Firoz Lalji Institute for Africa, LSE, London, UK
Department of International Development, LSE, London, UK.
BMJ Glob Health. 2022 Feb;7(2). doi: 10.1136/bmjgh-2021-007113.
The integration of more diverse perspectives into the development of evidence for decision-making has been elusive, despite years of rhetoric to the contrary. This has led to cycles of population-based health interventions which have not delivered the promised results. The WHO most recently set a target for schistosomiasis elimination by 2030 and called for cross-cutting approaches to be driven by endemic countries themselves. The extent to which elimination is feasible within the time frame has been a subject of debate.
Systems maps were developed through participatory modelling activities with individuals working on schistosomiasis control and elimination activities from the village through national levels in Uganda. These maps were first synthesised, then used to frame the form and content of subsequent mathematical modelling activities, and finally explicitly informed model parameter specifications for simulations, using the open-source SCHISTOX model, driven by the participants.
Based on the outputs of the participatory modelling, the simulation activities centred around reductions in water contact. The results of the simulations showed that mass drug administration, at either the current or target levels of coverage, combined with water contact reduction activities, achieved morbidity control in high prevalence settings, while both morbidity control and elimination were achieved in high prevalence settings within the 10-year time period.
The combination of participatory systems mapping and individual-based modelling was a rich strategy which explicitly integrated the perspectives of national and subnational policymakers and practitioners into the development of evidence. This strategy can serve as a method by which individuals who have not been traditionally included in modelling activities, and do not hold positions or work in traditional centres of power, may be heard and truly integrated into the development of evidence for decision-making in global health.
尽管多年来一直有相反的言论，但将更多元的观点纳入决策证据的制定工作仍难以实现。这导致了基于人群的卫生干预措施的循环，而这些措施并没有带来预期的结果。世界卫生组织（WHO）最近设定了到 2030 年消除血吸虫病的目标，并呼吁由流行国家自身推动跨领域方法。在规定的时间内实现消除的可行性程度一直是一个争论的话题。
通过在乌干达从村庄到国家各级参与血吸虫病控制和消除工作的个人开展参与式建模活动，制定了系统图谱。这些图谱首先进行了综合，然后用于构建随后的数学建模活动的形式和内容，最后使用开源的 SCHISTOX 模型，根据参与者的意见，明确告知模型参数的规范进行模拟。
基于参与式建模的结果，模拟活动集中在减少与水的接触上。模拟结果表明，大规模药物管理，无论是目前的还是目标的覆盖范围，结合减少与水的接触活动，在高流行地区实现了发病率控制，而在 10 年内，在高流行地区既实现了发病率控制又实现了消除。
参与式系统映射和个体建模的结合是一种丰富的策略，明确将国家和国家以下各级决策者和从业人员的观点纳入证据制定中。这种策略可以作为一种方法，让那些传统上未参与建模活动、不担任职位或不在传统权力中心工作的人有机会发表意见，并真正融入全球卫生决策证据的制定中。
