The study will highlight the most effective, cost effective, sustainable and acceptable current and complementary strategies to both implement scale-up to meet the 2020 London Declaration goals and strengthen health systems.
It will also help to identify generalizable factors influencing the acceptance, effectiveness, efficiency, and equity impact of scale-up from a health systems approach.
This research will document the most effective strategies to work with Community Drug Distributors (CDDs) and Community Health Workers to extend the scaling up of MDA to include hard to reach communities and build the resilience of vulnerable and marginalized groups.
The results will enable to explore how integrating NTD programmes strengthen health systems, foster cross sector working (e.g. sanitation, water resources and agriculture) to deliver a sustainable impact to overcome the vulnerability of NTD affected populations.
Moreover, the study will enable us to identify alternative strategies to scale up elimination of NTDs in target communities and provide opportunities for extrapolation of such techniques.
Research Aim and Objectives
The overall aim of the applied social science theme within COUNTDOWN is:
‘To assess the efficiency, equity and sustainability of current NTD control approaches, with a specific focus on end-user perspectives, to develop potential interventions to strengthen programmes at the national, district, community and household level.’
To achieve this, the team will conduct health systems implementation research at the national, regional/district and health area/community level across five research areas that we have identified as critical to efficient, equitable and sustainable NTD control and programme scale-up. These core research areas will be developed as sub-research protocols.
Research Area 1: Funding; governance and donor priorities
To assess the impact of government, policy, and donor decision making on unified, coordinated, and equitable NTD programme delivery.
Research Area 2: Partnership and multi-sectoral working within and beyond the health sector
1) To identify opportunities and challenges for working in partnership beyond the health sector (e.g. education; agriculture; water and sanitation) to contribute to more effective and equitable scale-up of NTD control.
2) To explore at the international and national level what multi-sectoral partnerships are currently in place to generate lesson learning regarding benefits, challenges and implementation of multi-sectoral approaches to NTD control.
3) To understand what potential multi-sectoral partnerships could exist to improve equitable scale-up of NTD control at the national level.
Research Area 3: Health systems integration and disease programme co-implementation
1) To explore the process, opportunities and costs of integrating or not integrating NTDs into the broader health system.
2) To understand at the international, national level the advantages and disadvantages of integrating NTDs into the broader health system.
3) To identify how the health system is currently supporting the NTD control programme and vice versa in each of the country contexts. 4) To explore how health system resources could be better leveraged to deliver more effective and equitable scale-up of NTD activities.
Research Area 4: Close to community providers/community drug distributors from a national planner perspective
1) To assess community based drug distributors’ motivation, supervision, sustainability and experiences within NTD programme delivery.
2) To identify how close to community providers (e.g. community drug distributors) are currently supported and co-ordinated by/within the health system.
3) To identify what incentives are currently provided to close to community providers (e.g. community drug distributors) currently working as part of NTD programmes, and how this is co-ordinated between different funding mechanisms.
Research Area 5: Gender, disability, equity and NTDs: perspectives from the international and national levels.
1) To explore how socio-economic factors such as poverty, age, gender, stigma and disability are accounted for within NTD programming and how they shape access to such programmes.
2) To conduct a review of national and international literature on intersectionality (with a specific focus on gender, equity and disability) and NTDs.
3) To explore how gender, disability and equity are currently considered within national policy and planning for NTD control.
Study Design
The study is separated into two: the Yaoundé team will research at the national and regional level whilst the COUNTDOWN Buea Social Science team are focused at the District, Health Area and Community levels. The qualitative methodology shall be used in collecting the data at the various levels and shall involve the use of different qualitative methods.
Study Sites
For the Buea work, the sites will be grouped into two clusters of "strong" (well-performing) versus "weak" (less well performing). The various concerned NTDs program reports will be used to determine the study sites. Health district will be selected from each cluster. Effectively the criterion for selecting the sites will be the relative success/non-success in implementing the targeted disease control programmes.