Table 2 Summary of key results by theme and country
Theme | Related CFIR constructs and other codes | Common findings across three sites | Country-specific findings | ||
|---|---|---|---|---|---|
Benin | India | Malawi | |||
Key facilitators for launching cMDA | |||||
Effective, tailored community sensitization is a key component of successfully launching cMDA | Engaging participants Engaging leaders Design quality and packaging Intervention complexity | Strong outreach activities at baseline are particularly important for overcoming myths related to cMDA rollout | Outreach activities will need to be tailored to address adults who may believe they are at low risk for STH infection | Outreach activities will need to be tailored to address adults who may believe they are at low risk for STH infection Outreach activities should be further tailored by geography, education, and socio-economic status | Outreach messages need to be tailored to community sub-groups, such as religious groups |
Opportunities to leverage existing health campaign infrastructure is important for policy stakeholders to support cMDA launch | Structural characteristics Tension for change Adaptability | Existing school-based and lymphatic filariasis MDA resources can be used to support the launch of cMDA including human resources and existing infrastructure | cMDA for STH should be integrated within child health programs | cMDA for STH should be integrated within maternal and reproductive health program objectives | No additional Malawi-specific findings |
Key barriers to launching cMDA | |||||
Policy stakeholders are concerned about health worker workload when implementing cMDA | Available resources Organizational incentives Implementation climate Relative advantage Intervention complexity Readiness | Stakeholders are concerned that Community Drug Distributors (CDDs) are overworked and that increasing workload will lead to poorly delivered cMDA programs | Stakeholders believe there are not enough CDDs available to support a cMDA program Insufficient incentives and a focus on performance-based targets are barriers to successfully launching cMDA Supervisors may not be able to provide adequate supervision to CDDs during cMDA programs | Stakeholders suggest that the CDD workforce would need to be increased to deliver cMDA and overcome challenges including delivery to hard-to-reach places The health workforce may not immediately accept launching cMDA if it increases their workload | Stakeholders believe there are not enough CDDs readily available to support a cMDA program Launching cMDA would require additional monetary incentives for the involved health workforce The CDD workforce would need to be expanded The cMDA program would need to account for challenges including delivery in hard-to-reach areas, inadequate time to deliver, and multiple visits |
Policy stakeholders are uncertain about the sustainability of cMDA programs without additional external funding | Relative priority Available resources Financial cost Donor relationships | There are a limited number of donors and partners supporting NTD programs globally, which might compromise the ability to scale-up cMDA programs more broadly | cMDA will not be successful in the long-term without support from donors and non-governmental organizations | Financial resources were not perceived to be a major barrier due to reduced donor dependence | cMDA will not be successful in the long-term without support from donors and non-governmental organizations |
Concerns about existing intragovernmental partnerships are barriers to launching cMDA | Cosmopolitanism | No common finding across all three countries | Did not highlight cross-ministry or partner coordination challenges | Did not highlight cross-ministry or partner coordination challenges | Stakeholders are concerned about the lack of formal information-sharing systems and supervisory structures necessary to collaborate between involved government ministries |
Cross-cutting theme | |||||
Future updates to STH policy will require rigorous evidence to ensure buy-in from policy stakeholders | Knowledge and beliefs Evidence strength and quality | Rigorous clinical and implementation evidence are needed before updating current STH policies Policymakers had positive attitudes that cMDA could potentially eliminate STH, primarily because they believed that tools are currently available to achieve targeted endpoints | No additional Benin-specific findings | No additional India-specific findings | No additional Malawi-specific findings |