Responses to Lassa fever disease in Nigeria: a multilevel ethnography of a health system.

Lassa fever (LF) is a deadly viral haemorrhagic fever endemic to West Africa. Nigeria has experienced outbreaks of increasing severity, despite growing prevention and response efforts deployed by national and international actors. This disconnect between increased health systems and scientific activity alongside an increasing disease burden requires a close examination of how strategies and programmatic actions are designed and implemented, how on-the-ground realities are addressed, how strategies are informed by epidemiological knowledge, and how policymakers navigate between national and global agenda priorities. This study will draw on health systems research and epidemiological research in addition to anthropological approaches, to examine how health system actors organise LF response strategies in Nigeria. I will conduct a multilevel ethnography at the interfaces of different 'levels' of the health system (the policymaking 'level' and the healthcare delivery 'level') in hotspots of previous LF outbreaks. Through a stakeholder analysis of the actors involved in LF response, in-depth interviews, and participant observation in the policymaking and healthcare delivery spheres, this study will contribute to improved understanding of LF responses in Nigeria and will help identify obstacles from design to implementation. Findings will be applicable to other emerging infectious diseases and will contribute to improved understanding of how health systems respond to outbreaks (such as SARS-Cov-2). Moreover, this study will provide insights into how the production of epidemiological knowledge and the organisation of a health system influence one another. From a methodological perspective, this innovative study will promote the use of interdisciplinary approaches in health systems research.