This presentation was given by Dr Luret Lar, Research Manager COUNTDOWN Nigeria during the European Congress on Tropical Medicine and International Health on 17th September 2019. This was during an organised session titled 'Health systems and Neglected Tropical Diseases a policy and practice debate: Inclusion, integration, innovation and implementation.' It was chaired by Dr Rachael Thomson, COUNTDOWN Director and higlights were presented by Dr Akinola Oluwole and Professor Sally Theobald.

1. Participatory research
methods to improve
community engagement and
programme coverage for mass
drug administration
Lar, L. A., Adekeye, T., Oluwole, A., Yashiyi, J.N., Isiyaku, S. , Dixon, R, Dean, L. Thomson, R.
Theobald, S. Bongkiyung, P. and Ozano, K.
Sightsavers, Federal Ministry of Health, Nigeria, Liverpool School of Tropical Medicine

2. Introduction
• Nigeria has the largest burden of neglected tropical diseases (NTD) in sub-Saharan Africa, accounting
for 25% of the continent's total NTD burden
• Mass administration of medicines (MAM) involves large scale nationalised interventions
• MAM relies significantly on successful engagement of communities
• New and emerging contexts have presented challenges for successful community engagement which
can compromise programme equity
• The aim of this work was to utilize participatory action research to support participatory planning
processes that allow for the development of a new and improved community engagement strategy for
ensuring no one is left behind in MAM delivery
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3. Introduction continued
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The research was conducted in Kaduna and Ogun
states, due to their varied programme support
Kaduna long-term financial and implementation
support
Ogun State- “orphaned “ has received limited
support for implementation

4. Using a participatory action research cycle
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• Co-learning research process, between
communities and researchers, of problem
identification, action and reflection leading to
further inquiry and action for change
• Participation is the defining principle throughout
the research process.
Iterative cycle of action/reflection (Levin 1945)

5. The practicalities of COUNTDOWN’s cycle
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Implementation of the developed
strategy and evaluation of the strategy
took place.
Recommendations
regarding what works best
for community engagement
with the NTD programme in
a variety of contexts

6. Phase one: participatory exploratory
6
Stakeholder meeting Discrete Choice
Experiment
Transect walk
Training cascade
Social mapping Information education and
communication (IEC) material review

7. Phase two : planning
7 7
Urban Context Rural context
Microplanning meeting
at the LGA level
Macroplanning meeting at
the State level

8. Phase three : implementation and ethnographic observation
Advocacy visit Market sensitization
Distribution at Urban area
Training of CDDs
Distribution at rural area

9. Tanahashi framework

10. Phase four: evaluation
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• Problem tree focus analysis with persistent missed
community members
• Interviews with community members who previously refused
MAM and have now accepted or were previously absent
and are now present.
• Interviews with marginalized community members (migrant
groups and PWDs)
• Focus Group Discussions with community members
• Survey to understand MAM coverage
• Review meetings

11. Availability
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Challenge:
Insufficient number of
CDDs trained
Insufficient number of
medications supplied
Insufficient resources
provided to CDDs to
enable effective
sensitisation and
distribution
Being measured prior to
having medication was seen
to confirm that CDDs were
appropriately trained.
Increased
motivation for
volunteers.
Actions Outcomes
• Sensitization conducted for one week
• CDDs provided with posters to use during
sensitization
• Community leaders provided additional dose poles

12. Accessibility
Challenge: Seasonality, timing and geographical locations can limit the reach of CDDs
Action: A variety of distribution methods should be utilised to reach everyone in the community,
including the children, young adults, elders, men and women of different religions, PLWD, people living in remote
locations.
Example outcome:

13. Acceptability
You see like those engaged for the polio distribution are
already known to us. They are the ones to meet with the
Village Head and inform him about the time and day of
the distribution of the medicines. Once the time is fixed
then everything is alright
Challenges:
• Distrust in CDDs (for example: not known by
community)
• Beliefs about the medicines (for example: given
for family planning)
• Lack of understanding about the medicine (for
example: absence of symptoms)
• Gender of CDDs ( For example:
social/cultural/religious beliefs)
Actions:
• Involvement of community leaders in selecting
CDDs
• Effective training of CDDs through role play to
increase understanding of how to council
community members regarding side effects
• Urban strategy using health care workers-In some
parts of Nigeria, people will not accept medicines
from CDDs.
what I heard about the drug is that it works to cure a lot of
infirmities in the body. It helps to prevent blindness,
that the drug is useful for a lot of things in the body if we collect
it. We were even told that if we collect it some people might
defecate some harmful worms from their body.
Outcomes
for this recent distribution, the CDDs made sure people were
informed that medicines will be brought, unlike the previous
one people were not informed, this time around too, the CDDs
also made sure every eligible person took the medicines. The
CDDs are also a friendly set of people.

14. Contact coverage
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Challenge:
• Some groups in the community were being missed due to sociocultural norms around gender
• People with disabilities, migrant groups or other marginalised groups were being missed
Action
• More female implementers were trained and involved in distributions
• A focus of disability was included in the training
Outcomes:
I live in a ghetto…so even if anything happens on the main street we don’t get to know about it in the ghetto. But,
those that did the announcement came to our ghetto and did adequate announcement, they had calendars with
them, pamphlet and we were told to come on a particular day and we went
Whatever we want to do, when it comes to selection a female should be included. Is that not so? A male and
a female should work as a team because there are some houses that a man cannot gain access but a female
will be allowed in.

15. Output of participation
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Document
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• Some actions came up that were not followed through,
issues included limits in funding and time.
• Overall, through this bottom up innovation, a more
equitable and effective programme implementation was
achieved.
• Recommendations from the research have been
presented in new tools to improve participatory
planning

16. www.ectmih2019.org
Thank You