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AG_Linnea+Linn+Kavita_CaseStudy_Presentation
- 1. Human African Trypanosomiasis in sub-Saharan Africa Linnéa Joandi, Linn Järnberg, Kavita Oehme
- 2. Outline ❖ Background ❖ Stressors ❖ Causal loop diagram ❖ Key actors ❖ Institutions ❖ Conclusion ❖ Discussion
- 3. Background ❖ African Trypanosomiasis, also known as "sleeping sickness” ❖ Caused by parasites and transmitted by the tsetse fly (Glossina species) ❖ Estimated 30 000 cases per year, mainly poor people in rural areas in sub-Saharan Africa (WHO 2014) ❖ Curable, but lack of available and affordable drugs ❖ Classified as neglected disease
- 4. Stressors “Stressors are seen as social, political, economic, biophysical and ecological drivers that create change in the SES in terms of contributing to HAT outbreaks. ” - Economic performance - Social unrest - Other prioritized diseases - Cattle as livelihood - Land & water use change - Population density - Famine - Poverty - (Climate change variability)
- 12. Key actors Scale Actor Responsibility/role International World Health Organization Support, research, coordination Pharmaceutical companies Research and development of drugs NGO’s, donor agencies etc. National Governments Health system, expenditures, budgetary priorities. Political stability. Local Local populations Livelihood options, land use change, disease control strategies etc.
- 13. Institutions (I) Health system (II) “Social contract” of public and private sector
- 14. Institutions (I) Health system Scale Examples of the institution International Support of international community International patent policy National Health policies Infrastructure Economic distribution Decentralization of health service Local Scepticism against western medicine Affordability & availability
- 15. Institutions (II) “Social contract” of public and private sector Scale Examples of the institution International & national Divide between nation states & pharmaceutical companies Drug research & development Neglected disease Local Availability & affordability
- 16. Conclusions ❖ Lack of governance within and across scales - Lack of state capacity among governments - Market-based drug development ill-suited in this context - Lack of supernetwork - Lack of resources and political will at national and international level ❖ Transformation needed - Initiative by Médicins sans frontières (Doctors without borders) to overcome limits to the “social contract” ❖ Impacts of climate change, tourism, political instability and economic development remains unclear
- 17. Discussion - The role of tourism for availability and affordability of drugs. - Potential of the system´s transformative capacity. - Lack of actors and/or institutions, a stressor? - Most suitable governing system: centralisation or decentralisation?
Editor's Notes
- Epidemic character 36 countries 30 000 cases each year. Mainly poor people in rural areas. Curable - many deaths per year due to poor availability and affordability of drugs Classified as neglected disease – group of diseases overlooked by drug developers, affect the world’s poorest
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- So who are the key actors in the case of the sleeping sickness? There is an international cooperation in fighting the disease and this is mainly framed by the World Health Organization. support and technical assistance to national control programmes, facilitates research on the disease Coordination in cases of outbreaks if disease.
- An institution is defined as a set of agreed upon, contextual norms and rules existing at different scales (Janssen and Anderies, 2013).
- support of the international community in order to implement disease control as a part in their health system in poor communities The health system in the national state is also dependent on things outside of national borders such as e.g. international patent laws On a national scale the national government regulates what health policies to implement, infrastructure to prioritize (e.g. making sure hospitals are built, roads for easy distribution of drugs etc.) general economic distribution (e.g. budgetary constraints for health ministries). The decentralization of the health service is another factor contributing to the difficulty of initiating and governing control strategies of the disease
- social contract describes how the public sector has distributed the responsibility of the drug development to the private sector, i.e. the pharmaceutical industry This is a global solution that tends to work in countries where purchasing power is high, providing incentives for pharmaceutical companies to develop a certain drug. This fails in cases where solvency is lacking, such as in the case in HAT-affected SSA countries (Yamey, 2002). Local Sometimes not even produced - not availabe for the affected when it is for westerners and such - not affordabaly for the people in the 36 countries in SSA Pharmaceutical companies can still develop medicines for neglected diseases when there are actors with purchasing power demanding a solution e.g. the case of malaria medicine development because of western travellers (Yamey, 2002). Even though there is availability of a drug it is still not affordable to all (Widdus, 2001).
- Linn Transformation: eradicate/stamp out the disease
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