Abstract
Elimination of a disease is the holy grail in global health. The pathology of several neglected tropical diseases (NTDs) such as lymphatic filariasis (LF) makes elimination a reality. However, successful elimination requires that NTD programs be sustainable-the ability to confirm that the disease has been eliminated and the capacity to ensure that it does not return. The WHO's guidelines on NTDs thoroughly detail how to reach elimination. Notwithstanding, comprehensive guidance regarding contextual and programmatic factors that influence sustainability is lacking. Moreover, a comprehensive NTD sustainability framework that includes these factors is nonexistent. This research aimed to develop a framework that identified the critical programmatic and contextual factors influencing sustainability of NTD elimination programs. The methodology included a literature review and a multiple case study. The literature review had two objectives: the first was to identify unique attributes of NTD elimination programs that should be considered when planning for sustainability and the second was to identify an existing sustainability framework that could be adapted to NTD elimination programs. The literature review resulted in a draft sustainability framework that was then tested, using a multi-case study methodology, on the Kenya National Program for Elimination of Lymphatic Filariasis. The result is the first comprehensive NTD sustainability framework that identifies key contextual and programmatic factors that influence NTD sustainability. This framework is an invaluable resource for practitioners and policy makers alike as many countries start to eliminate NTDs.