Integrating a community-based continuous mass dog vaccination delivery strategy into the veterinary system of Tanzania: A process evaluation using normalization process theory
Christian Tetteh Duamor,
Katie Hampson,
Felix Lankester,
Ahmed Lugelo,
Joel Changalucha,
Kennedy Selestin Lushasi,
Anna Czupryna,
Emmanuel Mpolya,
Katharina Kreppel,
Sarah Cleaveland,
Sally Wyke
Affiliations
Christian Tetteh Duamor
Department of Global Health and Biomedical Sciences, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania; Environmental Health and Ecological Sciences Thematic Group, Ifakara Health Institute – Tanzania, Ifakara, Tanzania; Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK; Corresponding author at: Department of Global Health and Biomedical Sciences, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania.
Katie Hampson
Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
Felix Lankester
Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA; Global Animal Health Tanzania, Arusha, Tanzania
Ahmed Lugelo
Environmental Health and Ecological Sciences Thematic Group, Ifakara Health Institute – Tanzania, Ifakara, Tanzania; Global Animal Health Tanzania, Arusha, Tanzania; Sokoine University of Agriculture, Morogoro, Tanzania
Joel Changalucha
Environmental Health and Ecological Sciences Thematic Group, Ifakara Health Institute – Tanzania, Ifakara, Tanzania; Global Animal Health Tanzania, Arusha, Tanzania
Kennedy Selestin Lushasi
Department of Global Health and Biomedical Sciences, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania; Environmental Health and Ecological Sciences Thematic Group, Ifakara Health Institute – Tanzania, Ifakara, Tanzania; Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
Anna Czupryna
Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK; Global Animal Health Tanzania, Arusha, Tanzania
Emmanuel Mpolya
Department of Global Health and Biomedical Sciences, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania; Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
Katharina Kreppel
Department of Global Health and Biomedical Sciences, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
Sarah Cleaveland
Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
Sally Wyke
Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
Abstract: Sustained vaccination coverage of domestic dog populations can interrupt rabies transmission. However, challenges remain including low dog owner participation, high operational costs associated with current (centralized and annually delivered (pulse)) approaches and high dog population turnover. To address these challenges an alternative (community-based continuous mass dog vaccination (CBC-MDV)) approach was designed. We investigated the potential for successful normalization of CBC-MDV into routine practice within the context of local communities and the veterinary system of Tanzania Methods: In a process evaluation of a pilot implementation of CBC-MDV, we conducted in-depth interviews with implementers and community leaders (n = 24), focus group discussion with implementers and community members (n = 12), and non-participant observation (n = 157 h) of delivery of the intervention components. We analyzed these data thematically drawing on the normalization process theory, to assess factors affecting implementation and integration. Main findings: Implementers and community members clearly understood the values and benefits of the CBC-MDV, regarding it as an improvement over the pulse strategy. They had a clear understanding of what was required to enact CBC-MDV and considered their own involvement to be legitimate. The approach fitted well into routine schedules of implementers and the context (infrastructure, skill sets and policy). Implementers and community members positively appraised CBC-MDV in terms of its perceived impact on rabies and recommended its use across the country. Implementers and community members further believed that vaccinating dogs free of charge was critical and made community mobilization easier. However, providing feedback to communities and involving them in evaluating outcomes of vaccination campaigns were reported to have not been done. Local politics was cited as a barrier to collaboration between implementers and community leaders. Conclusion: This work suggests that CBC-MDV has the potential to be integrated and sustained in the context of Tanzania. Involving communities in design, delivery and monitoring of CBC-MDV activities could contribute to improving and sustaining its outcomes.
