Photo Credit: Helen Keller International (HKI)

[Cross-posted from USAID’s Act to End NTDs |West]

What does it take to distribute almost 20 million pills to over 4.4 million people in just 14 days? Planning, training, and mobilization of thousands of community drug distributors (CDDs)—key elements that programs targeting neglected tropical diseases (NTDs) must organize in a typical year.

But this is not a typical year.

Guinea reported its first COVID-19 case on March 12, 2020. Shortly thereafter, the Government of Guinea (GoG) declared a state of emergency, closing national borders, prohibiting large gatherings and mandating mask-wearing.

Like most public health programs, NTD activities were initially put on hold while the country addressed the pandemic. However, the Ministry of Health was keen to restart NTD activities, believing that they could be implemented with minimal risk of COVID spread.

The MOH developed plans for safely implementing NTD activities and shared them with funding and implementing partners. By August, restrictions began to ease and the national NTD program (NTDP) began to resume activities.

With support from USAID’s Act to End Neglected Tropical Diseases (NTDs) | West program, led by FHI 360, Helen Keller International worked in partnership with the national NTDP to resume mass drug administration (MDA) in 19 health districts beginning in mid-August.

Before restarting, the national NTDP developed a plan to guide NTD activities in the COVID-19 context and reduce the risk of virus transmission. The plan included preparing drug distributors and communities for a new normal: physical distancing, mask wearing, and an even greater emphasis on handwashing. These measures—paired with a comprehensive social mobilization strategy—ensured community acceptance and participation in the campaign.

Demonstrating its commitment to this effort, the GoG provided handwashing stations and masks to MOH personnel and CDDs involved in the campaigns. Additionally, it mandated COVID-19 testing for all campaign staff and supervisors traveling from the capital, Conakry, to the field. The National Health Security Agency provided these tests at no cost to individuals.

Training for the campaign looked vastly different than in previous years, with fewer than 20 people per training session, compulsory masks, physical distancing of 2 meters between participants, and handwashing stations at room entrances.

With Act | West support, the NTDP trained CDDs to provide COVID-19 awareness messages in their communities and discourage large gatherings. They trained supervisors on monitoring sites for crowding or noncompliance with COVID-19 preventive measures and managing refusals.

Rather than distributing drugs at a fixed location in the community, CDDs went house-to-house to limit crowding. Supervisors used electronic data capture to monitor and communicate findings on compliance with COVID-19 barrier measures, including handwashing during drug distribution, contact with dose poles and medications, and social distancing.

Preliminary campaign results indicate that the NTDP surpassed the required percentage of the population in all 19 health districts for all targeted diseases, and most people complied with COVID-19 risk mitigation measures. There were no reports of serious adverse events or mass refusals due to COVID-19 fears or rumors.

The results underscore the effectiveness of the NTDP’s strategy for this decidedly unusual and challenging MDA—raising NTD awareness in Guinea’s beneficiary communities and providing reliable information on COVID-19 prevention to increase communities’ receptivity to NTD drugs, despite the pandemic.

It is clear from our experience in Guinea that although COVID-19 has required additional time for managing logistics—ensuring safe physical distancing and delivering medicine house to house, for example—it has not prevented efforts to work toward NTD elimination. With careful collaboration, innovation, and planning, the Guinea NTDP team and partners are committed to continuing this important work.