Socio-ecological dynamics and challenges to the governance of Neglected Tropical Disease control.
The current global attempts to control the so-called "Neglected Tropical Diseases (NTDs)" have the potential to significantly reduce the morbidity suffered by some of the world's poorest communities. However, the governance of these control programmes is driven by a managerial rationality that assumes predictability of proposed interventions, and which thus primarily seeks to improve the cost-effectiveness of implementation by measuring performance in terms of pre-determined outputs. Here, we argue that this approach has reinforced the narrow normal-science model for controlling parasitic diseases, and in doing so fails to address the complex dynamics, uncertainty and socio-ecological context-specificity that invariably underlie parasite transmission. We suggest that a new governance approach is required that draws on a combination of non-equilibrium thinking about the operation of complex, adaptive, systems from the natural sciences and constructivist social science perspectives that view the accumulation of scientific knowledge as contingent on historical interests and norms, if more effective control approaches sufficiently sensitive to local disease contexts are to be devised, applied and managed. At the core of this approach is an emphasis on the need for a process that assists with the inclusion of diverse perspectives, social learning and deliberation, and a reflexive approach to addressing system complexity and incertitude, while balancing this flexibility with stability-focused structures. We derive and discuss a possible governance framework and outline an organizational structure that could be used to effectively deal with the complexity of accomplishing global NTD control. We also point to examples of complexity-based management structures that have been used in parasite control previously, which could serve as practical templates for developing similar governance structures to better manage global NTD control. Our results hold important wider implications for global health policy aiming to effectively control and eradicate parasitic diseases across the world.
Eck Institute for Global Health, Department of Biological Sciences, University of Notre Dame, Notre Dame, USA. emichael@nd.edu.
Edwin
http://orcid.org/0000-0002-9473-4245
E
Michael
Department of International Development, London School of Economics and Political Science, London, UK.|Department of Management, London School of Economics and Political Science, London, UK.
Shirin
S
Madon
D003906:Developing Countries; D060740:Disease Eradication; D004605:Elephantiasis, Filarial; D006076:Government; D006801:Humans; D008288:Malaria; D017146:Models, Organizational; D058069:Neglected Diseases / Q000453:epidemiology / Q000517:prevention & control; D012552:Schistosomiasis; D012942:Social Sciences; D012959:Socioeconomic Factors; D014329:Tropical Climate; D014330:Tropical Medicine / Q000458:organization & administration*
Complex dynamical systems; Complexity-based governance; Lymphatic filariasis; Malaria; Neglected tropical diseases; Normal science paradigm; Organizational theory; Schistosomiasis; Smallpox; Socio-ecological dynamics