Mass drug administration (MDA) to eliminate trachoma – the world’s leading infectious cause of blindness – requires giving medication once a year to everyone in areas affected by the disease. This year in Zimbabwe that meant ten districts. In all, 1.4 million people needed to be reached. In one week!
With these types of numbers, and given the nature of the disease, which thrives in remote areas, MDA campaigns are an exercise in logistics and sheer willpower. Through the new Accelerate programme, this feat has been achieved, but even with a well-organised system, monitoring campaigns and keeping in touch with drug distributors and supervisors throughout can be a challenge.
Not being able to see where issues are occurring or communicate with the right workers when they need support negatively affects performance. But technology – in various forms – is helping to solve these issues.
Applying lessons learned from previous real-time MDA monitoring, carried out to eliminate other neglected tropical diseases, we built a platform to capture trachoma data. For this we used something called District Health Information Software (DHIS2), an open-source platform that reports, analyses and disseminates data for health programmes and is used by many ministries of health to collect monthly reports, including Zimbabwe.
We worked with Zimbabwe’s Health Information and Surveillance Unit to design a monitoring platform specifically for MDA, define the new reporting processes, and train field teams.
In total, we had 278 distribution teams tasked with bringing treatment to at-risk communities, and targets were set for each one. Each team uploaded data every day so progress could be tracked. Drug use and stock was also followed daily.
Engagement across the programme was extremely high during the campaign, and it was easy to see why. Thanks to the monitoring platform, for the first time national and province-level workers were able to have a view of the whole MDA as it unfolded.
District-level team leaders were able to identify the distribution teams that needed additional support then provide it, which helped to encourage individual teams to reach their target. The command centre ran a tight ship throughout, helping everyone else focus on delivering the campaign.
Once treatment was complete, a data verification process followed. Less than two weeks after the MDA, the programme had a full data set showing 87 per cent of people in target communities had been reached.
This is exciting for two reasons. First, treatment coverage was high. With trachoma MDA, the general goal is to reach between 85 and 90 per cent of people, but meeting this target is often a challenge because of the logistical complexities and visibility issues discussed above. The speed at which the reports were available was also significant. Data collation usually takes months, which can hinder review meetings and activity planning.