Understanding the Role of Health Workers in the LF Elimination Program in Kenya: Challenges Faced and Suggestions for Improved Program Performance

Bridget W Kimani; Lydiah Wanjiku Kibe; Collins Okoyo; Wyckliff P Omondi; Hadley Matendechero Sultani; Doris Wairimu Njomo

doi:10.37284/eajhs.3.1.393

Bridget W Kimani Kenya Medical Research Institute
Lydiah Wanjiku Kibe, PhD Kenya Medical Research Institute
Collins Okoyo Kenya Medical Research Institute
Wyckliff P Omondi Ministry of Health
Hadley Matendechero Sultani, PhD Ministry of Health
Doris Wairimu Njomo, PhD Kenya Medical Research Institute

DOI: https://doi.org/10.37284/eajhs.3.1.393

Keywords: Lymphatic Filariasis, Mass Drug Administration, Challenges, Opportunities, Health Workers, Neglected Tropical Diseases Coordinators

Share Article:

Abstract

The Kenyan Ministry of Health and its partners through the Division of Vector-Borne and Neglected Tropical Diseases, is in charge of the Lymphatic Filariasis Mass Drug Administration programme. This is implemented through the national, county, and sub-county neglected tropical diseases coordinators. The current study sought to understand the roles, challenges faced and suggestions of how program performance can be improved by the community health extension workers, county and sub-county neglected tropical diseases coordinators. Two wards of the Kaloleni sub-county; Kilifi County were purposively selected. In 2015, Kaloleni and Kayafungo wards had a treatment coverage of 58% and 54% respectively; 62% and 39% respectively in 2016, all below the recommended minimum treatment coverage of 65%. Qualitative data was collected through sixteen in-depth interviews with community health extension workers and two semi-structured interviews with the county and sub-county neglected tropical diseases coordinators. Data were analysed by QSR NVIVO version 10 according to identified themes. The study results show the various roles in planning and implementation of the program include; supply chain management; health information education communication and records management; health workforce training and management, leadership and governance, and service delivery. Challenges faced included insufficiency of drugs supplied and information education communication materials, the inadequacy of community drug distributors selected and trained, poor facilitation for training and supervision of community drug distributors, limited duration of the mass drug administration, and delayed reporting due to poor network coverage. The results of this study show that the community health extension workers, county and sub-county neglected tropical diseases coordinators are not fully involved in program leadership and governance, a role that is taken up at the national level. They should be involved in all the stages of the mass drug administration program to create ownership to improve the program performance

Downloads

Download data is not yet available.

References

WHO. Lymphatic filariasis. 2019. Fact sheet. https://www.who.int/news-room/fact-sheets/detail/lymphatic-filariasis (accessed Dec 30, 2019).

World Health Organization. (2005). Global Programme to Eliminate Lymphatic Filariasis: annual report on lymphatic filariasis 2003 (No. WHO/CDS/CPE/CEE/2005.52).

World Health Organization. (2010). Progress report 2000-2009 and strategic plan 2010-2020 of the global programme to eliminate lymphatic filariasis: halfway towards eliminating lymphatic filariasis (No. WHO/HTM/NTD/PCT/2010.6).

World Health Organization. Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021–2030. Geneva: World Health Organization; 2020.

Ottesen, E. A. (2000). The global programme to eliminate lymphatic filariasis. Tropical Medicine & International Health, 5(9), 591-594.

Bockarie, M. J., Kelly-Hope, L. A., Rebollo, M., & Molyneux, D. H. (2013). Preventive chemotherapy as a strategy for elimination of neglected tropical parasitic diseases: endgame challenges. Philosophical Transactions of the Royal Society B: Biological Sciences, 368(1623), 20120144.

Kyelem, D., Biswas, G., Bockarie, M. J., Bradley, M. H., El-Setouhy, M., Fischer, P. U., & Ottesen, E. A. (2008). Determinants of success in national programs to eliminate lymphatic filariasis: a perspective identifying essential elements and research needs. The American journal of tropical medicine and hygiene, 79(4), 480-484.

World Health Organization. (2010). Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. World Health Organization

Marinucci, F., Manyazewal, T., Paterniti, A. D., Medina-Moreno, S., Wattleworth, M., Hagembe, J., & Redfield, R. R. (2013). Impact of horizontal approach in vertical program: continuous quality improvement of malaria and tuberculosis diagnostic services at primary-level medical laboratories in the context of HIV care and treatment program in Ethiopia. The American Journal of Tropical Medicine and Hygiene, 88(3), 547-551.

Swanson, R. C., Atun, R., Best, A., Betigeri, A., de Campos, F., Chunharas, S., ... & Omaswa, F. (2015). Strengthening health systems in low-income countries by enhancing organizational capacities and improving institutions. Globalization and health, 11(1), 1-8.

Goldberg, J., & Bryant, M. (2012). Country ownership and capacity building: the next buzzwords in health systems strengthening or a truly new approach to development. BMC public health, 12(1), 531.

Van Olmen, J., Marchal, B., Van Damme, W., Kegels, G., & Hill, P. S. (2012). Health systems frameworks in their political context: framing divergent agendas. BMC Public Health, 12(1), 774.

Mounier-Jack, S., Griffiths, U. K., Closser, S., Burchett, H., & Marchal, B. (2014). Measuring the health system's impact of disease control programmes: a critical reflection on the WHO building blocks framework. BMC public health, 14(1), 278.

Senkubuge, F., Modisenyane, M., & Bishaw, T. (2014). Strengthening health systems by health sector reforms. Global health action, 7(1), 23568.

Obermann, K., Chanturidze, T., Richardson, E., Tanirbergenov, S., Shoranov, M., & Nurgozhaev, A. (2016). Data for development in health: a case study and monitoring framework from Kazakhstan. BMJ Global Health, 1(1).

Mutale, W., Bond, V., Mwanamwenge, M. T., Mlewa, S., Balabanova, D., Spicer, N., & Ayles, H. (2013). Systems thinking in practice: the current status of the six WHO building blocks for health system strengthening in three BHOMA intervention districts of Zambia: a baseline qualitative study. BMC health services research, 13(1), 291.

Fisher, J. R., & de Mello, M. C. (2011). Using the World Health Organization's 4S-Framework to Strengthen National Strategies, Policies and Services to Address Mental Health Problems in Adolescents in Resource-Constrained Settings. International journal of mental health systems, 5(1), 23.

Njenga, S. M., Kanyi, H. M., Mutungi, F. M., Okoyo, C., Matendechero, H. S., Pullan, R. L., ... & Won, K. Y. (2017). Assessment of lymphatic filariasis prior to re-starting mass drug administration campaigns in coastal Kenya. Parasites & vectors, 10(1), 99.

World Health Organization. (2017). Guideline: alternative mass drug administration regimens to eliminate lymphatic filariasis (No. WHO/HTM/NTD/PCT/2017.07). World Health Organization.

Ministry of Health. (2006). Taking the Kenya essential package for health to the community: a strategy for the delivery of level one services. Reversing the Trends-The Second National Health Sector Strategic Plan of Kenya, i-50.

"The Report of the Interim Independent Boundaries Review Commission (IIBRC): Delimitation of Constituencies and Recommendations on Local Authority Electoral Units and Administrative Boundaries for Districts and Other Units" (PDF). IEBC. 2010. Retrieved 29 May 2020.

"2019 Kenya Population and Housing Census Results". Kenya National Bureau of Statistics. Retrieved 29 May 2020.

"Kilifi County Statistical Abstract 2015". Kenya National Bureau of Statistics. Retrieved 29 May 2020

Creswell, J. W. (2013). Qualitative inquiry: Choosing among five approaches. Los Angeles, CA, 244.

Johnson, R. B., & Onwuegbuzie, A. J. (2010). Mixed research. RB Johnson & LB Christensen, Educational research: Quantitative, qualitative, and mixed approaches, 439-459.

World Health Organization. (2017). Guideline: alternative mass drug administration regimens to eliminate lymphatic filariasis (No. WHO/HTM/NTD/PCT/2017.07). World Health Organization.

Babu, B. V., & Kar, S. K. (2004). Coverage, compliance and some operational issues of mass drug administration during the programme to eliminate lymphatic filariasis in Orissa, India. Tropical Medicine & International Health, 9(6), 702-709.

Gunawardena, S., Ismail, M., Bradley, M., & Karunaweera, N. (2007). Factors influencing drug compliance in the mass drug administration programme against filariasis in the Western province of Sri Lanka. Transactions of the Royal Society of Tropical Medicine and Hygiene, 101(5), 445-453.

Partono, F., & Maizels, R. M. (1989). Towards a filariasis-free community: evaluation of filariasis control over an eleven-year period in Flores, Indonesia. Transactions of the Royal Society of Tropical Medicine and Hygiene, 83(6), 821-826.

Vanamail, P., Ramaiah, K. D., Subramanian, S., Pani, S. P., Yuvaraj, J., & Das, P. K. (2005). Pattern of community compliance with spaced, single-dose, mass administrations of diethylcarbamazine or ivermectin, for the elimination of lymphatic filariasis from rural areas of southern India. Annals of Tropical Medicine & Parasitology, 99(3), 237-242.

Cantey, P. T., Rout, J., Rao, G., Williamson, J., & Fox, L. M. (2010). Increasing compliance with mass drug administration programs for lymphatic filariasis in India through education and lymphedema management programs. PLoS Negl Trop Dis, 4(6), e728.

Mathieu E, et al. Factors associated with participation in a campaign of mass treatment against lymphatic filariasis, in Leogane, Haiti. Ann Trop Med Parasitol. 2004; 98(7):703–14.

Lahariya, C., & Mishra, A. (2008). Strengthening of mass drug administration implementation is required to eliminate lymphatic filariasis from India: an evaluation study. J Vector Borne Dis, 45(4), 313-20.

Kisoka, W. J., Tersbøl, B. P., Meyrowitsch, D. W., Simonsen, P. E., & Mushi, D. L. (2016). Community Members' perceptions of Mass Drug Administration for Control of Lymphatic Filariasis in Rural and Urban Tanzania. Journal of biosocial science, 48(1), 94-112.

Hodges, M. H., Smith, S. J., Fussum, D., Koroma, J. B., Conteh, A., Sonnie, M., ... & Zhang, Y. (2010). High coverage of mass drug administration for lymphatic filariasis in rural and non-rural settings in the Western Area, Sierra Leone. Parasites & vectors, 3(1), 120.

Hodges, M. H., Sonnie, M., Turay, H., Conteh, A., MacCarthy, F., & Sesay, S. (2012). Maintaining effective mass drug administration for lymphatic filariasis through in-process monitoring in Sierra Leone. Parasites & vectors, 5(1), 232.

Kisoka, W. J., Simonsen, P. E., Malecela, M. N., Tersbøl, B. P., Mushi, D. L., & Meyrowitsch, D. W. (2014). Factors influencing drug uptake during mass drug administration for control of lymphatic filariasis in rural and urban Tanzania. PLoS One, 9(10), e109316.

Cantey, P. T., Rout, J., Rao, G., Williamson, J., & Fox, L. M. (2010). Increasing compliance with mass drug administration programs for lymphatic filariasis in India through education and lymphedema management programs. PLoS Negl Trop Dis, 4(6), e728.

Vanamail, P., Ramaiah, K. D., Subramanian, S., Pani, S. P., Yuvaraj, J., & Das, P. K. (2005). Pattern of community compliance with spaced, single-dose, mass administrations of diethylcarbamazine or ivermectin, for the elimination of lymphatic filariasis from rural areas of southern India. Annals of Tropical Medicine & Parasitology, 99(3), 237-242.

Njomo, D. W., Mukoko, D. A., Nyamongo, N. K., & Karanja, J. (2014). Increasing coverage in mass drug administration for lymphatic filariasis elimination in an urban setting: a study of Malindi Town, Kenya. PLoS One, 9(1), e83413.

Vanamail, P., Ramaiah, K. D., Subramanian, S., Pani, S. P., Yuvaraj, J., & Das, P. K. (2005). Pattern of community compliance with spaced, single-dose, mass administrations of diethylcarbamazine or ivermectin, for the elimination of lymphatic filariasis from rural areas of southern India. Annals of Tropical Medicine & Parasitology, 99(3), 237-242.

Amarillo, M. L. E., Belizario, V. Y., Sadiang-Abay, J. T., Sison, S. A. M., & Dayag, A. M. S. (2008). Factors associated with the acceptance of mass drug administration for the elimination of lymphatic filariasis in Agusan del Sur, Philippines. Parasites & Vectors, 1(1), 14.

Njomo, D. W., Amuyunzu-Nyamongo, M., Magambo, J. K., Ngure, P. K., & Njenga, S. M. (2012). Factors associated with the motivation of community drug distributors in the Lymphatic Filariasis Elimination Programme in Kenya. Southern African Journal of Epidemiology and Infection, 27(2), 66-70.

Dembélé, M., Bamani, S., Dembélé, R., Traoré, M. O., Goita, S., Traoré, M. N., ... & MacArthur, C. (2012). Implementing preventive chemotherapy through an integrated national neglected tropical disease control program in Mali. PLoS Negl Trop Dis, 6(3), e1574.

da-Costa Vroom, F. B., Aryeetey, R., Boateng, R., Anto, F., Aikins, M., Gyapong, M., & Gyapong, J. (2015). Data reporting constraints for the lymphatic filariasis mass drug administration activities in two districts in Ghana: A qualitative study. SAGE open medicine, 3, 2050312115594083.

Cavalli, A., Bamba, S. I., Traore, M. N., Boelaert, M., Coulibaly, Y., Polman, K. ... & Van Dormael, M. (2010). Interactions between global health initiatives and country health systems: the case of a neglected tropical diseases control program in Mali. PLoS Negl Trop Dis, 4(8), e798.

Nonvignon, J., Mensah, E., Vroom, F. B. D. C., Adjei, S., & Gyapong, J. O. (2016). The role of health systems in the control of neglected tropical diseases in Sub-Saharan Africa. In Neglected Tropical Diseases-Sub-Saharan Africa (pp. 385-405). Springer, Cham.