03437nas a2200481   4500000000100000008004100001260003700042653004100079653002400120653003400144100001600178700001200194700001100206700001300217700001400230700001400244700001300258700001300271700001900284700001400303700001500317700001400332700001300346700001800359700001500377700001200392700001300404700001300417700001400430700001400444700001800458700001200476700001100488700001300499700002500512700001200537245019000549856010900739300000900848490000600857520207800863022001402941       2024                            d  bPublic Library of Science (PLoS)10aGeneral Earth and Planetary Sciences10aGeneral Engineering10aGeneral Environmental Science1 aPhillips RO1 aOwusu L1 aKoka E1 aOcloo EK1 aSimpson H1 aAgbanyo A1 aOkyere D1 aTuwor RD1 aFokuoh-Boadu A1 aAkuffo RA1 aNovignon J1 aOppong MN1 aMosweu I1 aAsante-Poku A1 aCobbinah J1 aMtuy TB1 aPalmer J1 aAhorlu C1 aAmoako YA1 aWalker SL1 aYeboah-Manu D1 aMarks M1 aPitt C1 aPullan R1 aSHARP collaboration 1 aBurza S00aDevelopment of an integrated and decentralised skin health strategy to improve experiences of skin neglected tropical diseases and other skin conditions in Atwima Mponua District, Ghana  uhttps://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0002809&type=printable  a1-160 v43 a<p>Integrated strategies are recommended to tackle neglected tropical diseases of the skin (skin NTDs), which pose a substantial health and economic burden in many countries, including Ghana. We describe the development of an integrated and decentralised skin health strategy designed to improve experiences of skin NTDs in Atwima Mponua district in Ashanti Region. A multidisciplinary research team led an iterative process to develop an overall strategy and specific interventions, based on a theory of change informed by formative research conducted in Atwima Mponua district. The process involved preparatory work, four co-development workshops (August 2021 to November 2022), collaborative working groups to operationalise intervention components, and obtaining ethical approval. Stakeholders including affected individuals, caregivers, other community members and actors from different levels of the health system participated in co-development activities. We consulted these stakeholders at each stage of the research process, including discussion of study findings, development of our theory of change, identifying implementable solutions to identified challenges, and protocol development. Participants determined that the intervention should broadly address wounds and other skin conditions, rather than only skin NTDs, and should avoid reliance on non-governmental organisations and research teams to ensure sustainable implementation by district health teams and transferability elsewhere. The overall strategy was designed to focus on a decentralised model of care for skin conditions, while including other interventions to support a self-care delivery pathway, community engagement, and referral. Our theory of change describes the pathways through which these interventions are expected to achieve the strategy’s aim, the assumptions, and problems addressed. This complex intervention strategy has been designed to respond to the local context, while maximising transferability to ensure wider relevance. Implementation is expected to begin in 2023.</p>
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