Scale up of a ‘bottom-up’ participatory planning approach for mass administration of medicines in Nigeria

• To develop and evaluate a sustainable approach to scaling up and embedding evidence for participatory planning and context specific implementation of mass administrations of medicine (MAM) through the use of participatory planning guides and capacity strengthening of neglected tropical disease (NTD) implementers

Nigeria carries 25 per cent of Africa’s NTD burden with all the debilitating consequences (WHO, 2016). COUNTDOWN which is an implementation research consortium, partners research specialists from the United Kingdom, United States of America, Ghana, Cameroon, Liberia, Nigeria and the Federal and some states ministries of health to generate new knowledge that will enhance increase in the reach and impact of the NTD treatment interventions in the different country-specific contexts.

The first stage of its activities was a situational analysis conducted in some communities in Kaduna and Ogun States to document strengths and weaknesses of the current NTD programme. Since then, a number of participatory action research approaches have been applied to engage different layers of stakeholders such as public health practitioners, non-governmental organisations and community-based groups such as adult men and women, young people, and boys and girls to meet the overarching objective of the partnership.

Data generated from all these engagements have been synthesised to create learning packs for school-based deworming and community-based MAM; micro planning template and participatory guide for planning MAM.

The use of these tools which are being co-created and the participatory approach of the research are being scaled up beyond the initial study sites to more areas in the 2019 MAM. This is simultaneously being evaluated, particularly the process of the use of these tools and the participatory approach and the outcomes.

Evidence from these evaluations will be presented to NTD policy makers across the relevant levels of health care in the country to inform policy changes and effective programme implementation in the country.

Phase 1: Tools and capacity strengthening: Following the creation of the tools to guide planning and implementation of programme, a working group has been constituted comprising policy makers and implementers of the NTD programme at the state and the local government levels from both states to review and advice on effective use of the tools across all relevant contexts in their states. This group in each state received capacity strengthening training which was cascaded to other implementers to ensure a paradigm shift in planning and implementation of NTD programme to a new one contained in the evidence based resources of the COUNTDOWN research starting with the 2019 MAM.

Phase 2: Evaluation: The process of using the tools and the capacity to use the participatory approach for the programme by implementers was evaluated using observational study through ethnography. The outcome of the application of the tools and the approach will be concluded using community evaluation through interviews and review meetings.

Phase 3: Engagement of stakeholders and policy makers: Evidence from both process and outcome evaluations will be presented to policy makers to inform policy changes. This will also be disseminated across relevant healthcare systems in a bid to further strengthen in-country capacity for effectively context-appropriate planning and implementation of the NTD programme.