Fig 5. The healthcare paradox for NTDs in endemic regions.

At the lowest level, the healthcare system in the NTD endemic region has minimally trained CHWs capable of providing referrals to a level up such as local dispensaries with limited resources including technicians and/or midwives, followed by health centers with trained medical professionals, laboratory space, equipment, and/or inpatient wards. These CHWs at the base of the pyramid also play a vital role in facilitating mobile health outreach services, thereby bridging the gap between patients and medical facilities. One level further up is adequately equipped provisional hospitals followed by fully functional national hospitals at the top of the pyramid. Notably, the burden of NTDs is highest at the lowest healthcare level. This indicates the healthcare paradox, i.e., the highest NTD needs occur at the base of the pyramid where resources are inadequate, and, thus, the disease spreads further due to unmet healthcare needs. To interrupt this vicious cycle of disease endemicity, easy-to-use NTD diagnostics should be introduced to the CHWs at the lowest level. Bringing NTD diagnostics at the doorstep of the endemic populations will ensure efficient disease diagnosis and treatment, reduce costs, and thereby alleviate the healthcare burden. CHW, community healthcare worker; NTD, neglected tropical disease.