A Systems Thinking Approach to Global Governance for Neglected Tropical Diseases
AbstractNeglected tropical diseases (NTDs) represent a major disease burden in sub-Saharan Africa and among the poorest of the poor in other regions around the world. A significant global effort is underway to deliver preventive chemotherapy (PC) medicines via mass drug administration (MDA) to people at risk the five PC-NTDs: lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths, and trachoma. Despite the existence of an effective, low-cost, and seemingly simple solution of MDA aided by donations of free drugs, most countries will fall far short of the ambitious global NTD control and elimination goals targeted to be achieved by 2020. The host organization for this DELTA project, the END Fund, is a private philanthropic initiative that pools and directs resources to PC-NTD programs. This project used a systems thinking approach to better understand the complex challenges around addressing NTDs in order to make recommendations to the END Fund on how it can catalyze NTD systems change. The mixed-methods approach included 1) a quantitative survey with social network analysis of global NTD stakeholders and 2) in-depth interviews at the global level and in Nigeria to develop a qualitative model of the NTD system. A parallel work stream involving a group-based systems thinking process was facilitated with END Fund staff in order to inform the research component and help generate actionable recommendations. The research uncovered a number of structural issues impeding progress on NTDs and identified five key leverage points for systems change: 1) clarify potential for and assess progress towards elimination, 2) increase support for interventions besides drug delivery, 3) reduce dependency on donors, 4) address the issue of health worker incentives, and 5) create a more inclusive global NTD community. Each of these areas was accompanied by recommendations for how the END Fund and NTD community can influence each lever. The project is an example of using rigorous research methods in a practical, applied way to bridge the gap between the academic and practice sectors. This model also points to the need for more documented evidence of successful and failed attempts to use systems thinking to make progress on complex social problems.
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