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Table 6 Facilitators and barriers to implementation across the eight MDA components, as commonly reported during interviews with key informants

From: An assessment of implementation and effectiveness of mass drug administration for prevention and control of schistosomiasis and soil-transmitted helminths in selected southern Malawi districts

CFIRa domain

MDAb component

Community awareness

Partnerships and collaboration

Integration with existing interventions

Training of implementers

Morbidity management

Delivery of supplies

Adequacy of implementers

Proper geographical demarcation

1). Characteristics of MDA programme

 Facilitators

 • Control or elimination of diseases

√

√

√

√

√

√

√

√

Barriers

 • Risk of developing drug resistance

x

x

x

x

x

x

x

x

2). External environment and context

 Facilitators

 • Existence of political will to control diseases

√

√

   

√

√

√

 • Existence of partners at national level

√

√

√

√

√

√

√

√

 • Multi-sectoral collaboration in diseases control

√

√

√

√

√

√

√

√

 Barriers

 • Existence of research gaps/limited information

x

x

x

x

x

 

x

x

 • No public-private partnerships

x

x

x

x

x

x

x

x

 • Exclusion of inaccessible or hard-to-reach communities

x

x

x

x

x

x

x

x

 • Community resistance due to misconceptions and beliefs

x

x

x

x

x

x

x

x

3). Internal context and setting

 Facilitators

 • Enabling policy framework

√

√

√

√

√

√

√

√

 • Existence of skilled health workers at all levels of the healthcare system

√

√

√

√

√

√

√

√

 • Existence of supportive community volunteers

√

√

√

√

√

√

√

√

 • Capacity to deliver effective health education

√

√

√

√

√

√

√

√

 Barriers

 • Non-existent complementary integrated interventions for diseases control

x

x

x

x

x

x

x

 

 • Lack of adequate resources for diseases control

x

x

x

 

x

x

x

x

 • No linkage between NTD and WASH programmes

x

x

x

x

x

x

  

 • Inadequate partners at district, health centre and community levels

x

x

  

x

x

x

x

 • Inadequate health workers in remote areas

x

x

 

x

x

 

x

x

4). Characteristics of MDA implementers

 Facilitators

 • Health education delivery skills

√

√

√

√

√

√

√

√

 Barriers

 • Low knowledge about schistosomiasis and STH

x

x

x

x

x

x

x

 

 • Poor community engagement skills

x

 

x

x

x

 

x

 

 • Lowly motivated health workers

x

  

x

x

 

x

 

5). MDA implementation process

 Facilitators

 • Convergent views on some priority health needs between health authorities and communities

√

 

√

 

√

√

√

 

 • Willingness of targeted populations

√

√

√

 

√

√

√

√

 Barriers

 • Scheduling of MDA coincides with rainy season or major public events

x

 

x

  

x

  

 • Delayed or inadequacy of drugs and supplies

x

x

x

 

x

x

 

x

 • Sidelining community in decision-making process

x

 

x

x

x

x

x

 

 • Some divergent views on priority health needs between health authorities and communities

x

 

x

 

x

x

  
  1. Source: [28]. For each MDA component where they apply, authors indicated facilitators with a checkmark (√) and barriers are indicated with a crossmark (x) from the interviews data
  2. aCFIR Consolidated Framework for Implementation Research
  3. bMDA Mass drug administration