By Samantha Page, Laura Dean, Estelle Kouokam, Fabrice Datchoua, Hermine Jatsa Boukeng, Christian Duamor Tetteh, Mary-Sheena Maingeh, Manuela Ngo Bakale, and Theobald Nji
We recently completed the first social science meeting in Cameroon for COUNTDOWN where colleagues from The University of Buea, The University of Yaoundé and Liverpool School of Tropical Medicine came together to develop collaborative social science research protocols for COUNTDOWN. So what?
Using methods from social science generates important data that has the potential to reduce the prevalence of Neglected Tropical Diseases (NTDs) in Cameroon; data which cannot be captured from the biomedical sciences. However social science methods are often overlooked when addressing NTDs, or even sneered at. Many ‘pure’ scientists cannot understand the value of conducting social science or what impact this academic discipline has in addressing these so called “diseases of poverty”. So what?
So this is one of the challenges we face when working on a multidisciplinary programme that involves social science, parasitology, entomology, and vector biology. To combat this challenge we have come up with key research questions addressing each level of the health system in Cameroon, of which there are five: national, regional, district, health area and community. These research questions can be grouped across five core areas which are critical to a holistic approach to NTDs. These are:
- Funding, governance and donor priorities;
- Health system integration and disease programme co-implementation;
- Partnerships and multi-sectoral working beyond the health sector;
- Community drug distributors; and
- Gender, disability, equity and NTDs.
So what does this mean in practice?
At the national level through key informant interviews and stakeholder workshops, linked to the research area of funding, governance and donor priorities, we will explore how donor priorities influence the way programmes are managed. In addition, we will assess how decisions made internationally support or challenge country priorities and processes for NTD control and elimination.
At the regional and district level through key informant interviews, stakeholder workshops, focus group discussions, direct observation and document review, linked to the research area of health systems integration and co-implementation, we will seek to understand how current platforms for NTD co-ordination are functioning and promoting co-implementation of disease programmes.
At the district level through key informant interviews, stakeholder workshops, focus group discussions, and direct observation, linked to the research area of partnerships and multi-sectoral working, we will identify what multi-sectoral partnerships are in place and what opportunities are missed.
At the health area level through participatory methods such as ‘photo-voice’, linked to the research area of community drug distributors, we will identify how community drug distributors are currently supported and co-ordinated by and within the health system. We will explore how their role within communities can promote community ownership of the philosophy of eliminating NTDs.
At the community level using anthropological methods such as ethnographic journals, linked to the research area of gender, disability equity and NTDs, we will seek to understand how communities perceive and talk about NTDs and how we can be more responsive to their understandings, particularly in the way we generate health education messaging. We will consider the needs of individuals currently ‘invisible’ to existing NTD programmes, such as out of school children, people living with disability and pregnant women. We will assess how stigma and disability present barriers in accessing treatment for NTDs.
The collaborative nature of social science within COUNTDOWN is not limited to work in Cameroon. Our work in Ghana takes a similar approach and the same is likely to be true in Liberia and Nigeria. So what?
Well, this allows for learning between these diverse African contexts who are in differing phases of disease control to address bottlenecks and implementation dilemmas to accelerate the elimination of NTDs. So what?
Social science may have a long way to go to prove its worth in the field of NTDs, but we believe that without it, elimination and eradication of diseases propagated by social processes is impossible. The medicines, the public health strategies are there. So what?
Control and elimination cannot succeed without the understanding and the explanation of the social process, social organisations, beliefs and perception of societies that are the principal actors and people affected by NTDs.