India's fight against Lymphatic Filariasis through a community-driven approach

Mumbai

Lymphatic Filariasis (LF) is the world's second most disabling disease after leprosy. In India, the numbers are alarming, with over 740 million people at risk of contracting LF. This mosquito-borne disease causes severe swelling in the limbs and other body parts, it can further progress to a chronic stage, including lymphoedema (tissue swelling) or elephantiasis (skin/tissue thickening) of limbs and hydrocele (scrotal swelling) leading to disability, profoundly affecting the lives of millions. However, India is fighting back with a multi-layered five-pronged strategy to make the country LF-free. This includes Mission Mode Mass Drug Administration (MDA) campaigns, Morbidity Management and Disability Prevention (MMDP), Vector Control (Surveillance & Management), High-Level Advocacy and Innovative Approaches like exploring alternate diagnostics. 

Social mobilization intricately links every part of this strategy to another. It empowers communities to take ownership of public health interventions by bringing together local stakeholders, health workers, and civil society as one to transform top-down government strategies into grassroot level movements. By integrating social mobilization into every facet of LF control India is ensuring that its public health campaigns reach their targets through lasting engagement needed for long-term impact.

Social Mobilization: Empowering Communities to Lead the Fight

India has made significant progress in achieving an MDA coverage of 82.5% in the year 2023 which has helped in controlling the spread of Lymphatic filariasis despite all challenges, showcasing collaboration of numerous players like Accredited Social Health Activists (ASHAs), Anganwadi Workers (AWWs), Auxiliary Nurse Midwives (ANMs), Community Health Officers (CHOs) can help us inch forward to eliminate the disease. They have ensured that populations receive medications along with awareness and education about vector control strategies and home-based morbidity management services.

Social mobilization is thus essential in creating an integrated approach to LF prevention as it helps spread awareness of the biannual administration of essential drugs along with vector control strategies. To overcome impediments to MDA implementation social mobilization is important. It helps in increasing the coverage of preventive treatment by overcoming misinformation and reluctance towards treatment. This helps in adapting messages to fit local contexts. It also overcomes cultural and logistical barriers, and encourages community members to proactively participate in MDA rounds, especially in remote areas. They employ a mix of methods, including door-to-door visits, street theater, local media, and social networks, to spread awareness about Lymphatic Filariasis, correct false beliefs and encourage participation in MDA programs and other prevention tactics. Public appeal videos disseminated via social media channels by prominent leaders encourage widespread public participation in MDA rounds.

In the states of Maharashtra, Uttar Pradesh, and West Bengal, which are some of the most high-burden states, an MDA coverage of 92%, 95%, and 90% was achieved, respectively, demonstrating how grassroots engagement boosts participation even in the most populous regions. In UP and Bihar, social mobilization has been facilitated through Filaria Patient Networks, which proved to be helpful in overcoming drug resistance in these states with a turnaround of 76% in drug compliance. They organized over 2000 MDA activities to reach 134000 beneficiaries. Medical colleges and rotaries have also launched awareness campaigns, supervised MDA activities and community events, and resource mobilization in different endemic regions.

The critical challenge in fighting LF is the stigma attached to the physical manifestations of the disease, which leaves many affected by the disease isolated from society. In fact, many patients are considered “cursed” and face exclusion from social events, are abandoned by their families, and lose employment opportunities. Patient support groups (PSGs) have also played their part in providing a solution to this by educating and assisting patients about healthcare services and to avail them equitably. In Uttar Pradesh’s Deoria district, PSGs have been coordinating with the Health Department to provide MMDP kits to the patients and educate them on how to manage LF symptoms.

These stories show that when government efforts are backed by the strength of people, they can reap substantial benefits and large-scale impacts by enhancing community engagement and health-seeking attitudes.

Generating demand for preventive care and medicines using platforms like self help groups and survivor networks is another benefit accruing out of social mobilization. This helps in extending help to even the most marginalized communities. In this process these social mobilization enablers end up creating communities of knowledge aggregators by spreading useful information and personal experiences about the disease, like schools, colleges and other institutions.

Social mobilization's benefits extend beyond fostering dialogues. It also closes the gap between communities and healthcare initiatives through practical implementation. All of this becomes possible because of the relentless support and dedicated efforts of District Magistrates (DMs), Chief Medical Officers (CMOs), and other key officials at the district and block level, whose work ensures that social mobilization strategies are implemented effectively and reach the most at-risk populations. 

Inter-sectoral convergence helps in amplifying the reach of grassroot level efforts by pooling in resources and coordinating efforts between different ministries and departments from the national level to the states and districts. This is for example shown by The Ministry of Rural Development which has been mobilizing self-help groups (SHGs) to increase drug compliance. The Ministry of Youth Affairs has also been vital in mobilising the youth by involving National Service Scheme (NSS) coordinators. They have been crucial in the MDA implementation and awareness efforts. 

When government and communities join forces, they build coordinated parts of one machinery that guarantees that benefits are delivered to those in dire need. Social mobilization thus forms an integrative approach in tackling public health challenges therefore providing grounds to tackle several other public health challenges. This is evidence of the power of community engagement and resource mobilization.

While progress is being made, the fight against LF is far from over. Under the capable stewardship of the National Center for Vector Borne Diseases Control (NCVBDC), social mobilization will be vital in achieving its health goals and becoming LF-free.

(Authored by Dr. Bhupendra Tripathi, Deputy Director - Infectious Diseases and Vaccine Delivery, Bill and Melinda Gates Foundation)