The impact of integrating the elimination programme for lymphatic filariasis into primary health care in the Dominican Republic

Abstract

Integration of disease-specific programmes into existing health care delivery systems is a challenge for many countries, made more salient as the scope and scale of disease-specific programmes increases. This paper reports on the programmatic outcomes of 2 years of integrating the lymphatic filariasis (LF) elimination programme into primary health care (PHC) in the Dominican Republic during a period of national health care reform and decentralization. Data were collected retrospectively from community volunteers, PHC staff and LF programme staff using a mix of quantitative and qualitative methods. Benefits of integration for LF elimination included increasing the extent of the geographic coverage of mass drug administration (MDA) and a 21% increase in municipalities achieving the MDA target coverage rate of 80%. Benefits which accrued to PHC included improved information systems and strengthened relationships between the health services and the community. This study also identified challenges to implementing integration and the solutions found. These include the importance of focusing on the professional development of disease-specific program staff as their roles change, strengthening specific weakness in the general health system and finding alternative solutions where these are not easily solved, actively engaging senior management at an early stage, continually evaluating the impact of integration and not pushing integration for the sake of integration.

Maintaining effective mass drug administration for lymphatic filariasis through in-process monitoring in Sierra Leone

“…In the Dominican Republic the challenges of integrating the LF program into primary health care demonstrated the importance of engaging senior management at an early stage. [13] Collaboration between NMCP and NTDCP-managers could have integrated LLITN and LF MDA distribution as in Central Nigeria [14]. …”

The Neglected Tropical Diseases of Latin America and the Caribbean: A Review of Disease Burden and Distribution and a Roadmap for Control and Elimination

“…For example, supported by grants from USAID and the Gates Foundation, Haiti is implementing a pilot project to combine MDA for LF elimination and STH control, while the Honduras Ministry of Health is piloting studies to add deworming for STH control to its maternal and child health, vitamin A delivery, and Chagas disease vector control programs. In the Dominican Republic, the Ministry of Health has successfully integrated MDA into its primary health care system in the southwest region [80]. Similarly, in Nicaragua, deworming is conducted in conjunction with annual nationwide child vaccination campaigns, and in Ecuador multiple partners collaborate to implement deworming of families as a part of a nutritional outreach program targeting the poorest communities.…”

Community-directed interventions for priority health problems in Africa: results of a multicountry study

“…6,7 Greater integration is particularly relevant for the delivery of those community-level interventions in which the community itself participates. 6,8 There is little scientific evidence, however, on how to achieve this integration within the context of primary health care. 9 More research on effective and integrated delivery strategies for community-based interventions is urgently needed.…”