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: