Review of the factors influencing the motivation of community drug distributors towards the control and elimination of neglected tropical diseases (NTDs)

Abstract

BackgroundCommunity drug distributors or neglected tropical disease (NTD) volunteers have played a crucial role in ensuring the success of mass drug administration (MDA) programs using preventive chemotherapy (PC) for lymphatic filariasis, onchocerciasis, schistosomiasis, trachoma and soil transmitted helminths. In recent years however, a noticeable decline in motivation of some of these volunteers has been perceived, potentially negatively impacting the success of these programs. Potential hypotheses for this change in motivation include the long duration of many MDA programs, the change in sociocultural environments as well as the changes to the programs over time. This literature review identifies factors that affect NTD volunteer performance and motivation, which may be used to influence and improve future programming.Methodology/Principal findingsA systematic search was conducted to identify studies published between January 1995 and September 2016 that investigate factors pertaining to volunteer motivation and performance in NTD drug distribution programs. Searches from several databases and grey literature yielded 400 records, of which 28 articles from 10 countries met the inclusion criteria. Quality assessment of studies was performed using the Critical Appraisal Skills Programme(CASP) checklist. Data pertaining to motivation, performance, retention and satisfaction was extracted and examined for themes. Recurring themes in the literature included monetary and material incentives, intrinsic motivation, gender, cost to participate, and health systems and community support. Of these, community support and the health system were found to be particularly impactful. Very few studies were found to explicitly look at novel incentives for volunteers and very few studies have considered the out of pocket and opportunity costs that NTD volunteers bear carrying out their tasks.Conclusions/SignificanceThere is currently great interest in incorporating more attractive incentive schemes for NTD volunteers. However, our results show that the important challenges that volunteers face (cultural, health systems, financial and community related) may have less to do with financial incentives and may actually have a larger impact on their motivation than has previously been understood. Further integration of NTD programs into existing health systems is expected to improve the NTD volunteer working environment. Relevant community engagement related to the MDA program should also provide the supportive environment needed in the community to support NTD volunteers. Programs need to consider these issues to improve working conditions for NTD volunteers.

Implementer and recipient perspectives of community-wide mass drug administration for soil-transmitted helminths in Kwale County, Kenya

“…A conceptual framework mapping out the key components of community-wide MDA was developed as a tool to shape the codebook and coding process. Development of the framework was based on existing literature and authors' implementation experience regarding delivery of MDA programs [14][15][16][17]. The framework (Fig 1) presents key inputs and contextual factors relevant to the planning and delivery of MDA leading to two outputs: "reach" and "uptake".…”

Gender-related factors affecting health seeking for neglected tropical diseases: findings from a qualitative study in Ethiopia

“…While gender-related differences in terms of NTD burden are well documented, there is a paucity of research on how gender interacts with NTD service provision and uptake. Of the limited literature available, studies have mainly explored access to mass drug administration (MDA) and how gender relates to the experience of being an NTD volunteer [29][30][31][32][33][34][35][36]. For example, that female NTD volunteers uniquely contend with the challenges of balancing work and family commitments [31].…”

“…Of the limited literature available, studies have mainly explored access to mass drug administration (MDA) and how gender relates to the experience of being an NTD volunteer [29][30][31][32][33][34][35][36]. For example, that female NTD volunteers uniquely contend with the challenges of balancing work and family commitments [31]. In terms of MDA coverage, a study in Uganda found that men may miss out on treatment as they were more likely to be away from their homes due to occupational roles, whilst some Community Drug Distributors (CDDs) withheld drugs from pregnant or breastfeeding women due to drug safety concerns [29].…”

“…However, a recent study of MDA coverage in 16 countries suggested that NTD programmes "consistently achieve at least equal levels of coverage for women" [30]. Study findings on NTD volunteer performance, specifically, the effectiveness and coverage of MDA by female versus male NTD volunteers and recipient compliance, varied by setting and treatment [31][32][33][34][35][36][37].…”

Gender norms and mass deworming program access in Comé, Benin: A qualitative assessment of gender-associated opportunities and challenges to achieving high mass drug administration coverage

“…This is likely due to the fact that FGD guides were not specifically designed to delve into gender-specific content. Several studies have similarly identified that male and female CDDs approach MDA delivery activities such as community sensitization differently and thus an awareness of the preferences and needs of each gender may be an important addition to CDD training activities [12,33]. A more gender-equitable CDD workforce may have a more balanced representation of the priorities and concerns of all genders, with positive effects on MDA treatment coverage.…”