Towards a science of global health delivery: A socio-anthropological framework to improve the effectiveness of neglected tropical disease interventions
Towards a science of global health delivery: A socio-anthropological framework to improve the effectiveness of neglected tropical disease interventions
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DOI：
10.1371/journal.pntd.0006537
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发表时间：
2018-07-01
影响因子：
3.8
通讯作者：
Bardosh, Kevin Louis
中科院分区：
文献类型：
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作者：
Bardosh, Kevin Louis
在过去十年中，实施研究和全球卫生服务科学已成为提高干预措施有效性的重要工具。控制被忽视的热带病的工作是在具有挑战性的环境和边缘化人群中开展的，因此特别需要关注具体情况的细节。社会人类学的见解提供了许多关于NTD交付的科学。在本文中，基于社会人类学研究，提出了一个可理解和可操作的框架，用于理解NTD干预有效性，并概述了其在项目规划、监测和评估方面的效用。该框架是通过比较分析在东非（2010 +/- 2013）开展的三项快速人种学研究得出的，这些研究涉及三种不同的大规模非传染性疾病干预措施：坦桑尼亚的狂犬病消除、乌干达的昏睡病控制和赞比亚的寄生虫预防。该框架包括五个“干预领域”，这些干预措施的有效性是在地方一级谈判和确定的。这涉及：1)干预的地形（包括季节性和地理变异）；2)社区代理（包括当地知识、风险认知、行为、领导和社会压力）；3)外地工作人员的策略和激励措施（技能、动机、能力和支持）；4)技术的社会物质性（干预工具的特征和采用过程本身）；5)干预措施的治理（政策叙述、可用的专业知识、官僚主义、政治和知识的利用）。本文通过案例研究，阐述了这些领域的重要性，并就这些见解如何改善干预措施的实施提出了经验教训和实用建议。结论/意义为了帮助缩小NTD规划的疗效和有效性之间的差距，重要的是现场工作人员：1)产生有关背景因素的有意义的知识；2)使用这些知识来定制现场策略；3)创建常规机制来解释执行本身的动态过程。这里提出的框架提供了一个简单的分析工具，以加强这些知识到行动的关系，现有的项目规划工具，借鉴社会人类学的见解。
BackgroundOver the last decade, implementation research and a science of global health delivery have emerged as important vehicles to improve the effectiveness of interventions. Efforts to control neglected tropical diseases (NTD) operate in challenging circumstances and with marginalized populations, making attention to context-specific details particularly relevant. Socio-anthropological insights have much to offer a science of NTD delivery. In this paper, an accessible and actionable framework for understanding NTD intervention effectiveness, based on socio-anthropological research, is presented and its utility for program planning and monitoring and evaluation is outlined.Methodology/Principal findingsThe framework was developed inductively by comparatively analyzing three rapid ethnographic studies undertaken in Eastern Africa (2010 +/- 2013) on three different large-scale NTD interventions: rabies elimination in Tanzania, sleeping sickness control in Uganda and the prevention of parasitic worms in Zambia. The framework includes five "intervention domains" where the effectiveness of these interventions was negotiated and determined at the local level. This involves: 1) the terrain of intervention (including seasonality and geographical variability); 2) community agency (including local knowledge, risk perceptions, behaviors, leadership and social pressure); 3) the strategies and incentives of field staff (skills, motivations, capabilities and support); 4) the socio-materiality of technology (characteristics of intervention tools and the adoption process itself); and 5) the governance of interventions (policy narratives, available expertise, bureaucracy, politics and the utilization of knowledge). The paper illustrates the importance of each of these domains by drawing on the case study research, presenting lessons learnt and practical recommendations for how such insights could improve intervention delivery.Conclusions/SignificanceTo help close the gap between efficacy and effectiveness in NTD programs, it is important that field staff: 1) generate meaningful knowledge about contextual factors; 2) use this knowledge to tailor field strategies; and 3) create routine mechanisms to account for the dynamic process of implementation itself. The framework presented here offers a simple analytical tool to strengthen these knowledge-to-action relationships existing project planning tools, drawing on the insights of socio-anthropology.