Human African Trypanosomiasis

in sub-Saharan Africa

Linnéa Joandi, Linn Järnberg, Kavita Oehme

Outline

❖ Background

❖ Stressors

❖ Causal loop diagram

❖ Key actors

❖ Institutions

❖ Conclusion

❖ Discussion

Background

❖ African Trypanosomiasis, also known as

"sleeping sickness”

❖ Caused by parasites and transmitted by the

tsetse fly (Glossina species)

❖ Estimated 30 000 cases per year, mainly poor

people in rural areas in sub-Saharan Africa

(WHO 2014)

❖ Curable, but lack of available and affordable

drugs

❖ Classified as neglected disease

Stressors“Stressors are seen as social, political, economic, biophysical and ecological drivers that

create change in the SES in terms of contributing to HAT outbreaks. ”

- Economic performance

- Social unrest

- Other prioritized diseases

- Cattle as livelihood

- Land & water use change

- Population density

- Famine

- Poverty

- (Climate change variability)

Causal loop diagram

Causal loop diagram

Causal loop diagram

Causal loop diagram

Causal loop diagram

Causal loop diagram

Causal loop diagram

Key actors

Scale Actor Responsibility/role

International World Health Organization Support, research, coordination

Pharmaceutical companies Research and development of drugs

NGO’s, donor agencies etc.

National Governments Health system, expenditures, budgetary

priorities. Political stability.

Local Local populations Livelihood options, land use change, disease

control strategies etc.

Institutions

(I) Health system

(II) “Social contract” of public

and private sector

Institutions

(I) Health system

Scale Examples of the institution

International Support of international community

International patent policy

National Health policies

Infrastructure

Economic distribution

Decentralization of health service

Local Scepticism against western medicine

Affordability & availability

Institutions

(II) “Social contract” of public and private sector

Scale Examples of the institution

International &

national

Divide between nation states &

pharmaceutical companies

Drug research & development

Neglected disease

Local Availability & affordability

Conclusions

❖ Lack of governance within and across scales- Lack of state capacity among governments

- Market-based drug development ill-suited in this context

- Lack of supernetwork

- Lack of resources and political will at national and international level

❖ Transformation needed- Initiative by Médicins sans frontières (Doctors without

borders) to overcome limits to the “social contract”

❖ Impacts of climate change, tourism, political instability

and economic development remains unclear

Discussion - The role of tourism for availability and affordability of drugs.

- Potential of the system´s transformative capacity.

- Lack of actors and/or institutions, a stressor?

- Most suitable governing system: centralisation

or decentralisation?