Case Synopsis

To be implemented successfully, most large-scale public health interventions, such as mass drug administration (MDA) campaigns for the elimination of lymphatic filariasis, require a large extent of human health resources. For several reasons, health workers and volunteer community drug distributors (CDDs) sometimes feel overwhelmed and unsupported in their work, which can cause them to give up their essential roles. In lower middle-income countries such as Côte d’Ivoire, where volunteers tasked with the distribution of antifilarial medications are already in short supply, losing valuable human health resources can ultimately cause MDA programs to fail. As such, it is crucial for implementers to recognize and address any issues with their health intervention plan that may lead to increased attrition among their workforce. Dr. Emmanuel Koffi, one of the neglected tropical disease program managers at Côte d’Ivoire’s Ministry of Health and Public Hygiene, recognizes that research is needed to investigate the factors contributing to increased stress and attrition rates among his volunteer CDDs. The steps that he should take to conduct an effective research project, however, remain uncertain. After reaching out to Dr. Myriam Kouamé at the University of Abidjan, Emmanuel has decided that applying an implementation research strategy may be best for this project. Having little experience with this type of research, he has enlisted Myriam’s assistance to develop a research plan that will help him identify how he can better support his volunteers. Emmanuel knows that time is short—the 2020 deadline to eliminate lymphatic filariasis in Côte d’Ivoire is fast approaching, and he must act quickly to ensure that the CDDs are well supported if they are to achieve this elimination goal.

Case Objectives

1. Adopt a systems-thinking approach to investigate the contextual factors influencing attrition rates and the resilience of CDDs in Côte d’Ivoire.

2. Apply implementation research principles to formulate a research plan to investigate increasing attrition rates among CDDs and identify feasible solutions to improve volunteer motivation and retention.

3. Identify appropriate members of the research team to ensure that there is a multidisciplinary approach

4. Explain the roles and responsibilities of different stakeholders in managing health human resources for MDA in Côte d’Ivoire to determine who to engage in the implementation research process and how.

5. Discuss the challenges associated with conducting implementation research across different contexts and propose strategies to overcome them.

6. Describe how implementation research can be used to improve health equity among people living in lower middle-income countries.

Case Study Questions

1. What is implementation research?
a. How can it be used to identify and address the factors you identified above?
b. What are some challenges associated with conducting implementation research in lower middle-income countries?

2. Brainstorm a list of contextual factors that could potentially influence the attrition rate of CDDs conducting an MDA in Côte d’Ivoire. What implications could these factors have for the MDA as a whole? Be prepared to share your list with the class.
a. Reflecting on your list of contextual factors, what kinds of researchers do you think should be part of the research team and why?

3. Which stakeholders do you think should be involved in the implementation research process?
a. At which point during the implementation research process would you involve each stakeholder? Why?
b. Which stakeholders would be interested in the results of the research? What aspects of the research would they be most interested in?
c. How would you tailor dissemination of the results of your research to each stakeholder?

4. What research methods would you use and what kinds of data would you collect? (e.g., quantitative, qualitative, mixed methods). Explain your reasoning.

5. How do you think implementation research can be used to improve health equity in lower middle-income countries?


Community drug distributors; implementation research; lymphatic filariasis; mass drug administration; neglected tropical diseases

Additional Author Information

Daniel Dilliott, BMSc, MPH

Alison Krentel, MScPH, PhD, Investigator, Bruyere Research Institute and Assistant Professor, University of Ottawa

Mark Speechley, PhD



Recommended Citation

Dilliott, D., Krentel, A. & Speechley, M. (2010). Vanishing Volunteers: The Use of Implementation Research to Improve Support for Community Drug Distributors in Cote d'Ivoire. In: Sibbald, S.L. & McKinley, G. [eds] Western Public Health Casebook 2019. London, ON: Public Health Casebook Publishing.