Initial COUNTDOWN research in Liberia identified limited community awareness on purpose of medicine, weak training of Community Drug Distributors (CDDs) and inappropriate drug distribution as key challenges to the delivery of Mass Drug Administration (MDA) in Liberia.
In consultation and collaboration with health system stakeholders and community members, COUNTDOWN extension research project set out to develop and pilot a decentralized package of planning, community engagement and implementation of MDA to equitably increase therapeutic coverage in four districts across Lofa and Grand Bass counties. Selected counties and districts failed the 2018 pre-transmission assessment survey (pre-TAS) for elimination of preventive chemotherapy NTDs (PC-NTDs) and were endemic for all priority NTDs in Liberia including Onchocerciasis, Lymphatic Filariasis, Schistosomiasis and Soil-Transmitted Helminthiasis. This implementation research will collaboratively engage health systems stakeholders and community members to design and deliver a community census to understand population estimates for medicine supply, a decentralized training process for CDDs, and engage community members in medicine supervision and monitoring during the 2020 MDA session. Qualitative (and quantitative) research methods will be used to access coverage data making comparison to previous coverage targets and to understand perceptions of community and health system stakeholders on the changes in the system. Key intervention resource documents and tools will be re-packaged for use by policy makers and NTD programme implementers.