Strengthening health systems for equity: the role of the REDRESS project in managing skin diseases in Liberia

Severe stigmatizing skin diseases (SSSDs), such as lymphatic filariasis, leprosy, Buruli ulcer, yaws, and onchocerciasis, which are among the neglected tropical diseases (NTDs), are considered the 4th leading cause of disability worldwide. For many individuals with SSSDs, limited access to effective healthcare and the ability to seek care has led to significant psychosocial consequences, complex treatment journeys, and devastating socio-economic impacts. A health system strengthening approach to managing SSSDs has been proposed as a key solution to address these challenges, particularly by improving equity and effectiveness. In Liberia, the strengthening of the health system has been promoted for quite some time. The "Investment for Building a Resilient Health System" created an opportunity to innovate and prioritize the integration of vertical disease programs. Seizing this opportunity, a project named REDRESS was launched with the goal of reducing the burden of SSSDs through equitable person-centred approaches to strengthening health systems. The project aims to evaluate how these approaches can enhance the equity, effectiveness, and sustainability of SSSD management. The consortium supporting REDRESS comprises international and national organizations, affected individuals, and community leaders, working closely with Liberia's Ministry of Health to address priority health needs, with the government leading the project for sustainability. This collaboration promotes mutual learning, equitable decision-making, fair distribution of resources, and the maximization of shared networks. Notably, the project includes a higher percentage of women researchers compared to men, addressing gender inequities in research structures. Moreover, it includes individuals with lived experience of NTDs, along with community health service supervisors and assistants, ensuring that the needs of those affected are accurately represented. The REDRESS project’s participatory methods and interdisciplinary co-production of evidence provide an exemplary response to NTDs, embodying a "no one left behind" approach that enhances case detection, referral, and treatment through a global health perspective.