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Optimising the performance of frontline implementers engaged in the NTD programme in Nigeria: lessons for strengthening community health systems for universal health coverage

Oluwole, Akinola, Dean, Laura ORCID:, Lar, Luret, Salami, Kabiru, Okoko, Okefu, Isiyaku, Sunday, Dixon, Ruth, Elhassan, Elizabeth, Schmidt, Elena, Thomson, Rachael, Theobald, Sally ORCID: and Ozano, Kim (2019) 'Optimising the performance of frontline implementers engaged in the NTD programme in Nigeria: lessons for strengthening community health systems for universal health coverage'. Human Resources for Health, Vol 17, Issue 1, e79.

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Background: The control and elimination of Neglected Tropical Diseases (NTDs) is dependent on mass
administration of medicines (MAM) in communities and schools by community drug distributers (CDDs) who are
supported and supervised by health facility staff (FLHF) and teachers. Understanding how to motivate, retain and
optimise their performance is essential to ensure communities accept medicines. This study aimed to capture and
translate knowledge, problems and solutions, identified by implementers, to enhance NTD programme delivery at
the community level in Nigeria.
Methods: Qualitative data was collected through participatory stakeholder workshops organised around two
themes: (i) identification of problems and (ii) finding solutions. Eighteen problem-focused workshops and 20
solution-focussed workshops were held with FLHF, CDDs and teachers in 12 purposively selected local government
areas (LGA) across two states in Nigeria, Ogun and Kaduna States.
Result: The problems and solutions identified by frontline implementers were organised into three broad themes:
technical support, social support and incentives. Areas identified for technical support included training, supervision,
human resource management and workload, equipment and resources and timing of MAM implementation. Social
support needs were for more equitable drug distributor selection processes, effective community sensitisation
mechanisms and being associated with the health system. Incentives identified were both non-financial and
financial including receiving positive community feedback and recognition and monetary remuneration. The results
led to the development of the ‘NTD frontline implementer’s framework’ which was adapted from the Community
Health Worker (CHW) Generic Logic Model by Naimoli et al. (Hum Resour Health 12:56, 2014).
Conclusion: Maximising performance of frontline implementers is key to successful attainment of NTD goals and
other health interventions. As NTDs are viewed as a ‘litmus test’ for universal health coverage, the lessons shared
here could cut across programmes aiming to achieve equitable coverage. It is critical to strengthen the
collaboration between health systems and communities so that together they can jointly provide the necessary
support for frontline implementers to deliver health for all. This research presents additional evidence that involving
frontline implementers in the planning and implementation of health interventions through regular feedback
before, during and after implementation has the potential to strengthen health outcomes.
Keywords: Frontline implementers, NTD programme, Optimising performance, Challenges and solutions, Nigeria,
Universal health coverage, Health equity, Participatory research methods

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 680 Tropical diseases (General)
Faculty: Department: Biological Sciences > Department of Tropical Disease Biology
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):
Depositing User: Rachel Dominguez
Date Deposited: 15 Nov 2019 12:05
Last Modified: 20 Nov 2019 14:08


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