Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine (LSHTM), UK.
Faculty of Infectious and Tropical Diseases, LSHTM, UK.
Soc Sci Med. 2019 May;228:51-59. doi: 10.1016/j.socscimed.2019.02.050. Epub 2019 Mar 2.
Recent global commitments to shift responsibility for Neglected Tropical Disease (NTD) control to affected countries reflect a renewed emphasis on sustainability, away from aid-dependency. This calls for a better understanding of how domestic stakeholders perceive investments in different strategies for NTD control. Soil transmitted helminths (STH) are among the NTDs targeted for elimination as a public health problem by international agencies through mass drug administration, provided periodically to at-risk population groups, often using drugs donated by pharmaceutical companies. This study was conducted in Kenya at a time when responsibilities for long running STH programmes were transitioning from external to national and sub-national agencies. Following an initial assessment in which we identified key domestic stakeholders and reviewed relevant scientific and government documents, the perspectives of stakeholders working in health, education, community engagement and sanitation were investigated through semi-structured interviews with national level policymakers, county level policymakers, and frontline implementers in one high-STH burden county, Kwale. Our conceptual framework on sustainability traced a progression in thinking, from ensuring financial stability through the technical ability to adapt to changing circumstances, and ultimately to a situation where a programme is prioritised by domestic policymakers because empowered communities demand it. It was clear from our interviews that most Kenyan stakeholders sought to be at the final stage in this progression. Interviewees criticised long-term investment in mass drug administration, the approach favoured predominantly by external agencies, for failing to address underlying causes of STH. Instead they identified three synergistic priority areas for investment: changes in institutional structures and culture to reduce working in silos; building community demand and ownership; and increased policymaker engagement on underlying socioeconomic and environmental causes of STH. Although challenging to implement, the shift in responsibility from external agencies to domestic stakeholders may lead to emergence of new strategic directions.
近年来，全球致力于将控制被忽视的热带病（NTD）的责任转移到受影响的国家，这反映了对可持续性的重新重视，摆脱了对援助的依赖。这需要更好地了解国内利益相关者如何看待不同 NTD 控制策略的投资。土壤传播的蠕虫（STH）是被国际机构作为公共卫生问题通过大规模药物管理来消除的 NTD 之一，定期向高危人群提供药物，通常使用制药公司捐赠的药物。这项研究是在肯尼亚进行的，当时长期运行的 STH 项目的责任从外部机构向国家和国家以下各级机构过渡。在初步评估中，我们确定了主要的国内利益相关者，并审查了相关的科学和政府文件，然后通过对一个高 STH 负担县（夸莱县）的国家一级决策者、县一级决策者和一线执行者进行半结构化访谈，调查了卫生、教育、社区参与和环境卫生领域利益相关者的观点。我们关于可持续性的概念框架追踪了思维的进展，从通过适应不断变化的环境的技术能力来确保财务稳定，最终到一个方案被国内政策制定者优先考虑的情况，因为赋权社区对此有需求。从我们的访谈中可以清楚地看出，大多数肯尼亚利益相关者都希望处于这一进展的最后阶段。受访者批评长期投资于大规模药物管理，即外部机构主要青睐的方法，因为它未能解决 STH 的根本原因。相反，他们确定了三个需要投资的协同优先领域：改变机构结构和文化，以减少各自为政的情况；建立社区需求和所有权；以及增加决策者对 STH 的潜在社会经济和环境原因的参与。虽然实施起来具有挑战性，但从外部机构向国内利益相关者转移责任可能会导致新战略方向的出现。
