The literature review looked at peer-reviewed theoretical and empirical literature around Preventative Chemotherapy (PC) NTDs from January 2006 to April 2017 which focused on Nigeria. Documents included in the policy review were identified through internet searches, key informant interviews and snowballing.

The qualitative component of the situational analysis consisted of key informant interviews and stakeholder meetings. Key informant interviews were conducted with purposively selected stakeholders at the National, State and Local Government Authority (LGA) levels across both Kaduna and Ogun states. The stakeholder meetings drew on Participatory Action Research (PAR) methods, and three were held in each LGA- one with teachers, one with Community Drug Distributors (CDDs) and one with frontline health facility staff.

There were four separate focus areas of the study, which used the different types of data sources to varying degrees. Below are the four areas with some of the key findings:

Financial and non-financial resource challenges for the Nigerian NTD programme

• Financial support for NTD programme implementation varies between Ogun and Kaduna state which leads to unequal progress towards NTD elimination.
• There is inadequate information on how much it costs to implement MAM at all levels of the health system.
• Weaknesses of the budgeting process combined with lack of information on costs leads to systematic gaps between funds available and funds needed.
•  There are delays in disbursing funds due to late budget approval.
• Stakeholders, predominantly at the LGA level and below, report paying for programme activities using personal funds to mitigate against programme delays or failure.
• Population estimates are based on projections made from 2006 national census- in some areas there can be large shifts in population numbers over short periods of time which can result in a shortage of medicines in some communities while others have a surplus.

Community engagement successes and challenges as perceived by stakeholders at all levels of the health system

• Community engagement is critical for success.
• A holistic development approach will help sustain and attain positive MAM outcomes.
• Declining NTD associated morbidity threatens engagement.
• Poor management of side effects leads to rejection of MAM; implementation of pharmacovigilance guidelines and tailored community sensitization efforts can help.
• Challenges with community sensitisation negatively impact MAM acceptability and coverage

Management of human resources and support for frontline health implementers in the NTD elimination programme

• CDDs in both states reported that the duration of the training (one day) was too short to fully understand the content and requirements of the job.
• The Community Directed Intervention model is not fully implemented, which impacts CDDs
• Lack of community participation in CDD selection led to a reduction in community ownership of the programme.
• Some longstanding CDDs reported that while incentives were decreasing their workload was increasing with CDDs being required to cover larger areas and more challenging concepts.
• Insufficient numbers of teachers are trained for MAM in schools.
• Teachers involved in the deworming programme reported that treating school children was stressful and considered it to be extra work without extra payment.
• A few teachers also felt that MAM should be the responsibility of health workers, not educators.

Expanding the National Coordination platform for NTDs in Nigeria to reach local levels and improve partner coordination

• The NTD programme has recently strengthened its focus on the integration and co-implementation of activities.
• Coordination and partnership mechanisms are well defined at national level and are present or emergent at state level.
• At the national level, participants reported that clear roles and responsibilities create a strong platform for enhanced collaboration and partnerships within the NTD programme.
• Types of coordination for NTD implementation at the national level include cross-sectoral coordination and coordination with partners/NGDOs.
• Multiple donors present a risk of dependence and challenges related to varying donor requirements.
• Challenges to co-implementation occur due to fears of job insecurity, competing priorities and difficulty engaging senior stakeholders.
• Over-reliance on ‘tacit knowledge’ can compromise continuity in programme delivery

Further reading can be found in the following policy briefs:

Community Engagement

Human resources

Coordination

Financial Resources