Presentation given by Laura Dean at the Royal Society conference The disease elimination agenda: the role of science, policy and advocacy http://rstmh.org/events/disease-elimination-agenda-role-science-policy-and-advocacy

1. Debunking the notion of a
magic bullet
Laura Dean, Samantha Page, Kate Hawkins, Russell Stothard,
Samuel Wanji, Margaret Gyapong, Ifeoma Anagbogu and Sally Theobald
http://www.countdownonntds.org/
@NTDCOUNTDOWN

2. Background
Who are COUNTDOWN and what do we do?
• DFID funded, multi-disciplinary implementation research consortium
• Dedicated to investigating cost-effective, scale up and sustainable solutions to
eliminate the seven most common NTDs by 2020
• Cameroon, Ghana, Nigeria and Liberia
What is the purpose of this presentation?
• Emphasise the importance of implementation research through key case
studies
• Highlight lessons for the expansion, scale-up and maintenance of NTD
interventions
http://www.countdownonntds.org/ @NTDCOUNTDOWN

3. Methods
• Informed by previously published work of COUNTDOWN consortium
members.
• Conducted observation at stakeholder meetings geared toward setting
COUNTDOWN research priorities.
• Analysis of stakeholder meeting reports from four separate stakeholder
meetings; Ghana, Cameroon and UK.
• Purposively sampled key informants to gain more in-depth information based
on observation and analysis from stakeholder meetings.
http://www.countdownonntds.org/ @NTDCOUNTDOWN

4. Context
• Lymphatic Filariasis in Ghana
Partnerships
• Guinea Worm and Polio
• Malaria and Lymphatic Filariasis
Changing Vulnerabilities
• Female Genital Schistosomiasis and the
life course in Ghana
Community Ownership
• Community Directed Treatment for
Onchocerciasis in Cameroon
http://www.countdownonntds.org/ @NTDCOUNTDOWN

5. Context
• Lymphatic Filariasis in Ghana
Partnerships
• Guinea Worm and Polio
• Malaria and Lymphatic Filariasis
Changing Vulnerabilities
• Female Genital Schistosomiasis and the
life course in Ghana
Community Ownership
• Community Directed Treatment for
Onchocerciasis in Cameroon
http://www.countdownonntds.org/ @NTDCOUNTDOWN

6. Importance of context: Lymphatic Filariasis and Ghana
64.00
66.00
68.00
70.00
72.00
74.00
76.00
78.00
80.00
82.00
84.00
86.00
83.95
84.56
79.28
81.43
71.56
82.78
82.08
81.06
82.73
79.96 79.91
Coverage of mass drug administration for LF
Coverage
http://www.countdownonntds.org/ @NTDCOUNTDOWN

7. Importance of context: Lymphatic Filariasis and Ghana
64.00
66.00
68.00
70.00
72.00
74.00
76.00
78.00
80.00
82.00
84.00
86.00
83.95
84.56
79.28
81.43
71.56
82.78
82.08
81.06
82.73
79.96 79.91
Coverage of mass drug administration for LF
Coverage
http://www.countdownonntds.org/ @NTDCOUNTDOWN

8. Importance of context: Lymphatic Filariasis and Ghana
64.00
66.00
68.00
70.00
72.00
74.00
76.00
78.00
80.00
82.00
84.00
86.00
83.95
84.56
79.28
81.43
71.56
82.78
82.08
81.06
82.73
79.96 79.91
Coverage of mass drug administration for LF
Coverage
‘Hotspot’ regions
for LF in Ghana
http://www.countdownonntds.org/ @NTDCOUNTDOWN

9. Community ownership is critical: Onchocerciasis and Cameroon
‘if communities perceive the intervention that
is brought to them as beneficial, they will
mobilise their members and become key in
implementing the intervention’ (Cameroonian
Key Informant)
‘community drug distributors become the
cement that brings together the health
system and the community’ (Cameroonian
Key Informant)
http://www.countdownonntds.org/ @NTDCOUNTDOWN

10. Community ownership is critical: Onchocerciasis and Cameroon
‘Community ownership is a basic
and essential philosophy of NTD
control, but it is not easy to
achieve it. If you start by bringing
things vertically the community
will never own it’ (Cameroonian
Key Informant).
http://www.countdownonntds.org/ @NTDCOUNTDOWN

11. So what does it all mean?
• “The problem isn’t our ability to provide a cure. It’s our will to provide the
infrastructure that can deliver it to the sufferers” (Desmond Swayne, UK
International Development Minister).
• “The challenge is to make resources available to get all the required medicine
to the people” (Dirk Engels, WHO).
• ‘Implementation research is crucial to improving our understanding of the
challenges we face in confronting the real world by broadening and
deepening our understanding of these real world factors and how they impact
implementation’ (Implementation research in health, WHO).
http://www.countdownonntds.org/ @NTDCOUNTDOWN

12. The way forward for implementation research….
Adapt to varying contexts Enhance partnership
working
Adapt to changing
vulnerabilities
Prioritise community
ownership
http://www.countdownonntds.org/ @NTDCOUNTDOWN

13. References
• Gyapong, M and Theobald, S. The Sexual and Reproductive Health Issue you’ve
probably never heard of. Open Democracy. Available online at:
https://www.opendemocracy.net/5050/margaret-gyapong-sally-theobald/sexual-
and-reproductive-health-issue-you%E2%80%99ve-probably-never-hear
• CDI Study Group (2010) Community-directed interventions for priority health
problems in Africa: results of a multicountry study.. Bull World Health Organ. 2010 Jul
1;88(7):509-18. doi: 10.2471/BLT.09.069203. Epub 2009 Dec 1. PMID: 20616970
• Wanji S, Tendongfor N, Nji T, Esum M, Che JN, Nkwescheu A, Alassa F, Kamnang G,
Enyong PA, Taylor MJ, Hoerauf A, Taylor DW (2009) Community-directed delivery of
doxycycline for the treatment of onchocerciasis in areas of co-endemicity with loiasis
in Cameroon.. Parasit Vectors. 2009 Aug 27;2(1):39. doi: 10.1186/1756-3305-2-
39.PMID: 19712455
• Wanji S. Rapid Assessment Procedures for Loiasis:Report of a Multi-Centre Study.
Geneva: UNDP/Worldbank/WHO Special Programme for Research & Training in
Tropical Diseases; 2001
http://www.countdownonntds.org/ @NTDCOUNTDOWN