Who is left behind in Mass Drug Administration?

Ensuring equity in the prevention of neglected tropical diseases (NTDs) is critical to reach NTD elimination goals as well as to inform Universal Health Coverage (UHC). Now, researchers reporting in PLOS Neglected Tropical Diseases have unmasked inequities in the delivery of Mass Drug Administration (MDA) programmes that leave vulnerable populations underserved.

Individuals and communities affected by NTDs are often the poorest and most marginalized. NTDs amenable to prevention through MDA programmes have been described as the "litmus test" for UHC due to the high MDA coverage rates needed to be effective and their model of community engagement for access and acceptance of medicines.

In the new work, Laura Dean of Liverpool School of Tropical Medicine, UK, and colleagues analyzed MDA programmes across Cameroon, Ghana, Liberia and Nigeria. They used both qualitative programmatic analysis and gendered intersectional theory— which provides a framework for how power and position shape people's experiences— to interrogate the domains of coverage within the Tanahashi Framework; availability, accessibility, acceptability, contact and effectiveness of programmes.

The team found effective treatment for individuals and communities is shaped by individual identities and the intersecting axes of inequity that converge to shape these positions, including gender, age, disability and geography. Health systems bottlenecks, challenges and limitations, sometimes due to lack of consideration and discussion of gender and equity issues have left vulnerable populations underserved in relation to the prevention and treatment of PC NTDs across all types of coverage explored within the Tanahashi framework.

"As we move toward the progressive realization of UHC, these findings should be central to discussions on providing health for all," the researchers say. "MDA campaigns have been implemented for many years and the inequities within them are only now being discussed."