Results

Collaborative Campaign Planning of Vitamin A Supplementation and LF Elimination

A pilot study of collaborative planning for integration of vitamin A supplementation and mass drug administration for eliminating lymphatic filariasis (LF) in Nepal.

Results

Pre-planning and formal structures

The collaborative pre-planning process fostered open communication, positively influenced stakeholders’ perceptions of integration, and created momentum for integration.

The Campaign Integration Working Group (CIWG), composed of division directors, focal persons from the Epidemiology & Diseases Control Division, Family Welfare Division, the crosscutting management division (Logistic section), and HEAL Group, was endorsed during pre-planning. The CIWG held formal meetings, approved a project work plan and guidelines, and issued directives for implementation activities.

Engaging health workers and volunteers 

The project team met with municipal health officials to conduct microplanning and prepare sessions for local health service providers and FCHVs

  • 41 health workers and 66 FCHVs received training on the CMS approach for identifying individuals who missed the preceding LF MDA campaign.  
  • Health workers and FCHVs provided recommendations during focus groups such as scheduling the LF campaign to better align with Nepal’s festival calendar, and development of IEC materials.

Community mobilization

Municipality officials suggested engaging the municipality’s Women & Children and Education Sections and Women’s Cooperative to mobilize school children to ask family members who returned home from festivals if they had received LF medication, and to encourage them to visit health facilities to receive MDA.

Educational materials that addressed misconceptions (e.g., LF medication should not be taken by people on hypertension or diabetes medications ) were developed with health workers, FCHVs, and community members, and distributed to health facilities, ward offices, and schools.

Community member reading an educational poster at a health facility

Outcomes

  • The CMS approach resulted in an increase in LF medication coverage (90% in 2021 vs. 85% in 2020). Educational  materials, along with FCHV identification and referral of those needing MDA, likely contributed to higher coverage.
  • 69 individuals who had not received LF medicine during the LF campaign were identified during the vitamin A/deworming campaign and received LF medication by visiting health facilities from mid-April to early May, including migrant workers.
  • Vitamin A coverage achieved was 80% in 2021, down from 85% in 2020, likely due to a number of children being away from the study areas.

Key Findings

  • Pre-planning meetings were a catalyst for collaboration and implementation
  • Leadership by Division chiefs facilitated collaborative planning
  • Joint planning and implementation with local stakeholders improved outcomes
  • Stakeholders perceived the benefits of integration 
  • Coverage for LF improved from 2020
  • Vitamin A coverage decreased from 2020 (fewer children present)

Challenges

Challenges Faced

  • Competing priorities due to COVID-19 response
  • Challenges in scheduling officials for collaborative planning meetings
  • Lack of policy directives and guidelines for integration of the health campaigns
  • Difficulties with integrated logistics management
  • Lack of budget for conducting awareness-raising activities to promote MDA intake among absentees returning home for the festival
  • FHCVs experienced some confusion about sharing both campaigns’ information at the same time due to differences in the target group’s age and reporting structures.
  • Drug hesitancy
  • Difficulty swallowing albendazole for children and people with disabilities

Mitigation

  • Staying the course on project plan development and submission, ethical clearances
  • Utilizing the collaborative planning process to identify solutions (e.g., logistics, IEC budgets)
  • Continued communication with officials
  • Rescheduled LF campaign enabled use of the CMS approach
  • Developed and distributed local, culturally-sensitive information, education, and communication materials
  • Crushing albendazole tablets to ease swallowing by children, per WHO guidelines (2021)

“This year's LF campaign is more effective in comparison to the past two years because we worked in collaboration with locally elected representatives. The integration of the LF campaign and vitamin A supplementation informs people about both medicines at the same time, asks them whether they intend to take [LF medicine] or not, and educates them. It has helped to increase the number of people taking LF medicine this time.” - Municipal Official