Successful Factors in Lymphatic Filariasis Elimination

Our analysis conducted in Maharashtra and Odisha shows the following common characteristics among high-performing MDA programs:

• Adapting global and national guidelines to the local context: Modifying training, guidelines, and communication and social mobilization strategies to the local context increases operational flexibility. WHO guidelines on eliminating lymphatic filariasis are based on extensive research and observation of interventions across contexts, and they incorporate practices and processes designed for effective program implementation. Successful programs communicated the guidelines clearly through translated tools that are adapted to the local context for easy adoption and implementation.
• Extensive microplanning for MDA implementation: Creating detailed microplans streamlines MDA implementation and helps anticipate hotspots, at-risk areas, and low-coverage areas.¹ Microplans can ensure that implementation meets program requirements by including information on the district’s demographics, human resources, training, communications, and social mobilization activities, in addition to estimates on staffing, funding, and drugs.¹  
• Strengthening staff capacity: Local staff need to receive training on disease epidemiology, MDA administration protocol, sensitization techniques, and troubleshooting in case of side effects. Strengthening capacity is imperative for successful implementation as experienced staff ensures high MDA coverage and compliance. WHO’s strategy highlights the significance of training frontline health care providers including drug administrators and volunteers in disease epidemiology, drug administration protocol, communication skills and sensitization techniques, and troubleshooting in case of side effects.¹  
• Leveraging support from local resources: Inclusion and participation from trusted frontline primary health care systems and local self-governing bodies lends credibility to MDA programs and increases community acceptance. Leveraging support from local resources and ensuring ownership of the MDA program by the local leaders enhance implementation by providing input that bridges gaps and enables last-mile flexibility to manage challenges. 
• Leveraging local networks for social mobilization: Local staff and governance bodies have existing relationships with communities and therefore play a critical role in communication and social mobilization efforts to increase participation in MDA.¹ Local influencers, including social and religious leaders, can help with behavior change efforts leading to high MDA coverage. These influencers can also play a role in door-to-door counseling and targeting noncompliant individuals to participate in MDA campaigns.²

MDA implementation efforts in India are supported through a multisectoral approach by a network of partners, including WHO, Project Concern International, Clinton Health Access Initiative, Global Health Strategies, PATH, and the Bill & Melinda Gates Foundation. Support from partners included:

• Providing tools for successful planning, implementation, and capacity strengthening of local staff.
• Developing capacity-strengthening materials for training at the state and district levels. Partners designed holistic training materials that emphasized capabilities such as soft skills and used innovative methods such as role-based training in real situations.
• Facilitating collaborations between key stakeholders and convening committees and meetings responsible for oversight and management. Partners also provided assistance to the National Vector Born Disease Control Programme and assisted NITI Aayog in the formulation of guidelines.
• Innovative technology to ensure effective monitoring, such as a decision-making tool that makes predictions for MDA and transmission assessment surveys based on historical data, and a pre-MDA tracking tool to assess preparedness of districts and state before MDA implementation.