There has in recent years been a growing interest in the social
significance of global health policy and associated interventions. This paper is
concerned with neglected tropical disease control, which prescribes annual
mass drug administration to interrupt transmission of, among others,
lymphatic filariasis. In Tanzania, this intervention is conducted through
community-directed distribution, which aims to improve drug uptake by
promoting community participation and local ownership in the intervention.
However, the average uptake of drugs often remains too low to achieve the
intended interruption of transmission. The qualitative research presented here
followed the implementation of mass drug administration in Lindi and
Morogoro Regions, Tanzania, in 2011 to understand the different forms of
involvement in the campaign and the experiences of stakeholders of their part
in community-directed distribution. Some health care workers, community
leaders and drug distributors were generally positive about the intervention,
emphasizing that the drugs were welcome. Other stakeholders, including
the drug-receiving population, reported facing a number of dilemmas of
uncertainty, authority and exclusion pertaining to their roles in the intervention.
These dilemmas should be of interest to donors, policymakers and
implementers. Community-directed distribution relies on social relations
between the many different stakeholders. Successful and justifiable interventions
for lymphatic filariasis require implementers to recognize the central
role of sociality and that the voices and priorities of people count.