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Glenn J, Kamara K, Umar ZA, Chahine T, Daulaire N, Bossert T. Applied systems thinking: a viable approach to identify leverage points for accelerating progress towards ending neglected tropical diseases. Health Res Policy Syst 2020; 18:56. [PMID: 32493485 PMCID: PMC7268457 DOI: 10.1186/s12961-020-00570-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 05/07/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Systems thinking is a conceptual approach that can assist stakeholders in understanding complexity and making progress on persistent public health challenges. Neglected tropical diseases (NTDs), a complex global health problem, are responsible for a large disease burden among impoverished populations around the world. This aim of this study was to better discern the many complexities of the global NTD system in order to identify and act on leverage points to catalyse progress towards ending NTDs. METHODS Existing frameworks for systems change were adapted to form the conceptual framework for the study. Using a semi-structured interview guide, key informant interviews were conducted with NTD stakeholders at the global level and at the country level in Nigeria. The interview data were coded and analysed to create causal loop diagrams that resulted in a qualitative model of the global NTD system. RESULTS The complete qualitative model is discussed and presented visually as six separate sub-components that highlight key forces and feedback loops within the global NTD system. CONCLUSIONS We identified five leverage points for NTD system change, namely (1) clarify the potential for and assess realistic progress towards NTD elimination, (2) increase support for interventions besides drug delivery, (3) reduce dependency on international donors, (4) create a less insular culture within the global NTD community, and (5) systemically address the issue of health worker incentives. The specific findings for NTDs raise a number of uncomfortable questions that have not been addressed, at least in part, because it is easier to continue focusing on 'quick win' solutions. The study provides a model of a systems thinking approach that can be applied to other complex global health and development challenges in order to understand complexity and identify leverage points for system change.
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Affiliation(s)
- Jeffrey Glenn
- Department of Public Health, College of Life Sciences, Brigham Young University, 2032 LSB, Provo, UT, United States of America.
| | | | | | - Teresa Chahine
- Yale School of Management, New Haven, CT, United States of America
| | - Nils Daulaire
- Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Thomas Bossert
- Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Griswold E, Unnasch T, Eberhard M, Nwoke BEB, Morales Z, Muheki Tukahebwa E, Kebede B, Anagbogu I, Katabarwa M, Habomugisha P, Tadesse Z, Miri ES, Evans D, Cohn D, Elhassan E, Richards F. The role of national committees in eliminating onchocerciasis. Int Health 2019; 10:i60-i70. [PMID: 29471337 DOI: 10.1093/inthealth/ihx048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/30/2017] [Indexed: 11/14/2022] Open
Abstract
National onchocerciasis elimination committees (NOECs) serve to help ministries of health complete the pathway to successful verification of elimination of onchocerciasis (river blindness), as outlined in the 2016 World Health Organization guidelines. These guidelines, however, only take effect when the country believes it has reached a point that elimination can be demonstrated, and do not address the preceding milestones. Therefore, NOECs can be of great help with guiding and tailoring earlier planning, programming and assessments to empower national programs to aggressively move toward their countries' elimination goals. In this article, we provide suggestions for organizing NOECs and examples of four such committees that have successfully operated in Africa and the Americas.
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Affiliation(s)
- Emily Griswold
- The Carter Center, One Copenhill, 453 Freedom Parkway, Atlanta, GA30307
| | - Thomas Unnasch
- University of South Florida, 4202 E Fowler Ave, Tampa, FL33620
| | - Mark Eberhard
- US Centers for Disease Control and Prevention (retired), Atlanta, GA 30333, USA
| | | | | | | | | | | | - Moses Katabarwa
- The Carter Center, One Copenhill, 453 Freedom Parkway, Atlanta, GA30307
| | | | | | | | - Darin Evans
- US Agency for International Development, Washington, DC
| | - Daniel Cohn
- RTI International, Washington, DC 20005, USA
| | | | - Frank Richards
- The Carter Center, One Copenhill, 453 Freedom Parkway, Atlanta, GA30307
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Elhassan E, Zhang Y, Bush S, Molyneux D, Kollmann MKH, Sodahlon Y, Richards F. The role of the NGDO Coordination Group for the Elimination of Onchocerciasis. Int Health 2018; 10:i97-i101. [PMID: 29471339 DOI: 10.1093/inthealth/ihx050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/30/2017] [Indexed: 11/14/2022] Open
Abstract
The NGDO Coordination Group for the Control of Onchocerciasis was launched in 1992, and with the paradigm shift from control of disease to elimination of onchocerciasis transmission, the Group shifted its orientation to that new paradigm in 2013. It also changed its name, replacing 'control' with 'elimination.' In doing so, the Group has repositioned itself to build on the successes of the past to finish the job it began over 25 years ago.
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Affiliation(s)
| | | | | | - David Molyneux
- Liverpool School of Tropical Medicine and Hygiene, Liverpool, UK
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Dieye Y, Storey HL, Barrett KL, Gerth-Guyette E, Di Giorgio L, Golden A, Faulx D, Kalnoky M, Ndiaye MKN, Sy N, Mané M, Faye B, Sarr M, Dioukhane EM, Peck RB, Guinot P, de los Santos T. Feasibility of utilizing the SD BIOLINE Onchocerciasis IgG4 rapid test in onchocerciasis surveillance in Senegal. PLoS Negl Trop Dis 2017; 11:e0005884. [PMID: 28972982 PMCID: PMC5640270 DOI: 10.1371/journal.pntd.0005884] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 10/13/2017] [Accepted: 08/18/2017] [Indexed: 11/25/2022] Open
Abstract
As effective onchocerciasis control efforts in Africa transition to elimination efforts, different diagnostic tools are required to support country programs. Senegal, with its long standing, successful control program, is transitioning to using the SD BIOLINE Onchocerciasis IgG4 (Ov16) rapid test over traditional skin snip microscopy. The aim of this study is to demonstrate the feasibility of integrating the Ov16 rapid test into onchocerciasis surveillance activities in Senegal, based on the following attributes of acceptability, usability, and cost. A cross-sectional study was conducted in 13 villages in southeastern Senegal in May 2016. Individuals 5 years and older were invited to participate in a demographic questionnaire, an Ov16 rapid test, a skin snip biopsy, and an acceptability interview. Rapid test technicians were interviewed and a costing analysis was conducted. Of 1,173 participants, 1,169 (99.7%) agreed to the rapid test while 383 (32.7%) agreed to skin snip microscopy. The sero-positivity rate of the rapid test among those tested was 2.6% with zero positives 10 years and younger. None of the 383 skin snips were positive for Ov microfilaria. Community members appreciated that the rapid test was performed quickly, was not painful, and provided reliable results. The total costs for this surveillance activity was $22,272.83, with a cost per test conducted at $3.14 for rapid test, $7.58 for skin snip microscopy, and $13.43 for shared costs. If no participants had refused skin snip microscopy, the total cost per method with shared costs would have been around $16 per person tested. In this area with low onchocerciasis sero-positivity, there was high acceptability and perceived value of the rapid test by community members and technicians. This study provides evidence of the feasibility of implementing the Ov16 rapid test in Senegal and may be informative to other country programs transitioning to Ov16 serologic tools. As onchocerciasis control programs succeed and transition to elimination efforts, different diagnostic tools are needed. The goal of this study was to determine if integrating the Ov16 rapid test is feasible based on acceptability, usability, and cost. A study was conducted in 13 villages in southeastern Senegal in May 2016. Community members were invited to participate in a demographic questionnaire, a rapid test, a skin snip biopsy, and an acceptability interview. Technicians were also interviewed and a costing analysis was conducted. Out of 1,173 participants, 1,169 (99.7%) agreed to the rapid test while 383 (32.7%) agreed to skin snip microscopy. The rapid test result was reactive in 2.6% of those tested, while none of the skin snips were positive. Community members thought the rapid test was performed quickly, was not painful, and provided reliable results. If no one had refused skin snip microscopy, the total cost would have been around $16 per person tested for either method. In this area with little if any remaining onchocerciasis, there was high acceptability and perceived value of the rapid test. This study suggests that implementing the Ov16 rapid test in Senegal is feasible and these findings may be informative to other country programs.
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Affiliation(s)
- Yakou Dieye
- PATH, Seattle, Washington, United States of America
| | - Helen L Storey
- PATH, Seattle, Washington, United States of America
- * E-mail:
| | | | | | | | | | - Dunia Faulx
- PATH, Seattle, Washington, United States of America
| | | | | | - Ngayo Sy
- Senegal Ministry of Health and Social Action, Dakar, Senegal
| | - Malang Mané
- Senegal Ministry of Health and Social Action, Dakar, Senegal
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Rotondo LA, Harrison W, Bush S, Hopkins AD, Koporc K. The Neglected Tropical Disease Non-governmental Development Organization Network (NNN): the value and future of a global network aiming to control and eliminate NTDs. Int Health 2016; 8 Suppl 1:i4-6. [PMID: 26940309 DOI: 10.1093/inthealth/ihw004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lisa A Rotondo
- NTD NGDO Network, RTI International, Washington, D.C., USA
| | - Wendy Harrison
- NTD NGDO Network, Schistosomiasis Control Initiative, Imperial College, London, UK
| | - Simon Bush
- NTD NGDO Network, Sightsavers, Haywards Heath, West Sussex, UK
| | - Adrian D Hopkins
- NTD NGDO Network, Mectizan Donation Programme, Task Force for Global Health, Decatur, GA, USA
| | - Kim Koporc
- NTD NGDO Network, Children Without Worms, Task Force for Global Health, Decatur, GA, USA
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Molyneux DH, Ward SA. Reflections on the Nobel Prize for Medicine 2015--The Public Health Legacy and Impact of Avermectin and Artemisinin. Trends Parasitol 2015; 31:605-607. [PMID: 26552892 DOI: 10.1016/j.pt.2015.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/21/2015] [Indexed: 11/15/2022]
Abstract
The award of the Nobel Prize to Dr Bill Campbell and Professor Satoshi Ōmura for their role in the discovery of avermectin and Professor Youyou Tu for her work on the development of artemisinin has been universally welcomed by the International Health community for what the Nobel Committee described as 'The discoveries of Avermectin and Artemisinin have revolutionized therapy for patients suffering from devastating parasitic diseases. Campbell, Ōmura and Tu have transformed the treatment of parasitic diseases. The global impact of their discoveries and the resulting benefit to mankind are immeasurable'.
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Affiliation(s)
- David H Molyneux
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
| | - Steve A Ward
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Bundy DAP, Dhomun B, Daney X, Schultz LB, Tembon A. Investing in Onchocerciasis Control: Financial Management of the African Programme for Onchocerciasis Control (APOC). PLoS Negl Trop Dis 2015; 9:e0003508. [PMID: 25974134 PMCID: PMC4431882 DOI: 10.1371/journal.pntd.0003508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Bilkiss Dhomun
- World Bank Group, Washington, D.C., United States of America
| | | | - Linda B. Schultz
- World Bank Group, Washington, D.C., United States of America
- * E-mail:
| | - Andy Tembon
- World Bank Group, Washington, D.C., United States of America
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Roungou JB, Yameogo L, Mwikisa C, Boakye DA, Bundy DAP. 40 Years of the APOC Partnership. PLoS Negl Trop Dis 2015; 9:e0003562. [PMID: 25974289 PMCID: PMC4431867 DOI: 10.1371/journal.pntd.0003562] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jean-Baptist Roungou
- World Health Organization/African Programme for Onchocerciasis Control (WHO/APOC), Ouagadougou, Burkina Faso
| | - Laurent Yameogo
- World Health Organization/African Programme for Onchocerciasis Control (WHO/APOC), Ouagadougou, Burkina Faso
| | - Chris Mwikisa
- World Health Organization/African Programme for Onchocerciasis Control (WHO/APOC), Ouagadougou, Burkina Faso
| | - Daniel A. Boakye
- World Health Organization/African Programme for Onchocerciasis Control (WHO/APOC), Ouagadougou, Burkina Faso
- * E-mail:
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