at the end of it, um, in the NTD space, we're working with a 2030 NTD roadmap where you know has various indicators to support countries to kind of um you know eliminate various um diseases. So um from where I see it is um in as much as um there are a lot of disruptions when it comes to having very strategic uh partnerships, uh, because uh you know um governments can never really work alone. Um even in the most developed nations, we still have the private sector, the non-governmental organizations always stepping in to kind of support or complement um government efforts. And looking at African governments, we're really grappling with external debts. And there's an opportunity for uh debt concessions uh where you know we are able to discuss with maybe some of those um external funders that African governments owe them a possibility of can we go for debt for health swaps? And maybe you know, some of the repayments you're supposed to make, they allow us to reinvest that back into our public health system so that we can kind of improve the health of our populace. And if we invest in public health systems, make them robust and resilient, then I think 2030 is in as much as it's fast approaching, there is much we can still do within five years to accelerate uh you know some of the targets. It's about moving the needle a bit more faster than uh you know what we've been doing. So that uh, you know, we in as much as we are working in a challenging situation at the moment, but um there is still hope. Five years is such a short time, but still yet a long time if we double our efforts. It's not time to double down, but it's a time to double up and see how we are able to move the needle faster, invest more, build more uh you know, um robust health um systems, and at the same time, as governments do all this, have the communities at the mind, uh at their mind, or rather at the center of uh you know economic development and looking at health indicators, how do they perform vis-a-vis um economic development?

SPEAKER_00: 27:37

Yeah, no, um, that's that's absolutely so true. And we still remain optimistic that you know, some of these challenges and the roadmap that you've you've you've clearly described, uh we can meet some of these targets with some of these wonderful interventions um that you mentioned. Um, Michael, as we are wrapping up, we've learned a lot. Um I've learned a lot rather than I'm sure some of my listeners have learnt a lot. I wanted to ask you, um, for our listeners who vary from young scientists to um everyday citizens who might not be aware of um entities, um, what advice on what simple but meaningful action um can they possibly take to help end the neglect in that um in the word um neglected tropical disease?

SPEAKER_01: 28:31

So in addressing the neglect in neglected tropical diseases, um it requires a whole of society um approach beyond the governments, and I think I've clearly outlined what governments can do, uh, you know, uh what strategic partnerships can do through, you know, external from external uh, you know, uh partners, but at the same time looking at researchers, looking at uh, you know, uh young advocates, um it's about ensuring the voices of the voiceless are elevated um in the decision-making table. But primarily um the researchers, there is much that still needs to be done um in the African um continent to just understand these neglected tropical diseases better, develop uh better tools um that can help to um address the burden. And of course, as I had I had earlier mentioned, this requires strategic partnerships, looking at uh you know, researchers and um our friends, the friends of Africa globally, how can then we tap into their experiences, into the platforms and the systems within their uh uh you know? Within their reach, how can we tap into them? Have young scientists, young researchers tap into their potential and their facilities to kind of develop uh tools and systems that uh you know are um easily utilized or adopted here in Africa to um kind of address the burden of neglected tropical diseases. And so this calls for very strategic partnerships, looking at the uh the global north as our friends, uh not as our competitors, but at the same time, also the global north kind of supporting the young and upcoming researchers, uh, trying to capacity build them. Transfer of skills, transfer of knowledge. For instance, uh disease like visceral ishmaniasis, Africa, and especially East Africa bear 70% of the burden. But um, you know, our drugs are manufactured and produced from the global north. Um uh the diagnosticates are also not uh you know uh produced here in Africa. And recently uh the Africa Union launched the African Medical Um Agency. So, how can then, using those platforms and opportunities, the global south collaborate with the global north to transfer skills? The global north can also invest in Africa by ensuring that maybe diseases that are found in Africa produce uh you know the drugs, the molecules, and the diagnostics from African continent. One, this will help to kind of address uh uh unemployment, lead to economic development, which over time will help reduce the burden of neglected tropical diseases. But at the same time, because these are private entities, they're still able to get um their profits at the same time when empowering Africa. So I think what I'd call for is the scientists from the global north and the younger upcoming scientists get into very strategic um collaborations which can then uh contribute to addressing the burden of negro tropical diseases, whether be it diagnosticates, drugs, epidemiology of the diseases, and just understanding the science of the diseases a bit more, there is an opportunity for that.

SPEAKER_00: 32:40

1000% agree with that. Um, you know, you the key thing that you've stressed in this conversation is the key strategic um efforts in addressing this burden. And I hope even a conversation like this right now um, you know, is something that also brings awareness. And I thank you for your time. I thank you for your um insights and expertise on this on this topic. Also, thank you for the work that you are doing with the organization, specifically in Kenya. And I truly hope that over time we can have positive um results on how we are addressing this issue. And um I am I am optimistic.

SPEAKER_01: 33:26

I'm usually very optimistic, but I think with some of the maybe just one final thing to acknowledge at least 56 countries globally have eliminated at least one neglected tropical disease. And in Africa, over 20 have done so there are successes. So there's still hope that we can.

SPEAKER_00: 33:45

Yes. Oh, I love that. So there is there is reason to be optimistic. And I'm sure over time, with advancements in research and collaboration and funding and policy and government um collaborations, this can be something that we can talk about in the promised tense. Um, yeah, thank you so much, Michael, for coming onto the show once again. I really, really appreciate it. Thank you very much for hosting. Okay, and everybody else who's tuned in, thank you so much for listening to another episode of the Roots of Science podcast with your girl and with an E. Until next time. Goodbye.