Abstract
BackgroundSri Lanka was acknowledged to have eliminated lymphatic filariasis (LF) as a public health problem in 2016, largely due to its success in Mass Drug Administration (MDA) to interrupt disease transmission. Analysis of the Strengths, Weaknesses, Opportunities and Threats (SWOT) of the national Morbidity Management and Disability Prevention (MMDP) program, the other pillar of the LF control program, was carried out with the objective of evaluating it and providing recommendations to optimize the use of available resources.MethodologyA situation analysis of the MMDP activities provided by the state health sector was carried out using published records, in-depth interviews with key informants of the Anti Filariasis Campaign, site-visits to filariasis clinics with informal discussions with clinic workforce and personal communications to identify strengths and weaknesses; and opportunities to overcome weaknesses and perceived threats to the program were explored.The principal strength of the MMDP program was the filariasis clinics operational in most endemic districts of Sri Lanka, providing free health care and health education to clinic attendees. The weaknesses identified were the low accessibility of clinics, incomplete coverage of the endemic region and lack of facilities for rehabilitation. The perceived threats were diversion of staff and resources for control of other vector-borne infections, under-utilization of clinics and non-compliance with recommended treatment. Enhanced high level commitment for MMDP, wider publicity and referral systems, integration of MMDP with other disease management services and collaboration with welfare organizations and research groups were identified as opportunities to overcome weaknesses and challenges.ConclusionsThe recommended basic package of MMDP was functional in most of the LF-endemic region. The highlighted weaknesses and challenges, unless addressed, may threaten program sustainability. The identified opportunities for improvement of the programme could ensure better attainment of the goal of the MMDP program, namely access to basic care for all affected by lymphatic filarial disease.
Highlights
lymphatic filariasis (LF) is an important public health and socioeconomic problem worldwide
Data was collected for the SWOT analysis by reviewing LF data published in reports of the Anti-Filariasis Campaign (AFC), by in-depth interviews with identified key informants of the AFC and Regional Filariasis Control Units (RFCU), sitevisits and focus group discussions with service providers of Management and Disability Prevention (MMDP)
Two open ended questions were included into interviews and group discussions to evaluate service performance and perceived challenges to MMDP program, namely, practices implemented for management of lymphoedema in their respective units and the challenges and obstacles faced by the respective units in implementing the program activities, especially those perceived to be linked to LF elimination status
Summary
LF is an important public health and socioeconomic problem worldwide. It has been ranked as the second leading cause of permanent disability [1]. Physical and social functions as well as psychological wellbeing of patients with lymphoedema and elephantiasis are significantly impaired due to the pain and discomfort, restricted mobility, social stigmatization, feelings of embarrassment and emotional distress that accompany these chronic disfiguring manifestations [2, 3, 4]. Those afflicted with advanced disease may lose their livelihoods due to the associated disability or social stigma [5]. Analysis of the Strengths, Weaknesses, Opportunities and Threats (SWOT) of the national Morbidity Management and Disability Prevention (MMDP) program, the other pillar of the LF control program, was carried out with the objective of evaluating it and providing recommendations to optimize the use of available resources
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