title: Challenges and opportunities associated with neglected tropical disease and water, sanitation and hygiene intersectoral integration programs.
abstract: BACKGROUND
  Recent research has suggested that water, sanitation, and hygiene (WASH) interventions, in addition to mass drug administration (MDA), are necessary for controlling and eliminating many neglected tropical diseases (NTDs).
  
  
  OBJECTIVE
  This study investigated the integration of NTD and WASH programming in order to identify barriers to widespread integration and make recommendations about ideal conditions and best practices critical to future integrated programs.
  
  
  METHODS
  Twenty-four in-depth, semi-structured interviews were conducted with key stakeholders in the global NTD and WASH sectors to identify barriers and ideal conditions in programmatic integration.
  
  
  RESULTS
  The most frequently mentioned barriers to WASH and NTD integration included: 1) differing programmatic objectives in the two sectors, including different indicators and metrics; 2) a disproportionate focus on mass drug administration; 3) differences in the scale of funding; 4) siloed funding; and 5) a lack of coordination and information sharing between the two sectors. Participants also conveyed that a more holistic approach was needed if future integration efforts are to be scaled-up. The most commonly mentioned requisite conditions included: 1) education and advocacy; 2) development of joint indicators; 3) increased involvement at the ministerial level; 4) integrated strategy development; 5) creating task forces or committed partnerships; and 6) improved donor support.
  
  
  CONCLUSIONS
  Public health practitioners planning to integrate NTD and WASH programs can apply these results to create conditions for more effective programs and mitigate barriers to success. Donor agencies should consider funding more integration efforts to further test the proof of principle, and additional support from national and local governments is recommended if integration efforts are to succeed. Intersectoral efforts that include the development of shared indicators and objectives are needed to foster conditions conducive to expanding effective integration programs.
authors.affiliation: The George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW Suite 400, Washington, DC, 20051, USA. eajohnston87@gmail.com.
authors.forename: E Anna
authors.initials: EA
authors.lastname: Johnston
authors.affiliation: WASH Advocates, 1506 21st Street NW, Suite 200, Washington, DC, 20036, USA. jlteague2011@gmail.com.
authors.forename: Jordan
authors.initials: J
authors.lastname: Teague
authors.affiliation: The George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW Suite 400, Washington, DC, 20051, USA. jgraham@gwu.edu.
authors.forename: Jay P
authors.initials: JP
authors.lastname: Graham
mesh_terms: D006801:Humans; D006920:Hygiene; D007407:Interviews as Topic; D058069:Neglected Diseases; D015397:Program Evaluation; D011634:Public Health; D036301:Qualitative Research; D012499:Sanitation / Q000379:methods; D014329:Tropical Climate; D014881:Water Supply