Results

A Model for Integration of Lymphatic Filariasis and Deworming MDA

Explorative research to inform a model for full integration of lymphatic filariasis and deworming MDA with learnings from the Pulse Polio campaign

Results: Enablers and Barriers

Perception of enablers and barriers varied across national, state, regional, and community levels, but there was consensus in many areas. Participants identified the following enablers of integration.

  1. Microplanning: Adapted from the Pulse Polio campaign, similar in process and detail for both campaigns.
  2. Human resources: The same field workers implement LF and STH MDA and know the populations.
  3. Campaign processes: Similar planning, implementation, and post-implementation activities.
  4. Public acceptance: Perceived to be high in the community.
  5. Partner participation: Benefits advocacy, capacity building, M&E, and communications campaigns.
  6. Integrated communications campaigns: Combined messaging and shared platforms achieves expanded reach.
  7. Monitoring and evaluation plan: Robust M&E plan should include a supportive budget and human resources.
  8. Supply and logistics: Drug availability and similar logistics to distribute (block and field level enabler)

Participants described the following barriers to integration.

  1. Vertical implementation: LF and STH MDA programs are owned by different departments; lack of interdepartmental coordination.
  2. Data management and flow: Reporting and recording processes by field workers vary across campaigns.
  3. Capacity building: LF and STH MDAs are conducted in different settings, training modules vary.
  4. Limited budgets: For training, IEC, social mobilization, and increased field worker remuneration.
  5. Adverse drug reactions: Fears may cause drug refusal; poor management and response may damage program success.
  6. Inefficient supervision: Auxiliary nurse midwives are overloaded with routine work and MDA supervision.
  7. Supply and logistics: Procurement of drugs is done by different departments (national and state-level barrier).

Perception of certain factors as enablers vs. barriers varied somewhat across national, state, regional, and community levels. 

Key Findings

Integration is possible, especially if key learnings from the Pulse Polio campaigns are applied:

  • Dedicate mechanisms of reviews at all levels.
  • Daily evening briefing meetings are helpful.
  • Ensure robust monitoring and evaluation.
  • Continue advocacy by influencers.
  • Standardize trainings.
  • Streamline supply chain and logistics.

Participants also had different understanding of “integration” although many defined it as the planning and implementation of the campaigns happening simultaneously.

A uniform definition of integration was developed based on the input of participants. “Integration is a process of combining components for a specific program, designed to address a specific disease or health need, with another health program; and support in maintaining ongoing interventions in a synchronized and harmonious way. This also includes [bringing] cross-cutting opportunities from both campaigns to make the integrated campaign efficient and effective.”

Challenges

Challenges during the study

  • COVID-19 pandemic made face-to-face interviews difficult.
  • Long approval processes.
  • Diverse ideas of the concept of integration.
  • Competing priorities; i.e., the COVID vaccine.

Mitigation

  • Most interviews were virtual.
  • Face-to-face interviews were conducted with all safety precautions.
  • The project team sensitized participants on integration, and prepared a uniform definition through the answers given in the interview.
  • The team regularly communicated and coordinated with participants.

“Integration does not only mean giving all the services at the same time. It also means bringing in cross-cutting opportunities from various campaigns, which may help in effective and efficient campaign implementation.” Country Lead - Elimination Programs, Neglected Tropical Diseases, Bill & Melinda Gates Foundation