The world is waking up to Africa's health crisis and realising a different approach is needed.
As you read this, more than 1 billion people – a sixth of the global population – are spending their days living with the most debilitating parasitic infections on the planet.
Until recently, most of the developed world has been oblivious to the misery caused by these infections – termed neglected tropical diseases – which inflict severe health burdens on the world’s poor, especially in Africa.
But thanks to the publicity efforts of global philanthropists such as Bill Gates and the advocacy efforts of a group of highly committed public health activists, the world is waking up to this appalling situation, and working out ways to not only control NTDs but also to potentially eliminate some of them.
In the past few years, dealing with the NTDs has become a top priority for the World Health Organization and for major aid donors, such as the UK’s Department for International Development.
Drug companies have agreed to make millions of tablets available, free of charge, many claiming that it is the most effective way of making poverty history.
But can it really be made to work?
Professor Tim Allen, Head of the Department of International Development at LSE, and Dr Melissa Parker, the Director of the Centre for Research in International Medical Anthropology at Brunel University, have published a series of papers highlighting problems with the current strategies.
Based on detailed local level research in East Africa, they have found that the concentration on mass drug administration, at the expense of other approaches, has had very mixed results.
“Many infected groups are not actually receiving treatment. In fact, at numerous sites, this is the majority,” Professor Allen says.
“Nuanced and less context-free strategies are needed to seriously engage with the targeted populations and more convincingly explain the purpose of giving tablets to people who seem healthy.
“Walking into a village and handing out tablets is not enough and can be counter-productive,” Professor Allen says.
According to Dr Parker, those people who overwhelmingly are infected with neglected tropical diseases have little political voice, and are persistently excluded from the benefits of economic development.
“Can such political and social realties be overcome? Also, for control of these diseases to be successful requires people to take the medications before they have any signs or symptoms of infection. To persuade them to do so is a challenge.”
Other researchers grounded in both the social and natural sciences have similarly raised concerns with the current juggernaut of mass drug administration (MDA) programmes.
Some have raised biological issues, such as the effect of tablets on immune systems. Others have shown how the concentration of funding can overwhelm or sideline national health structures.
The upshot of these issues is a growing consensus among scholars and policy makers that a more biosocial approach is essential to effectively tackle neglected tropical diseases.
To this end, Professor Allen and Dr Parker, together with Dr Katja Polman of the Institute of Tropical Medicine, Antwerp, hosted a workshop in London in July, bringing together people at the heart of the debate.
“We were able to bring together people from diverse backgrounds who have been in quite fierce debate over this issue but who all have a common goal – to rid the suffering of millions of people,” Professor Allen says.
The participants included recognised academic leaders in this field, such as African experts Professor John Gyapong from the University of Ghana and Professor Mutamid Amin from Afhad University in Sudan; tropical diseases expert Dr Johannes Sommerfeld representing the World Health Organization; and Professor Alan Fenwick from Imperial College London, who is Director of the Schistosomiasis Control Initiative.
More than 20 biological and social science experts – many with opposite views – argued passionately in defence of their preferred treatment programs to control NTDs and discussed their personal experiences in the field.
“It made for some fiery conversations but I think everyone recognises the need for a multi-faceted approach if we are to make serious headway with neglected tropical diseases,” Professor Allen says.
“Behavioural change is necessary because many of these diseases are transmitted by poor sanitation and a lack of understanding. Simple measures may contribute, such as using mosquito nets to help prevent lymphatic filariasis, and ensuring people do not urinate or defecate near water sources to help prevent schistosomiasis. However, the key thing is that infected people need proper explanations about the treatment so that they begin to demand the tablets for themselves and their children, rather than wonder what is going on.”
“It is no use just going into an African village and expecting people to take medicines if they don’t understand how the tablets work. The rationale for treatment needs to be explained to them very clearly because otherwise it can create a culture of suspicion, resistance and even violence. That requires a huge improvement in health education and more broadly in communication between those promoting treatment and those who are supposed to be on the receiving end.”
Dr Parker echoes these sentiments: “It is apparent that we are dealing with highly complex infections which require complex interventions. Without a shadow of a doubt, no single discipline has a monopoly of insight into controlling neglected tropical diseases.”
“By bringing together biological and social scientists in one venue, we were able to discuss how to develop a more coherent, effective and holistic approach and ultimately alleviate the suffering of millions of impoverished people around the world.”
To hear the views of these workshop participants click on the links below:
Professor Mutamid Amin
Professor John Gyapong
Dr Johannes Sommerfeld
Professor Alan Fenwick
Dr Edwin Michael (Epidemiologist, Notre-Dame University, USA)
Uploaded August 2013
Professor Tim Allen is Professor of Developmental Anthropology and Head of the Department of International Development at the London School of Economics and Political Science. He has expertise in the fields of complex emergencies, ethnic conflict, forced migration, local conception of health and healing, East Africa (especially Sudan, Uganda and Kenya), development aid and agencies and ethics of aid.
The Department of International Development (ID) at LSE was established in 1990 as the Development Studies Institute (DESTIN) to promote interdisciplinary post-graduate teaching and research on processes of social, political and economic development and change.