Understanding what helps and hinders cross-departmental collaboration in the health sector: Experience from the Liberia NTD Programme

NTD Program Communication Strategy Technical Working Group Meeting

Alice Perkins, Research Manager COUNTDOWN Liberia, Laura Dean, Georgina Zawolo, Anthony Bettee, Karsor Kollie and Sally Theobald

COUNTDOWN is a multi-disciplinary partnership formed in 2014 following a grant from the UK Department for International Development (DFID). The programme is focused on conducting research on improved ways to support the scale-up of interventions in sub-Saharan Africa against neglected tropical diseases (NTDs). In Liberia, COUNTDOWN is partnering with the Ministry of Health & University of Liberia – Pacific Institute of Research and Evaluation (ULPIRE) to carry out implementation research to strengthen NTD Programme activities.

During the COUNTDOWN launch in Liberia, the partners set as an objective, to look at current NTD policies relating to NTDs and consider opportunities for those policies to influence the NTD Programme more positively. Against this background, preliminary results from COUNTDOWN implementation research conducted in Bong and Maryland Counties, revealed gaps and challenges in programme delivery. Early findings emphasized a lack of awareness amongst communities in relation to the NTD programme. Consequently, through discussion with the NTD programme manager and other stakeholders, it was decided that the NTD programme needed a specific communication’s strategy to ensure targeted awareness activities reach all members of the population.

With support from COUNTDOWN, the NTD Programme joined with the National Health Promotion Department to develop a communications strategy. The National Health Promotion Department seemed the logical choice for this collaboration given their expertise in the development and roll-out of communication campaigns related to diseases of public health importance in Liberia. Together, the departments developed targeted messages and clear communication aims that will lead to effective advocacy. They also developed Social Behaviour Change Communication (SBCC) materials to address awareness, uptake, and acceptance of the NTD programme at the county level and below. This is the first time that the NTD Programme and the National Health Promotion Department have collaborated on a communications initiative.

The iterative process involved a series of meetings with different partners involved in NTD programmes. A pre-meeting with the Health Promotion Department and the NTDs Programme was held to develop an outline of the document. The largest meeting, which was a key meeting with partners and stakeholders in Buchanan between 4th – 5th December 2017 where technical content was developed and expanded. Following a series of document reviews and refinements, a validation meeting was held on 19th September 2018 in Monrovia. The Communication’s Strategy is being finalized based on the input offered in the validation meeting. Once it is signed off by the Ministry of Health, the NTD Communication’s Strategy will become an addendum to the National Health Promotion Communication Strategy.

Based on our experience supporting the development of the communication strategy, we can share reflections about how underlying social and political factors shaped the ability of two departments in the Ministry of Health, the NTD Programme and the National Health Promotion Department to collaborate. The narrative is based on participants’ observation of the collaborative process for policy. Through individual and group reflections on the policy development process (which we were a part of), we discovered how different strategies for partnership-building could support health systems to galvanize expertise from within to develop new and innovative strategies for collaborative action.

The strength of the collaborative process in Liberia included merging of technical expertise (from National Health Promotion, NTD programme, Ministry of Education, Ministry of Agriculture and partners – Sightsavers, Partnership for Advancing Community-Base services [PACs]) to generate appropriate messaging for target audiences. It was a unique opportunity for different governmental departments to gain knowledge and share ideas leading to increased availability of and access to evidence, resources, and data.

We also observed that some factors, if not anticipated and mitigated, threaten the success of intersectoral collaboration. Potential threats and some ways to combat them are presented below:

  1. Cross purposes of expertise and tendency to prioritize own discipline/specialist area: Members of each group must have faith that others’ contributions to the process are just as reliable and reasonable as their own. Collaborators with different expertise bring different interests that strengthen the process of strategy development.
  2. Collaboration lasting too long: The duration of the collaborative process and even the length of a single meeting must be sufficiently short to facilitate participation by professionals who are already overburdened. Discussion on a particular topic must be contained, and the participants must be focused on efficiently reaching consensus and concluding.
  3. Funding constraints challenge collaboration. Despite goodwill of different departments and willingness to actively participate, limited funding can constrain the amount of time available to complete the work. Leaders of the policy-making process must be realistic and advocate for sufficient funding to support a robust collaborative process.
  4. Research data can be insufficient to shape the process: When content there is no baseline data or previous policy documents to build upon, then extra time must be built into the process to gather critical information and prepare new documents to serve as resources.
  5. Communication breakdown once one party is satisfied with the end-product: Participants must be committed to the entire process, remaining involved beyond the point when their own priorities are addressed. They must stay engaged and support other ideas presented by their counterparts.

Collaboration amongst representatives from different disease programmes and disciplines gives a rich opportunity to support health systems development by addressing diverse challenges across varying contexts. By sharing our thoughts on what helps and hinders collaborative practice within the health sector, we aim to contribute toward new mechanisms of governance that support coherent action on health challenges. Future collaborative activities may wish to promote shared agenda setting, including timelines, budgets, activity roles and deadlines; invest time in relationship building and setting up trust between the collaborating teams; and ensure that enough time and resources are provided to continue monitoring and revisions to products until they reach successful completion.

COUNTDOWN at the 15th International Symposium on Schistosomiasis, Brazil

COUNTDOWN at the 15th International Symposium on Schistosomiasis, Brazil (1)

Professor Russ Stothard & Professor Louis Albert Tchuem-Tchuenté

The 15th International Symposium on Schistosomiasis was held in Brazil from 1st – 3rd August 2018. It is the longest running international meeting of its kind devoted to research and control of schistosomiasis. Originally established with a founding grant from the World Health Organization (WHO), the Symposium was first held in 1987. Since then, it has rotated across the various institutes of the FIOCRUZ Foundation(link is external) with a significant portion of the scientific programme traditionally given over to international delegates, particularly those from Africa and China.

Presenting COUNTDOWN findings at this meeting offered an excellent opportunity for technical discussions and future research uptake.  There were some 500 delegates attending this meeting with keynote and roundtable discussion presentations(link is external) highlighting the state of the art.

Without doubt, the regularity of these symposia over the past 30 years has helped harmonise ongoing activities not only within Brazil but also across the Pan-American Health Organisation(link is external) (PAHO) region. These also underpin and augment the activities of the Brazilian National Control Programme which has a broad global impact by influencing WHO policies and practices. For example, the standard diagnostic used for surveillance of intestinal schistosomiasis, the Kato-Katz method as used in COUNTDOWN studies, originated in Brazil with its inventor Professor Naftale Katz, honoured to be President of this 15th Symposium.  Today, the national prevalence of infections with Schistosoma mansoni in Brazil has declined to below 2%(link is external) in most endemic areas, with Brazil pioneering multi-sectoral approaches and interventions.

COUNTDOWN first presented at the 14th International Symposium held in Salvador in 2015. Since then, the programme has highlighted the burden of schistosomiasis in Africa and the need to scale-up treatment. COUNTDOWN has further helped to stimulate global interest on the needs of pre-school-aged children (PSAC) and has undertaken targeted interventions for this vulnerable group in Ghana and Cameroon. Professor Russell Stothard presented several COUNTDOWN activities and articles  to share evidence and experiences. A key theme in this 15th Symposium was expanding access of praziquantel treatment to PSAC with an important update presented by the Paediatric Praziquantel Consortium(link is external). It is now estimated that up to 50 million African children will need this oral dispersible tablet formulation which will be available from 2021. A formal access plan, however, is yet to be developed but will most likely involve a not-for-profit donation model (the expected price per tablet is approximately 10 pence). COUNTDOWN studies in Ghana and Cameroon are helping to shape the future roll-out of this child-friendly medication.

Multisectoral actions are very much needed in Africa as illustrated in the Brazilian programme which is approaching disease elimination in several settings. However, certain high transmission hotspots remain a persistent factor in achieving elimination in both settings. These hotspots continue to challenge performance of currently used interventions, highlighting the need to change, adapt and revise intervention tactics. At the Symposium, tactics for schistosomiasis control were discussed not only in the Brazilian context but also the sub-Saharan Africa context.  Experiences of COUNTDOWN in Cameroon were prime examples. Professor Tchuem-Tchuenté presented highlights from his recent paper in Infectious Diseases of Poverty(link is external) explaining how components of the PHASE approach, as recently recommended by the TES Conference in Cameroon from last year, are best applied.

Just as Symposium participants were discussing disease hotspots or recalcitrant transmission foci, it was very timely that Prof Tchuem Tchuenté’s PLoS NTD paper on precision mapping, published that day. From broader discussions with other research groups and policy makers present at this Symposium, the importance of precision mapping gained approval, especially considering the Brazilian situation where resources need to be focused to attain local interruption of transmission.

We congratulate the 15th Symposium organisers, with special thanks to Dr Theresa Favre, for developing an exciting scientific programme. Furthermore, as research uptake is a continuous process, several of COUNTDOWN themes presented here on schistosomiasis, such as precision mapping, will be further discussed later in the year at COR-NTD and ASTMH, so watch this space!