WOMEN-LED TSETSE CONTROL: A PILOT STUDY IN NORTHWEST UGANDA

ABSTRACT Women-led tsetse control: a pilot study in North West Uganda Vanja Kovačič INTRODUCTION Human African Trypanosomiasis (HAT) is a disease caused by infection with trypanosomes and transmitted by tsetse flies, which continues to threaten thousands of people in Africa. Tiny targets –small pieces of cloth impregnated with insecticide– are a new, cheap, and effective entomological tool to prevent transmission. The most sustainable and effective way to implement these targets remains uncertain, but their simplicity makes them an excellent candidate for community led schemes. The aim of this research was to design, implement, and evaluate a women-led tsetse control intervention using tiny targets in an area endemic to HAT. METHODS The research was conducted in North West Uganda and organized in three distinct phases: 1) The baseline phase used in-depth interviews, GPS human tracking, seasonal calendars and participatory mapping to explore the factors influencing community participation; 2) The intervention and evaluation phase piloted a women-led tsetse control operation in three villages and evaluated its impact using action research; 3) The stakeholders’ reflections phase explored the community and decision-makers’ perceptions of community involvement in future HAT control interventions, through community role play and in-depth interviews with decision-makers. RESULTS During the baseline phase, the community did not express negative perceptions towards HAT control programmes, although they recalled past experiences with different programmes imposed upon them. Both men and women perceived women to be at greater risk of tsetse bites then men because of their daily activities in close proximity to rivers, and this was an important facilitator for their involvement. However, the GPS human tracking study suggested that the actual risk was similar among men and women. During the six month pilot intervention, women were highly motivated, and their ownership of the programme and sense of empowerment increased. Participants perceived the intervention as feasible. The evaluation demonstrated that more tiny targets were functional at six months post deployment in the pilot villages than in an expert-led programme in an adjacent area, due to community maintenance of the targets. The pilot community-led intervention was also more cost-effective. Through role-play in the stakeholders’ reflection phase, women demonstrated with confidence their ability to define priorities, good negotiation skills, and critical insights into decision-making. During in-depth interviews, decision- makers acknowledged that the community has an important role in HAT elimination, but that they lacked knowledge and skills in community based approaches. Women are not well represented in HAT control policy and planning, and the perception of tsetse control as a male domain was an additional barrier to women-participation approaches. CONCLUSIONS This study demonstrated that a community-based tsetse control programme organized and led by women was feasible and cost-effective. The high-level of engagement and motivation of these women and their effective management of the tiny targets provide evidence that community-based approaches may be a sustainable option for tsetse control. However, this will need widespread engagement of policy and programme staff and recognition that communities are equal partners in HAT elimination