IR THEME 2MST2 Applied Social Science research

Sally Theobald with Margaret Gyapong & Eleanor MacPherson

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

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)

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

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

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

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

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

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

Thank you…..

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