Microplanning improves stakeholders’ perceived capacity and engagement to implement lymphatic filariasis mass drug administration
Authors: Worrell Caitlin M. , Brant Tara A. , Javel Alain , Denis Eurica , Fayette Carl , Monestime Franck , Knowles Ellen , Bennett Cudjoe , Utzinger Jürg , Odermatt Peter , Lemoine Jean-Frantz 
Published: March 2024

AbstractBackgroundAchieving adequate mass drug administration (MDA) coverage for lymphatic filariasis is challenging. We sought to improve stakeholder engagement in MDA planning and improve subsequent MDA coverage through a series of microplanning workshops.Methodology/Principal FindingsPrior 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 used 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 following the 2-day microplanning workshop. Changes in pre- and post-scores were analyzed using Wilcoxon-signed rank tests. 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, drug coverage increased in all five communes during the 2018 MDA.Conclusions/SignificanceParticipatory stakeholder workshops during MDA planning can increase self-reported engagement of key personnel and may improve personnel performance and contribute to achievement of drug coverage targets. Microplanning success was supported by MDA results, with all communes achieving preset MDA coverage targets.Author summaryLymphatic filariasis is a neglected tropical disease that can be eliminated by treating entire at-risk communities with safe and efficacious medicines, a strategy known as mass drug administration (MDA). MDA campaigns require intense planning to ensure that every eligible person within the community can receive the medicines if they desire. We aimed to improve the campaign by better involving key MDA stakeholders such as volunteers and other important community members in the planning process, through microplanning. The participants suggested many strategies to help the campaign reach more community members, including better ways to prepare and inform that community that the campaign is happening. We invited the microplanning participants to give feedback on how this new strategy worked compared with their experiences during past campaigns. Participants reported that they felt better engaged by health authorities, and in particular, that they had more information about the results of past campaigns, where they should be distributing medicines, and their specific tasks and responsibilities during the campaign. We found that more people received medicines during the campaign that followed the microplanning workshops compared with the previous campaigns. We conclude that microplanning helped to increase the number of people who received MDA medicines.