Beneficiary feedback mechanisms: Exploring ways to systematically integrate community feedback in mass drug...

Neglected tropical diseases (NTDs) affect over one billion people globally and disproportionately impact marginalized populations in low- and middle-income countries. Mass drug administration (MDA) is the WHO recommended strategy for controlling five major NTDs. However, persistent operational challenges, like treatment fatigue, mistrust, and systematically missed populations, undermine MDA effectiveness. Beneficiary Feedback Mechanisms (BFM) are emerging tools in global health that enable structured collection of community input to improve program delivery, but their application in NTD programs remains limited and understudied. This study examines how BFM are operationalized within routine MDA programs, providing operational insight into their perceived value, practical applications, and implementation challenges across diverse stakeholder roles.

This study used semi-structured key informant interviews (KII) to examine how BFM can be operationalized to enhance MDA delivery. Interviews were conducted with 14 informants involved in MDA implementation, funding, monitoring and evaluation, and research, primarily across countries in sub-Saharan Africa that were supported by the Accelerating the Sustainable Control and Elimination of Neglected tropical Diseases (ASCEND) program. Participants were selected purposively based on their professional experience with BFM and MDA. Transcripts were analyzed using a thematic analysis approach in NVivo software, applying both inductive and deductive coding strategies to identify patterns and develop meaningful themes.

Informants identified that BFM yielded timely and actionable feedback, particularly through daily community drug distributor meetings and post-MDA surveys, as the most impactful. Integrating BFM into existing systems was favored over new platforms, particularly in resource-constrained settings. Key barriers included limited integration into digital monitoring systems and lack of dedicated personnel to review and respond to feedback. BFM also highlighted issues that may have hindered optimal drug coverage in some communities, including gender barriers and misinformation. Informants emphasized that closing the loop, communicating back to communities how their feedback was used, was essential to maintaining trust and engagement in future MDA activities.

BFM were perceived by informants as a promising pathway to enhance the equity, responsiveness, and effectiveness of MDA programs. Their success depends on timely use, integration into routine systems, and capacity to address community concerns. Multilateral organizations such as WHO can support scale-up by issuing guidance and standardizing tools. Further research is needed to evaluate impact and best practices for implementation.