Governance of Human
African Trypanosomiasis
Hanna Ahlström, Jonas Gren & Gustav Grusell
Stockholm Resilience Center, 3 Mar...
Human African Trypanosomiasis (HAT)

•
•
•
•
•

Parasitic infection
Occurs in Sub-Saharan Africa
Transmitted by tsetse fli...
Human African Trypanosomiasis (HAT)

•
•
•
•

Two types: Trypanosoma brucei gambiense
and Trypanosoma brucei rhodesiense
T...
(Brun 2010)
Human African Trypanosomiasis (HAT)

•
•

Cattle provide main reservoir for T.b.
rhodesiense
Humans provide main reservoir...
Historical cases of t.b. gambiensis

(Brun 2010)
Recent cases of t.b. gambiensis

(WHO database)
Actors

•
•
•
•

World Health Organization, WHO
National governments
Colonial authorities (until 1960s)
Universities/ rese...
Actors

•
•
•

NGOs, e.g. Doctors Without Borders
Private companies, medicines
Inhabitants mainly in rural areas of Democr...
Institutions

•

Office International des Epizooties An
international (OIE)
The World Health Organization (WHO)
The Nation...
CHANGE, SHOCKS, AND UNCERTAINTY

Figure 2. The
diagram is
centered around
an individual in
southeastern
Uganda at risk
of ...
CHANGE, SHOCKS, AND UNCERTAINTY

•

•

Continued spread of the HAT - in spite of previous
efficient control actions - high...
CHANGE, SHOCKS, AND UNCERTAINTY

•
•
•

Our impression: Governance of Sub-Saharan HAT (by WHO,
NGO:s and states) fails to ...
CHANGE, SHOCKS, AND UNCERTAINTY

•
•

•
•

“Neglected disease”
Parts of SES governed through Public-Private
Partnerships
C...
CONCLUSION

•
•

This case seems to show the need for
deeper understanding of the non-linear
relations between social and ...
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Hat presentation afternoon

  1. 1. Governance of Human African Trypanosomiasis Hanna Ahlström, Jonas Gren & Gustav Grusell Stockholm Resilience Center, 3 March 2014
  2. 2. Human African Trypanosomiasis (HAT) • • • • • Parasitic infection Occurs in Sub-Saharan Africa Transmitted by tsetse flies Leads to coma and death if left untreated Referred to as a “neglected disease” (tropical infections in low-income countries; different organizations have different definitions)
  3. 3. Human African Trypanosomiasis (HAT) • • • • Two types: Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense T.b. gambiense responsible for majority of reported cases (~98%) T.b. rhodesiense characterized by fast progression Early detection increases success rate of treatment
  4. 4. (Brun 2010)
  5. 5. Human African Trypanosomiasis (HAT) • • Cattle provide main reservoir for T.b. rhodesiense Humans provide main reservoir for T.b. gambiense
  6. 6. Historical cases of t.b. gambiensis (Brun 2010)
  7. 7. Recent cases of t.b. gambiensis (WHO database)
  8. 8. Actors • • • • World Health Organization, WHO National governments Colonial authorities (until 1960s) Universities/ research groups
  9. 9. Actors • • • NGOs, e.g. Doctors Without Borders Private companies, medicines Inhabitants mainly in rural areas of Democratic Republic of the Congo (DRC), Angola, Central African Republic, southern Sudan, and Uganda (Brun et al. 2010)
  10. 10. Institutions • Office International des Epizooties An international (OIE) The World Health Organization (WHO) The National Sleeping Sickness Control Programmes (NSSCP) And also: Public–private partnerships (PPP) • • •
  11. 11. CHANGE, SHOCKS, AND UNCERTAINTY Figure 2. The diagram is centered around an individual in southeastern Uganda at risk of sleeping sickness (Berrang-Ford et al., 2005)
  12. 12. CHANGE, SHOCKS, AND UNCERTAINTY • • Continued spread of the HAT - in spite of previous efficient control actions - highlights that humans are unable to understand and predict the distribution of the infection (Berrang-Ford et al. 2005) PROBLEM OF FIT: Spatial: Local, regional, trans-national Temporal: Social turmoil and war; time-lag between NGO redrawal and new outbreaks
  13. 13. CHANGE, SHOCKS, AND UNCERTAINTY • • • Our impression: Governance of Sub-Saharan HAT (by WHO, NGO:s and states) fails to organise efficient disease control over the total system (Brun et al. 2010) says: “vector control, to reduce the number of flies in existing foci, needs to be organised on a pan-African basis”. WHO says: if concerted action is taken by national control programmes, international organisations, research institutes, and philanthropic partners, elimination of this disease might be possible (Brun et al. 2010)
  14. 14. CHANGE, SHOCKS, AND UNCERTAINTY • • • • “Neglected disease” Parts of SES governed through Public-Private Partnerships Could be seen as “supernetworks”, (Galaz 2014) - i.e. networks of networks: International org., states, universities, NGOs etc. Polycentric coordination patterns
  15. 15. CONCLUSION • • This case seems to show the need for deeper understanding of the non-linear relations between social and ecological parts of the system We argue for a transnational, holistic approach that takes “problem of fit” into account
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