|Community-directed Treatment of Lymphatic Filariasis in Africa - Report of a multi-centre study in Ghana and Kenya (UNDP - WB - WHO, 2000, 44 p.)|
|REASONS FOR BETTER PERFORMANCE OF ComDT|
A number of issues could be attributed to the reasons why ComDT performed much better than HST. They include
In both arms of the study, there was community involvement to a certain extent. In the ComDT arm, however, the community took control of the whole drug distribution process and could thus better ensure that the distribution was organized and executed in a manner that was most acceptable and convenient to them.
In the HST arm the health worker went to the community after reporting at work and most of the time this was after 8 am. In the ComDT arms however, the distribution was often done from dawn till 8 am and then after 6 pm when people had return from their farms.
· We distribute at dawn. It was explained that, when you take the drug, you do not eat until after an hour, so it made me distribute it early in the morning (CDD).
· We assembled the people at dawn and distributed the drugs and as I already said, it was the teacher who did the work. It was done from house to house, even whilst youre asleep, he knocks at your door to give it to you (Key Informant).
Since distributors in the ComDT arm lived in the communities, it was easier for them to work odd hours. None of the implementation health staff lived in the communities. They had to commute to the communities to get the drugs distributed and this had implications for proper coverage rates.
In the HST arm, the implementation health staff went into the community, did the distribution and left the drugs for people in the community to continue with the distribution. In the ComDT arm however, the number of distributors per community ranged from 1-6 but in each community, other community members who had the time also helped with the registration of community members before the actual distribution took place.
Whereas the implementation health staff saw the distribution exercise as an additional responsibility and were concerned about the effort involved, the drug distributors once they understood the concept saw it as something which if they did properly would benefit their community.
· And also I should have been given some fuel money but because I was doing other programmes, I was unable to devote much time to that programme. (Health worker)
· I begun with one of the boys on my rounds but later, when I go and call him, he does not come, he said that there was nothing in the work like money, so he would not do the work, I also could not stop because I had decided to help out. (CDD)
Since the distributors came from and lived in the communities, there were internal checks and balances that ensured that the distribution was done properly. Once people heard about the positive effects of the drugs like expelling of worms, etc, they came chasing the distributor if they had not received the drug in their homes.
In Ghana, apart from the traditional set up of chiefs and elders, the lowest level of political administration is the unit committee and their role is to make sure that things run properly and everyone is given a fair share of anything in the community. Over 70% of the drug distributors selected by the communities were unit committee members and apart from being community members, they had to make sure they performed so that they would be appointed in subsequent elections.
In both countries, both the implementation health staff and the community were satisfied with the ComDT process.
· In fact going house to house was the best thing because you reach even those who can not walk. The people liked it because they felt it was not interfering with their daily duties, drug distributors were people they knew and thus had faith in them. I interviewed a few people and they term the drug as a saviour for a problem that had affected them for many years. (Health worker)
· The evaluation instruments for the present study were not designed to assess the opinion of senior health staff about the ComDT concept. However, informal discussions with members of the DHMTs indicated that they were very satisfied with the concept. They were pleased that the community, with training, had been able to deliver drugs and help them do their work.