Improving Community Participation in LF Drug Campaigns

Lymphatic filariasis (LF) is a disease caused by tiny worms that can lead to severe swelling and disability. To fight this disease, many countries run programs to eliminate it. One of the key ways these programs work is by giving out medicine in mass drug administration (MDA) campaigns. However, getting enough people in the community to participate in these campaigns is still a problem in many places.

In recent years, some countries have started using a new approach by giving out a combination of three types of medicine at once during these mass campaigns. This could help speed up efforts to eliminate LF, but the success of these programs depends on getting a lot of people who are at risk to take the medicine. Many factors affect whether people choose to participate, and these factors can change over time.

#Challenges Faced by MDA Programs

While many studies focus on why some people do not take part in these programs, there is a growing interest in understanding issues related to the providers of the drugs, such as Community Drug Distributors (CDDs). In Tanzania, for example, many people who did not receive the medicine mentioned problems with the program, like distributors not visiting all eligible households or not knowing when the campaigns were happening.

Other common issues include running out of medicine, not having enough staff, not training drug distributors properly, and lacking Engagement with the community during the planning stages of the campaigns. If health workers and community members do not work together well, it can lead to poor implementation of the MDA and low participation rates. However, when communities are actively involved in planning and implementing the campaigns, they tend to be more successful, especially in urban areas.

#The Role of Microplanning

Microplanning is a strategy that can improve access and participation in these campaigns by addressing the various challenges faced by both providers and recipients of the medicine. This approach typically involves engaging local people in planning by using Local Knowledge to identify problems and solutions.

During microplanning, local representatives help define which groups of people are eligible for the medicine in their area. They look closely at where these people are located and plan ways to reach them, often paying special attention to those who are hard to access, such as people living in remote areas. This planning takes into consideration local resources and aims to use them effectively.

Microplanning has shown to improve coverage in public health programs and is part of a broader strategy aimed at strengthening immunization systems. It has also been utilized for various health interventions beyond vaccines, such as in caring for HIV and preventing malaria. However, it has not yet been widely used in neglected tropical diseases (NTDs) programs, partly due to limited funding.

#The Situation in Haiti

Haiti has been conducting mass drug administration campaigns for lymphatic filariasis since 2000. Despite reaching good coverage targets initially, some areas, especially in Port-au-Prince, struggled to maintain these levels in later rounds of the campaigns. In 2016, assessments revealed that many parts of Port-au-Prince needed additional rounds of MDA before they could qualify for further evaluations.

In response to ongoing challenges, the Ministry of Public Health in Haiti organized meetings with partners to come up with a plan to improve coverage. One of the strategies they decided to pursue was microplanning.

#The Microplanning Process

In 2018, a microplanning activity was conducted in five communes of Port-au-Prince that had seen a drop in MDA coverage. The objectives were to identify gaps and solutions, measure the engagement of key stakeholders, and evaluate the coverage achieved in the subsequent MDA campaigns.

The first phase involved collecting data about where the medicine was distributed in previous campaigns using mobile technology. This information was visually mapped to identify areas that may not have had enough access. These maps would be used in follow-up workshops.

In the second phase, community leaders and other stakeholders were invited to participate in workshops. They discussed the objectives of the LF elimination program, previous campaign results, and challenges faced during the MDA. Participants reviewed their roles and responsibilities and proposed changes to improve the next campaign, such as extending the number of days for the MDA and adjusting distribution times.

The workshops also allowed for the setting of defined boundaries for areas where community leaders would be responsible for distributing the medicine, thus ensuring no one was left out.

#Measuring the Impact of Microplanning

After the workshops, participants were asked to evaluate their understanding of their roles and the overall process of the MDA before and after the training. This self-assessment showed significant improvements in their understanding of their responsibilities and the boundaries they were to cover.

The 2018 MDA campaigns were held across the five communes, and it was noted that reported coverage increased significantly in all areas, indicating the positive effects of the microplanning efforts. For example, in Tabarre, the coverage jumped from 50% to 120%, and other areas also saw increases, showing that the strategies discussed were effective.

#Key Outcomes from Microplanning

Through the microplanning process, several important outcomes were achieved:

1. Clear Boundaries: The workshops allowed for clearly defined supervision areas, helping to ensure that no one was missed during the drug distribution.

2. Community Engagement: The participatory nature of the workshops led to greater involvement from local leaders and stakeholders, who identified their challenges and proposed solutions.

3. New Data: Collecting data on distribution points helped establish an effective tracking system for the campaigns.

4. Increased Motivation: Local stakeholders felt more engaged and took initiatives beyond their assigned tasks, demonstrating a sense of ownership over the MDA process.

#Lessons Learned

The experience in Port-au-Prince highlighted the importance of engaging community members in the planning and implementation of health programs. It showed that understanding local contexts and addressing specific challenges could lead to much higher participation rates.

Programs should consider using microplanning, especially in areas with previous difficulties in achieving good coverage. This approach allows for better resource management and can help build trust and involvement in health initiatives within communities.

#Conclusion

Microplanning can be an effective tool in public health campaigns, particularly for programs focused on eliminating neglected tropical diseases like lymphatic filariasis. By involving local stakeholders and addressing specific challenges, these campaigns can achieve greater success and reach more people in need of treatment. The experience in Haiti serves as a valuable lesson for other regions facing similar challenges.