RESUMO
Gambiense Human African Trypanosomiasis (g-HAT) is a neglected tropical disease caused by trypanosomes transmitted by tsetse flies. In 2017, a pilot community-based project was launched in three villages in DRC with the overall goal of empowering community members to control tsetse using Tiny Targets which attract and kill tsetse. In this paper, we assess the community participation process in these three pilot villages over >4 years and evaluate to what extent this resulted in the empowerment of communities. We conducted a qualitative study using a participatory research approach. Together with community members of the three pilot villages from the endemic Kwilu province, we evaluated changes in project participation, community empowerment and perception of future participation at three different time points (September 2017, September 2018 and November 2021) over a 4-year period using participatory workshops and focus group discussions (FGD). We used a thematic content approach to analyse both workshop notes and FGD transcripts. The community identified five indicators to evaluate participation: (1) Leadership & Ownership, (2) Organisation & Planning, (3) Willingness, (4) Autonomy and (5) Community Involvement. The participation experience described by community members was characterised by a rapid growth of empowerment in the first year and sustained high levels thereafter. Community participants were willing to engage in potential future projects and continue to be supported by their Tiny Target project partner. However, they identified an imbalance in the power relationship within the committee and with the Tiny Target partners that limit the extent of empowerment attained. The intervention had broader benefits of community empowerment but this was limited by perceptions of being part of wider "top down" programme and by stakeholders attitude toward community participation. If empowerment is to be an important objective of projects and programmes then the needs identified by communities must be recognised and attitude of sharing power encouraged.
RESUMO
The National Programme for the control of human African trypanosomiasis in Democratic Republic of Congo includes a large-scale vector control operation using Tiny Targets. These are small panels of insecticide-impregnated cloth that are deployed in riverine habitat where tsetse flies concentrate. The effectiveness of Tiny Targets depends partly on acceptance by local communities. In 2018, we conducted research to explore the perception and acceptability of Tiny Targets in two different village clusters where Tiny Targets had been deployed by the local community or external teams. We conducted fourteen focus group discussions and seven semistructured interviews in three villages from each cluster in the Yasa Bonga health zone. Our findings showed that acceptability was better in the cluster where communities were involved in the deployment of Tiny Targets. Also in this cluster, awareness about Tiny Targets was satisfactory and the project was implemented within local customs, which promoted a positive perception of Tiny Targets and their benefits. In the cluster where external teams deployed Tiny Targets, a lack of information and communication, stereotypes applied by communities towards the deployment teams and the impression of inadequate respect for local customs led to anxiety and a misleading interpretation of the purpose of Tiny Targets and negatively influenced acceptability. This study highlights the importance of involving communities for programme acceptance. Our research underlined how awareness campaigns and communication are essential, but also how working within the scope of community social norms and customs are equally important. Prospects for the successful use of Tiny Targets are greater when communities are involved because the use can be adapted to social norms.
