Accelerating Progress Against NTD Elimination: GEAR Evaluation Tool Discussion
Discussion draft for the Global Elimination or Eradication Acceleration Review (GEAR) focusing on evaluating progress against NTD elimination goals, specifically oncho outcomes. The draft covers findings, expert meeting goals, GEAR process overview, and strategic lessons for effectively presenting recommendations to stakeholders.
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Draft for discussion only The Global Elimination or Eradication Acceleration Review (GEAR): Developing an evaluation tool to support progress against NTD Elimination or Eradication goals Outcomes of oncho evaluation and evaluation process DRAFT for discussion with Oncho Expert Group PART 1 review of findings (background) 1
SUMMARY OF ONCHO EXPERT MEETING GOAL SUMMARY OF ONCHO EXPERT MEETING GOAL Goal for today with your input: Discuss the final outcomes of the oncho evaluation and evaluation process Discuss how to package the final outcomes to effectively present recommended areas for improvements that will increase the likelihood of stakeholders accepting and using the recommendations for planning and decision making in the global oncho program Agenda Brief review of lessons from E&E program- GEAR s origination Brief review of GEAR s process Recall of survey results Discuss focus group and interview results Discuss GEAR s presentation for recommended areas for improvements
OVERVIEW OF GEAR PROCESS 1 2 3 4 5 CONSULT ANALYZE SHARE ENGAGE PREPARE 3 - 4 weeks 8-10 weeks 3 - 4 weeks 3 - 4 weeks 2 - 3 weeks Mobilizing experts, socializing the concept and soliciting guidance on approach Developing the survey and soliciting inputs and feedback from a variety of stakeholders Analyzing data to define key opportunities for the selected disease area Validating conclusions and disseminating outcome of the process Framing the exercise and collecting information on the disease area and stakeholders ITERATIVE Select disease program Establish facilitation team Compile documentation Conduct desk review Develop project overview Map stakeholders Define opportunities Share key takeaways Finalize process outcomes Produce final report Disseminate to the community Solicit buy-in Establish Independent Advisory Committee and Disease Expert Group Onboard collaborators Tailor and test survey Conduct survey Organise data Analyse survey results Conduct interviews and focus groups Collate survey results Analyze survey data and findings Analyze interview and focus group data and findings Review results with collaborators
SEVEN STRATEGIC LESSONS FROM ELIMINATION AND SEVEN STRATEGIC LESSONS FROM ELIMINATION AND ERADICATION PROGRAMS ERADICATION PROGRAMS 1. Know and test your assumptions 2. Understand the context-specific infrastructure 3. Engage communities and adapt locally 4. Continuously test and adapt your tools 5. Expect the unexpected 6. People and partnership matter 7. Think about and plan for the last mile
AREAS THAT WERE EXAMINED IN THE SURVEY AREAS THAT WERE EXAMINED IN THE SURVEY BASED ON THE STRATEGIC LESSONS IN THE WHITE PAPER, THE FOLLOWING AREAS WERE IDENTIFIED AS RISKS OR POTENTIAL AREAS OF WEAKNESS FOR DISEASE PROGRAMS 1. TOOLS 2. KNOWLEDGE 3. STRATEGY 4. PARTNERSHIP 5. RESEARCH AGENDA
GENERAL OBSERVATIONS FROM SURVEY RESULTS GENERAL OBSERVATIONS FROM SURVEY RESULTS RESPONSES Total: 106 respondents (78 English + 28 French) Similar responses across all categories Country staff and donors more optimistic about tools and strategies CATEGORIES LEVEL OF EXPERIENCE Donors < 5 years Endemic country staff < 5 years NGOs < 10 years Researchers > 15 years
KNOW AND TEST ASSUMPTIONS KNOW AND TEST ASSUMPTIONS Answers indicate that there are several insufficiently tested assumptions Transmission patterns are stable Resistance will not develop MDA is enough to reach elimination alone Tools for the start of the program will be sufficient to get through and measure the end If you keep doing the same thing long enough it will work Vector control and environmental control are unimportant to reach elimination
ADAPTING AND TESTING TOOLS ADAPTING AND TESTING TOOLS Majority note host limitations to tools and populations where interventions cannot be used. (Loa loa, preg, <5yo) Need to target interventions better to reach elimination (re- mapping, hypo-endemic) Need new treatments and tools to reach the elimination goal. (macrofil, Loa safe treatment) Vector control and environmental control activities were left behind Cannot detect resistance if it develops. Limited ability to detect changes in transmission in the host, parasite, vector, environment and not prepared with response if it does change Research agenda does not respond well to changes and learnings from the field.
PEOPLE AND PARTNERSHIPS PEOPLE AND PARTNERSHIPS Weaknesses in partnership, a lot of confusion on the partnership and what is the partnership Lack of leadership noted Weakness at WHO with lack of focal point Not a process for rewarding good management or good people Not a clear process to ensure measuring of endpoint, delivery of intervention, or supervision Comments about too many different partnerships
CONTEXT SPECIFIC INFRASTRUCTURE CONTEXT SPECIFIC INFRASTRUCTURE Overall low ranking for taking country specific contexts into consideration Overall a need for communication between local, national, global Research agenda and strategy do not take in learnings from the field New findings and interventions not quickly put into the field- barriers in order of priority Funding; Technical Capacity, Guidelines, Supportive national policy Noted that NOECs help with this area Researchers ranked all categories of taking the local context into account the lowest of any other group except cultural diversity where countries gave the lowest ranking
ENGAGE COMMUNITIES AND ADAPT ENGAGE COMMUNITIES AND ADAPT Community level consideration in global strategy; doing well in implementation and program planning, not so well in learning to support global strategy & including communities in innovation and adaptation Trust in the program was ranked relatively high Research agenda does not cover social science well and does not respond to developments in the field Not good feedback mechanisms to all levels
DETECT AND UNDERSTAND THE UNEXPECTED DETECT AND UNDERSTAND THE UNEXPECTED A lot of programmatic strategic blind spots Ability to detect changes in transmission are low and even lower to adapt to the change Do not have way to detect cases where not expected Do not have a way to detect outliers or resistance, outliers found are not investigated or used to adapt program (but may be in some Francophone areas?) Do not account for population movement in the strategy Weakness in ability to detect re-emergence Transmission not well covered in the research agenda
LAST MILE LAST MILE Strong agreement that additional tools are needed to reach and sustain the goal and that the targeting of current tools is not sufficient to reach the elimination goal More investment needed in tools for the endgame. There are investments now in primarily diagnostics but not sufficient for the later stages of the program (PTS, PES) and environmental approaches are lagging. Concerns that there is not a strong partnership for the last mile and funding for the end game. Concerns that program cannot measure the endpoint or detect re-emergence and if re-emergence is seen, no plan of how to respond
