Ghana’s 2014 MDA Showcases Efficiency Advances, Areas for Improvement
August 7th, 2014
Each year, Ghana’s national Neglected Tropical Diseases Program (NTDP) delivers Mass Drug Administration (MDA) to over 25 million Ghanaians as part of its treatment strategy to prevent diseases including lymphatic filariasis (LF), onchocerciasis (Oncho), schistosomiasis (SCH), soil-transmitted helminthiasis (STH) and trachoma across the country.
Coordinating the delivery of medicines to that many people over such a wide geographical area is a massive feat. In addition to mobilizing complex logistics and supplies, adherence to tight timelines is critical to the MDA’s success. Whereas in previous years, it sometimes took as long as three months to reach every region and district in Ghana during MDAs due to competing demands from various health initiatives, this year the NTD program succeeded in ensuring that most of the country’s regions and districts conducted the MDA over the course of just one month.
Laying the Groundwork
In the days leading up to the 2014 MDA, the NTDP organized a three-day national meeting to train the trainers charged with orienting program managers, disease control officers and lower-level staff. This meeting was followed by cascading training sessions that reached staff at all levels, from the regional level to the thousands of community drug distributors (CDDs) who actually distribute the medicines to each household.
In addition to preparing the trainers, program managers and staff, and community drug distributors, the NTDP also sought to ensure that Ghanaian citizens would be ready and willing to participate in the MDA. This meant raising awareness via community mobilization activities and mass media education in advance of the drug administration.
The NTDP team participated in several television and radio talk show programs. Ghana’s most popular TV station GTV ran talk shows in English and several local and regional languages, including Akan, Ga and Ewe. Various regional and district-level mass media outlets also ran awareness-raising pieces and announcements.
At the community level, CDDs and sub-district level health officers mobilized communities for MDA directly via community-level announcements and group education. They also distributed and prominently displayed numerous community posters explaining the importance of taking the NTD prevention medicines.
One Month Later…Success! (and a few challenges)
Overall, the NTDP declared the 2014 MDA a great success, given that the majority of the regions conducted MDA activities within the scheduled timeframe. In fact, only three regions exceeded the stipulated one-month duration of the 2014 MDA.
However given the huge size and scope of the 2014 MDA campaign, it’s not surprising that the NTDP encountered a few challenges along the way. An END in Africa monitoring team visited several communities while MDA was underway in order to observe the challenges first-hand, document lessons learned and formulate recommendations for the future.
Visit to the Ekutuase Community, Mpohor District
The monitoring team first visited the Ekutuase community in the Mpohor district to observe an orientation session for CDDs. The session covered drug administration procedures, including how to use wooden poles to measure the height of each household member (since medicine dosages are determined by height), how to capture and report data, and why it’s important to ensure maximum coverage (i.e. to prevent disease transmission within the community).
Like many communities, Ekutuase is struggling to cope with the nuisance posed by the blackfly. Walking through the community, the team noticed that community members cover virtually every part of their bodies to prevent bites. They came upon Akua, bucket and hoe in hand, who told them that she was returning home from her farm along the river because it is heavily infested with blackflies.
Even though the community experiences yearly blackfly invasions, some community members lack adequate knowledge about how the flies reproduce and proliferate. For example, some believe that blackflies come from growths on tree trunks that expand in size until they burst, releasing swarms of flies into the community. While the NTDP’s focus has been on reducing the blackfly’s infectivity rate, it’s clear that community education on blackfly population control is needed and would likely assist the NTDP in achieving its primary goal of reducing blackfly infectivity rates, as well.
Visit to the Nzulezu Community, Wassa West district
The next stop on the END in Africa monitoring team’s field visit was to the Nzulezu community in the Wassa West district. Nzulezu is one of the district’s hard-to-reach communities. It has some 400 residents who live along the Amanzure River in buildings constructed with and suspended on sticks.
Although the NTDP had expected to obtain 100 percent drug coverage among the eligible population during the MDA in Nzulezu, considering the small, close-knit nature of the community, this was not the case. Instead, some people refused to participate in the MDA or take the medicines, either because they didn’t think they were at risk or because they just weren’t interested in the program.
At the same time, the local CDD unfortunately lacked the skills needed to convince his neighbors to participate in the MDA. When MDAs fail to achieve 100% coverage of eligible individuals, it increases the risk not just for those who decline to participate, but also for the entire community. Thus, important take-aways from our visit to Nzulezu were the need to improve CDDs’ negotiation, motivational and behaviour change communication (BCC) skills prior to MDA events, potentially by including these topics in CDD training sessions. The NTDP also needs to find ways of engaging and educating the community on disease risk, transmission and treatment, as well as the purpose of MDAs.
Visit to the Town of Elubo, Noe District
The final stop on the END in Africa monitoring team’s visit was Elubo, a vibrant town in the Noe district located on the border with the Cote d’Ivoire, where medicines are distributed each year to treat onchocerciasis. Even though neighboring districts in both countries collaborate closely on other health campaigns such as polio, this has not extended to MDAs for NTDs. Coordination is important for ensuring that every eligible person receives the medicine during MDAs, including those who cross the border daily for business purposes or other reasons.
Port health staff on the Ghana side of the border aim for 100% coverage of both civilians and the uniformed men who work at the border. Their strategy includes distributing drugs over multiple days and targeting workers on each shift. Drug distributors and health post officials work closely with unit heads and leaders in the armed forces to ensure that all eligible border staff takes the medicines.
In recent television news segment on the Ghana 2014 MDA, the medical chief of Noe Dr. Louis R. Assi emphasized the importance of cross-border collaboration saying, “We are obliged to work together because the cases found in the Ivory Coast can also be found in Ghana.”
“We hope that in the end, we can be able to serve patients on both sides of the border,” Dr. Assi continued. He called for stronger ties between the two countries and periodic meetings.
Ghana Deputy Program Director for NTDs Dr. Benjamin Marfoh agreed saying, “It [onchocerciasis] affects more or less the poorest of the poor, so it’s very important that the government steps in to assist.”
After observing the MDA and listening to the comments of local health professionals, the main lesson from the Elubo visit was that the NTDP should continue to advocate for expanding cross-border collaboration with the Ivory Coast and other neighboring countries.
- Expand efforts to educate affected communities on disease vector reproduction, proliferation and population control, as well as disease risk, transmission and treatment, and the purpose of MDAs.
- Include topics such as building negotiation, motivational and BCC skills in training sessions for CDDs and other program staff and volunteers.