Empowering the NTD Workforce – Highlighting Community Drug Distributors

By Pamela Bongkiyung & Prof. Sally Theobald

Mass Drug Administration (MDA) remains a fundamental part of approaches to address several Neglected Tropical Diseases. However, the people who make this process happen at the community level – Community Drug Distributors (CDDs),  are sometimes not given enough attention or  sufficient acknowledgement  for their contributions and how best to motivate with some form of remuneration and reward this critical cadre is subject to much debate

Most CDDs come from the communities in which they work, and are chosen through community processes. Training and supervision is varied and often not given enough resources or attention. Their selection, supervision and training remain a community effort. For a very long time, they have not been sufficiently considered as an essential part of the health system around the world. This in turn has meant that in some contexts they are considered by governments as voluntary workers who don’t always need formal payment. Though there have been promises to include some payments for CDDs in national budgets, this frequently doesn’t materialise in practice. The issue of paying CDDs is embedded in controversy – who should pay?

The idea to start using CDDs was created during the Bamako Initiative in 1987 and then enacted in the Community Directed Treatment with Ivermectin (CDTi), rolled out by APOC (African Programme for Onchocerciasis Control). This process was designed from the onset to be owned by the community but challenges such as support, sustainability and remuneration remain.

Given that these communities were too poor to pay for drug distribution themselves, CDD work was viewed as serving one’s community and therefore a reward in itself. It was not envisaged that serving your village or clan should be met with monetary rewards. There remains a great difficulty in putting monetary value to the high esteem given to these individuals within communities.

The work of CDDs is also relevant in the detection of diseases, but they are often not mobilised to fulfil a monitoring role. The situation is further complicated when gender is inserted into the mix.  In the analysis of Community health worker programmes, men are more likely to be paid then women; and also more likely to be in senior roles. Little is known about how gender shapes the experience of being a CDD; the relationships that are built at community level and the implications for equitable and gender transformative processes.

Although CDDs have been central for over three decades, there is very little recent literature making an appraisal of their inputs and how best to support them. . It is imperative that their work is better acknowledged as a key interface for NTD elimination. So, we ask, how can we help sustain CDDs in health systems?
This is why COUNTDOWN has taken the initiative to bring the issues and experiences of CDDs to the limelight in the Coalition for Operational Research of Neglected Tropical Diseases (COR-NTD) from 10 – 11 November 2016. We will host a specific-session exploring evidence and evidence gaps. Panellists from Ghana, Nigeria and Cameroon will discuss the experience of CDDs in different contexts, how gender, poverty and relationships shape this and priorities for action.

COUNTDOWN will also be well represented at the Health Systems Global (#HSG2016) Conference in Vancouver, Canada from 14 – 18 November 2016. The Liberia COUNTDOWN Country Director – Karsor Kollie is presenting on the experience of Community Health Workers in the Ebola response in Liberia; and we have a panel on intersectionality which explores the interplay between different axes of inequalities.


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