Developing and adopting complex health innovations – The case of genetically modified mosquitoes for malaria eradication
File(s)
Author(s)
Cisnetto, Valentina
Type
Thesis
Abstract
Background: Malaria, a preventable and curable disease, is still one the primary
causes of death worldwide. Around 90% of deaths occur in sub-Saharan Africa.
Increased funding and new programmes by international agencies and national
governments have led to significant progress in malaria control, but the
improvement curve is levelling off. This is due to the limitations of current
technologies and difficulties in deploying the interventions on the ground. There
are calls for technological innovations which are able to provide interventions that
are cost-effective, sustainable, area-wide and equitable. The development of selfsustaining
genetically modified (GM) Anopheles mosquitoes is deemed to have
these potential attributes, but this technology is not only innovative, but also highly
complex and controversial. Using the introduction of GM mosquitoes for malaria
eradication in Burkina Faso as an example this study helps to better understand how
complex health technology innovations are adopted in low-income countries.
Methods: The research uses a mixed methods approach and combines an in-depth
analysis of the Burkinabé (Burkina Faso) health system and its wider context,
qualitative system dynamics modelling and an econometric analysis in order to
investigate the key barriers and enablers that influence the adoption of GM
mosquito technology.
Results: The research confirms the importance of community trust and acceptance,
and health system readiness, in influencing the adoption process. It also emphasises
the need for a perspective on the adoption of highly complex innovations which
takes more account of the iterative nature of their development, the
interrelationship between development and adoption, and the cognitive barriers in
stakeholders’ understanding of the technology.
Conclusions: The intrinsic complexity of the technology development and local
adoption processes, and the fact that the nature of the technology itself means that
adoption decisions are societal rather than individual, together have important
implications for policy and practice. These need to be taken into consideration both
by local policy makers and technology researchers.
causes of death worldwide. Around 90% of deaths occur in sub-Saharan Africa.
Increased funding and new programmes by international agencies and national
governments have led to significant progress in malaria control, but the
improvement curve is levelling off. This is due to the limitations of current
technologies and difficulties in deploying the interventions on the ground. There
are calls for technological innovations which are able to provide interventions that
are cost-effective, sustainable, area-wide and equitable. The development of selfsustaining
genetically modified (GM) Anopheles mosquitoes is deemed to have
these potential attributes, but this technology is not only innovative, but also highly
complex and controversial. Using the introduction of GM mosquitoes for malaria
eradication in Burkina Faso as an example this study helps to better understand how
complex health technology innovations are adopted in low-income countries.
Methods: The research uses a mixed methods approach and combines an in-depth
analysis of the Burkinabé (Burkina Faso) health system and its wider context,
qualitative system dynamics modelling and an econometric analysis in order to
investigate the key barriers and enablers that influence the adoption of GM
mosquito technology.
Results: The research confirms the importance of community trust and acceptance,
and health system readiness, in influencing the adoption process. It also emphasises
the need for a perspective on the adoption of highly complex innovations which
takes more account of the iterative nature of their development, the
interrelationship between development and adoption, and the cognitive barriers in
stakeholders’ understanding of the technology.
Conclusions: The intrinsic complexity of the technology development and local
adoption processes, and the fact that the nature of the technology itself means that
adoption decisions are societal rather than individual, together have important
implications for policy and practice. These need to be taken into consideration both
by local policy makers and technology researchers.
Version
Open Access
Date Issued
2016-12
Date Awarded
2018-03
Advisor
Crisanti, Andrea
Barlow, James
Sponsor
Target Malaria
Publisher Department
Life Sciences
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)