English - Global Alliance to Eliminate Lymphatic Filariasis

REPORT OF THE 6 TH GAELF MEETING, JUNE 2010
Half-time Strategy:
Major Technical Challenges
Chair: Dr. Frank Richards
LF in the City – The Urban Problem
Dr Margaret Gyapong, Director of the
Dodowa Health Research Centre,
reviewed the challenges presented by
rapid urbanization. Some 38% of Africans
live in urban areas, and MDA coverage in
urban areas in Africa has been suboptimal
(generally 40-50%). Contributing
to this is the fact that people who live in
cities tend to be busier, making social
mobilization more difficult; populations
are heterogeneous,
with complex social,
economic, and
religious structures;
and urban dwellers
place a higher
priority on privacy.
In urban areas,
communities tend
to be defined by
affiliation or identity,
rather than by geographical proximity.
Because of these differences, simply
importing MDA strategies from rural to
urban areas is not likely to be successful.
Specific challenges to MDA in rural areas
begin with defining and demarcating the
community; slums are often immediately
adjacent to high-rise apartments of some
of the richest and certainly the “nonpoor”.
Community-directed treatment
(ComDT) and use of volunteer distributors
does not work as well in urban areas.
Elites, who may be at risk of LF in urban
areas, perceive their risk as being low,
consider LF a “disease of the poor,” and
limit access through security guards and
dogs. In such a setting, what is the
appropriate denominator for calculating
drug coverage?
However, with appropriate preparatory
work these problems can be addressed.
Populations can be characterized not only
by location but also by socioeconomic,
religious, and demographic status. Existing
informal networks can contribute to MDA
implementation. Knowledge of existing
health and related interventions can be
helpful. Regardless of
how the community
is defined, it needs to
be engaged and
consulted to
determine the best
approaches. It is
important to involve
community members,
to seek their input and
suggestions as
collaborators, and to empower them to
make decisions and implement and
manage change.
Urban MDA will require more involvement
of the private sector than is typically the
case in rural areas. This includes private
medical practitioners; hospitals; private
clinics; other non-health sectors;
politicians; and others. A team approach
should be used, with as many
stakeholders as possible, for advocacy
planning.
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