Promoting equity through inclusive learning, planning and implementing: lessons from Nigeria's mass drug administration programme for neglected tropical diseases

Abstract

Background: An inclusive, localised approach to planning and implementing equitablemass drug administration was developed through participatory action research (PAR). This new approach aligns with principles of learning health systems (LHS). Tools were co-developed to support scaling up the new approach across two Nigerian states. Lessons are distilled here to enable learning for other programmes. Methods: Observations and reports by researchers (2019-2021) from 23 meetings and workshops, 8 in-depth interviews and 8 focus group discussions (FGDs) were used. Results: Nine key steps of best practice were identified to promote inclusive LHS for participatory planning and implementing: utilise participatory researchmethodologies to facilitate community engagement and tailor interventions; develop tools and governance structures to support learning, teamwork and sustainability; strengthen capacity for participation and collaboration with space for dialogue and shared learning; undertake participatory planning to develop action plans; advocate for implementation; monitor action plans; review and act on successes and challenges; apply community evaluation to understand challenges and enablers and disseminate policy and programme changes. Conclusions: PAR in disease programmes can support health systems to embed cyclical and iterative learning to sustainably address localised equity challenges. However, it takes time, resources and political commitment.