Using social Science methods to address Neglected Tropical Disease Implementation

challenges Margaret Gyapong and Sally Theobald

Progress with Neglected Tropical Diseases

Massive progress in the last 20 years to facilitate the control of Neglected Tropical Diseases

0

50

100

150

200

250

300

350

400

450

500

LF ONCHO STH SCH TRA

Pe

rso

ns

req

uir

ing

PC

(m

illio

ns)

2008

2009

2010

2011

2012

2013

Status of PC 2013 in the African Region

PC implementation 2013 (incomplete data) LF ONCHO STH SCH TRA

Number of countries requiring PC in 20131 34 27 43 41 27

Number of people treated 2013 139M 100.5M 100.1M 27.5M 53.7M

Coverage (%) 29.7 59.5 30.9 10.4 30.2

331M

472.1M

224M

324.2M

213M

240.7M

124M

177.6M168M

67.5M

0

20

40

60

80

100

$90

$76

$12$15

$30

$49

Inadequate buying practices Quantificationproblems

Inefficientprocurement

Inefficientdistribution

Irrationalprescription

Non-complianceby patients

Inefficiency and waste in the supply of drugs from budget allocation to consumer

U.S. Dollars

Budget allocation for drugs

Value receivedby consumer

Remaining value Cumulative losses

= 37%

98%

H

The case of Genital Schistosomiasisse traction in health systems

Efficacy

X Access

X Diagnostics

X Provider compliance

X Patient adherence

Effectiveness

X 95%

X 95%

X 70%

X 60%

Averages mask inequities

X 40%

X 90%

X 75%

X 60%

= 16%Poorest quintile

Original example from Malaria study in Tanzania

COUNTDOWN: Filling the Gap with Implementation Research

A systematic approach to addressing and understanding barriers to effective and quality implementation of health innovations, strategies and policies.Systematic and critical investigation and analysis of the dynamic processes that influence how individuals, populations and health systems adapt in order to adopt new technologies and interventions.

• Identification of implementation bottlenecks• Thinking through optimal approaches to addressing implementation

challenges• Ensuring the uptake of research findings to inform policy decisions

COUNTDOWN: Filling the Gap with Implementation Research

• Understanding the contexts• Understanding the physical, socio economic and cultural context within which these

interventions are delivered

• Understanding the health system within which these interventions are delivered

• Key stakeholders and institutions needed to ensure the effective delivery of the interventions

• Understand the issues at stake from the perspective of the • Patients and their networks

• Unaffected people and their networks

• Health care providers operating in a complex and under funded system

RATIONALE

• Relieving individuals communities and societies of their pain and disability and ending their misery goes beyond

Applied Health Social Science

• Cross cutting all the thematic areas of work

• Informed by the implementation research guidelines which were cited in the call which focus on the different levels of the health system and beyond : • Inter-sectoral

• National – district

• District – community

• Community – household

Integration • Different levels of health system

• Across different Neglected Tropical Disease programmes

• Within the health sector

• Beyond the health sector

Social Science Basket of Tools

Diagrams

Observation

Community Map

Seasonal CalendarProblem Tree

Focus Group Discussions

PhotovoiceIn Depth Interviews

Documentation of processes

To assess and inform the equity, efficiency and sustainability of current Neglected Tropical Disease approaches and inform policy and practice

National – District Levels:

Assessing evaluation of health system support for Neglected Tropical Disease

programming and current levels of integration e.g.:

• How health systems currently support Mass Drug Administration and the role of human resources for health e.g. how the health workforce supports Mass Drug Administration, for example, the extent to which district health teams monitor and support activities (challenges related to health worker fatigue in Ghana)

• How health system resources could be more fully leveraged to deliver more effective and equitable scale-up of Neglected Tropical Disease activities (e.g. challenges around monitoring and evaluation in Cameroon)

Explore and assess how Neglected Tropical Disease programmes have been integrated into health systems in different contexts, documenting generalisable lessons about the factors favouring effective integration.

Image: www.a-wol.com

District-Community Levels:

Assessment of close-to-community providers/community based practitioners/Community Drug Distributors and their integration with the health system:• Roles, remuneration, experience, motivation, sustainability, integration (challenges

of supervision in Cameroon and incentives and motivation in Liberia) • Synergies between frontline services and the community (this is important in

Liberia) • Assess the effectiveness of the Community Drug Distributor programme from

different perspectives using a health systems approach (for example in Ghana)

Thematic Working Group on CHWs and links with the African Programme for Onchocerciasis Control.

Community/Household Levels:

• Analysis of community perceptions of integrated drug regimes for the control of Neglected Tropical Diseases and seek opportunities to feed these into ongoing programmes and practices

• Exploring the ways in which social processes and markers (such as poverty, gender, disability, age and stigma) are likely to shape access and adherence to Mass Drug Administration for the control of Neglected Tropical Diseases and the experiences of affected individuals and households; out of school and pre-school children (all countries)/morbidity management (Ghana)

Image: www.msh.org

THANK YOU