Table 1 Description of components of the context-specific evidence-based quality improvement intervention

Actor(s)

• District director, sub-district NTD focal persons, disease control officers and implementation/QI team (district and sub-district NTD focal persons and heads, DCO, HPO, Assemblymen/women and PI) who have been trained.

• Intervention implementation/QI team (district and sub-district NTD focal persons, opinion, religious and traditional leaders and PI).

• Intervention implementation/QI team

• Intervention implementation/QI team and CDDs

Action(s)

• Train drug distributors to have a good understanding of the programme and to be able to instil the same knowledge to the community members.

• Train drug distributors to be able to convince every qualified person in the endemic area to participate in the MDA exercise.

• Train drug distributors on the inclusion and exclusion criteria of the MDA.

• Train drug distributors on the possible adverse drug reactions and be able to explain them to the community members.

• Instilling the skills of communication and interaction to the drug distributors and the importance of being patient and tolerant with difficult community members.

• Vigorous enforcement of the MDA procedures, in particular, DOT policy during training and supervision.

• An evidence-based, multi-channel communication strategy to result in high levels of awareness among community members, (radio discussions and announcements, announcements in churches, mosques, schools, etc., community durbars and meetings with social groups to explain MDA relevance and public/community announcements).

• Focus key messages on cause and mode of transmission of the disease, importance of the MDA and how to identify, what to do and minimise adverse drug reactions.

• Community/opinion leaders such as Chiefs, Assemblymen/women, religious and traditional leaders should be involved in the MDA exercise.

• An adequate number of days should be dedicated to the distribution exercise (not less than 1 week)

• The distribution should reach people in institutions, markets, places, offices and homes.

• People with higher-level qualifications and a good knowledge of the MDA should be sent to institutions and offices to distribute the drug.

• Strong enforcement of the DOT policy.

Target (s) of the action

• Drug distributors in the endemic communities.

• People in the endemic communities.

• Community leaders.

• People in the endemic communities.

Temporality

• The drug distribution should start within 1 week after the training of drug distributors.

• Social mobilisation and sensitisation should start 2 weeks before and should continue during the MDA.

• Before, during and after MDA exercise.

• During the drug distribution

Dose

• The training of the CCDs should be detailed enough to equip them well for the MDA task, and the training period should not be more than 1 day to enhance their active participation in the training.

• Each endemic community should have at least two social mobilisation and sensitisation exercises (community durbar, school education, information centre announcement, education at church and mosque, and or radio talk shows etc.) for the start of MDA and at least one during MDA.

• Every endemic community must have a community leader representing it.

• The distribution exercise should not be less than 1 week in the endemic district.

• Over 80% of the people in the endemic communities must be covered.

Implementation outcome(s) and effect

• Increase the level of adherence to LF MDA implementation procedures and participants’ responsiveness.

• At least 15% increase in MDA coverage and reduction in the number of refusals (increased participant responsiveness).

• At least 15% increase in MDA coverage and reduction in the number of refusals (increased participant responsiveness).

• At least 15% increase in MDA coverage and reduction in the number of refusals (increased participant responsiveness).

Justification

• Researchers suggest that drug distributors are the interface between MDA programs and their targeted population; hence, their adequate training is crucial to the success of the MDA [7,8,9,10].

• It has been shown that evidence-based, context-specific and multi-channel social mobilisation and sensitisation is required for the LF elimination programme to succeed [4, 10, 11].

• Stakeholder engagement and involvement in LF MDA cannot be overemphasised [4, 9, 10].

• The MDA implementation process is crucial for participants’ responsiveness to the program [4, 10].