Framework to help integrate social sciences into neglected tropical disease interventions

It has long been argued that social science perspectives have a great deal to offer the world of global public health. A new paper, published this week in PLOS Neglected Tropical Diseases, lays out an accessible and actionable socio-anthropological framework for understanding the effectiveness factors of neglected tropical disease (NTD) interventions.

While strides have been made in integrating socio-anthropologists into NTD research programs, progress is slow and uneven. The question of how to bring existing interventions to scale, embed them successfully in health systems, and ensure that they reach their full potential in diverse local settings, remains a challenge and could be informed by socio-anthropological approaches.

In the new paper, Kevin Louis Bardosh, of the University of Florida, USA, describes a framework that was developed after analyzing three large-scale NTD intervention studies undertaken in Eastern Africa, from 2010 to 2013: one to eliminate rabies in Tanzania; sleeping sickness control in Uganda; and the prevention of parasitic worms in Zambia. The effectiveness of each intervention was analyzed with respect to issues of coverage, adoption, participation, and the use of health technologies.

The coverage achieved by the three interventions studied was low in all cases, but Bardosh argues that it could have been increased by modest changes in operational plans. He describes a framework with five intervention domains for NTD researchers to think about—terrain, or seasonality and geographic variability; community agency; the strategies and incentives of field staff; the socio-materiality of technology; and the governance of interventions. In each case, giving special attention to the socio-anthropology of these domains, and seeking out information on questions of implementation, can help NTD interventions succeed.

"The way we think about the world influences the way we approach social problems like disease and poverty," Bardosh writes. "In global health and in NTD control, intervening is a social and political act, one that extends biomedicine, public health and development from the center to the periphery."