Evaluating a Transition to Government Ownership of Schistosomiasis and Soil-Transmitted Helminth Control Programs

Research Project

Evaluating a Transition to Government Ownership of Schistosomiasis and Soil-Transmitted Helminth Control Programs

Findings from four districts in Nigeria

Summary

The Carter Center conducted a study on the transition of schistosomiasis and soil-transmitted helminth treatment to the primary health system in four districts across Nigeria.

Nigeria

Districts in the states of Plateau, Nasarawa, Delta and Edo

Neglected tropical diseases

Schistosomiasis and soil-transmitted helminths (STH)

Promising Practices

Identify which external partner supports are foundational to the intervention’s implementation to determine which components may not be appropriate for transitioning to government ownership.
Begin planning for mainstreaming at least four years in advance of the transition.
Raise awareness of the importance of schistosomiasis and soil-transmitted helminth campaigns to promote successful transitions.
See all promising practices.

Key Messages

Partnering with the state and local ministries of health in Nigeria, The Carter Center conducted a mixed-methods study. Its purpose was to explore the implications of transitioning interventions for schistosomiasis (SCH) and soil-transmitted helminth (STH) to government ownership in four districts in Nigeria. Researchers evaluated stakeholder perceptions of mainstreaming within this context, piloted several transitions, and compared mass drug administration (MDA) coverage before and after these transitions. Findings include:

After pilot transitions, mebendazole coverage for STH remained at a similar level, while praziquantel coverage for SCH decreased somewhat post-transition.
Stakeholders are skeptical about mainstreaming SCH and STH campaigns and fear that transitioning these programs to government ownership would negatively affect children’s health.
Management of drug distribution is the greatest need in terms of external support for government-led SCH and STH interventions.
If solutions are put in place to ensure seamless MDA, government-led interventions for suppressing SCH and STH have the potential to attain similar levels of effectiveness as those led by external partners.
To increase the likelihood of a successful transition, mainstreaming of SCH and STH health campaigns must occur gradually.
Access to treatment is a primary barrier to MDA.
Governmental and nongovernmental partners may have different perceptions of the external partner’s role in the campaign, and these divergent viewpoints are an important consideration for transition planning.

Photo: Workers conducting coverage surveys in Nigeria. The household survey asked children about their participation in recent MDAs for intestinal worms and schistosomiasis.

Background

Context

Schistosomiasis (SCH) and soil-transmitted helminths (STH) are parasitic diseases that primarily affect school-aged children. Nigeria has the highest prevalence in the world of people who need SCH treatment and the fourth-largest population of individuals who require STH treatment. Current interventions include the administration of praziquantel to children to suppress SCH and mebendazole to control STH.

Mainstreaming, which refers to transitioning the management of a health campaign from a nongovernmental organization to the national primary health care system, is a possible avenue for sustaining interventions without relying on traditional mass drug administration campaigns.

Problem or Gap

Limited data are available regarding the effects of mainstreaming on SCH and STH treatment coverage.

Study Objectives

Transition schistosomiasis and soil-transmitted helminth treatment programs to the primary health care system or routine health services in select districts currently supported by The Carter Center.
Evaluate the effects of transitioning the program to full government ownership by comparing treatment coverage among the target population before and after the transition to the primary health care system or routine health services to evaluate the success of the transition, supplementing the results with qualitative data.
Develop recommendations based on study findings to inform SCH/STH transition plans for other districts and states in Nigeria.

View the slides for details on the methods for this project.

Results

Summary

The findings from this study suggest that in many cases, when distribution logistics are well planned, government-led mass drug administration (MDA) for schistosomiasis (SCH) and soil-transmitted helminth (STH) suppression can be as effective as campaigns led by external partners.

Scroll down for more key findings.

Dr. Jenna Coalson walks through the results, lessons learned, methods, and implications from this project.

Key Findings

By sampling for MDA coverage before and after transitions, researchers found the following:

Pre-transition coverage for mebendazole and praziquantel administration was generally high, with administration primarily occurring in school settings.
Post-transition mebendazole coverage generally declined, but this decrease was only statistically significant for one of the districts studied.
Praziquantel administration decreased after mainstreaming, possibly due to an unstable supply chain and different administration approaches. This finding was statistically significant for three of the four districts.
Administration approaches deployed by local government areas after the transition included:
- Parent–teacher associations
- Immunization programs
- Local governments
- Community volunteers
- Trained government staff

Participants’ responses regarding their views of mainstreaming SCH and STH campaigns in Nigeria revealed the following findings:

The sustainability of MDA post-transition was stakeholders’ primary concern.
Respondents perceived governmental entities as largely uninvolved in current MDA efforts.
Stakeholders recommended advocating for the importance of SCH and STH interventions and encouraging government budget allocations for the campaigns, as well as building relationships with, collaboratively planning with, and training all parties.
Access to treatment poses a substantial challenge for school-based MDA, with coverage being low among unenrolled children.

“Government taking ownership of the program is the natural way to go if the program must be sustained. However, there are a lot of concerns. The concern is in the readiness of the government to take over the responsibilities. The government has solely relied on TCC [The Carter Center] for the technical and other support, and the sudden transition will cause a lot of undesirable changes.” - Director, State Health Care Board

For programs initiated by external partners, explore and document the program components that rely on the nongovernmental organization’s support and consider transitioning only the components that do not fall into this category.
Begin planning for mainstreaming well in advance of the transition—preferably at least four years prior—to enable sufficient time to design and test new approaches.
Advocate for and raise awareness about the importance of the health campaigns in preparation for the transition.
Leverage partnerships to provide additional support for government-led campaigns.
Clarify the type of support that would best complement government-led interventions and work closely with the government to plan each aspect of the campaign’s transition in ownership.
Identify components that have the potential to fail and develop alternative plans for addressing these issues.

Research Project