'We can not just keep it in our palm: A policy analysis of the integration of the case management of Neglected Tropical Diseases into the health system of Liberia

This study investigates the development and translation process of a novel policy to integrate the case management of Neglected Tropical Diseases (NTDs) in Liberias health system. The policy responded to inequitable access and resource fragmentation challenges in NTD care, as highlighted in Liberias 2016 national strategic plan for the integrated Case Management of NTDs (1). This study explores Liberias efforts to integrate NTD case management into crucial health system components from the perspectives of multiple stakeholders engaged in the policy development and translation process. A qualitative case study method was employed. The study examines stakeholder experiences and perspectives and utilises multiple analytical frameworks, including the Policy Analysis Triangle, the Power Cube and Network Analysis. Data triangulation led to the development of a conceptual framework that identifies key factors in effective health policy development and implementation and has five critical domains: people, place, process, politics, and power. These five domains are interconnected, dynamic and essential for translating complex health policies into practice. The findings emphasise the need for health policies to embrace the complexities of integrating disease control programmes, calling for a shift from clinical-centric to holistic, multi-dimensional and multi-stakeholder approaches and policies. These insights contribute to global health policy-development evidence, underscoring the importance of contextually relevant and inclusive approaches to address health inequities and strengthen system sustainability. Author SummaryIn this paper, we explore the experiences and reflections of key stakeholders involved in the policy development and implementation of an integrated approach to the case management of NTDs in Liberia. The integrated approach was developed and articulated in the 2016 national strategic plan to address the inequity in access to NTD care through the health system in Liberia and the fragmentation and sustainability of human, technical and financial resources in providing NTD care in Liberia. We conducted a policy analysis using a qualitative case study of the NTD programme in Liberia. We examine the people, place, process, politics and power dynamics that enabled Liberia to be one of the few countries in the world to integrate the NTD care within critical health system building blocks. We triangulate our data sets and analyse the data, developing a conceptual framework that has five critical domains adapted from the Policy Analysis Triangle (1). These five domains are dynamic and contribute to successfully developing and translating complex health policies into practice. The results of the paper have broader implications: Embracing Complexity in Policy-Development: Policies in low-resource settings must recognise and adapt to the complexities of integrating disease control programmes into health systems. Shift from biomedically focused to holistic approaches: There is a crucial need to transition from clinically focused policies to those that encompass holistic, multi-dimensional health strategies that consider the dynamic interactions of multiple factors beyond the framework of one discipline. Adopting Multi-Stakeholder Strategies in Policy Development and Translation: Effective global health policy-development requires the active involvement of a diverse range of stakeholders beyond healthcare professionals and policymakers.