Leaving No One Behind: Using Photo-Voice To explore Community Health Volunteer’s Lived Experiences in rural Ghana

Mass Drug Administration (MDA) for whole communities is key to the global strategy to eliminate neglected tropical diseases including Lymphatic Filariasis (LF). In Ghana, there are districts where LF transmission is ongoing despite more than 10 years since the inception of the 5- year programme. Community Drug Distributors(CDDs) are key to the success of this as they physically deliver the drugs to community members, and maximise the chances of reaching them all.

However, complex power dynamics mean that CDDs voices have not always been heard in the design and implementation of the programme. Photovoice provided the CDDs with the opportunity to visually represent and articulate through the photos and group discussions the challenges they encountered in delivering drugs to the affected communities.

Key lessons included: the high number of CDD out-of-pocket expenses; problematic timing of drug distribution during the rainy season when access is difficult; the impact of gendered norms and livelihood on ability to observe drug taking by community members; the challenge of lack of basic equipment. 

(COUNTDOWN-Calling time on Neglected Tropical Diseases Project sponsored by DFID through LSTM and Dodowa Health Research Centre.)

Submitted by:

Irene Tsey

Shoes bought by CCD for her sibling who looks after her store when she has to go distribute drugs.

The picture represents cost incurred at a personal level because of her work as a CDD. “When she watches the shop for me I buy her shoes as a gift since she is a school girl”.

Photographer: Jemimah Cudjoe

When it rains

The picture shows how the terrain looks like in an already hard to reach area with scattered settlements and its implication for the Directly Observed Approach to MDA. This makes it very difficult and sometimes impossible for the CDD to visit each and every household to administer drugs.

Photographer: Joseph Sib Sammy

Integration from CDD’s perspective

In trying to enhance their work, some CDDs use supplies received from other programmes to supplement their work. CDDs sometimes use spoons, bags, towel, soaps and pens from other programmes to enhance their work and sometimes their personal logistics.

Photographer: Rose Buah

Giving CDDs drugs and posters not enough

CDDs are given MDA drugs and posters for education however they are not given money to buy glue to stick these posters neither are they given bags to carry the drugs or spoons to administer the drugs during their rounds. Are they therefore expected to bear these cost in addition to volunteering to distribute the drugs?

Photographer: Jemimah Cudjoe

Opportunity cost of being a CDD

“That is my shop. But because of the work I have to close it unless my sibling returns from school to open it. When she watches the shop for me I buy her shoes as a gift since she is a school girl. Because I am not there, what would have been bought will still be there. I decrease my income. Banana for instance will go bad if I do not sell it. So it is a challenge I face”.
Photographer: Jemimah Cudjoe