The impact of a community engagement intervention on the effectiveness of mass drug administration in Nigeria: evidence from Kaduna and Ogun States

• To understand the costs, cost drivers and impact of scaling up local context-specific neglected tropical diseases (NTD) programme implementation in Kaduna and Ogun states through quantitative surveys and costing activities

COUNTDOWN Nigeria has applied a participatory action research (PAR) approach to improve equity of mass administration of medicines (MAM) and inform NTD policy through an enhanced community engagement strategy.

Following completion of the PAR approach, the participatory guide for planning MAM was produced. The PGP is an interactive way to engage in participatory planning for context specific implementation of MAM for state coordinators, NTD local government coordinators and others. It provides knowledge and planning mechanisms for MAM including the need to plan programme activities based on context specific LGA macro and micro plans.

The quantitative aspect of this study involved two sections. The first examined the cost drivers of MAM activities, while the second focused on the success of the intervention in improving MAM coverage using a pre-post, intervention control design. The first survey took place before the current MAM cycle relating to the 2017 distribution and a second survey happened after the 2019 MAM cycle.

Methods

To estimate the cost of scaling up the intervention, researchers used the ingredients approach and activity-based costing methods to document and quantify the costs of scaling up a ‘bottom-up’ participatory planning approach for MAM in Nigeria. The costing focused on the supply side perspective including costs incurred at national, state, LGA and below. Costs were measured in financial and economic terms. To guide collection of cost data, we developed a costing template with details for each roll out model (1-3),  the activity (e.g. meeting or training event), cost type (capital cost such as vehicle, non-capital cost such as staff time), cost category (e.g. person time, transport costs, materials), sub-cost categories (cadre of person, type of material), quantity and unit cost of resources used.

To measure the success of the intervention, we studied the coverage of MAM in the previous and 2020 MAM cycle focusing on accessibility (people to who the drugs were made available) and adherence (people who took the medicines as directed). We hypothesised that community mobilisation and sensitisation packages would improve accessibility and adherence through increased acceptability and awareness of community members.

A descriptive analysis of both the baseline and follow-up data was carried out to examine differences in accessibility and adherence before and after the intervention. Regression analysis was used to study the factors that affected accessibility and adherence in the different LGAs of interest.

• Participatory guide to planning drug treatment programmes – project summary
• Costing tool for the participatory guide to planning drug treatment programmes
• Standard operating procedure to increase equity in drug treatment programmes