Odisha’s mass drug administration (MDA) program was remarkable in its adoption of best practices to drive the success of the program. Although the state faced many implementation challenges related to compliance and geographic disparities, Odisha took the necessary measures to address them. Other states can draw lessons from Odisha’s creative solutions and adapt them to their own contexts. In this section we look at two distinct challenges that Odisha faced and overcame during the MDA program.
Koraput District is predominantly tribal, with more than 70 percent of its population belonging to tribal communities, who together make up 52 tribal groups. Geographically, the region consists of large swaths of rugged hills, interspersed with deep river valleys and broad plateaus. District and block officials in Koraput reported the following challenges due to tribal demographics and the remote and difficult geography:
- Diversity of dialects: Koraput District borders the states of Chhattisgarh and Andhra Pradesh, where various languages and dialects are spoken. Thus, the dialects in Koraput differ vastly from one tribe to the next. This linguistic challenge was overcome by providing all training to drug administrators in the particular dialects of the area assigned to them. This also ensured that drug administrators were able to conduct effective social mobilization and drug administration to successfully ensure awareness, uptake, and compliance with MDA.
- Delayed communication due to low mobile network connectivity: Koraput District suffers from poor mobile connectivity, which resulted in delayed communication of MDA dates and drug administrators’ training schedules. In the latter case, a lag in communication often resulted in drug administrators missing their training sessions, which proved problematic as drugs were distributed at these training sessions. To resolve these challenges, district-level authorities identified informers (usually a relative of a health worker already visiting Koraput for personal reasons) to relay essential information about the MDA campaign and deliver drugs for the drug administrators stationed in Koraput.
- Timeline for mop-up activities: Koraput’s hilly terrain and scattered population posed challenges in completing the MDA campaign in the allotted time. The mop-up timeline was therefore extended from two days to one week in Koraput.
- Safety concerns for female drug administrators: Koraput is a remote region with geopolitical challenges, where hamlets are highly dispersed––usually 4 to 5 kilometers apart. The drug administrators therefore had to walk long distances through isolated landscapes, which created safety concerns for drug administrator teams who were generally composed of women, namely community health workers and Anganwadi workers. To address this challenge, district officials selected male family members of drug administrators for safety—and sometimes transportation support if they possessed bicycles and motorcycles.
For an MDA program to succeed, community buy-in and availability of community members during drug administration are perhaps the most important factors. In Odisha, there were reported issues of low community buy-in and a distrust in government health care services.
Low Community Buy-in
A large number of community members refused to take the drugs because they were unaware of the benefits. To address this issue, local influencers including health workers, ward members, members of Panchayati Raj Institutions (a system of self-government at the village level), and the Sarpanch (elected head of the Gram Panchayat) actively worked to sensitize the community about the benefits and reasons for the drugs and engaged with them to convince them to participate in the MDA rounds.
Distrust in Government Health Care Services
In the coastal districts of Kendrapara and Jajpur, communities are economically stronger, largely literate, and they have a preference for private health workers. As a result, there is widespread distrust in government-provided health care services, including the MDA program. To address this challenge, additional information, education, and communication activities and local media advocacy were carried out to influence perceptions in these areas. As people began trusting in the public health system and programs, compliance improved with subsequent rounds of MDA.