COUNTDOWN Launch Meeting 2015

1. Using social Science methods to address
Neglected Tropical Disease Implementation
challenges
Margaret Gyapong and Sally Theobald

2. Progress with Neglected Tropical Diseases
Massive progress in the last 20 years to facilitate the control of Neglected
Tropical Diseases

3. 0
50
100
150
200
250
300
350
400
450
500
LF ONCHO STH SCH TRA
PersonsrequiringPC(millions)
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
177.6M
168M
67.5M

4. 0
20
40
60
80
100
$90
$76
$12
$15
$30
$49
Inadequate buying practices Quantification
problems
Inefficient
procurement
Inefficient
distribution
Irrational
prescription
Non-compliance
by patients
Inefficiency and waste in the supply of drugs from budget allocation to consumer
U.S. Dollars
Budget allocation
for drugs
Value received
by consumer
Remaining value Cumulative losses

5. = 37%
98%
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

6. 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

7. 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

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

9. 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

10. Social Science Basket of Tools
Diagrams
Observation
Community Map
Seasonal Calendar
Problem Tree
Focus Group Discussions
Photovoice
In 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

11. 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

12. 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.

13. 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

14. THANK YOU