The contribution of community drug distributors (CDDs) to the success of mass drug administration (MDA) for Preventive Chemotherapy Neglected Tropical Diseases (PC-NTD) to date cannot be overemphasized. Through their efforts, millions of tablets have been distributed to endemic communities to such an extent that some communities have been freed of one or more of the NTDs. There is ample evidence to support the fact that the performance of the CDDs has an important impact on drug coverage with the MDA. In some circumstances, they are more motivated than the formally recruited health workers. They are trusted by their communities, such that people report taking the drugs because of the instructions of the CDDs. CDDs provide explanations about the drugs and side effects in the community that improve compliance, however when this information is inadequate or poorly communicated by CDDs, people report being less likely to take the pills. If communities perceive that the CDDs are doing their work well, they report high levels of compliance. It is widely acknowledged in the individual programs (namely LF and onchocerciasis) that CDDs play an essential role in motivating and influencing drug coverage rates with MDA in their communities. Our implementation research project works to identify and test feasible interventions to improve and sustain CDD motivation.
Throughout history, interventions to improve people’s health have been introduced into populations. Vaccinations to reduce infectious diseases, screening programs, mass drug administration to prevent communities from infection, or new ways to provide care and prevention to mothers, newborns and young children are all effective interventions in perfect conditions. Yet each of these interventions, once introduced into the complexity of the real world and its health systems, risks losing some of its effectiveness. Providers may not have the tools to provide the intervention as it is intended or may have poor adherence to the protocols. Community members may not have access to the intervention, may not adhere as intended or may not feel that the intervention is relevant for them.
Our experience has shown that well planned and timely research that is embedded within the program can show where, why and how these problems or bottlenecks to interventions occur. At the same time, this implementation research can also provide insight into feasible and acceptable solutions to improve the effectiveness of the public health intervention.
We work together alongside national governments and researchers to provide technical advice and guidance on how to conduct implementation research. Through research and dialogue into health interventions, our experience has shown that it is possible to improve their delivery and ultimately, health outcomes in the community. National health systems are increasingly stretched by new initiatives, global goals, changing epidemiological profiles and societal transitions while at the same time facing a reduction of available resources (human and financial). Therefore, identifying challenges and feasible solutions to correct them has become important now more than ever.