Trachoma Control: How to Identify Key Players to Deliver F&E

Delivering the F&E components of the SAFE strategy presents trachoma stakeholders with a complex set of challenges.

• How to provide the basic infrastructure, such as water, which is needed to break the transmission cycle of trachoma. This is especially important as endemic communities are likely to be lacking these services.
• How to change deeply rooted behaviours and cultural norms around hygiene and sanitation?
• How to fund such interventions?

Answers to these questions lie beyond the remit of trachoma programmes. This is why partnership is such an important aspect of delivering F&E.

Who are the key players for F&E?

Potential partners exist in different sectors, including water, sanitation and hygiene (WASH), health, education, and the business sector.

Ministerial responsibilities for health and education are clear in most places. However, different aspects of WASH are often spread across the ministries of water, environment, infrastructure, health and education.

Coordination across the sectors at the national level reduces the potential for fragmentation. This can be achieved through a memorandum of understanding (MoU) or sector wide approaches (known as SWaps) using steering committees or working groups.

Depending on the level of decentralisation in a country, coordination may also take place at district level. Many African and South Asian countries have district-level WASH offices that convene WASH coordination committees with stakeholders from local government and non-governmental organisations (NGOs). These structures coordinate service delivery and often lead district-wide sanitation initiatives. These groups may hold annual Joint Sector Reviews and issue reports.

• Non-governmental structures: NGOs often have their own coordination structures. For example, Uganda, Tanzania, Kenya, Ethiopia and Ghana all have a single national network for WASH NGOs. Health or education working groups often exist within national NGO coalitions and are a good starting point for finding partners.
• Donors and other funders come in a variety of forms. Some may not have national-level presence so collaboration with their national partners is needed to access their support. Bilateral (set up by two governments) and multilateral (e.g. the United Nations) agencies often provide large infrastructure investments. They may also be part of a sector’s donor coordination and take part in government-led structures.

F&E stakeholders all have their own motivations (Click to expand)

Case study: Smart partnerships pave way for trachoma reduction in Ghana

Between 2000 and 2014, the Ghana Trachoma Control Programme (part of a joint programme targeting trachoma, guinea worm and cholera) was able to reduce the prevalence of active trachoma from over 16% to less than 4% in endemic districts. How did they manage to do it? Partnerships. The programme brought together 15 government, donor, international and local NGOs to ensure the full implementation of the SAFE strategy.

Interventions included provision of water, school toilets, sanitation promotion using the Community-Led Total Sanitation approach and hygiene promotion by community health workers, volunteers and mass media broadcasting. A school health education programme was designed to ensure that the SAFE strategy was added to the national curriculum. In endemic areas, booklets for children were developed and distributed, and teaching materials were developed. Implementing the full SAFE strategy has ensured sustained progress over time in reducing the prevalence of active trachoma and trichiasis.

Case study taken from: All you need for F&E: A practical guide to partnering and planning, ICTC. CC BY-NC-SA

How to engage these partners?

The first step is to actively seek out new partners. Programmes need to try to understand the reasons for any current lack of engagement and develop messages that respond to concerns or barriers. Non trachoma actors may not see the opportunity that adds value to their own objectives.

Engaging WASH decision makers:

Challenge: WASH agencies are not held to account for improving disease outcomes, and may not prioritise working towards a specific disease, or they may regard another, fatal disease as more urgent.

Response: Trachoma programming can help target ‘expensive’ areas more effectively. Maps are useful to highlight areas of need by showing the distribution of trachoma relative to access to water and sanitation in endemic areas

Challenge: WASH agencies are increasingly held to account for the equitable targeting of services. They may not have identified trachoma as an opportunity to meet equity needs more effectively.

Response: Programming can help target poor and under-served areas/groups more effectively. Again, use maps to show distribution of trachoma relative to water and sanitation access in endemic areas, to highlight areas of need.

Engaging health stakeholders

Challenge: The health sector has many urgent priorities and targets; trachoma is one disease among many. It is not immediately obvious that trachoma programmes can contribute to the broader system.

Response: F&E interventions can improve other health outcomes (diarrhoea, pneumonia, nutrition, other NTDs). This message can help increase buy-in to the trachoma agenda, and create the basis for identifying opportunities to link trachoma interventions with other health programmes.

Engaging education stakeholders

Challenge: The education sector’s key priorities are to increase school attendance and improve educational attainment. It is not immediately obvious that trachoma programmes can help meet these objectives.

Response: F&E interventions can strengthen the education system by contributing to overall child health, providing educational tools, improving school WASH infrastructure and strengthening teacher capacity.

Engaging business/corporate stakeholders

Challenge: Businesses see value in Corporate Social Responsibility (CSR) that increases their credibility and reputation, and contributes to the communities they affect. They may not have identified trachoma as a potential CSR opportunity.

Response: Trachoma work provides businesses with an opportunity to show that their CSR efforts are focused on where the need is greatest, and provides an example to other businesses.

Engaging the wider business community

Especially, but not only sanitation hardware producers and marketers and soap manufacturers, importers and distributors)

Challenge: Businesses are profit-driven entities. In order to take an interest in trachoma, it needs to be clear to a business ‘what’s in it for them’.

Response: Promotion of positive trachoma related behaviours can create increased demand for sanitation products, for example soap.

What to do next?

1. Make a list of all the relevant health/NTDs, education, WASH and corporate stakeholders. It’s important to be clear about the reasons to engage each potential partner, for example they are an influential ally or have expertise on behaviour change.
2. Organise a formal/informal stakeholder meeting as a starting point for collaboration and to form a working group.

Reasons to meet include:

• Assess the available human, technical and financial resources
• Develop partnerships between participants who already deliver, or could deliver, key components of the programme, for example water and sanitation infrastructure
• Enhance ownership of the trachoma programme by involving everyone at the beginning a trachoma planning process.

Starting the conversation brings trachoma programmes one step closer to an effective partnership and a core team is then selected to carry out an analysis of the F&E situation.

F&E working group activity plan (Click to expand)