debunking the notion of a magic bullet
TRANSCRIPT
Debunking the notion of a magic bullet
Laura Dean, Samantha Page, Kate Hawkins, Russell Stothard, Samuel Wanji, Margaret Gyapong, Ifeoma Anagbogu and Sally Theobald
http://www.countdownonntds.org/
@NTDCOUNTDOWN
Background Who are COUNTDOWN and what do we do?• DFID funded, multi-disciplinary implementation research consortium• Dedicated to investigating cost-effective, scale up and sustainable solutions to
eliminate the seven most common NTDs by 2020 • Cameroon, Ghana, Nigeria and Liberia
What is the purpose of this presentation?• Emphasise the importance of implementation research through key case
studies • Highlight lessons for the expansion, scale-up and maintenance of NTD
interventions
http://www.countdownonntds.org/ @NTDCOUNTDOWN
Methods• Informed by previously published work of COUNTDOWN consortium
members.
• Conducted observation at stakeholder meetings geared toward setting COUNTDOWN research priorities.
• Analysis of stakeholder meeting reports from four separate stakeholder meetings; Ghana, Cameroon and UK.
• Purposively sampled key informants to gain more in-depth information based on observation and analysis from stakeholder meetings.
http://www.countdownonntds.org/ @NTDCOUNTDOWN
Context• Lymphatic Filariasis in Ghana
Partnerships• Guinea Worm and Polio• Malaria and Lymphatic Filariasis
Changing Vulnerabilities• Female Genital Schistosomiasis and the
life course in Ghana
Community Ownership• Community Directed Treatment for
Onchocerciasis in Cameroon•
http://www.countdownonntds.org/ @NTDCOUNTDOWN
Context• Lymphatic Filariasis in Ghana
Partnerships• Guinea Worm and Polio• Malaria and Lymphatic Filariasis
Changing Vulnerabilities• Female Genital Schistosomiasis and the
life course in Ghana
Community Ownership• Community Directed Treatment for
Onchocerciasis in Cameroon•
http://www.countdownonntds.org/ @NTDCOUNTDOWN
Importance of context: Lymphatic Filariasis and Ghana
Ashanti
Brong-A
hafo
Centra
l
Easter
n
Greater
Accra
Northern
Upper Ea
st
Upper W
est Volta
Western To
tal65.00
70.00
75.00
80.00
85.00 83.9584.56
79.28
81.43
71.56
82.7882.08
81.06
82.73
79.96 79.91
Coverage of mass drug administration for LF
Coverage
http://www.countdownonntds.org/ @NTDCOUNTDOWN
Importance of context: Lymphatic Filariasis and Ghana
Ashanti
Brong-A
hafo
Centra
l
Easter
n
Greater
Accra
Northern
Upper Ea
st
Upper W
est Volta
Western To
tal65.00
70.00
75.00
80.00
85.00 83.9584.56
79.28
81.43
71.56
82.7882.08
81.06
82.73
79.96 79.91
Coverage of mass drug administration for LF
Coverage
http://www.countdownonntds.org/ @NTDCOUNTDOWN
Importance of context: Lymphatic Filariasis and Ghana
Ashanti
Brong-A
hafo
Centra
l
Easter
n
Greater
Accra
Northern
Upper Ea
st
Upper W
est Volta
Western To
tal65.00
70.00
75.00
80.00
85.00 83.9584.56
79.28
81.43
71.56
82.7882.08
81.06
82.73
79.96 79.91
Coverage of mass drug administration for LF
Coverage
‘Hotspot’ regions for LF in Ghana
http://www.countdownonntds.org/ @NTDCOUNTDOWN
Community ownership is critical: Onchocerciasis and Cameroon
‘if communities perceive the intervention that is brought to them as beneficial, they will mobilise their members and become key in implementing the intervention’ (Cameroonian Key Informant)
‘community drug distributors become the cement that brings together the health system and the community’ (Cameroonian Key Informant)
http://www.countdownonntds.org/ @NTDCOUNTDOWN
Community ownership is critical: Onchocerciasis and Cameroon
‘Community ownership is a basic and essential philosophy of NTD control, but it is not easy to achieve it. If you start by bringing things vertically the community will never own it’ (Cameroonian Key Informant).
http://www.countdownonntds.org/ @NTDCOUNTDOWN
So what does it all mean?• “The problem isn’t our ability to provide a cure. It’s our will to provide the
infrastructure that can deliver it to the sufferers” (Desmond Swayne, UK International Development Minister).
• “The challenge is to make resources available to get all the required medicine to the people” (Dirk Engels, WHO).
• ‘Implementation research is crucial to improving our understanding of the challenges we face in confronting the real world by broadening and deepening our understanding of these real world factors and how they impact implementation’ (Implementation research in health, WHO).
http://www.countdownonntds.org/ @NTDCOUNTDOWN
The way forward for implementation research….
Adapt to varying contexts Enhance partnership working
Adapt to changing vulnerabilities
Prioritise community ownership
http://www.countdownonntds.org/ @NTDCOUNTDOWN
References• Gyapong, M and Theobald, S. The Sexual and Reproductive Health Issue you’ve probably never
heard of. Open Democracy. Available online at: https://www.opendemocracy.net/5050/margaret-gyapong-sally-theobald/sexual-and-reproductive-health-issue-you%E2%80%99ve-probably-never-hear
• CDI Study Group (2010) Community-directed interventions for priority health problems in Africa: results of a multicountry study.. Bull World Health Organ. 2010 Jul 1;88(7):509-18. doi: 10.2471/BLT.09.069203. Epub 2009 Dec 1. PMID: 20616970
• Wanji S, Tendongfor N, Nji T, Esum M, Che JN, Nkwescheu A, Alassa F, Kamnang G, Enyong PA, Taylor MJ, Hoerauf A, Taylor DW (2009) Community-directed delivery of doxycycline for the treatment of onchocerciasis in areas of co-endemicity with loiasis in Cameroon.. Parasit Vectors. 2009 Aug 27;2(1):39. doi: 10.1186/1756-3305-2-39.PMID: 19712455
• Wanji S. Rapid Assessment Procedures for Loiasis:Report of a Multi-Centre Study. Geneva: UNDP/Worldbank/WHO Special Programme for Research & Training in Tropical Diseases; 2001
http://www.countdownonntds.org/ @NTDCOUNTDOWN