Understanding the factors that motivate and sustain community drug distributors in the changing context of NTD control and elimination in Uganda and Côte d'Ivoire

The contribution of community drug distributors (CDDs) to the success of mass drug administration (MDA) for Preventive Chemotherapy Neglected Tropical Diseases (PC-NTD) to date cannot be overemphasized. Through their efforts, millions of tablets have been distributed to endemic communities to such an extent that some communities have been freed of one or more of the NTDs. There is ample evidence to support the fact that the performance of the CDDs has an important impact on drug coverage with the MDA. In some circumstances, they are more motivated than the formally recruited health workers. They are trusted by their communities, such that people report taking the drugs because of the instruction of the CDDs. CDDs provide explanations about the drugs and side effects in the community that improve compliance, however when this information is inadequate or poorly communicated by CDDs, people report being less likely to take the pills. If communities perceive that the CDDs are doing their work well, they report high levels of compliance. It is widely acknowledged in the individual programs (namely LF and onchocerciasis) that CDDs play an essential role in motivating and influencing drug coverage rates with MDA in their communities. In recent times NTD program managers have faced implementation challenges with the use of volunteers for MDA programs. This was expressed at the Program Managers session at the 2014 COR-NTD meeting held in New Orleans and also during a brainstorming session held with African program managers in Ghana (April 2015). Research resulting from these meetings was used to develop subsequent studies in Cote d’Ivoire and Uganda. The primary aim of the mixed methods research was to explore the external and internal factors that motivate CDDs in their NTD work. A secondary component included exploration of resilience and documentation of out of pocket and opportunity costs that CDDs incur in the course of their work. In Uganda, two districts were selected for data collection –Omoro and Zombo, both rural areas in the north of the country. In Côte d’Ivoire, two areas were selected: Abidjan (urban) and N’Zi Iffou (rural). Due to the importance of context in this qualitative research, the study's authors request that you contact Dr. Alison Krentel ([e-mail]) prior to using this data.