COUNTDOWN Launch Meeting 2015

1. IR THEME 2
MST2 Applied Social Science research
Sally Theobald with Margaret Gyapong & Eleanor MacPherson

2. MST 2: In a Nutshell
• Informed by Implementation Research Guidelines – cited in the call – which focus
on the different levels of the health system & beyond :
• Inter-sectoral
• National –district
• District – community
• Community – household
Need to 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
Integration
• Different levels of health system
• Across different NTD programmes
• Within the health sector
• Beyond the health sector

3. Learning Across Contexts at the
Heart of Implementation Research
What works for whom & why – Implementation Research embedded in context;
“implementation issues often arise as a result of contextual factors that policy makers and health systems managers may not
even have considered”
“IR is of immense value in shining a light on the often bumpy interface between what can be achieved in theory and what
happens in practice” (Peters et al 2013)
Ebola, fragility & conflict as contextual contexts
Broader political and strategic contexts – SDGs, UHC, PRDP (Liberia) (Research
Uptake & research & ethics)

4. MST 2: In a Nutshell (cont)
• Intersectional – gender, poverty, age - analysis key to our approach – opportunity
for impact and filling research gaps
• Aiming to link across all COUNTDOWN themes and feed into holistic evidence base
to inform policy and practice
• Where is social science in the roadmap?
• Using a range of health systems research methods (informed by sociology &
anthropology) for implementation to assess and inform the equity, efficiency and
sustainability of current NTD approaches and inform practice

5. Four Themes within Literature Relevant to the Social
Science Research in COUNTDOWN
1. Understanding factors that shape adherence to MDA regimes and
documenting how they have been successfully/unsuccessfully implemented, e.g.
adherence to MDA has been much lower in urban setting when compared to
rural settings in both Asia and Africa.
2. Understanding health systems and MDA/NTD policy. This has been quite
limited but there are some papers exploring how MDA has (or hasn’t) been
embedded in health systems (see for instance Marchal et al 2011)
3. Experiences of people living with the clinical manifestations of NTDs, these
include papers exploring the gendered impacts of NTDs (in particular LF).
4. Understanding how the broader social environment shapes vulnerability and
risk to NTDs

6. Intersectoral Questions:
Q5) How can integrating NTD programmes strengthen health systems
and foster cross sector working (e.g. sanitation, water resources and agriculture) deliver a
sustainable impact to overcome the vulnerability of NTD affected populations?
We require new partnerships and approaches within NTDs; and the broader health sector; and
beyond the health sector (new partnerships link to RU approach)
Identifying opportunities and challenges for cross-sector (e.g. agriculture, education, water
and sanitation) collaboration and developing strategies to foster further strategic integration -
CLTS
Participatory assessments, joint working, workshops and links with Integrated Control
Strategies Themes
Image: www.unocha.org

8. National – District Levels:
Assessing evaluation of health system support for NTD
programming and current levels of NTD integration e.g.:
• how health systems currently support MDA and the role of HRH here e.g. how the
health workforce supports MDA, for example, the extent to which district health
teams monitor and support CDD activities (Nana & hw fatique)
• how health system resources could be more fully leveraged to deliver more
effective and equitable scale-up of NTD activities (e.g. challenges M&E Cameroon)
Explore and assess how NTD programmes have been integrated into health systems in
different contexts, documenting generalisable lessons about the factors favouring
effective integration.
Stakeholder interviews/in-depth interviews/secondary data analysis
Image: www.a-wol.com

9. District-Community Levels:
Assessment of close-to-community providers/community
based practitioners/ (CDD) and their integration with the health system
• Roles, remuneration, experience, motivation, sustainability, integration (challenges
supervision Cameroon, incentives and motivation - Liberia)
• Synergies frontline services and community (Liberia gaps here)
• Assess the effectiveness of the CDD programme from different perspectives/health
systems approach (Ghana)
Qualitative interviews, group discussions, photovoice to document CDD’s experiences and
participatory action research to develop and implement strategies to enhance the motivation
and sustainability of this critical cadre.
Thematic Working Group on CHWs and links with APOC
Image: Dr Francesca Tamarozzi

10. Community/Household:
Analysis of community perceptions of integrated drug regimes for
the control of NTD 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 & stigma) are likely to shape access and adherence to
MDA for the control of NTDs and the experiences of affected individuals and
households; out of school and pre-school children (all countries)/ morbidity
management (Ghana)
Qualitative interviews, focus group discussions, observations, critical incident
narratives, photovoice?
Image: www.msh.org

11. Thank you…..
Holistic multidisciplinary analysis…the whole is bigger than the sum of the
parts….