Research Approach
This narrative sought to identify and document best practices and learnings from the mass drug administration (MDA) campaigns in Maharashtra, implemented as part of the Elimination of Lymphatic Filariasis (ELF) program.
To understand these best practices, the study examined MDA program design and implementation across three stages—pre-MDA activities to plan and prepare the campaign, the MDA campaign, and post-MDA activities. A descriptive analysis of management and disability prevention activities complemented the study. Political, social, and economic factors that shaped the development of the MDA program in Maharashtra were also considered for context throughout the process.
Advisory Panel
The Bill & Melinda Gates Foundation and Gates Ventures worked closely with the National Vector Borne Disease Control Program (NVBDCP) 18-member technical advisory committee consisting of select state representatives and experts including the Indian Council of Medical Research and the Vector Control Research Center. The panel helped identify the right parameters for the selection of exemplar states to ensure that findings from the study would remain relevant to other endemic states.
Input from partners such as the World Health Organization, PATH, Project Concern International, and Global Health Strategies was also leveraged throughout the study.
Research and Narrative Partners
IQVIA conducted the identification of key documents and stakeholders, field research, and analysis for this narrative. Sattva translated the research findings into this narrative.
The study relied heavily on publicly available program guidelines issued by the National Health Mission, NVBDCP, and the Vector Control Research Center. Learnings from these guidelines were supplemented by a review of more than 20 to 30 documents on the landscape and disease burden of lymphatic filariasis (LF) across states in India, and the various policies and programs being undertaken to address it. The documents studied included peer-reviewed journal articles, program evaluation studies, and strategy documents.
The study also analyzed data shared by NVBDCP and Maharashtra state officials on the LF burden including microfilaria rates, MDA coverage, and socioeconomic indicators such as nutrition, immunization rates, and gross domestic product for the selection of the states.
IQVIA conducted 33 semi-structured interviews in Wardha and 22 in Amravati, with key state, district, and block-level stakeholders. Two focus group discussions were conducted in Wardha and three in Amravati, with field-level workers. All interviews were recorded and transcribed.
Findings from the literature review informed the development of the interview guides. The questionnaires were directed toward understanding the experiences, challenges, and constraints encountered in the course of ELF management, from MDA implementation to morbidity management and disability prevention implementation, as shown in Figure 1.
Figure 1: Implementation of MDA and MMDP
The data collected were analyzed and synthesized according to the study framework. Findings from these interviews were further triangulated with LF experts to develop this narrative.