Tool-in-Hand, Field-in-Flow: a field-embedded South-South trainers-of-trainers practicum for first-time trachoma mass
Gilbert Baayenda1, Agha Mohammad Abid Totakhil2, Rapheal Opon3
1The Fred Hollows Foundation, Uganda.
Objectives:
To describe a field-embedded South-South trainers-of-trainers (ToT) practicum for trachoma mass drug administration (MDA) and report MDA performance in Afghanistan after the practicum.
Methods:
We conducted a descriptive implementation case study with two linked phases. In April-May 2025, Afghan ToTs joined a live trachoma MDA campaign in Moroto District, Uganda, to practice core delivery tasks using routine tools and workflows. In December 2025-January 2026, trained ToTs contributed to cascade training, microplanning, and coaching-oriented supervision during Afghanistan's first trachoma MDA in seven endemic districts, working alongside Ministry of Public Health, HealthNet TPO, provincial, and district supervisors. We summarized therapeutic coverage, adverse events reports, and supervision observations from aggregated routine program data and campaign documentation.
Results:
Across seven districts, 382,070 people were targeted and 373,051 were treated, giving therapeutic coverage of 97.6%. District coverage ranged from 94.7% in Asadabad to 99.7% in Khas Kunar. Supervision identified early, correctable gaps in dose-pole use and treatment recording; on-site coaching was the main corrective response. Reported adverse events were predominantly mild gastrointestinal symptoms, with no serious or clustered events documented.
Conclusions:
A field-embedded ToT practicum was feasible and was followed by very high trachoma MDA coverage in Afghanistan. Causality cannot be inferred, but the model appears operationally promising for newly initiating trachoma programmes and warrants comparative evaluation.
