Assessing the sustainability of Rwanda’s mass drug administration program for schistosomiasis and soil-transmitted helminthiasis: A mixed-methods application of the program sustainability assessment tool

Background: Mass drug administration (MDA) is a key strategy for controlling schistosomiasis and soil-transmitted helminthiasis in low-resource settings. Assessing its long-term sustainability is important for maintaining and expanding disease control achievements. This study examined the sustainability capacity of Rwanda’s MDA program using the Program Sustainability Assessment Tool (PSAT). Methodology: A mixed-methods approach was used. Twenty-one key informants, including government officials, donors, and local stakeholders, participated in qualitative interviews, and 16 of them also completed the PSAT quantitative survey. Qualitative data were thematically analyzed, while quantitative findings from the survey were used to calculate domain-specific and overall sustainability scores. Findings: The overall Rwanda MDA program sustainability score was 3.75 out of 5. Partnerships scored the highest at 4.1, with qualitative data emphasizing strong collaboration among government agencies, international organizations, and community stakeholders. Political support and program evaluation both received a score of 3.9, with qualitative data emphasizing good policy alignment, but some issues with data accuracy. Funding stability was the weakest domain, scoring 3.3, and qualitative data highlighted reliance on external donors. Strategic planning scored 3.5, with qualitative data highlighting limited development of long-term financial strategies and the absence of a dedicated sustainability plan. Conclusion: This assessment revealed a moderate sustainability capacity for the MDA program, characterized by strong political support, active partnerships, and promising adaptations, including the expansion of treatment coverage to adults. However, dependence on donor funding, staffing shortages, and data management issues continue to pose a risk to the program’s sustainability. Improving domestic resource allocation, investing in human resources, and strengthening data systems could enhance the program’s capacity for sustainability. Author summary: This study evaluated the sustainability of Rwanda’s mass drug administration (MDA) program for schistosomiasis and soil-transmitted helminthiasis. Using interviews and a standardized sustainability tool (PSAT), we assessed the program’s current sustainability capacity. The results show that the program benefits from strong political support and strong partnerships among government, donors, and communities. However, funding stability and long-term planning are weak due to heavy reliance on donors and limited domestic financing. The overall program sustainability score was 3.75 out of 5, indicating moderate sustainability. To sustain progress, Rwanda must improve domestic resource allocation to the program, invest in workforce capacity, and strengthen data systems to ensure the continued delivery and expansion of MDA.