Establishing an enhanced community engagement package for preventative chemotherapy neglected tropical diseases in Kaduna and Ogun state, Nigeria

• To increase effectiveness of neglected tropical disease (NTD) programmes with a focus on reaching poor and vulnerable people
• To ensure enhanced community ownership of and participation in the NTD programme, facilitated by building common goals for mass drug administration (MDA) between the health system and community

COUNTDOWN is an implementation research project set in four African countries (Nigeria, Liberia, Cameroon and Ghana) selected due to their varying points in NTD control. The collaboration includes Liverpool School of Tropical Medicine bringing technical guidance, and Sightsavers bringing the perspective of large scale implementing partner. (Sightsavers is a collaborating partner in the Nigeria programme.)

The consortium is dedicated to investigating the cost-effective scale-up of sustainable solutions necessary to control and eliminate the seven most common neglected tropical diseases by 2020, including soil-transmitted helminths and schistosomiasis.

The COUNTDOWN team in Nigeria is led by the Federal Ministry of Health (FMOH) and includes social scientists, health economists, a research uptake officer (embedded in FMOH), and a research manager/officer.

The first stage of COUNTDOWN research in Nigeria was a situational analysis, which sought to document the current strengths and weaknesses of the NTD programme, specifically in Ogun and Kaduna States, with a view to identifying areas for future implementation research. Within this situational analysis, it was identified that across both States, the NTD programme is currently facing significant challenges in adapting a once very successful community engagement strategy to suit the changing needs of rural communities, as well as the needs of populations living in emerging and varied contexts.

These challenges included: competing community development needs such as provision of safe drinking water, food etc.; steady decline in visible morbidity associated with NTDs meaning communities no longer perceive a need for, or an intrinsic benefit of the NTD programme; weak community mobilisation and sensitisation activities; improper management of drug side effects leading to drug refusal; and other disrupting factors such as community fatigue, religious and spiritual beliefs, alternate community structures, and disengagement of community volunteers due to a lack of remuneration from the NTD programme.

This study seeks to better understand and address community engagement challenges for the NTD programme in Nigeria using a participatory action research (PAR) approach. The research will facilitate effective community engagement around mass administration of medicines (MAM) through adaptive use of community structures to contribute toward NTD elimination in Ogun and Kaduna states in Nigeria.

A PAR process was chosen due to its central principles of inclusivity, ownership and sustainability that places communities, frontline implementers and government bodies at the centre of the research process. This approach has been shown to strengthen health systems and ensure ownership of programmes that meets the needs of the country rather than purely directed by external agents.

This study will be conducted in four core phases:

1. Build on findings from the situational analysis and involve the use of participatory research methods to understand the existing context in relation to community engagement and the NTD programme within Kaduna and Ogun state. This phase will aim to understand two key elements of community engagement within the NTD programme: i) the use and potential use of community structures in programme delivery and ii) community and implementer perceptions of existing information, education and communication (IEC) tools and processes.
2. Involve the development of an enhanced community engagement package for the NTD programme in Nigeria. This will be done through a collaborative action planning process with programme implementers informed of the evidence gathered in phase one.
3. Implement the developed community engagement strategy. A process evaluation involving timely reflection will be a central focus to ensure that lessons learned are captured and addressed. In addition, a full cost-effectiveness evaluation of the strategy will take place.
4. Make recommendations regarding what works best for community engagement with the NTD programme in a variety of contexts.

• Read the journal article ‘Optimising the performance of frontline implementers engaged in the NTD programme in Nigeria: Lessons for strengthening community health systems for Universal Health Coverage’
• Read the blog ‘Using research to reach people at risk of NTDs’

Countdown resources

• Visit the Countdown website
• Countdown implementation – research blog 
• Countdown – Annotated Bibliography 2017
• Countdown – Community Engagement 2017
• Countdown – Financial Resources 2017
• Countdown – Human Resources 2017
• Countdown – Partner Coordination 2017
• Countdown – Policy Summary 2017