SCALING-UP COMMUNITY PARTICIPATION FOR COMMUNICABLE DISEASE CONTROL AND ELIMINATION. Dr Jo-An Atkinson The Australian Prevention Partnership Centre

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1 SCALING-UP COMMUNITY PARTICIPATION FOR COMMUNICABLE DISEASE CONTROL AND ELIMINATION Dr Jo-An Atkinson The Australian Prevention Partnership Centre

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3 Community participation in successful communicable disease elimination programs Elimination of malaria in Taiwan in 1960 s Elimination of malaria in Aneityum, Vanuatu in 1990 s The elimination of onchocerciasis in 11 West African Countries The elimination of shistosomiasis in Guangxi, China The global eradication of smallpox by 1980.

4 Barriers to achieving scale The benefits for the current malaria elimination campaign are yet to be fully realised due to: 1. Lack of understanding of the range of factors that influence participation 2. Lack of a framework and infrastructure for achieving community participation at scale 3. Inadequate financial resources allocated to achieving community participation at scale

5 1. Understanding the range of factors influencing participation

6 Influences on community participation Household-level factors Gender roles / power relationships Cultural norms / social mechanisms Access Urban vs. rural implementation Individual-level factors Knowledge/perceptions Vulnerability vs. resilience Stigma Incentives Acceptability Government/civil society-level factors Political environment Government support Commitment to PHC Decentralisation Multi-sectoral collaboration Resources Civil society support Community-level factors Community characteristics Epidemiology & complexity of interventions Process of engagement Congruence of external targets and local priorities

7 1. Understanding the range of factors influencing participation cont. Relative importance of these factors will vary depending on: Context Disease Phase of program Routine control =>Intensified control =>Elimination =>Holding the line

8 Insights from community participation for malaria elimination in the SW Pacific 1. Phase specific strategies for community participation required (i.e. disease control, intensified control, elimination, holding the line) 2. Don t neglect the system-level factors that can undermine efforts to achieve community participation at scale. Tanna Island, Vanuatu Figure courtesy of Heidi Reid, PacMISC J Atkinson, L Fitzgerald, H Toaliu, et al. Community participation for malaria elimination in Tafea Province, Vanuatu: Part I. Maintaining motivation for prevention practices in the context of disappearing disease. Malaria journal: 2010; 9, 93.

9 Possible approaches for determining which factors to target to optimise community participation Periodic empirical research Systems science methods Sentinel sites

10 Sentinel sites - a model for research integration to support and maintain participation at scale Local volunteers trained and supported to use a tool kit of qualitative and participatory research methods in selected communities. Sentinel sites could: Trial new technologies or implementations strategies Provide in-depth, real-time feedback Allow programs to remain responsive to changes in community attitudes, perceptions, priorities and practices Provide an avenue for constructive dialogue and exchange of views between community members, program staff and policy makers

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12 Barriers to achieving scale The benefits for the current malaria elimination campaign are yet to be fully realised due to: 1. Lack of understanding of the range of factors that influence participation 2. Lack of a framework and infrastructure for achieving community participation at scale 3. Inadequate financial resources allocated to achieving community participation at scale

13 Case Management Diagnosis Treatment Enabling Environment Health Systems Strengthening: Governance, information, financing, service delivery infrastructure, human resources, medicines & technology Prevention Vector Control Personal Protection Community Participation Governance / leadership, advocacy, communications, capacity building, engagement/ partnership, cross-sectoral collaboration, monitoring & evaluation / research Surveillance Health and Malaria Information Systems Passive Case Detection Active Case Detection Adapted from: de Savigny D, Adam T Systems thinking for health systems strengthening. Geneva: World Health Organization.

14 Maladies sans frontières Communicable diseases don t respect borders Consider regional partnerships that can leverage combined expertise in governance, public policy, advocacy, diplomacy, capacity building and civil society / private sector contacts

15 APMEN Community Participation Working Group

16 Barriers to achieving scale The benefits for the current malaria elimination campaign are yet to be fully realised due to: 1. Lack of understanding of the range of factors that influence participation 2. Lack of a framework and infrastructure for achieving community participation at scale 3. Inadequate financial resources allocated to achieving community participation at scale

17 3. Inadequate financial resources allocated to large-scale community engagement and participation activities Funding cuts => CP sacrificed Despite rhetoric of importance of CP it is still considered an optional extra How do we get CP off the sidelines of public health policy and integrated as an essential component of all programs? Changes in Global Fund malaria funding (analysis by UCSF Global Health Group s Malaria Elimination Initiative) APMEN.pdf

18 The challenges ahead: Understanding the relative importance of multi-level influences on participation in particular contexts and across phases of a program Design and adequately cost national frameworks for community participation and integrate them into national disease control and elimination programs Building a compelling case for adequate donor investment using strategies that suggest optimisation of donor investment Framing CP as a critical enabler of a successful program Demonstrate cross-border collaboration and coordination for CP Establishing regional consensus on CP frameworks

19 THANK YOU