Ripple Effects Mapping of a gender equity and social inclusion behaviour change activity in Uganda's trachoma effort

Uganda's trachoma program has faced persistent challenges in achieving adequate preventive medicine coverage. To address these, the Ministry of Health applied Ripple Effects Mapping (REM) to assess a gender equity and social inclusion (GESI) behaviour change activity (BCA). To our knowledge, this represents one of the first documented applications of REM to a neglected tropical disease (NTD) program.

Seven REM workshops were conducted with government officials, health staff and community members. Facilitators guided participants to identify the BCA's inputs, outputs and intended and unintended outcomes. Findings were consolidated and analysed using mind-mapping software.

Workshop participants reported that the BCA increased access, demand and uptake of trachoma preventive medicine among populations missed in previous campaigns. Workshops also demonstrated diversification of campaign stakeholders; improved water, sanitation and hygiene and prevention practices; and stronger social accountability between communities and local government.

REM provided the Uganda NTD program with a participatory way to validate intended results and uncover additional effects of a trachoma BCA. Findings from the workshops point to REM's potential value for informing investment, replication and strategy to accelerate trachoma elimination in Uganda and similar settings.