Understanding who is left behind and why in mass drug administration (MDA) initiatives: Lessons from four country contexts

Background: A study by Dean et al (2019),³⁰ established that active engagement of the community is critical for the success of an IR project. They used participatory community mapping methods across, Cameroon, Ghana, Liberia and Nigeria and identified key medicine distribution methods during MDA.

Results: Across all contexts, both house-to-house and fixed-point distribution methods were called for by community members. In Liberia, house-to-house methods were preferred in some rural areas because it allowed community drug distributors (CDDs) to identify those who were reluctant to take medicines and to ensure appropriate spread of awareness messaging. On the other hand, in Nigeria and Cameroon both house-to-house and fixed-point distribution methods were indicated to minimize cost and time for community members. However, in other rural areas, fixed point distribution was preferred as group distribution was thought to have the potential to increase medicine acceptability especially among women who felt more comfortable taking medicines in the presence of their friends.

Conclusion: Intersectional factors that guided preference for fixed-point distribution locations across contexts included geography (urban/rural), religion, gender, presence of clinics, existing community meeting points, religious structures, and marketplaces. The social position of chiefs in Cameroon and Nigeria enhanced their house to be selected as distribution points.