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Agboraw E, Sosu F, Dean L, Siakeh A, Thomson R, Kollie K, Worrall E. Factors influencing mass drug administration adherence and community drug distributor opportunity costs in Liberia: a mixed-methods approach. Parasit Vectors 2021; 14:557. [PMID: 34711278 PMCID: PMC8555123 DOI: 10.1186/s13071-021-05058-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 10/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background Preventive chemotherapy delivered via mass drug administration (MDA) is essential for the control of neglected tropical diseases (NTDs), including lymphatic filariasis (LF), schistosomiasis and onchocerciasis. Successful MDA relies heavily on community drug distributor (CDD) volunteers as the interface between households and the health system. This study sought to document and analyse demand-side (households) and supply-side (health system) factors that affect MDA delivery in Liberia. Methods Working in two purposively selected counties, we conducted a household MDA access and adherence survey; a CDD survey to obtain information on direct and opportunity costs associated with MDA work; an observational survey of CDDs; and key informant surveys (KIS) with community-level health workers. Data from the CDD survey and Liberian minimum wage rates were used to calculate the opportunity cost of CDD participation per MDA round. The observational data were used to calculate the time spent on individual household-level tasks and CDD time costs per house visited. KIS data on the organisation and management of the MDA in the communities, and researcher reflections of open-ended survey responses were thematically analysed to identify key demand- and supply-side challenges. Results More respondents were aware of MDA than NTD in both counties. In Bong, 39% (103/261) of respondents reported taking the MDA tablet in the last round, with “not being informed” as the most important reason for non-adherence. In Maryland, 56% (147/263) reported taking MDA with “being absent” at the time of distribution being important for non-adherence. The mean cost per CDD of participating in the MDA round was −$11.90 (median $5.04, range −$169.62 to $30.00), and the mean time per household visited was 17.14 min which equates to a mean opportunity cost of $0.03 to $0.05 per household visited. Thematic analysis identified challenges, including shortages of and delays in medicine availability; CDD frustration over costs; reporting challenges; and household concerns about drug side effects. Conclusions Improved adherence to MDA and subsequent elimination of NTDs in Liberia would be supported by an improved medicine supply chain, financial compensation for CDDs, improved training, healthcare workforce strengthening, greater community involvement, capacity building, and community awareness. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-021-05058-w.
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Affiliation(s)
- Efundem Agboraw
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Street, Liverpool, L3 5 QA, UK.
| | - Fred Sosu
- University of Liberia, Pacific Institute for Research and Evaluation (UL-PIRE), Capitol Hill, Monrovia, Liberia
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Street, Liverpool, L3 5 QA, UK
| | - Alice Siakeh
- University of Liberia, Pacific Institute for Research and Evaluation (UL-PIRE), Capitol Hill, Monrovia, Liberia
| | - Rachael Thomson
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Street, Liverpool, L3 5 QA, UK
| | - Karsor Kollie
- Ministry of Health, SKD Boulevard, Monrovia, Liberia
| | - Eve Worrall
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Street, Liverpool, L3 5 QA, UK
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Ozano K, Dean L, Adekeye O, Bettee AK, Dixon R, Gideon NU, Gwani N, Isiyaku S, Kollie K, Lar L, Oluwole A, Piotrowski H, Siakeh A, Thomson R, Yashiyi J, Zawolo G, Theobald S. Guiding principles for quality, ethical standards and ongoing learning in implementation research: multicountry learnings from participatory action research to strengthen health systems. Health Policy Plan 2021; 35:ii137-ii149. [PMID: 33156936 PMCID: PMC7646736 DOI: 10.1093/heapol/czaa123] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 12/17/2022] Open
Abstract
Global health gains can be achieved through strengthening health systems to identify and address implementation challenges in low- and middle-income countries. Participatory research, that promotes joint problem and solution finding between communities and different health systems actors, supports policy implementation analysis at all levels. Within the neglected tropical disease programmes in Liberia and Nigeria, we applied participatory action research (PAR) to address programmatic and health system bottlenecks with health systems strengthening embedded. This paper shares learning from 20 interviews with co-researchers, from national and sub-national levels and academic researchers who worked collaboratively to understand challenges, co-create solutions and advocate for policy change. Through analysis and reflections of existing PAR principles, we inductively identified five additional guiding principles for quality, ethical standards and ongoing learning within PAR projects that aim to strengthen health systems. (1) Recognize communities as units of identity and define stakeholder participation to ensure equitable engagement of all actors; (2) enable flexible action planning that builds on existing structures whilst providing opportunities for embedding change; (3) address health systems and research power differentials that can impede co-production of knowledge and solution development; (4) embed relational practices that lead to new political forms of participation and inquiry within health systems and (5) develop structures for ongoing learning at multiple levels of the health system. PAR can strengthen health systems by connecting and co-creating potentially sustainable solutions to implementation challenges. Additional research to explore how these five additional principles can support the attainment of quality and ethical standards within implementation research using a PAR framework for health systems strengthening is needed.
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Affiliation(s)
- Kim Ozano
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
| | - Laura Dean
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
| | - Oluwatosin Adekeye
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Anthony K Bettee
- Ministry of Health, Government of Liberia, SKD Boulevard, Monrovia, Liberia
| | - Ruth Dixon
- Sightsavers, 35 Perrymount Rd, Haywards Heath RH16 3BZ, UK
| | - Ntuen Uduak Gideon
- Ministry of Health, Government of Nigeria, Federal Secretariat, Complex Garki PMB, 83 Abuja, Nigeria
| | - Noela Gwani
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Sunday Isiyaku
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Karsor Kollie
- Ministry of Health, Government of Liberia, SKD Boulevard, Monrovia, Liberia
| | - Luret Lar
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Akinola Oluwole
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Helen Piotrowski
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
| | - Alice Siakeh
- Pacific Institute for Research and Evaluation UL-PIRE Africa Center, University of Liberia, Capitol Hill Liberia
| | - Rachael Thomson
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
| | - James Yashiyi
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Georgina Zawolo
- Pacific Institute for Research and Evaluation UL-PIRE Africa Center, University of Liberia, Capitol Hill Liberia
| | - Sally Theobald
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
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Kollie K, Siakeh A, Zawolo G, Wickenden A, Theobald S, Rogers E, Zaizay Z, Thomson R, Dean L. Donor reliance and the impact on neglected tropical disease programme delivery: reflections and solutions for change from programme management perspectives. Int Health 2021; 13:376-378. [PMID: 33155044 PMCID: PMC8253985 DOI: 10.1093/inthealth/ihaa090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/29/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022] Open
Abstract
Health systems within many developing countries are reliant on donor funding and non-governmental development organisations (NGDOs); this has had positive results but also presents challenges to sustainability and national ownership, with national programmes needing to respond to changing donor priorities. Simultaneously, the WHO neglected tropical disease (NTD) roadmap 2021–2030 calls for increased country ownership and domestically financed NTD programmes. Focusing on Liberia and blending primary research from the COUNTDOWN consortium and personal programmatic experience, this commentary reflects on the sustainability and financing of NTD programme delivery within the current context. We explore the successes and challenges of current models of collaboration and opportunities to improve country ownership and sustainability.
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Affiliation(s)
- Karsor Kollie
- Neglected Tropical Disease Programme, Ministry of Health, Government of Liberia, Monrovia, Monsterrado, Liberia
| | - Alice Siakeh
- University of Liberia Pacific Institute for Research and Evaluation, Monrovia, Montserrado, Liberia
| | - Georgina Zawolo
- University of Liberia Pacific Institute for Research and Evaluation, Monrovia, Montserrado, Liberia
| | - Anna Wickenden
- Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Sally Theobald
- Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Emerson Rogers
- Neglected Tropical Disease Programme, Ministry of Health, Government of Liberia, Monrovia, Monsterrado, Liberia
| | - Zeela Zaizay
- Actions Transforming Lives (ACT), Monrovia, Monsteraddo, Liberia
| | - Rachael Thomson
- Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Laura Dean
- Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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