Background: Indonesia began its national lymphatic filariasis (LF) elimination programme in 2002, including conducting an annual mass drug administration (MDA) in endemic regions. By 2014, some regions had conducted at least five rounds of effective MDA and thus would qualify for Transmission Assessment Surveys (TAS) to determine if MDA could be halted. In the Agam District, despite multiple MDA rounds, drug coverage was insufficient and persistent LF transmission was observed. In Depok City, the programme could not qualify for TAS because of insufficient drug coverage for multiple MDA rounds. The reasons for the insufficient coverage in Depok City and the presence of ongoing LF transmission in Agam District were not understood. It was against this background that researchers sought to increase their understanding of how to guide and assist these areas to implement additional MDA rounds beyond the 4–6 rounds initially suggested by the programme. This was done through the development of a novel survey designed to collect short stories about people’s direct experiences with MDA for LF.

Planning phase: Working with the programme implementers, the research team developed a study tool to establish the factors that might be responsible for the sub-optimal coverage in the two study sites. Through a collaborative process, research themes were identified, a project implementation plan was developed and data collection tools were designed. This process involved regular communication with the district health teams to ascertain important dates for the enumerator training, community surveys, MDA awareness activities and the dates for MDA itself. Before surveys were conducted, the research team sought ethical approval from the Faculty of Health at the Universitas Indonesia for the research in both study sites.

Execution phase: The project was implemented in three phases: A first (baseline) phase where data was collected, analyzed and interpreted and feasible recommendations shared among the stakeholders before the next MDA. The second phase (execution) involved adopting MDA using the recommendations based on the baseline survey findings. These recommendations were used to develop a flow chart to aid those carrying out drug distribution. The third phase (evaluation) involved another round of data collection (end-line survey) to assess the changes that may have occurred as a consequence of the baseline survey recommendations. The figure shows the timelines for project execution.

Figure. Execution timeline for the overall project

Quality assurance:

To ensure quality of data:

• questionnaires were pre-tested with a cohort of individuals in Depok City prior to data collection;
• data collectors were trained on the survey methodology;
• all questionnaires were administered by trained enumerators;
• supervisors checked completed questionnaires at the end of each day;
• the same sampling frame and methodology were used in both baseline and end-line surveys;
• data was double entered (using Epi-Info);
• data was checked for response bias, range and consistency.

Conclusion: Through the collaborative process described, researchers and implementers developed a valid and effective tool that was able to detect operational issues within MDA programmes. They were also able to draw up an effective implementation plan.

Lessons: Planning requires team work and close collaboration between programme implementers and researchers. This close collaboration enables research activities to be aligned with programme activities. Quality must also be maintained throughout the life cycle of the project.