LEAD project research at the Firoz Lalji Institute for Africa
Mass drug administration, or ‘preventative chemotherapy’, is the large-scale distribution of pharmaceuticals used to treat various so-called ‘neglected tropical diseases’. Schistosomiasis, or bilharzia as it is commonly known, has been one such targeted disease, in populations or sub-populations within defined geographic areas without individual diagnosis. Despite these efforts aimed at controlling the disease, schistosomiasis continues to be prevalent and highly endemic in many areas. Why have mass drug administration campaigns failed?
Researchers based at LSE and the London School of Hygiene and Tropical Medicine have been examining this question in particular localities in Eastern Africa since 2005. A common thread in this research is that the strategy does not take into account local perspectives nor local evidence, leading to the continued implementation of ‘one size fits all’, top-down approaches to public health control, without genuine feedback from individuals living and working in these areas.
In 2019, the LEAD team at the Firoz Lalji Institute for Africa facilitated a series of participatory workshops in Uganda and Malawi with health practitioners and those involved in schistosomiasis treatment and control at village, district and national levels. The aim was to create links between these practitioners and national level policymakers, with discussions focusing on the socio-political, economic and environmental complexities of programme implementation and the specificities of local circumstances.
Public health practitioners participating in the LEAD workshops echoed findings from previous anthropological research in this area. The issues range from the inappropriate ways in which existing health information materials depict people from different areas, offer patronising narratives, incomprehensible artwork or biologically incomplete storylines, as well as ignore the social context in the localities where the parasites and people co-exist. Public health practitioners described how failings in communication led to a lack of knowledge and, in-turn, undiagnosed conditions at critical junctures of disease onset. ‘Trickle down’ dissemination of health advice is rarely effective; poor quality, or absent, health communication materials can significantly reduce uptake of the public health control programmes on offer, and even prompt resistance to mass drug distributions.