Final program evaluation methods and results of a National Lymphedema Management Program in Togo, West Africa

In order to eliminate Lymphatic Filariasis (LF) as a public health problem, the World Health Assembly recommends an approach which includes interruption of transmission of infection and the alleviation of morbidity. In 2000, the Togolese National Program to Eliminate Lymphatic Filariasis (PNELF) started the annual mass drug administrations and in 2007, the program added a morbidity component for the management of lymphedema. This manuscript describes the methods of an evaluation aimed at assessing the strengths and weaknesses of the Togolese National Lymphedema Morbidity Program. The evaluation was conducted through in-depth interviews with stakeholders at each programmatic level. Interviews focused on message dissemination, health provider training, patient self-care practices, social dynamics, and program impact. The evaluation demonstrated that the program strengths include the standardization and in-depth training of health staff, dissemination of the program's treatment message, a positive change in the community's perception of lymphedema, and successful patient recruitment and training in care techniques. The lessons learned from this evaluation helped to improve Togo's program, but may also provide guidance and strategies for other countries desiring to develop a morbidity program. The methods of program evaluation described in this paper can serve as a model for monitoring components of other decentralized national health programs in low resource settings.