Equity-effective Interventions to Reduce the Burden of Disease

This composite approach will consider different dimensions of poverty and deprivation, the most vulnerable urban populations and their existing resilience strategies. In conjunction to research theme Determinants of Vulnerability and Resilience environmental monitoring is extended to tackle spatial patterns of disease risks (with malaria, HIV/Aids and diarrhoea as lead diseases) in poor urban environments.

Using a gender-sensitive vulnerability-resilience assessment and taking HIV/AIDS and tuberculosis as lead conditions, we study:

Gender specific resilience in Abidjan, Côte d'Ivoire: Access to diagnosis and treatment in relation to power relations in the household e.g. women’s potentials, empowerment and probabilities of seeking health care;

Perception, resilience and coping in rural pastoral nomadic dwellings compared to those of the same ethnic groups living in urban centres against the background of the changing socio-demographic environment (sedentary vs. mobile lifestyle in Nouakchott, Mauritania, and/or N'Djaména, Chad). A complementary molecular epidemiologic study will explore transmission dynamics in relation to vulnerability, access to treatment and socio- demographic dynamics.

Within the framework of a health systems approach to contribute to the MDGs, the following activity lines are pursued: 

A comprehensive health systems analyses in urban and rural case studies in West Africa and Central Asia by assessing the human resource implications of expanding the coverage of priority health interventions and by evidence based health planning using district health profiles. The outcomes will be combined with vulnerability and resilience assessments from 1 and 2 to optimize equity effectiveness as leverage for scaling up of health systems in the framework of new institutional partnerships.

Together with partners from the research theme Resources & Sustainability, participatory systems modelling will be applied to assess determinants of sustainable pastoralism in case studies in ChadKyrgyzstan and other countries. The social organisation will be reviewed under the paradigms of the new institutionalism and conflict resolution (links with research themes Governance & Conflict, and Livelihoods & Globalisation). 
Potential improvements will be analysed in a framework of inter-sectoral (health, agriculture) economic assessments to identify synergies of scale and finally combine the ecosystemic and public health approaches to health.

NCCR research on equity-effective interventions to reduce the burden of disease follows three basic objectives:

1. Identify and test key interventions in health, environmental sanitation and social systems that reduce health burdens
2. Assess how these interventions govern equity effectiveness and hence contribute to poverty alleviation among the population studied
3. Asess the external validity and potential to generalize the tested interventions in comparable population groups

This research theme examines the novel concept of equity effectiveness within a systems approach of establishing, validating and promoting mitigation actions (interventions). Equity effectiveness will be comparatively assessed with community effectiveness, based on a systemic approach that uses the combination of methods for health and environmental systems associated with human resources dynamics at a sub-national, decentralised level. The research-cum-action of this theme will draw from the evidence generated in the research themes Vulnerbaility & Resilience, and Environmental Sanitation.




Jakob Zinsstag
Swiss Tropical Institute (STI), Switzerland

Patricia Schwärzler
Swiss Tropical Institute (STI), Switzerland