Improving anti-LF drug compliance among Tribal and Rural Communities

Lymphatic Filariasis (LF) is a mosquito-borne, infectious disease which can cause permanent disfigurement and disability.  To interrupt the transmission of the disease, 65% of the at-risk population in an area needs to consume a booster dose of anti-LF drugs for five consecutive years. However, the continued prevalence of lymphatic filariasis indicates a gap in consumption amongst those who do not consume anti-LF drugs in front of the DA.

Supported by the Gates Foundation, we partnered with PCI to design scalable solutions that bridge the gap between the receipt and consumption of anti-LF drugs, with an emphasis on DOT. Our team of human-centered designers shadowed the DAs during MDA and had conversations with users who did not consume the drug. From our learnings, we defined outcomes and designed interventions for behaviour change. Finally, we worked closely with DAs to test the efficacy of their interventions during MDA.

Our set of 9 interventions will be piloted in 200 blocks - via campaigns, IEC materials, DA training and additions in the system.

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In their Post MDA Social Mobilisation Assessment, PCI found that in spite of 89% of households reached by Drug Administrators (DA), only 38% of the at-risk population consumed the drug in-front of the Drug Administrator.

During the MDA, we observed that the DA administers the drugs to all those willing to consume them immediately and hands over the drugs to users who are on an empty stomach, absent or sick. She neither personalises the benefits to hesitant users nor revisits missed users, both of which require additonal effort that is not rewarded.

With our conversations with users, we learnt that users evaluate the drugs on their perception of its benefits (or their risk to LF) and their perception of harm that can be caused by the drugs.

We captured irrational patterns in the users’ and DAs’ behaviours and diagnosed them using behaviour economics principles. We found that the users’ perceptions were driven by what drew their attention or was salient to them. On the other hand, the drug administrators maintained their default pitch, administering drugs to all those willing to consume them immediately, and handing some over for those who were sick, on an empty stomach, or absent.By maintaining a dual-focus on the DA and the user, we were able to craft outcomes that enable the DA to pitch the drug better. Here’s an example of the same:

Machhar Se Filaria

Users don’t perceive benefits of consuming the preventative drugs unless they perceive themselves to be susceptible to LF. Since the current perception of filaria is associated with a swollen foot (elephantiasis) or hydrocele, users who don’t see any case of lymphedema in and around their village, don’t perceive themselves to be at risk of filaria, and hence don’t see any benefit in consuming the drugs.

To make the risk of LF salient, the program shifts the narrative from the infrequent consequence (lymphedema or hydrocele) to a much more frequent risk (exposure to mosquito). The DA pitches the anti-filaria booster dose as a set of drugs administered once annually to kill the filaria worms released by mosquitoes.

Dawa Durust 

Those on medication for an illness, injury or medical condition such as diabetes or hypertension, are wary of the drugs reacting with their condition or medication. The DA avoids administering the drug to these users who seem less fit than others, to avoid being blamed for adverse health effects in her community.

To ensure the DA assesses individual condition before rejecting administration, we objectively showed a list of health conditions that are safe for drug consumption. The DA uses this sheet to address doubts regarding safety of consumption.

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Filaria Surkashit Nishani  

Users prefer to wait to see the effects of the drugs on others like them, before deeming the drugs safe for consumption, while those who have seen neighbours, friends, and family members consume the drugs safely are more likely to consume the drugs.

To reassure the users of drug safety, we showed proof of drug consumption as the norm in the area by making drug consumption salient. The DA pitches the drug using a handy visual showing fingerprints of all who consumed the drug. The visual is divided into four different age groups, this helps the user see proof of consumption of their age group.

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