The BEST framework informs practice across NTDs. How does the Triple Zero framework used by leprosy NGOs align?
Frameworks can be useful tools to help us understand, plan and evaluate tasks and issues. Sometimes they help us think about what might be missing or what needs to be done. In the NTD world, the BEST framework – Behaviours, Environment, Social Inclusion and Treatment - is gaining impetus and attention.
The Triple Zero framework developed by ILEP – The International Federation of Anti-leprosy Assocations - is used across the leprosy world to frame a major campaign and to keep partners focussed on the main goal - a world free of leprosy. Triple Zero has three components: Zero Transmission, Zero Disabilities and Zero Discrimination, which are vital steps towards that main goal. Interestingly these two frameworks seem to align quite well.
The first part of the BEST framework relates to behaviours. It includes physical behaviours to prevent NTDs such as hygiene initiatives like WASH and vector control. In the leprosy framework, it aligns with treatment-seeking behaviours, which come under Zero Transmission. Community and individual attitudes are recognised as very important in both frameworks because they can lead to stigma and misconception. They are a target of Zero Discrimination. Likewise the BEST focus on institutional behaviours, such as improving treatment systems, aligns with calls for system strengthening, which are integral to the Zero Transmission and Zero Disabilities campaigns.
The environment dimension of BEST includes things like sanitation, vector management and control, and infection control. In the leprosy world, the focus is more on addressing environmental factors such as poverty and inequality under the Zero Transmission focus. Two other important environment dimensions that aren't specifically mentioned under BEST, are well highlighted in Triple Zero. Environment adaptations such as disability aids, appliances and environmental supports are an aspect of Zero Disabilities, and the social, legal and policy environments are specific focus points of Zero Discrimination.
The BEST focus on social inclusion emphasises universal health coverage and access to health care for populations at risk. This is also vital within both Zero Transmission and Zero Disabilities. The commitment to addressing barriers to participation and mainstreaming inclusion in health and other services aligns with the leprosy goals under Zero Disabilities and Zero Discrimination. Similarly, the focus on empowering communities and addressing stigma and discrimination which are core to social inclusion are also core to the Zero Discrimination focus.
Finally, the treatment aspect of BEST includes a commitment to strengthen health and other systems under universal health coverage which aligns with the focus under Zero Transmission and Zero Disabilities. The core focus of the Zero Transmission goal in the leprosy world aligns very with actions towards functional disease surveillance and preventive chemotherapy. Approaches like surgery, disease management, self-care and rehabilitation are all core activities for reaching Zero Disabilities. Likewise, where self-care and disease management include addressing causes of poverty, stigma and exclusion, they align well with the focus on Zero Discrimination among leprosy organisations.
So, almost all aspects of BEST are reflected in Triple Zero, and vice versa. That is an encouraging sign that we're on the same page, and a good foundation for collaboration and sharing of knowledge.