Evaluating coverage of Rwanda's mass drug administration program for schistosomiasis and soil-transmitted helminthiasis and assessing the program’s capacity for sustainability
Embargo Date
2027-05-27
OA Version
Citation
Abstract
BACKGROUND: Schistosomiasis and soil-transmitted helminthiasis (STH) are two of the most prevalent neglected tropical diseases in Rwanda. Mass drug administration (MDA) has been the primary strategy for reducing the two diseases burden.
METHODS: A mixed-methods approach was used to evaluate the reach of Rwanda’s MDA program from 2019 to 2023, and its capacity for sustainability. Quantitative analyses utilized secondary data from national MDA coverage reports across all 30 districts. A linear mixed effects model was used to examine districts determinants MDA coverage. The Program Sustainability Assessment Tool (PSAT) was used to assess eight sustainability domains: political support, funding stability, partnerships, organizational capacity, program evaluation, adaptation, communications, and strategic planning. Semi-structured interviews were conducted to collect insights on each sustainability domain and to explore challenges in MDA data management.
RESULTS: Between 2019 and 2023, MDA coverage expanded nationwide. However, no important district-level predictors of district coverage were identified. This likely resulted from data quality issues and the use of aggregated district-level data, which obscured important local variations in MDA uptake. PSAT results found an overall sustainability score of 3.75/5; partnerships (4.1) were the highest-rated sustainability domain, whereas funding stability (3.3) was the lowest. Qualitative findings highlighted strong collaboration among national and international stakeholders in funding mobilization, with local governments and communities playing a role in building community trust. However, the program remains heavily dependent on external donor funding, with insufficient government funding contributions. Data quality issues were also highlighted, driven by weak validation mechanisms, inconsistent target population estimates, and centralized data management compounded by understaffing at the central level.
CONCLUSIONS: Rwanda’s MDA program coverage has expanded nationwide with a moderate sustainability capacity level. To increase program sustainability and efficiency, data quality must improve to support robust program evaluation. This requires developing clear guidelines for the target population setting and establishing rigorous data validation processes. In addition, effectively utilizing prevalence data during planning to target areas with confirmed high schistosomiasis or STH prevalence will concentrate resources where they are needed most, thereby reducing operational costs and ultimately enhancing the overall impact and sustainability of the MDA program.
Description
2025