Integration of LF morbidity management and disability prevention (MMDP) into community health services: exploring the coverage and equity of community health worker-driven LF MMDP burden assessment and service uptake in Côte d’Ivoire.
This study will test the reliability of community health worker-led (CHW) MMDP burden estimates by having CHWs first estimate MMDP burden, followed by a rigorous population-based survey to get a representative estimate of MMDP burden for the district. Six months later, these cases will be followed up to see whether they accessed the MMDP services and assess the quality of care. The study will examine the accuracy of the CHW estimates, CHWs’ ability to diagnose properly, social biases of health care workers that may prevent equitable care delivery, and the cost comparison of the CHW method vs. population-based survey. In addition, the team plans to conduct an evaluation of the quality of MMDP service provision, including available psychosocial support, at all facilities in the selected health district. Programs need a feasible and reliable method for coming up with MMDP burden estimates for LF and strategies to ensure that people have access to care and utilize that care. This study addresses the two pillars of WHO dossier development for MMDP and will provide the Ministry of Health with essential information to plan and adapt their program to accommodate MMDP services.
Utility of screening easy to access population sub groups as a surveillance tool in monitoring interruption of LF transmission
The question of how to conduct post-elimination surveillance is a high priority for the NTD community, given that most NTD programs scale back or shut down completely once elimination as a public health problem is achieved. Few solutions exist and this proposal provides an interesting and useful case study for surveillance moving forward. The study team plans to target 1708 pregnant women as a proxy for measuring LF resurgence in a post-elimination context. As a comparison group, they plan to conduct a prevalence survey of 427 households (1708 participants) in the same community to compare LF prevalence found in each methodology. Each participant at the health facility’s residence will be geo-referenced to understand the coverage area. They also plan to conduct interviews with patients and health workers, a time-motion study, and a cost analysis to assess the additional burden on health care workers and the health system. The study will occur in 14 facilities in one district of Malawi where LF was highly endemic prior to the launch of the program.
Improving Neglected Tropical Disease (NTD) services and integrating into primary health care in Southern Nations, Nationalities, and Peoples' Region (SNNPR), Ethiopia
This study outlines an important first step to understanding NTD program integration in Ethiopia and builds on previous work in SNNPR. The study team plans to carry out significant formative research to better understand what gaps currently exist in the Ethiopian primary health care system that prevent integration of NTD services. They aim to answer the following questions:
- What are the current gaps in the Ethiopian primary health care system for implementing integrated NTD services and how can they be addressed?
- What is the community’s perception and awareness of selected NTDs and how can it be improved?
Following the gap analysis, the study team, along with the ministry of health and NTD taskforce of Ethiopia, will develop interventions to address these gaps. Outputs of the intervention stage are expected to include the following: a detailed description of the intervention, including case definitions, roles and responsibilities at the different levels of the health system, data recording and reporting mechanisms, referral systems; training manuals for the different primary healthcare system levels, job aids, guidance for supportive supervision. The team has made extensive plans to address issues of sustainability and scalability of the project including a cost analysis of the interventions, developing close partnerships with health facilities’ procurement departments, and close engagement during budget planning exercises of district health offices.
Integrating NTD programme monitoring into routine health systems data: evaluating a DHIS2 platform for real-time mass administration of medicines (MAM) reporting
This study includes an assessment of the Sightsavers rollout of a DHIS2 based tool for data collection in the NTD program in 2 states in Nigeria. In particular, the research project seeks to evaluate the health system strengthening effects of the tool for planning, monitoring and reporting of MDA. They plan to examine:
- the functionality of the tool at scale
- ease of integration across different NTD interventions
- data accessibility, accuracy, timeliness, and usefulness.
The team also aims to understand whether the implementation of this tool would enhance government ownership of the data and the NTD programme in general. This research will aid in identifying barriers and opportunities for potential scale up of the tool throughout Nigeria. The team also plans to focus on understanding how the data will be used at different levels of the health system.
The Zambia Neglected Tropical Disease Control Programme’s role in the attainment of Universal Health Coverage in Zambia: an implementation research study.
This study aims to conduct a landscape analysis to better understand the implementation context for the NTD control programme in Zambia. The activities include:
- an assessment of institutional structures, service delivery systems, existing resources/capacity
- mapping gaps, facilitators, and barriers to program implementation
- identifying potential opportunities to introduce innovative approaches for program integration and improvement.
Key informant interviews and focus group discussions with policy makers and NTD program officers will complement an extensive document review. The results of this assessment will be fed into the next National Health Strategic Plan, which expires in 2021.
Integrating spatial analysis in mixed methods approach to improve MDA Access by reaching underserved and vulnerable populations of Mali in NTD elimination framework
This mixed methods study plans to focus activities around two kinds of mobile, underserved populations: nomadic pastoralists in the rural district of Tominian and economic migrants and displaced groups from conflict areas in the urban district of Kalabancoro. Activities include:
- Quantitative questionnaire with a micro-narrative component. Micro-narratives are an established methodology focused on rapidly collecting qualitative data from a large number of participants
- Spatial analysis of study participants
- In-depth interviews and focus group discussions with health workers and community/opinion leaders
- Integrated analysis of the spatial data with questionnaire and micro-narrative data to better describe trends in the targeted vulnerable populations with respect to accessibility and acceptability of NTD program services
The team aims to combine spatial analysis with qualitative data collection to answer the following research questions:
- What are the factors leading to low coverage of MDA within underserved and vulnerable populations in Malian community?
- How are underserved and vulnerable populations currently being served by the public health interventions/health system?
- How effective and efficient is the ISAMA process for NTDs coverage in underserved and vulnerable populations compared to the current data collection and analysis approach?
- What critical factors influence the use of ISAMA approach in data analysis system process?
- How are characteristics of low coverage geographically distributed and the factors associated in underserved and vulnerable populations?
- Who are the underserved populations and what are their characteristics?
Urban dwellers have frequently been included as "hard to reach" when examining MDA coverage and uptake. Poor coverage in urban settings is a key factor that prevents programs in some settings from achieving success. This research study proposes a community-based participatory action research (CBPAR) strategy to better understand the reasons why this population isn’t reached and/or their decision not to participate in onchocerciasis and lymphatic filariasis MDAs. The results will help identify last mile strategies for urban populations and will generate a technical toolkit for how to conduct rapid participatory research in areas that require novel outreach methods amongst hard-to-reach populations. This form of social science methodology has not been used frequently within the NTD community and this proposal offers an opportunity to build the evidence base for these methods within the context of hard to reach populations.
The researchers plan to conduct a number of activities in order to determine the effectiveness of the participatory approach in targeting urban populations as compared to the standard mobilization and delivery approach.
- Rapid ethnographic interviews, a new technique aimed at rapidly collecting and analyzing qualitative data, to gather community feedback regarding barriers in accessing treatment
- An intervention development workshop with community leaders, health workers, researchers, and the ministry of health
- Deliver the newly designed strategy in Za-Kpota district and compare coverage in urban settings to Ouinhi district
- Finalize a rapid participatory approach toolkit and conduct a time-motion study of the approach to improve the business case to the MoH for uptake 5. Surveys and individual interviews with key stakeholders to determine acceptability, appropriateness, and feasibility of the proposed approach and toolkit
The influence of stigma on social participation and mental well-being amongst men and women affected/disabled by lymphatic filariasis and leprosy in the districts of Jaunpur and Patna in India
To what extent does stigma affect social participation and mental wellbeing among men and women affected/disabled by lymphatic filariasis or leprosy in Jaunpur in Uttar Pradesh and Patna in Bihar?