This theme draws on sociology, anthropology, quantitative epidemiology and health systems research. It will assess the efficiency, equity and sustainability of current MDA approaches and develop interventions to strengthen them.
The aim of the social science research theme is to assess the efficiency, equity and sustainability of current Neglected Tropical Disease (NTD) control approaches, with a specific focus on end-user perspectives, in order to develop potential interventions to strengthen programmes at the national, district, community and household level.
National: Identifying opportunities and challenges for cross-sector (e.g agriculture, water and sanitation) collaboration and developing strategies to foster further strategic integration: through participatory assessments and workshops.
National/district: Evaluation of health system support for NTD programming and current levels of NTD integration.
District/community: Assessment of community-based drug distributors (CDDs) and their integration with the health system.
Community/household: Analysis of community perceptions of integrated drug regimes for the control of NTD and adapt programmes to respond to these.
Health Systems implementation research will include work on:
1. Funding, governance, and donor priorities
NTDs have only recently drawn the attention of many major donors. Funding, governance, and donor priorities often dictate the way that health systems and disease programmes operate. Consideration of these factors is therefore critical in evaluating potential for scale-up and sustainability of new and existing NTD control interventions. It is particularly important to understand how decisions made by policy makers, governments and donors can impact on the planning and delivery of services
2. Partnership and multi-sectoral working beyond the health sector
It is thought that multi-sectoral responses are critical to the control and elimination of NTDs, for example encouraging the health sector to link with agriculture or zoonosis departments. However, little evidence presently exists about their feasibility and impact on systems and communities. Nor is there much evidence on different types of collaboration for example public-public partnerships (i.e. the Ministry of Health working with the Ministry of Education, Agriculture, Water Resources, Gender, Children and Social Protection); public-private partnerships (i.e. the Ministry of Health working with pharmaceutical companies; banks); public-non-profit partnerships (i.e. the Ministry of Health working with the voluntary sector; development agencies). Through this work we will identify opportunities and challenges for working beyond the health sector and explore community perceptions of these partnerships.
3. Health systems integration and disease programme co-implementation
While vertical health programmes have benefits in terms of achieving rapid success in relation to disease control, sustainability can be challenging and often they fail to strengthen the overall health system. Co-implementation is often the first step toward more integrated control of disease. Co-implementation focuses on synergies both between different NTD control programmes (e.g. combined MDA for Lymphatic Filariasis and Schistosomiasis or combined surveillance with the Polio programme) as well as between NTD control programmes and other disease programmes (e.g. Lymphatic Filariasis and the Malaria programme). Given the co-endemicity of many diseases, co-implementation is believed to be a time and cost-effective mechanism for NTD control and elimination, however limited information currently exists about its feasibility and acceptability at the international, national, district and community level. This work will explore the advantages and disadvantages of the co-implementation and the integration of NTD control into health systems, identify how the health system is currently supporting the NTD control programme and vice versa, and explore how health system resources could be better leveraged to deliver more effective and equitable scale-up of NTD activities. This will include a focus on community perceptions of the benefits and challenges and the impact on community drug distributors and other health volunteers.
4. Close-to-community providers/community drug distributors
Community health workers and community drug distributors are the lynch pin of mass drug administration activities for NTD control and elimination, however few studies look at their experiences of such programmes and how they are supported, motivated, and integrated into the wider health system. Community workers are often most impacted by decisions of co-implementation, integration, changes in funding, and multi-sectoral collaborations. We hope that exploring these issues from their perspective will allow for more informed and responsive policy and programming that is likely to retain a highly motivated and dedicated cadre of close-to-community providers working on NTD control.
5. Gender, equity and NTDs
It is critical that NTD programming and its scale-up is equitable and informed by community voices so that no sections of the population are ‘left behind’ in striving toward control and elimination of NTDs. This research will explore how socio-economic factors such as poverty, age, gender, stigma and disability are accounted for within NTD programming and how they shape access to interventions. This will include an exploration of the knowledge, attitudes and beliefs of different community members, barriers to service access with a particular focus on those marginalised by existing NTD programmes (e.g. out of school children, pregnant women, people living with disability), exploration of the socio-economic characteristics of areas that have persistent transmission of specific NTDs, and better understanding of NTD-related stigma and its impact of service uptake and morbidity management and disability inclusion.