Monitoring and Supervising the Annual Mass Drug Administration for Neglected Tropical Diseases in Ethiopia using a Rapid Coverage Survey Tool: A Case Study

MDA

Annual Mass Drug Administration (MDA) is one of the strategies used to combat Neglected Tropical Diseases (NTDs) such as trachoma, onchocerciasis, lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis (STH). NTDs affect more than a billion people around the world, mainly in developing countries, including Ethiopia.

The Supervisor’s Coverage Tool (SCT) is a rapid, simple, and inexpensive monitoring and supervising tool recently endorsed by the World Health Organization (WHO). The tool is generally implemented by a district or sub-district level supervisor prior to the end of an MDA round. The SCT can help detect issues related to poor compliance, the drug distribution strategy, and the performance of community drug distributors. The tool can also be used to identify districts in need of additional (‘mop-up’) treatments.

The SCT was included and implemented nationally in Ethiopia in the 2017-2018 annual MDA rounds. The MDA in Benishangul-Gumuz, which was one of the regions where an integrated MDA training was being piloted, took place in February 2018. Shortly after the integrated MDA training was completed, each MDA was implemented one week apart (from the end of one MDA to the beginning of another MDA), starting with onchocerciasis and lymphatic filariasis.

According to an Assosa based NTD technical advisor, Assosa town and one district in Benishangul-Gumuz have performed poorly during past MDAs. The inhabitants of the town often refuse to take the medications because they consider themselves to be knowledgeable and do not feel the need for the medications, or out of fear of side effects, as they believe the medications were not tested in laboratories. In another district with poor performance, Homosha, health extension workers have had difficulties distributing medications as many residents had left for gold mining in forests far away, and others, mainly of Berta ethnic group, are often gone for soccer tournaments which is a major part of their culture and falls right during the MDA.

Interview

Overall, the implementation of the SCT was smooth and was beneficial to district supervisors in determining MDA coverages and detecting issues. However, in some districts and kebeles, there was some confusion regarding the implementation of the SCT, particularly around the targeting of supervisory areas with low performance, the random selection of households, keeping samples of medications on hand to show during SCT implementation, filling out the paperwork fully, having enough SCT implementation paperwork, and avoiding bias in residents’ response upon seeing the health extension worker during SCT implementation. As this is the first national roll-out of the SCT, these confusions can be expected, but as more MDA rounds and trainings are completed, these issues should be easily resolved, and the SCT can continue to be used as an easy but powerful in-process tool to monitor and supervise coverage.

 

Photos (Credit: Ahlam Awad Mohammed)

Top: A resident receives albendazole and ivermectin after being measured using a drug pole

Bottom: A district supervisor interviews a young girl at her house while implementing the SCT with the help of a cluster coordinator