Microplanning improves stakeholders' perceived capacity and engagement to implement lymphatic filariasis mass drug administration.

Abstract

Background: Achieving adequate mass drug administration (MDA) coverage for lymphatic filariasis is challenging. We sought to improve stakeholder engagement in MDA planning and increase subsequent MDA coverage through a series of microplanning workshops.

Methodology: Prior to the 2018 MDA, Haiti's Ministry of Public Health and Population (MSPP) and partners conducted 10 stakeholder microplanning workshops in metropolitan Port-au-Prince. The objectives of the workshops were to identify and address gaps in geographic coverage of supervision areas (SAs); review past MDA performance and propose strategies to improve access to MDA; and review roles and responsibilities of MDA personnel through increased stakeholder engagement. Retrospective pre-testing was employed to assess the effectiveness of the workshops. Participants used a 5-point scale to rank their understanding of past performance, SA boundaries, roles and responsibilities, and their perceived engagement by MSPP. Participants simultaneously ranked their previous year's attitudes and their attitudes about MDA following the 2-day microplanning workshop. Changes in pre- and post-scores were analyzed using Wilcoxon signed-rank tests.

Principal findings: A total of 356 stakeholders across five communes participated in the workshops. Participants conducted various planning activities, including revising SA boundaries to ensure full geographic reach of MDA, proposing or validating social mobilization strategies, and proposing other MDA improvements. Compared with previous year rankings, the workshops increased participant understanding of past performance by 1.34 points (standard deviation [SD] = 1.05, p <0.001); SA boundaries by 1.14 points (SD = 1.30; p <0.001); their roles and responsibilities by 0.71 points (SD = 0.95, p <0.001); and sense of engagement by 1.03 points (SD = 1.08, p <0.001). Additionally, compared with 2017, drug coverage increased in all five communes during the 2018 MDA.

Conclusions/significance: Participatory stakeholder workshops during MDA planning can increase self-reported engagement of key personnel and may improve staff performance and contribute to achievement of drug coverage targets. Microplanning success was supported by MDA results, with all communes achieving preset MDA coverage targets.