by Dr Vijayashree HY
This session was chaired by Mr.Sunil Nandraj (Faculty, Public Health Foundation of India, Delhi) and co-chaired by Dr.Werner Soors (Institute of Tropical medicine, Antwerp).
Prof Fran Baum (Flinders University, Adelaide, Australia), in her presentation entitled ‘ The Tip of the Iceberg: neglected diseases and social determinants of health and health inequities’ spoke about approaches in reducing health inequities through action on social determinants of health (SDH). Click here to listen to her presentataion
Another panelist Dr Devaki Nambiar (Research Scientist, Public Health Foundation of India, New Delhi), by narrating a story of snake bite from the field, highlighted the health system failures at various levels in managing snake bite cases. She illustrated how larger cultural and social factors but also environmental factors shapes situations where snakebites cases becomes common in India. She emphasized the urgent need of health system preparedness to tackle such situations. It was debated that snake bite is indeed a neglected tropical disease and deserves more attention.
Dr. Upendra Bhojani (Faculty, Institute of Public Health, Bangalore) emphasized what Prof. Fran Baum described as Health in All policies concept. By highlighting how policies in different sectors like, transport, food, trade, taxation, agriculture as well as larger political economy affect whether tobacco use gets promoted or reduced in India. Subsequently he made other point that, it is not that health sector has no role in addressing SDH but there is an unique challenge to health professional to go beyond health care sector and become advocate for healthy policies in other sectors. He demonstrated how the practice of advocacy for health in all policies might look like, by briefing his experience along with his team members: Dr. Vishal, cancer surgeon who does political and administrative advocacy, Mr. Mohanraj, cancer patient spearheading voice of tobacco victim movement, and Mr. Amit doing media advocacy.
Some more discussions surrounding panelists’ presentations:
by David Hendrickx
The NTD (neglected tropical diseases) debate continued this morning at the ITM-IPH colloquium with a closer look at a few key challenges the research community is being faced with in terms of informing NTD control initiatives. Although the session focused predominantly on the case of visceral leishmaniasis and its control in the Indian subcontinent, the questions discussed throughout the presentations and discussions were just as relevant to other NTDs. What is the precise role of vector control in reducing disease incidence? What is the best vector control strategy, considering factors such as (cost-)effectiveness, acceptability and risk of insecticide resistance? What is the role of asymptomatic carriers of infection in disease transmission? How can we effectively and safely treat patients for these conditions, without running the risk of losing the few drugs we currently have at our disposal to drug resistance?
These were just a few of the questions that were raised. It was sobering (yet fitting, for a neglected problem?) to observe that many of the presented studies put forward more questions and ‘known unknowns’ than they provided answers and clear ways forward. It feels like we are slowly piecing together a huge and complex puzzle, with the added challenge of not knowing how many pieces we will need, nor what the picture on the box looks like. So where should our research priorities lie in terms of NTD control? And should we focus on implementing what we think we know? Or would we be wise to invest more time and resources in exploring alternate control strategies and possible ‘unknown unknowns’? As we continue to piece together the puzzle of NTD control, it remains clear that our continued research efforts are much needed, whatever our discipline or expertise.
Fran Baum: “The Tip of the Iceberg: neglected diseases and social determinants of health and health inequities”
Watch the video and post your questions to Prof Baum either as comment below this post or on the Colloquium Facebook group.
by Dr Vijayashree HY
This session started with Prof. Freddie Ssengooba’s (Makerere University School of Public Health, Uganda) presentation. He talked about the health system evidence to guide disease control. He emphasized that public health interventions are often implemented without much pre-trial development research and invariably there will be program adaptations during implementation. Thus, the evaluation methods need to take into account the complexity and evolutionary adaptions. He also stressed the importance of using randomization methods for evaluating public health innovations in such situations where contextual and implementation learning are not vital.
Some discussions surrounding this presentation:
The second key note speaker, Prof. Venkat Raman (Faculty of management studies university of Delhi), talked about public private interface in disease control strategies. By providing some examples of Public Private partnerships (PPP) in health care, he discussed the advantages of working with the private sector but stressed the challenges in partnering with private sector health providers. Some issues which deserves further discussion are:
The third key note speaker, Prof. Guy Kegels (Institute of Tropical Medicine, Antwerp), talked about Vertical analysis. He discussed ‘operational analysis’ following Piot’s model, the ‘learning cycle’ for Action Research. He stressed the need to involve generalist program implementers in program design, whenever possible.
The fourth speaker, Dr Melissa Parker (Centre for Research in International Medical Anthropology, Brunel University) spoke about her experiences of working in Uganda and Tanzania on the uptake of drugs for neglected tropical diseases. She stressed the need to understand how social, political, economic and historical issues influence the uptake of drugs, and pointed out that anthropologists can fill in the gaps in understanding the contextual issues in the health system for certain outcomes.
Editor’s note: If the above quoted six questions are not thought-provoking enough, here are some additional questions you may want to elaborate on in the comments:
by David Hendrickx
The colloquium got off to an energetic start this morning with a session on the state of the art of neglected tropical diseases (NTDs) control in Asia. In the opening plenary presentation Professor Jacob John (Christian Medical College, Vellore, India) defined this group of diseases as those for which no health system based intention of control exists. He argued that if certain infectious diseases are currently not under control or no initiatives are in place to move towards control, it is because of a lack of interest and determination on a political level. Professor John therefore urged the colloquium delegates to consider their role in demanding their country’s political actors to address the issue of health and accept the principle that people’s health should be an intrinsic responsibility of the state, especially in the case of the poorest of the poor.
The session’s second keynote speaker, Professor Suman Rijal (BP Koirala Institute for Health Sciences, Dharan, Nepal) illustrated some of the opportunities and key challenges regarding the control of NTDs in Southern Asia. His presentation highlighted the tremendous burden this group of diseases represents for the region, amounting to estimates as high as 14.8 million DALYs. The need for integrated efforts towards NTD control was discussed, stressing that effective interventions need to be multifaceted. This was illustrated by the case of Kala Azar (or visceral leishmaniasis) and the elimination initiative that has been put into place in the Indian subcontinent. This program adopted a two-pronged strategy consisting of early diagnosis and treatment, and integrated vector control.
Throughout the various presentations and discussions the session also put forward a call for moving beyond the vertical programme-based approach to NTD control in Southern Asia. This strategy was considered unrealistic, uneconomical, and potentially damaging to the health system. Instead, it was argued that the health system’s own capacity to monitor and control NTDs should be strengthened. A well-established disease surveillance system is essential for developing such an integrated strategy for the control of NTDs, although it was argued that the value of such a system is wholly dependent on the ability to effectively translate the generated information into interventions. Or how concerted action speaks louder than numbers and histograms.
Other challenges and knowledge gaps for NTD control were highlighted throughout the session, including our limited understanding of the role of animal reservoirs in disease transmission and the need for improved clinical guidelines for the hands-on management of NTDs. Nevertheless, there was reason for optimism, as several NTDs are coming close to elimination in Southern Asia. However, given the current resurgence of malaria in India after it was previously considered to be under control, we should learn from past lessons. Vigilance is in order. With the few NTD elimination goals that are currently within our reach in Southern Asia, complacency is a luxury we clearly cannot afford.
So are we close to NTD elimination in Southern Asia? What is your take?
The Strategic Network of Neglected Diseases and Zoonoses held a satellite workshop before the Colloquium 2013.
The presentations and other resources have been posted on their website, so interested parties can have a look here: