Integration as the next step in controlling Neglected Tropical Diseases

by Dr Suzy Campbell

Integration is the “old/new” global development buzzword: old, because it’s certainly not new! New, because there has been an unprecedented focus on it recently in international commitments, being a key message to emerge at the Neglected Tropical Diseases (NTD) Summit in Geneva, Switzerland last week.

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What it’s all about – the 2017 World Health Organization Fourth Report on NTDs

The NTD Summit was organised in conjunction with the release of the World Health Organization (WHO) Fourth Report on NTDs, the fourth anniversary of the London Declaration pledge, and next round of global commitments by international donors, culminating in the Geneva Commitment (see picture) to reaffirm the commitments to fight NTDs that were made in the original London Declaration.

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The Geneva Commitment, signed by delegates at the NTD Summit (Photo courtesy: J Vercruysse)

For those NTDs amenable to preventive chemotherapy approaches, the success of integrated delivery of largely donated medicines to alleviate morbidity is without question. Further level of integration within and across the health system needs to continue and it is now time to augment this with tailored activities along with global advocacy. Increased cross-sectoral work is essential to integrate NTD control and elimination programmes within the broader vision of universal health coverage. But, as highlighted by Dr Dirk Engels, Director of the WHO Department of Control of NTDs, integration is extremely complex and no one yet knows enough about what this means. Without doubt, though, NTD development will improve general living conditions, and thus striving for better cross-sector working with integrated solutions is crucial.

Dr Anthony Costello, Director of the WHO Department for Maternal, Newborn, Child and Adolescent Health, gave insight into some guiding principles, namely: approaches must be country-led, have a sound evidence base, be assessable at scale, and have district-level systems. Assessment of programmes at scale is a major current epidemiological challenge – large-scale evaluations are required. Dr Costello then invited us all to join him in “LALA Land” – a novel way to encompass essential parameters of leadership, action, learning and accountability! Recognising the integration challenges, and the importance of continuing to strive to overcome them, Dr Margaret Chan (Director-General, WHO) gave a strong statement of support emphasising that “What gets measured, gets done”. In this she indicates WHO commitment to NTD indicators – if there is an indicator that programmes need to meet, NTD work will continue.

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Dr Anthony Costello, Director of the WHO Department for Maternal, Newborn, Child and Adolescent Health

To provide a global tool to integrate, advocate and ultimately address underrepresented NTDs and control efforts (including water, sanitation and hygiene (WASH), vector control, veterinary public health, and care programmes) the BEST Framework was launched. Complementing existing WHO and UN frameworks and strategies, the BEST Framework provides a comprehensive approach for collaborative investment in NTDs for development, and for standardising measurement of these interventions to maximise benefit. Building on the four components of Behaviour, Environment, Social inclusion and Treatment, the framework emphasises the necessity of cross-sectoral work and strengthening systems to improve equity and inclusion, and maximise positive impact of development investments in NTD countries.

With this strongly supported integration theme underpinning the entire Summit, there is much optimism that significant progress will continue to be made in combatting NTDs, even as we tackle the heady issues of elimination for some of them, which already requires refinement of existing strategies. The existing progress in combatting NTDs that has already been made has provided the best possible platform for continued partnership and development.

COUNTDOWN Consortium: Sharing Learning on using a Multidisciplinary Approach to the Study of Neglected Tropical Diseases and Contributing to Policy Change for NTD Control

By Akinola Oluwole, Kabiru Salami, Luret Lar, Solomon Jacob, Ndelle, Dr Nebe Obiageli, Pamela Bongkiyung

COUNTDOWN is a consortium which is using a multidisciplinary approach to research with the aim of contributing to policy change in the implementation of Neglected Tropical Diseases (NTDs) control and elimination programmes. We are working in four countries: Nigeria, Liberia, Ghana and Cameroon.

There is an African proverb that says “If you want to go quickly, go alone. If you want to go far, go together.”  This proverb fits with the COUNTDOWN consortium’s vision to improve the control/elimination of NTDs through a “multidisciplinary research approach” to generate quality data. To achieve this, the consortium draws together experts from different disciplines. Undertaking good multidisciplinary research is an art which takes time and dedication. Reflecting on our experiences it is important to consider the following factors:

Harmonise Objectives

The first task as a multidisciplinary team in COUNTDOWN is the need for the different disciplines involved to come together and identify the main objective of the project, the different specific objectives and responsibilities of each discipline. This can be done by developing sub-objectives together which ensures complementarity and avoids duplication. COUNTDOWN has gone further in exemplifying harmonisation through its numerous workshops held to plan and streamline calendars and cross-them working. One of such workshops held in Limbe, Cameroon birth lessons highlighted in this blog – “Multidisciplinary Research at the Foothills of a Live Volcano” by Prof. Sally Theobald.

Respect of Values

To work together as a strong team and for the team to thrive, respect for each team member’s values and recognising each other’s strengths and weaknesses, is a good recipe for working together. There is a need for willingness on both sides to start from the basics and move forwards, with mutual respect for disciplines. One way of ensuring respect and collaboration is working from the central concept of a single team rather than separate ones. When you travel to the field we have one goal in mind – producing quality evidence research. There should also be a conflict resolution plan, to inform how disagreements (which inevitably happen) can be resolved.

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L-R: Prof. Uche Amazigo, Dr Oluwatosin Adekeye & Dr Akinola Oluwole








Establish Coordination of Activity Timelines, and Programmatic Structures for Communication

As a multidisciplinary group, the need to come up with deliverables, given a timeline and budget to the activities cannot be over emphasized. This is to avoid delays or setbacks to implementing time-related activities as well as preventing discord that may arise from overspending on one discipline to the detriment of another.

In addition, an effective coordination and communication structure with quality study design and purpose must be put in place. The team must agree on how data will be harmonized across the different disciplines requiring that all team members make a concerted effort to understand each other’s methodologies, decision on authorship order in publication and most important of all having equal access to data generated. This will ensure the continuous involvement of all disciplines where everyone’s voices are reflected and count equally in identifying research problems and shape teams to meet research needs. It is equally important that from concept to delivery, all country-level managers of NTD programmes need to be involved as they play a crucial role in effective implementation of the research objectives and outcome.

Physical interaction among the team members is also important as this will enable members to agree on ideas. There should be time for face to face interaction through periodic meetings so that members of the team can ask questions, resolve conflicts, clarify issues, explain and agree on different disciplinary terminologies and perspectives. During the meetings, team members are encouraged to come open-minded to learn new ideas and maintain regular communication with feedback.

This is embodied in COUNTDOWN’s Annual Partners Meeting (APM), where partners that make up the consortium, from the various countries (Cameroon, Ghana, Liberia, Nigeria, UK & USA) come together to learn about progress in each country and cross-sharing of knowledge takes place during discussions. The recent partners meeting took place in Yaoundé, Cameroon from 28 – 30 March 2017.

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Capacity Development Within COUNTDOWN, we do not use capacity development interchangeably with training. Training is one component of developing capacity, which we take seriously as seen in the PCR training in Ghana, the recent Evidence Synthesis held in Yaoundé, Cameroon from 7 – 9 February 2017, including Health Economics data analysis, basic Nvivo and qualitative analysis training at the APM. All our training has been designed to consider the local cultural, policy and organisational context. We recognise that shoring up capacity in the areas of policy research as seen in the recent situational analysis undertaken by the Nigeria COUNTDOWN team, policy immersion (our collaboration with policy making bodies) and awareness building, are essential to the capacity development of COUNTDOWN.

Overall, there is a need for an inclusive leadership where a representative from each of the collaborating institutions forms a management team with the responsibility of driving the coordination of activities in multidisciplinary projects.

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