Debunking the notion of a magic bullet

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

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

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.


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•


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•


Importance of context: Lymphatic Filariasis and Ghana

Ashanti

Brong-A

hafo

Centra

l

Easter

n

Greater

Accra

Northern

Upper Ea

st

Upper W

est Volta

Western To

tal65.00

70.00

75.00

80.00

85.00 83.9584.56

79.28

81.43

71.56

82.7882.08

81.06

82.73

79.96 79.91

Coverage of mass drug administration for LF

Coverage



Ashanti

Brong-A

hafo

Centra

l

Easter

n

Greater

Accra

Northern

Upper Ea

st

Upper W

est Volta

Western To

tal65.00

70.00

75.00

80.00

85.00 83.9584.56

79.28

81.43

71.56

82.7882.08

81.06

82.73

79.96 79.91


Coverage



Ashanti

Brong-A

hafo

Centra

l

Easter

n

Greater

Accra

Northern

Upper Ea

st

Upper W

est Volta

Western To

tal65.00

70.00

75.00

80.00

85.00 83.9584.56

79.28

81.43

71.56

82.7882.08

81.06

82.73

79.96 79.91


Coverage

‘Hotspot’ regions for LF in Ghana


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)


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).


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).


The way forward for implementation research….

Adapt to varying contexts Enhance partnership working

Adapt to changing vulnerabilities

Prioritise community ownership


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


https://www.opendemocracy.net/5050/margaret-gyapong-sally-theobald/sexual-and-reproductive-health-issue-you%E2%80%99ve-probably-never-hear

https://www.opendemocracy.net/5050/margaret-gyapong-sally-theobald/sexual-and-reproductive-health-issue-you%E2%80%99ve-probably-never-hear

http://www.ncbi.nlm.nih.gov/pubmed/20616970








Health & Medicine

Debunking the notion of a magic bullet