Community participation in mass drug administration for lymphatic filariasis in Luangwa district, Lusaka province

Abstract

The World Health Organisation recommends implementation of mass drug administration (MDA) programmes in areas at high risk of infection with lymphatic filariasis (LF), as a principle strategy for elimination of the disease. However, these programmes are faced with numerous challenges some of which include: establishing accurate monitoring and evaluation systems by the communities, increasing involvement of the local communities and engaging in effective advocacy for continued MDA for LF support. This study sought to explore how the various engagement approaches used in MDA for LF shaped community participation in the programme in Luangwa district of Lusaka province. A qualitative grounded theory approach was employed in answering the research question at hand. Aided by the theoretical sampling approach, FGDs (n=9), in-depth (n-5) and key (n=7) informant interviews were conducted with various participants that included programme managers, district programme coordinators, health workers, community leaders, community members, community drug distributors and other key stakeholders. The results showed that engagement strategies to promote community support and stakeholder by-in included the use of community health structures, non-governmental organisations (NGOs) and the district development committee. Awareness creation strategies comprised of IEC materials, drama, public-address system, community meetings and the door-to-door approach. Overall, the engagement and awareness creation strategies were effective as most of the community members had a good understanding of LF, the essence of MDA for LF and its benefits. Although, the engagement and awareness creation processes were effective, a number of barriers to implementation such as the short MDA for LF implementation period, mobile populations, large and distant catchment areas, shortage of drugs, and refusal to take the drugs hampered community participation. Some strategies such as providing appropriate and timely incentives, innovative awareness creation and morbidity management were suggested as ways enhance both community participation and programme implementation. A theoretical model explaining how community engagement can be made more effective in facilitating community participation was developed. Three core categories that should be priority for all programme planners and implementers were identified, namely; well-motivated community health structures, appropriate and adequate health education and partnership approaches to MDA for LF implementation, as essential elements in developing an effective community engagement strategy. Key words: Community participation, community engagement, lymphatic filariasis, mass drug administration and implementation.