A mixed methods approach to evaluating community drug distributor performance in the control of neglected tropical diseases.
Trusted literate, or semi-literate, community drug distributors (CDDs) are the primary implementers in integrated preventive chemotherapy (IPC) programmes for Neglected Tropical Disease (NTD) control. The CDDs are responsible for safely distributing drugs and for galvanising communities to repeatedly, often over many years, receive annual treatment, create and update treatment registers, monitor for side-effects and compile treatment coverage reports. These individuals are 'volunteers' for the programmes and do not receive remuneration for their annual work commitment.



A mixed methods approach, which included pictorial diaries to prospectively record CDD use of time, structured interviews and focus group discussions, was used to triangulate data on how 58 CDDs allocated their time towards their routine family activities and to NTD Programme activities in Uganda. The opportunity costs of CDD time were valued, performance assessed by determining the relationship between time and programme coverage, and CDD motivation for participating in the programme was explored.



Key findings showed approximately 2.5 working weeks (range 0.6-11.4 working weeks) were spent on NTD Programme activities per year. The amount of time on NTD control activities significantly increased between the one and three deliveries that were required within an IPC campaign. CDD time spent on NTD Programme activities significantly reduced time available for subsistence and income generating engagements. As CDDs took more time to complete NTD Programme activities, their treatment performance, in terms of validated coverage, significantly decreased. Motivation for the programme was reported as low and CDDs felt undervalued.



CDDs contribute a considerable amount of opportunity cost to the overall economic cost of the NTD Programme in Uganda due to the commitment of their time. Nevertheless, programme coverage of at least 75 %, as required by the World Health Organisation, is not being achieved and vulnerable individuals may not have access to treatment as a consequence of sub-optimal performance by the CDDs due to workload and programmatic factors.
Schistosomiasis Control Initiative, Imperial College London, London, UK. f.fleming@imperial.ac.uk.
Fiona M
FM
Fleming
School of Economics, Makerere University, Kampala, Uganda.
Fred
F
Matovu
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
Kristian S
KS
Hansen
Department of Infectious Disease Epidemiology, Imperial College London, London, UK.|Department of Pathology and Pathogen Biology, Centre for Emerging, Endemic and Exotic Diseases (CEEED), Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK.
Joanne P
JP
Webster
D000328:Adult; D000368:Aged; D000977:Antiparasitic Agents / Q000008:administration & dosage*; D003140:Communicable Disease Control / Q000379:methods*; D003153:Community Health Services / Q000592:standards*; D003150:Community Health Workers / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058069:Neglected Diseases / Q000188:drug therapy*; D010272:Parasitic Diseases / Q000517:prevention & control*; D015397:Program Evaluation / Q000379:methods; D012424:Rural Population; D014454:Uganda; D000078329:Workforce; D055815:Young Adult
D000977:Antiparasitic Agents
Community drug distributors; Control; Integration; Mixed methods; Neglected tropical diseases; Opportunity cost; Performance; Preventive chemotherapy