Unlocking Trust in Community Health Systems: Lessons From the Lymphatic Filariasis Morbidity Management and Disability Prevention Pilot Project in Luangwa District, Zambia.

Joseph M Zulu,Patricia Mubita,George Sichone,Frank Shamilimo,Patricia Maritim,Charles Michelo,Adam Silumbwe,Hikabasa Halwiindi,Chileshe H Mpandamabula

doi:10.34172/ijhpm.2021.133

Abstract

Background: Surgery for hydrocele is commonly promoted as part of morbidity management and disability prevention (MMDP) services for lymphatic filariasis (LF). However, uptake of these surgeries has been suboptimal owing to several community level barriers that have triggered mistrust in such services. This study aimed at documenting mechanisms of unlocking trust in community health systems (CHSs) in the context of a LF hydrocele management project that was implemented in Luangwa District, Zambia. Methods: Qualitative data was collected through in-depth interviews (IDIs) and focus group discussions (FGDs) (n=45) in February 2020 in Luangwa District. Thirty-one IDIs were conducted with hydrocele patients, community health workers (CHWs), health workers, traditional leaders and traditional healers. Two FGDs were also conducted with CHWs who had been involved in project implementation with seven participants per group. Data was analyzed using a thematic analysis approach. Results: The use of locally appropriate communication strategies, development of community driven referral systems, working with credible community intermediaries as well as strengthening health systems capacity through providing technical and logistical support enhanced trust in surgery for hydrocele and uptake of the surgeries. Conclusion: Implementation of community led communication and referral systems as well as strengthening health services are vital in unlocking trust in health systems as such mechanisms trigger authentic partnerships, including mutual respect and recognition in the CHS. The mechanisms also enhance confidence in health services among community members.

Highlights

Lymphatic filariasis (LF), a neglected tropical disease, accounts for 1.36 million disability adjusted life years globally.[1]
Implications for the public Community health systems (CHSs) play a key role in shaping the uptake of interventions aimed at addressing neglected health challenges such as hydrocele for lymphatic filariasis (LF) in endemic regions
In order to improve access to management and disability prevention (MMDP) services in an endemic district in Zambia, the University of Zambia School of Public Health working alongside the Ministry of Health launched a pilot project to explore how implementation and operations research can be used to support the delivery of quality services to LF patients.[12]

Summary

Introduction

Lymphatic filariasis (LF), a neglected tropical disease, accounts for 1.36 million disability adjusted life years globally.[1]. The overall prevalence of the circulating filarial antigen is 7.4%, and regional distribution ranges from 1% to 54% across the ten provinces.[8,9] Efforts to combat disease transmission through mass drug distribution and provision of MMDP care to those with LF chronic manifestations have been ongoing since 2014.10 effective coverage and uptake of MMDP services has been suboptimal in most endemic countries, including Zambia.[11] In order to improve access to MMDP services in an endemic district in Zambia, the University of Zambia School of Public Health working alongside the Ministry of Health launched a pilot project to explore how implementation and operations research can be used to support the delivery of quality services to LF patients.[12] A baseline assessment prior to the pilot found that prevailing community beliefs and practices such as gender norms, play an essential role in the adoption of MMDP services.[11]

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Conclusion