Multidisciplinary research at the foothills of a live volcano

unknownSally Theobald, COUNTDOWN consortium

Mount Cameroon, a live volcano, and the highest mountain, in west and central Africa was the site of our COUNTDOWN Cameroon planning meeting. Looking out to sea emerges another Volcano: Bioko, the island capital of neighbouring  Equatorial Guinea. My inner geographer was enthralled. Prof Wanji, our host, and himself a strong supporter and initiator of multidisciplinary research, explained how the 2 volcanoes are connected by tectonic plates that run under the ocean. The last volcanic eruption on March 28, 1999, which caused lava to flow down the mountain stopping just before our hotel, was triggered by tectonic movements mount between Mount Bioko and Mount Cameroon. Hence the volcanos are intricately interlinked shaping the movements of each other.

We spent the week ensuring our research plans across our multiple disciplines – parasitology, vector biology, entomology, health economics, applied social science and anthropology – cohere and triangulate to enable strong health systems research that responds to the demands of policy makers and will support the scale up of promising interventions. Through all the different discussions what emerged for me was the critical interface role close to community providers such as community based drug distributors play in the delivery of NTD programmes and how central they are to their efficiency, equity, sustainability and the ethics of interactions with women, men, girls and boys. They link NTD programmes and communities just like the tectonic plates link Mount Cameroon and Mount Bioko. They are critical to the success of NTD programmes and universal health coverage, yet the evidence base on their experience, the opportunities and challenges they face from their own perspectives, and that of communities and other health providers is sadly limited. COUNTDOWN will focus in here; for example, in our work on alternative strategies to address onchocerciasis in areas of co-endemnicity for Loa loa, close to community providers will play a role in larviciding; whereas work to enhance access to Mass Drug Administration includes partnership with community drug distributors to ensure children who are out of school can also access praziquantel to treat schistosomiasis. Our stream of social science work will explore community based drug distributors’ perceptions and experiences of their role, including in new alternative strategies; and our health economics colleagues will assess the direct and indirect costs of MDA, from the perspectives of multiple stakeholders including community based drug distributors.

Back to Cameroon and its amazing geography – my Bradt guidebook – describes Cameroon as “the melting pot of Africa, Africa in miniature and Africa in microcosm”, because it encompasses much of the diversity of the continent as a whole: from lush rainforests in the south to near desert in the north. Culturally Cameroon is incredibly diverse, with multiple different groups and more than 275 ethno-linguistic groups. This diversity is also why community based drug distributors are such a central cadre; they are embedded and come from the communities they serve, understanding the cultural, linguistic, social and gender norms, and often have high levels of intrinsic motivation to serve their own communities.  How best to recognise and remunerate this cadre needs further debate.

CDDs and other close to community providers are arguably critical to meeting the Sustainable Development Goals, and we need more evidence and discussion on how to enable them to best deliver their critical interface role. Come and learn more and engage in these discussions:

  1. COUNTDOWN is having a panel discussion on CDDs, gender and equity at the COR-NTD meeting in the USA precisely in Atlanta, Georgia. Chaired by Theresa Hoke (FHI, 360, USA) speakers include Samuel Wanji (University of Buea, Cameroon), Margaret Gyapong (Dodowa, Ghana), Ifeoma Anagbogu (Director of NTD programme in Nigeria) and Suzie Campbell (LSTM, UK).
  2. COUNTDOWN (Theresa Hoke) is presenting in a panel at ASTMH on CDDs and their role in NTD programmes.
  3. COUNTDOWN (Karsor Kollie, NTD Coordinator, Liberia) is presenting at the Thematic Working Group on Community Health Workers at the Health Systems Global Meeting in Vancouver. 
  4. Cameroon is hosting the first schistosomiasis conference in March 22-23, 2017, and the call for abstracts will be open soon, and it would be good to see submissions that focus on CDDs.

Please also consider joining Health Systems Global Thematic Working Group on Community Health Workers – an active community of researchers, practitioners, policy makers and donors involved in community health worker programmes. There are lots of resources, and ideas to share. Contact Faye Moody for further information.


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