Abstract
BackgroundWhile some evidence supports the beneficial effects of integrating neglected tropical disease (NTD) programs to optimize coverage and reduce costs, there is minimal information regarding when or how to effectively operationalize program integration. The lack of systematic analyses of integration experiences and of integration processes may act as an impediment to achieving more effective NTD programming. We aimed to learn about the experiences of NTD stakeholders and their perceptions of integration.MethodologyWe evaluated differences in the definitions, roles, perceived effectiveness, and implementation experiences of integrated NTD programs among a variety of NTD stakeholder groups, including multilateral organizations, funding partners, implementation partners, national Ministry of Health (MOH) teams, district MOH teams, volunteer rural health workers, and community members participating in NTD campaigns. Semi-structured key informant interviews were conducted. Coding of themes involved a mix of applying in-vivo open coding and a priori thematic coding from a start list.FindingsIn total, 41 interviews were conducted. Salient themes varied by stakeholder, however dominant themes on integration included: significant variations in definitions, differential effectiveness of specific integrated NTD activities, community member perceptions of NTD programs, the influence of funders, perceived facilitators, perceived barriers, and the effects of integration on health system strength. In general, stakeholder groups provided unique perspectives, rather than contrarian points of view, on the same topics. The stakeholders identified more advantages to integration than disadvantages, however there are a number of both unique facilitators and challenges to integration from the perspective of each stakeholder group.ConclusionsQualitative data suggest several structural, process, and technical opportunities that could be addressed to promote more effective and efficient integrated NTD elimination programs. We highlight a set of ten recommendations that may address stakeholder concerns and perceptions regarding these key opportunities. For example, public health stakeholders should embrace a broader perspective of community-based health needs, including and beyond NTDs, and available platforms for addressing those needs.
Highlights
A major challenge facing health systems in low-resource settings is the often ad-hoc and vertically silo-ed approach to organizational structure
We evaluated differences in the definitions, roles, perceived effectiveness, and implementation experiences of integrated neglected tropical disease (NTD) programs among a variety of NTD stakeholder groups, including multilateral organizations, funding partners, implementation partners, national Ministry of Health (MOH) teams, district MOH teams, volunteer rural health workers, and community members participating in NTD campaigns
Public health stakeholders should embrace a broader perspective of community-based health needs, including and beyond NTDs, and available platforms for addressing those needs
Summary
A major challenge facing health systems in low-resource settings is the often ad-hoc and vertically silo-ed approach to organizational structure. Many global health leaders are promoting the integration of vertical programs into a shared delivery infrastructure to strengthen the efficiency, effectiveness, and sustainably of health systems and to optimize resources with the goal of promoting equitable and synergistic health improvements [1,2,3]. Five of the world’s most prevalent NTDs are generally considered “tool ready” and are primarily controlled through mass drug administration (MDA), including: lymphatic filariasis (LF), onchocerciasis, schistosomiasis, soil transmitted helminths (STH), and trachoma [6]. Schistosomiasis and STH MDA programs are typically delivered to pre-school and school-age children via school-based delivery platforms. LF, onchocerciasis, and trachoma programs, on the other hand, are typically delivered via community-based delivery platforms. We aimed to learn about the experiences of NTD stakeholders and their perceptions of integration
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