Neglected tropical diseases, a group of 21 conditions clustered in tropical regions with poor access to clean water and sanitation, affect more than 1.7 billion people worldwide. In Ghana the burden is strikingly broad: 14 endemic NTDs have been identified, and at least two of them are present in every district. Schistosomiasis and soil-transmitted helminths occur nationwide, onchocerciasis is found in 53 percent of districts, and lymphatic filariasis in 44 percent. These diseases cause disability, disfigurement, stigma and lost productivity, yet they are largely preventable or treatable. The World Health Organization’s 2021 to 2030 roadmap for NTDs explicitly calls for integrating their control into primary health care as a route toward universal health coverage, the Sustainable Development Goal target that promises essential services without financial hardship. The problem, until now, has been operational: how do you actually detect these conditions in scattered rural households when the health system’s data streams barely register them?

The Ghanaian team, led by researchers from World Vision Ghana, the Kumasi Centre for Collaborative Research in Tropical Medicine and the Ghana Health Service, chose a pragmatic entry point. Community Health Officers already criss-cross their catchment areas conducting home visits, recording maternal health, immunization, nutrition and blood pressure data in a standard register. The researchers convened a five-day technical workshop with the NTD Programme, the Centre for Health Information Management and other stakeholders to select seven syndromic indicators that frontline workers could recognize without laboratory equipment: blood in urine, skin lesions, visible deformities such as clawed or shortened digits, eye complications, lymphoedema or limb swelling, suspected hydrocele, and deep skin wounds with undermined edges. Each indicator maps onto multiple priority diseases. Blood in urine suggests urogenital schistosomiasis; lymphoedema, hydrocele and visible deformities point to chronic lymphatic filariasis; skin lesions and eye signs reflect onchocerciasis, trachoma, yaws, scabies or leprosy-related morbidity.

The pilot unfolded in three districts chosen to represent Ghana’s different ecological zones: Kassena Nankana West in the rural north, Nkwanta South in the middle belt, and the more peri-urban Ga South municipality near the coast. After two-day training sessions covering case definitions, visual aids and basic software skills, the officers deployed the revised register, in both electronic and paper versions, during routine outreach from September to December 2023. The design was deliberately a feasibility test rather than an epidemiological survey: there was no population sampling frame or prevalence estimate, only a question of whether ordinary health workers could absorb the new task and whether the resulting data would be useful. Twenty-three disease control officers, public health nurses and health information officers were trained alongside them to provide supervision and monitoring.

The detection results were encouraging. Skin lesions were the most common finding across all three districts, accounting for the bulk of the 1,117 recorded observations, and the geographic patterns made epidemiological sense. The coastal Ga South district produced 75 percent of all blood-in-urine reports, a hallmark of urogenital schistosomiasis in communities with freshwater exposure. Kassena Nankana West, in the north, contributed 80.8 percent of lymphoedema observations and 67.5 percent of eye-related complications, consistent with chronic filarial disease and eye conditions in that zone. Ga South also dominated the visible deformity count, while deep skin wounds clustered in Nkwanta South and Ga South. For a health ministry long hampered by sparse and fragmented NTD data, the message was clear: community health officers can act as effective surveillance sentinels, generating locally relevant intelligence that could shift resources from uniform interventions toward targeted, equitable allocation.

Uptake of the training was equally strong. Post-implementation monitoring found that more than 85 percent of trained health workers were actively applying the new identification and reporting protocols. In Kassena Nankana West every single trained officer, 21 of 21, was observed implementing the training, compared with 84 percent in Ga South and 83.3 percent in Nkwanta South. Monitoring teams also compared the electronic and paper registers running in parallel and found no major discrepancies that would compromise interpretation, an important signal for a country weighing digital health investments. The authors argue that this high engagement transforms community health officers into more comprehensive primary care practitioners, capable of sustaining an integrated model rather than depending on short-lived vertical campaigns.

Then came the catch. Of the 1,117 suspected cases identified, 615 referrals were made to health facilities, but only 67 percent of referred individuals actually attended, and district-level compliance ranged from a remarkable 92.1 percent in Kassena Nankana West down to 52.4 percent in Nkwanta South and a dismal 6.5 percent in Ga South, where just four of 62 referred patients reached a facility. Referral generation also varied enormously, from 60.6 percent of home visits in Nkwanta South to 9.2 percent in Ga South. The study did not investigate why patients failed to complete referrals, but the authors point to plausible culprits documented elsewhere in the literature: distance and transport costs, out-of-pocket expenses, stigma attached to visible conditions, competing priorities, and in peri-urban areas the easy availability of alternative providers such as pharmacies and informal healers. Whatever the mix of causes, the pattern demonstrates that passive referral slips handed to patients are insufficient to bridge the gap between community detection and clinical care.

The district contrasts carry their own lessons. Kassena Nankana West’s success, with full training implementation and near-universal referral completion, suggests the model is particularly well suited to remote areas with established, trusted community health structures and strong community-facility linkages. Ga South’s struggles hint that integration strategies cannot simply be copied across contexts; a large municipality with different patient expectations and health-seeking options may need adapted approaches, perhaps patient navigation, transport subsidies or community sensitization dialogues to build trust. The authors recommend that high-performing districts share their practices through audit-and-feedback visits, and that future iterations add digital decision-support tools to help officers distinguish between look-alike conditions and apply standardized management algorithms.

The study’s limitations are candidly acknowledged. The three-month window could not capture seasonal transmission peaks, such as those driving schistosomiasis. The indicators were deliberately syndromic, prioritizing sensitivity over specificity, so suspected cases were never confirmed diagnostically and misclassification is possible; without facility data, the positive predictive value of community identification could not be calculated. There was no population denominator, so screening coverage cannot be estimated, some indicators rest on small numbers, and the short duration says nothing about long-term data quality or worker motivation. Still, as proof of concept the pilot is persuasive: a low-cost modification of an existing tool, co-designed with national and district stakeholders, turned routine household visits into a functioning surveillance network within weeks.

The implications reach well beyond Ghana. Many countries in sub-Saharan Africa are betting on community health worker networks to deliver universal health coverage, and this study offers a template for loading those networks with additional, high-value tasks without building parallel structures. The same platform could be adapted to screen for Buruli ulcer, monitor adverse events after preventive chemotherapy, or support post-elimination surveillance, as Ghana is already doing for trachoma by retaining eye indicators after eliminating the disease as a public health problem. What the pilot makes unmistakably clear, however, is that integration is a two-way street. Embedding seven questions in a home visit register can fill data gaps and surface hidden suffering, but unless health systems invest equally in the referral pathway, in facility capacity, diagnostics, transport and trust, the patients found at the end of a dusty path will still never reach the care that early detection was supposed to unlock.

Subject of Research: Integration of neglected tropical disease surveillance into community-based primary healthcare in Ghana

Article Title: Integrating neglected tropical diseases into primary healthcare services in Ghana: Results from an initial pilot

Article References: Dadzie, A. Q., Ananya, S. A., Tougoue, J. J. N., Tuwor, R. D., Nkrumah-Appau, M., Opare, J. K. L., Mensah, E., Bimpeh, K. A., Gberbie, L. T., Agbanyo, A., Dzathor, I., Agbavor, B., Phillips, R. O., & Amoako, Y. A. (2026). Integrating neglected tropical diseases into primary healthcare services in Ghana: Results from an initial pilot. PLOS Neglected Tropical Diseases, 20(10), e0014792. https://doi.org/10.1371/journal.pntd.0014792

Image Credits: AI Generated

DOI: 10.1371/journal.pntd.0014792

Keywords: neglected tropical diseases, Ghana, primary health care, CHPS, community health workers, surveillance, schistosomiasis, lymphatic filariasis, universal health coverage, referral compliance, PLOS Neglected Tropical Diseases, implementation research

The problem the initiative set out to address is structural. Health policy and systems research is an interdisciplinary field focused on how health systems shape and implement policy, and it is considered critical to achieving the United Nations Sustainable Development Goals. Unlike clinical practice guidelines, which target care for individual patients, health systems guidelines aim to improve the efficiency, equity and quality of care across an entire system. Yet there is a persistent gap in the availability and quality of such guidelines designed within low- and middle-income countries. As a result, health system stakeholders in these settings often rely on guidelines produced by the World Health Organization or by high-income countries — documents that are frequently not adapted to local needs, contexts or political realities, and that often clash with the priorities of the policymakers expected to implement them.

To close this gap, the WHO Alliance for Health Policy and Systems Research funded six research teams from Colombia, Ghana, India, Mozambique, Nigeria and Zambia through the RAISE portfolio. Each team was required to partner with at least one policymaker or knowledge user — someone positioned to use research results to make informed decisions — to support the practical uptake of the guidelines. The projects were strikingly diverse: home visit guidelines in Ghana, prioritization of WHO guidelines in Colombia, antenatal care guidelines in tribal communities in India, cholera control guidelines in Zambia, a WHO digital intervention guideline for mental health system strengthening in Nigeria, and guidelines to reduce primary care waiting times in Mozambique. Selection followed a rigorous peer review process in which 21 eligible proposals out of 27 submissions were scored by 16 reviewers on team qualifications, methods quality, engagement strategy, impact potential, innovation, feasibility and value for money, with scores ranging from 45.00 to 90.67 before an international adjudication panel made the final choices.

Following a competitive process, the Alliance selected the Knowledge Translation Program at St. Michael’s Hospital–Unity Health Toronto, in partnership with the South African Cochrane Centre and the WHO Ethiopia country office, to act as the Technical Support Centre. Crucially, the centre’s approach was rooted in integrated knowledge translation, a methodology in which the knowledge users themselves — the RAISE researchers, trainees and policymakers — were engaged in designing the content and delivery of the support program. This matters because integrated knowledge translation is known to improve buy-in, increase evidence uptake and reduce research waste. It stands in deliberate contrast to the one-size-fits-all or so-called blueprint models that have dominated past capacity-strengthening efforts, which systematic reviews suggest are often driven by high-income country actors pursuing their own spotlight topics rather than the priorities identified by LMIC actors themselves.

The design process began with a needs assessment. In August 2019, 22 participants from the six countries — 10 men and 12 women, including seven principal investigators, six co-investigators, two knowledge users and six research staff — completed a survey with a 63 percent response rate. All teams reported difficulty identifying their specific methods needs before their projects had begun, but six teams requested rigorous training in evidence-based implementation methods, with additional requests covering barrier and facilitator assessments, stakeholder engagement and qualitative analysis. The resulting program had several components: a mandatory three-day in-person inception workshop in Istanbul, Turkey in September 2019; seven pre-recorded webinars delivered between November 2019 and January 2021 through the Canvas online learning platform; online discussion boards; virtual workshops held from April to July 2021 after the COVID-19 pandemic forced the cancellation of planned in-country visits; and ongoing one-to-one coaching calls and email support from methods experts.

The inception workshop covered the full methodological arc of guideline work: introduction to knowledge translation and health policy and systems research, identifying health system gaps, appraising guideline quality using established tools, prioritizing recommendations through Delphi processes, adapting guidelines, mapping barriers and enablers to implementation strategies, and evaluating implementation quality alongside ethical considerations. Participants rated the workshop a mean 6.30 out of 7, praising the quality and applicability of the content and the opportunity to collaborate across teams. The webinars were also well received, rated between 4 and 5 out of 5, with the session on the AGREE II approach to guideline development, evaluation and adaptation drawing the highest engagement. The on-demand format proved essential for teams working across time zones and, as it turned out, through a pandemic.

The evaluation used a mixed-methods design across three phases, applying the Durlak and Dupre process evaluation framework, validated self-efficacy surveys administered at baseline, 12 and 24 months, and semi-structured exit interviews coded thematically with inter-rater reliability checks. The headline quantitative finding was encouraging but nuanced: mean scores for eight of nine research capacity outcomes improved over time, and the improvement in researchers’ ability to develop evidence-based knowledge translation interventions reached statistical significance between 12 and 24 months (Z = −2.93, p < 0.05). The absence of significant change in the other outcomes was attributed to relatively high baseline scores, the small sample size, staff turnover and pandemic-related disruptions to participation. Twenty-one participants responded at baseline, eleven at 12 months and fourteen at 24 months, with only five completing all three time points — an attrition pattern the authors acknowledge as a limitation that may have introduced response bias.

The qualitative findings may prove the most valuable for the field. Teams identified consistent barriers to adapting and implementing health systems guidelines: competing health system structures and stakeholder interests, lack of available data, poorly maintained field equipment for data collection, and insufficient training among staff tasked with implementation. The COVID-19 pandemic compounded these with project delays, reduced human resources, difficulty engaging stakeholders virtually and community fears that study personnel might spread the virus. Yet the enablers the teams identified form a practical playbook. Partnering with health system stakeholders at project inception rather than at study end sustained engagement and buy-in throughout. Employing a multi-sectoral approach that reached beyond the health sector, allocating financial resources for data collection and partnership strengthening, adopting rapid analysis methods to keep qualitative work moving, and building the competencies of the implementation team — a role the Technical Support Centre itself played — all helped projects survive and, in many cases, thrive.

Participants were candid about the program’s friction points as well. Some felt overwhelmed by the sheer number of supports and activities, struggling to balance capacity-strengthening sessions with actual research implementation. Quarterly monitoring templates were seen as helpful for accountability but time-consuming and repetitive. Knowledge user participation in the evaluation was limited by turnover, heavy workloads and pandemic constraints, and internet connectivity varied enough by country that on-demand resources were not equally accessible — page view statistics likely undercount viewership because teams downloaded webinars and watched them together offline. These honest appraisals are part of what makes the study useful: it documents not just what worked but where the model strained.

The authors conclude that the Technical Support Centre offers a replicable model for supporting health policy and systems research capacity in LMICs, with three defining features: a user-driven approach that lets stakeholders determine priorities and activities, flexibility to adapt supports as needs evolve, and multi-modal delivery that extended benefits beyond the core teams to their networks, trainees and associated institutions. Participants recommended sustaining the network of RAISE teams and connecting WHO regional and in-country offices to keep the collaboration alive. As health systems worldwide continue to grapple with pandemic aftershocks and competing priorities, the study’s central lesson resonates well beyond its six countries: capacity strengthening works best when it is not something done to researchers in low- and middle-income countries, but something built with them, on their terms, from the very beginning.

Subject of Research: Implementation and evaluation of a technical support center for health systems guideline research capacity strengthening in low- and middle-income countries

Article Title: Implementation and evaluation of a technical support center for the Research to Enhance the Adaptation and Implementation of Health Systems Guidelines in LMICs [RAISE] initiative

Article References: Fahim, C., Pratt, J., Purewal, A., Marsot-Shiffman, L., de Launay, K. Q., Baddeliyanage, R., Davenport-Huyer, L., Yangchen, S., Gebregiorgis, A. H., Wiysonge, C. S., Tricco, A. C., Puchalski-Ritchie, L., Pham, B., Tuncalp, O., Langlois, E. V., Marten, R., & Straus, S. E. (2026). Implementation and evaluation of a technical support center for the Research to Enhance the Adaptation and Implementation of Health Systems Guidelines in LMICs [RAISE] initiative. Health Research Policy and Systems, 24(S1), Article 73. https://doi.org/10.1186/s12961-026-01462-9

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01462-9

Keywords: health policy and systems research, capacity strengthening, LMICs, knowledge translation, guideline adaptation, implementation research, WHO Alliance for HPSR, RAISE initiative, technical support centre, integrated knowledge translation, health systems guidelines, COVID-19