What is mass drug administration?

A young girl takes treatment from a community volunteer during a mass drug administration to protect the community from lymphatic filariasis and onchocerciasis in Tambura State, South Sudan.

©MENTOR/Olivia Wetherill

Sightsavers works with thousands of local volunteers to distribute millions of donated treatments and protect people from five neglected tropical diseases.

Mass drug administration (MDA) is ‘the administration of treatment to every member of a defined population or every person living in a defined geographical area’. This means that all eligible people, regardless of whether or not they are infected, receive the treatment they need.

MDAs are a vital process in the control and elimination of neglected tropical diseases (NTDs), as by treating all eligible people in a population on a regular basis, you’re ensuring that those who are infected are treated, and that those who aren’t are protected from future infection.

Since 2016, more than a billion people a year have received treatment through MDA for the NTDs that affect their communities. Here, we identify the key steps to a successful MDA.

Step one: Identify where treatment is needed

One way Sightsavers works with countries to identify where treatment is needed is through mapping surveys. Two examples of these are:

The Tropical Data project, a data-collection initiative that helps countries carry out surveys as they work towards eliminating trachoma.
The Onchocerciasis Elimination Mapping Project, which is used to map the spread and transmission of river blindness.

Both projects use smartphone technology to collect high-quality, standardised data so ministries of health are able to pinpoint exactly where to run treatment programmes.

A Tropical Data trainee examines a young child for trachoma while the recorder enters data into a mobile phone.

Step two: Raise awareness in communities

Mobilisers go out to the communities where treatment is needed to raise awareness of the disease and treatment process. Then, planning meetings are held to clearly lay out the roles and responsibilities of everyone involved.

The information about the disease and planned MDA is often then shared with those who need the treatment via community gatherings at a local church or school.

A community volunteer explaining about river blindness to community members. — Clécio, a biologist with Ministry of Health Mozambique, explains how river blindness is spread by the bite of a black fly to community members in Zambezia Province.

Step three: Train community volunteers to distribute treatment

Local volunteers, known as community-designated distributors (CDDs), are nominated by their communities to distribute treatments. Many have experienced how NTDs affect lives and understand their community’s dynamics and customs. This enables them to reach people who need help the most, and ensures that vital drugs are distributed in even the poorest and most remote places.

The volunteers go through training to learn more about the diseases, as well as how to properly distribute the treatment. For example, CDDs are each given a dose pole, a light universal device used to measure the height of patients and to calculate the correct dose depending on how tall they are.

This community-focused approach means the communities themselves are at the centre of efforts to combat NTDs, ensuring long-term and sustainable solutions.

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Community volunteers sit through a training for mass drug administration in South Sudan. — Community volunteers sit through a training session for mass drug administration in South Sudan. ©MENTOR/Olivia Wetherill

A community volunteer stands with her dose pole following training. — A community volunteer stands with her dose pole following a training session in South Sudan. ©MENTOR/Olivia Wetherill

Step four: Ship treatments to the communities

Treatments for the five NTDs that Sightsavers treat are generously donated by pharmaceutical companies including Pfizer, Merck & Co, GlaxoSmithKline, Merck Serono and Johnson & Johnson. They are shipped to the countries which require intervention, and once they arrive they are distributed to the local communities where the MDA will be carried out.

A volunteer unloads packages from a plane. — Treatment and equipment arrive in Tambura, South Sudan, to be used in local MDA. ©MENTOR/Olivia Wetherill

Step five: Distribute treatment to entire population

The communities are notified that an MDA will be happening and are advised to stay near their homes. Treatments are then most often distributed at a central point, for instance a school, but volunteers will also go house-to-house to ensure they reach everybody. During MDAs, CDDs can walk several miles a day to deliver treatment.

CDDs make a record of treatments given in logbooks, to ensure they have reached the correct households. If a household member is absent during the day of an MDA, volunteers arrange follow-up visits to try and reach them.

This means that even in hard-to-reach rural areas, Sightsavers is able to protect those most in need.

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A community volunteer walks down a dirt road with his dose pole. — A community volunteer walks down a remote road with his dose pole during an MDA in South Sudan. ©MENTOR/Olivia Wetherill

A community volunteer distributes treatment to a couple. — Mohammad and his wife Sanaa are given treatment as part of an MDA to combat trachoma near Matay, Egypt.

A young girl's height is measured using a colourful dose pole. — A young girl's height is measured using a colourful dose pole during an MDA in Matay, Egypt.

Community volunteers look at data in South Sudan. — Community volunteers look at data collected during mass drug administration in South Sudan. ©MENTOR/Olivia Wetherill

Step six: Evaluate impact

On completion of the MDA campaign, logbooks are collected and the data is summarised and then observed by the local Ministry of Health and The World Health Organization (WHO), to evaluate coverage and determine next steps. MDAs will usually be carried out at recurring intervals until the WHO determines the area is free of the disease.

Elimination in Ghana

Zenabu dances and sings with joy after having her sight restored through surgery.

In 2018, Sightsavers and partners announced that trachoma had been eliminated in Ghana, making it the first sub-Saharan African country to do so – this was largely thanks to MDA campaigns in the country.

Our work with neglected tropical diseases

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What is mass drug administration?

Sightsavers works with thousands of local volunteers to distribute millions of donated treatments and protect people from five neglected tropical diseases.