Assessing Implementation Fidelity Following the Mass Drug Administration Programme for Lymphatic Filariasis in South Bangka District, Indonesia: an Implementation Research

Berita Kedokteran Masyarakat
Vol 36, No 5 (2020)

Background: Since the MDA for LF started, a significant progress has been made in Indonesia. However, some challenges have been found in the implementation of MDA. South Bangka District failed post-MDA surveillance and re-implemented MDA in 2018 and 2019. If this failure continue to happen, the elimination goal might be difficult to attain. Therefore there is a need to investigate why there is a persistent transmission of LF despite eight rounds of MDA which has sufficient reported coverage.Objectives: This study aimed to assess implementation fidelity and its potential moderators of the MDA programme for LF in South Bangka District.Method: This was a qualitative study which used case study approach that took place in South Bangka District and Bedengung Village. Data were collected through IDI with six stakeholders from different level of health offices, one village secretary and fourteen community members. Meanwhile, FGD were conducted with eight CHWs and five community members. All participants should have involvement in the previous MDA programme to be recruited in this study.Results: MDA programme were implemented according to its guideline with some changes in terms of timeline, screening process of target population, implementation strategy, and monitoring process. Community leader engagement and DOT-MDA strategy have improved the community compliance. However, noncompliance and low participation in community-based health education were found as main challenges. Training, intersectoral socialization and advocacy, and health education were suboptimal. There was also potential bias on the screening process of eligible population. In addition, policy influenced the resources allocation during MDA implementation.Conclusion: The implementation of MDA can be improved by focusing on community mobilization. The screening process should also be done carefully in order to cover all eligible population. Besides, it is important to optimize the resource allocation by improving the coordination with all potential partners.