Table 2. A basic troubleshooting guide for commonly encountered problems in MDA programs.

Scenario	Description of issue	Suggested areas for intervention
Low reported coverage	Drugs are not reaching targeted population.	1. Who are drug distributors—are they appropriate for the community?
		2. Check motivation of drug distributors in terms of incentives, training, logistical capacity.
		3. Assess security situation and time of MDA.
		4. Is the distribution method appropriate?
		5. Check reporting forms and systems.
High reported coverage with low drug coverage (e.g., compliance with treatment)	Drugs distributed to targeted population are not being swallowed.	1. Consider how DO-MDA can be implemented (time of day for MDA, distribution method).
		2. Assess level of awareness about MDA in the community; should novel communications be introduced (cell phones, social media)?
		3. Are local leaders and groups involved in the process?
		4. Assess fear and management of adverse events.
		5. Evaluate role and reputation of health services in the population.
High rates of systematic non-compliance	Individuals have not ingested the drugs in any MDA round.	1. Identify subgroups with high non-compliance rates and design programs to target these groups.
		2. Consider a test-and-treat approach.
		3. Use of behavior change models to address persistent non-compliance (e.g., motivational interviewing).
Local health system (at IU level) weak and unable to conduct MDA	Local health system weakened due to lack of personnel, funds, or post-conflict situation.	1. Identify local NGOs or organizations who would be capable of conducting MDA in a specific IU.
		2. Where logistics are challenged, identify possible private sector participants to fill the gap.
Reported coverage decreasing as MDA rounds continue	Drugs are not reaching the population as MDA continues.	1. Consider health service personnel and drug distributor fatigue and how to address it.
		2. Has there been a change in local management?
		3. Has there been a change in logistical provision?
Drug coverage decreasing as MDA rounds continue	Individuals who may have taken drugs in previous rounds are refusing to comply with treatment.	1. Has there been a population increase to affect the denominator?
		2. Are there persistent rumors affecting the campaign?
		3. Are adverse events being adequately managed?
		4. Assess drug distributors' ability to respond to questions, fears.
High reported coverage and low surveyed coverage	Drug distributors report distributing adequate number of drugs to the targeted population, but independent coverage surveys report lower rates of drug coverage or compliance.	1. Check reporting forms and systems.
		2. Review possible population shifts.
		3. Consider how DO-MDA can be implemented (time of day for MDA, method of distribution).
		4. Assess security situation and timing of MDA.
		5. Is the distribution method appropriate?