6 -7th October, University of Edinburgh
By Prof. Russ Stothard
Funded by the Economic & Social Research Council (ESRC), Spaces of Evidence is a global network of scholars, practitioners and activists exploring the intersections of politics, measurement and evidence-based policy in health, development, economics, medicine and beyond. The network organises regular discussion meetings. This symposium took place at Edinburgh University, being the last in its series of events, and focused on five topics: Institutional responses to demand for evidence, neglected tropical data, evidence shaping policy, performing evidence generation and the politics of evidence generation. I thank the organisers Drs Ian Harper and James Smith for hosting such a stimulating meeting.
Being the only biomedical parasitologist there, it was a good forum for me to learn and exchange concepts and ideas in a wider audience. Each topic was assessed across the two days by a combination of presentations and panel-led discussions often responding to questions from the floor. At first-glance, neglected tropical diseases are typically lodged within health-specific silos, so to be given a chance to present their wider socio-political context was important. A key thread throughout was, what evidence is or data are judged to be most appropriate for assessing effective development and (or) poverty-reduction activities? There is no simple answer to this I am afraid, for there is no accepted technique or protocol that can piece together the jigsaw of evidence into a picture that all can understand, or even use generically to evaluate original goals and ambitions.
The controversy behind worm wars was much debated, as it should in an academic venue such as this, including the future use of neglected tropical diseases (NTDs) as tracers of development. I was glad to present my perspective on this with examples taken within COUNTDOWN, and from my recent survey work in Uganda. In so doing, I was able to explore with Professor Tim Allen and Dr Georgina Pearson, from the London School Economics, the common ground needed to support interventions against soil-transmitted helminthiasis and schistosomiasis, highlighting the global importance of NTDs. In the end, we all agreed there is no doubt that infected children need treatment, on equity grounds alone, but the question remains how best to empower the local health system to do so and COUNTDOWN will provide sensible answers to make it happen.
During the meeting, the growing fascination with metrics and results from random controlled trials was debated. Much of the desire to do ‘good’ typically gets lost within numbers and analytical designs. The danger here is to fall victim with the love of numbers to the occlusion of the guiding principles in bioethics, autonomy, justice, beneficence and non-maleficence. The challenge should simply boil down to better measuring these in the most robust way, not forgetting voicing the experiences of those doing and receiving the intervention in a meaningful manner. I was glad to share Prof. Sally Theobald and Dr Ifeoma Anagbogu’s blog in The Lancet Global Health about the importance of Expanded Special Project for Elimination of NTDs (ESPEN), discussing the many facets of evidence we will need in future.
Those of us in COUNTDOWN know that ‘development’ and ‘poverty-reduction’ has many dimensions and location-specific facets. This makes assessing the progress of any specific-intervention, albeit framed as outputs, outcomes and(or) impact, within a broader remit difficult to dovetail. During the spaces of evidence discussions, it brought it home to me the tremendous importance of our COUNTDOWN logframe and theory of change. Critically, these two documents help us be logically consistent and able to measure our progress in a considered and step-wise manner. Without them, complex projects like COUNTDOWN which is navigating across new ground by exploring interdisciplinary methods, would get lost. Put simply, if you have no idea of where you are going then you do not know which direction to take.
All this may sound trivial, but it is easy to get lost in details for it was clear to me from open discussions that considered the list of failed projects, their doom rooted back to a common catalogue of problems: misconceived ideas, inappropriate interventions, unrealistic donor-driven demands, poorly co-ordinated teams and each with members having mismatched skills. Sadly, in the growingly commercialised landscape of implementation research, it is all too easy for large consortia to be formed, or rather malformed, primarily upon greed beset with vague intentions. This is not the case with COUNTDOWN for our long term intention is described best described within the Sustainable Development Goal 3.3 – By 2030, to end the epidemic of AIDS, tuberculosis, malaria and neglected tropical diseases. All we need to do is simply get on with it!