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Pictures and Video

http://www.youtube.com/watch?v=u4kQWvUv_Ns

References

Levine, R. (2007). Reducing Guinea Worm in Asia and Sub-Saharan Africa. Case Study 11. Case studies in global health: Millions saved. Boston: Jones and Bartlett Publishers.

Yohalem, D. (1990). Programming Guide for Guinea Worm Eradication. WASH Field Report No. 329. Whole ICE Catalog No. T0067.

World Health Organization. (2008). Integrated Health Services-What and Why? Technical Brief No. 1.

PATH’s Framework for Health Services Integration. Retrieved from: http://www.path.org/publications/files/GP_hsi_overview_bro.pdf

Diamenua, S., et al. (1998). Guinea worm disease – a chance for successful eradication in the Volta region, Ghana. Social Science & Medicine.

Volume 47, Issue 3, Pages 405–410

The Carter Center. Guinea worm disease eradication the road to eradication: Countdown to zero. Retrieved from: http://www.cartercenter.org/health/guinea_worm/mini_site/index.html

Questions for the Class

The fundamental intervention for guinea worm is behavior change and education. What does this tell us about the components of successful behavior change programs for other public health problems? Why did behavioral change work in guinea worm disease control?

 

Can you think of another disease where behavior change can mitigate the public health impact so it is no longer a public health problem?

Do you believe that guinea worm disease could increase if it is not eradicated soon?

 

What are other strategies that could have been used to pursue the public health goal of the eradication of guinea worm?

 

When would Integrated Health Services not be needed?

Questions?

Where Guinea Worm Disease

Still Remains

http://www.gatesfoundation.org/neglecteddiseases/Pages/working-to-eradicate-guinea-worm-disease.aspx

Conclusion

One of the most successful international collaborations. However, not completely eradicated; after more than 30 years, 4 countries remain.

Keys to Success

-Coordination

-Power of data

-High level advocacy and political leadership

Plans for Program Monitoring and Evaluation

Planning

Collaborating Services and Agencies cont’d

Collaborating Services and Agencies

The Model

Funding

The estimated cost of the global campaign between 1987 and 1998 is $87.5 million.

Estimated costs per case was $5 to $8

World Bank determined that the campaign has been highly cost-effective and cost-beneficial

http://blog.cartercenter.org/2010/10/12/signing-ceremony-takes-place-at-the-carter-center-guinea-worm-eradication-and-river-blindness-elimination-receive-major-boost-with-us-1-million-donation-from-opec-fund/

Key Players/Stakeholders

The Center for Disease Control and Prevention

The Carter Center

United Nations Children’s Fund

Peace Corps

World Health Organization

United States Agency for International Development

Governments Involved: Canada, Denmark, Finland, Japan, the Netherlands, Norway, Qatar, Saudi Arabia, Spain, Sweden, United Arab Emirates, the United Kingdom, and the United States.

Other Organizations Involved: BASF (formerly American Home Products), E.I. DuPont Corporation,

and the Bill & Melinda Gates Foundation

20 countries implemented national guinea worm eradication programs, run through their ministries of health

Community Involvement

Essential component of the eradication campaign was to empower the community members—the people at risk have the responsibility for fighting the disease.

Global Campaign was managed and delegated to the national levels through the Health Ministries.

“Village Volunteers”

http://www.gatesfoundation.org/neglecteddiseases/Pages/working-to-eradicate-guinea-worm-disease.aspx

Primary Interventions

Surveillance

Community education and action

Water supply improvements

Water supply and sanitation (WS&S) projects

Case management

http://blog.cartercenter.org/2010/02/10/southern-sudan-guinea-worm%E2%80%99s-final-frontier/

Project Guidelines

Linkage (integration) of Water Supply, Sanitation and Hygiene

Maximizing project sustainability and replicability

The role of the community

The role of community women

http://www.globalnetwork.org/water-and-sanitation

Fight toward Eradication

In 1980, the CDC first planted the seeds of the global guinea worm eradication campaign

1981, launch of an international initiative to provide universal access to safe drinking water

1986, U.S. President Carter began his involvement in the campaign, becoming a powerful advocate for eradication

1989, WHO’s 42nd World Health Assembly declares the goal of eliminating guinea worm disease as a public health problem

Global/National Goal and Objectives

Goal: Wipe out the disease by stopping the worm’s transmission from every location it occurs, effectively bringing the case incidence to zero

Objectives:

-Collaboration

-Education

-Programming

-Training

-Monitoring and Evaluation

Carter Center Video

http://www.youtube.com/watch?v=u4kQWvUv_Ns

Why the need for Guinea Worm Eradication?

-Economically Crippling

-Effects mostly women and children

-Preventable Disease

http://www.npr.org/blogs/health/2013/01/19/169694721/inching-closer-to-the-demise-of-a-stubborn-parasitic-worm

Treatment

http://www.sudan4jesus.com/2013/01/guinea-worm-s-sudan-worlds-most.html

Lifecycle of Guinea Worm Disease

Background

What is Guinea Worm Disease?

-The Forgotten disease of the forgotten people

-Known as the disease of the poor; has vanished from developed countries since the introduction of safe drinking water

-Dracunculiasis

-Contracted when a person drinks stagnant water that is contaminated

CASE STUDY

Reducing Guinea Worm in

Asia and Sub-Saharan Africa

Planning Elements

Essential for successful integration:

Planning and budgeting

Organization of health services

Staffing

Training

Supervision

Logistics

Community Outreach

Referral Services

Monitoring, evaluation, and research

Integrated Service Packages

Starting Point to Assess Whether Integration is Possible or Desirable

What type of service integration, if any is needed?

To what extent should services be integrated?

What steps are needed to establish and sustain high-quality integrated services?

What information is needed to measure success and inform improvement, replication, or scale-up?

Integrated Health Services:

Reducing Guinea Worm in Asia and Sub-Saharan Africa

Bobbi Snowden

SPHL 610: Global Health Program, Planning and Evaluation

February 7, 2013

Overview

-Integrated Health Services (IHS)

-Examples of IHS

-Planning Elements of IHS

-Review of Case Study

-Conclusion

-Questions

References

Levine, R. (2007). Reducing Guinea Worm in Asia and Sub-Saharan Africa. Case Study 11. Case studies in global health: Millions saved. Boston: Jones and Bartlett Publishers.

Yohalem, D. (1990). Programming Guide for Guinea Worm Eradication. WASH Field Report No. 329. Whole ICE Catalog No. T0067.

World Health Organization. (2008). Integrated Health Services-What and Why? Technical Brief No. 1.

PATH’s Framework for Health Services Integration. Retrieved from: http://www.path.org/publications/files/GP_hsi_overview_bro.pdf

Diamenua, S., et al. (1998). Guinea worm disease – a chance for successful eradication in the Volta region, Ghana. Social Science & Medicine.

Volume 47, Issue 3, Pages 405–410

The Carter Center. Guinea worm disease eradication the road to eradication: Countdown to zero. Retrieved from: http://www.cartercenter.org/health/guinea_worm/mini_site/index.html

CASE STUDY

Reducing Guinea Worm in

Asia and Sub-Saharan Africa

Pictures and Video

http://www.sudan4jesus.com/2013/01/guinea-worm-s-sudan-worlds-most.html

http://www.npr.org/blogs/health/2013/01/19/169694721/inching-closer-to-the-demise-of-a-stubborn-parasitic-worm

http://www.globalnetwork.org/water-and-sanitation

http://blog.cartercenter.org/2010/02/10/southern-sudan-guinea-worm%E2%80%99s-final-frontier/

http://www.gatesfoundation.org/neglecteddiseases/Pages/working-to-eradicate-guinea-worm-disease.aspx

http://blog.cartercenter.org/2010/10/12/signing-ceremony-takes-place-at-the-carter-center-guinea-worm-eradication-and-river-blindness-elimination-receive-major-boost-with-us-1-million-donation-from-opec-fund/

http://www.gatesfoundation.org/neglecteddiseases/Pages/working-to-eradicate-guinea-worm-disease.aspx

Integrated Health Services (IHS)

“The organization and management of health services so that people get the care they need, when they need it, in ways that are user friendly, achieve the desired results and provide value for money”

World Health Organization, 2008

The Model

Key Players/Stakeholders

Background

Global/National Goal and Objectives

The Center for Disease Control and Prevention

The Carter Center

United Nations Children’s Fund

Peace Corps

World Health Organization

United States Agency for International Development

Governments Involved: Canada, Denmark, Finland, Japan, the Netherlands, Norway, Qatar, Saudi Arabia, Spain, Sweden, United Arab Emirates, the United Kingdom, and the United States.

Other Organizations Involved: BASF (formerly American Home Products), E.I. DuPont Corporation,

and the Bill & Melinda Gates Foundation

20 countries implemented national guinea worm

eradication programs, run through their

ministries of health

What is Guinea Worm Disease?

-The Forgotten disease of the forgotten people

-Known as the disease of the poor; has vanished from developed countries since the introduction of safe drinking water

-Dracunculiasis

-Contracted when a person drinks stagnant water that is contaminated

Goal: Wipe out the disease by stopping the worm’s transmission from every location it occurs, effectively bringing the case incidence to zero

Objectives:

-Collaboration

-Education

-Programming

-Training

-Monitoring and Evaluation

Benefits of IHS

More cost effective use of limited resources

Increased reach and efficiency for health programs; more streamlined care for patients

Leads to a coordinated approach (e.g. engages sectors such as education or agriculture in addition to health sector) to solve health issues

Improved funding for health issues that are not prioritized by current funding streams

Collaborating Services and Agencies

Questions for the Class

Funding

Lifecycle of Guinea Worm Disease

The estimated cost of the global campaign between 1987 and 1998 is $87.5 million.

Estimated costs per case was $5 to $8

World Bank determined that the campaign has been highly cost-effective and cost-beneficial

Collaborating Services and Agencies cont’d

The fundamental intervention for guinea worm is behavior change and education. What does this tell us about the components of successful behavior change programs for other public health problems? Why did behavioral change work in guinea worm disease control?

 

Can you think of another disease where behavior change can mitigate the public health impact so it is no longer a public health problem?

Do you believe that guinea worm disease could increase if it is not eradicated soon?

 

What are other strategies that could have been used to pursue the public health goal of the eradication of guinea worm?

 

When would Integrated Health Services not be needed?

Fight Toward Eradication

Planning

http://blog.cartercenter.org/2010/10/12/signing-ceremony-takes-place-at-the-carter-center-guinea-worm-eradication-and-river-blindness-elimination-receive-major-boost-with-us-1-million-donation-from-opec-fund/

In 1980, the CDC first planted the seeds of the global guinea worm eradication campaign

1981, launch of an international initiative to provide universal access to safe drinking water

1986, U.S. President Carter began his involvement in the campaign, becoming a powerful advocate for eradication

1989, WHO’s 42nd World Health Assembly declares the goal of eliminating guinea worm disease as a public health problem

Questions?

Plans for Program

Monitoring and Evaluation

Conclusion

Where Guinea Worm Disease

Still Remains

Examples of IHS

One of the most successful international collaborations. However, not completely eradicated; after more than 30 years, 4 countries remain.

Keys to Success

-Coordination

-Power of data

-High level advocacy and political leadership

Combined HIV/AIDS and tuberculosis diagnosis and care in Tanzania

Integrated care for HIV/AIDS and maternal/child health in Kenya

Integrated interventions for diarrheal disease and child health in Vietnam

http://www.gatesfoundation.org/neglecteddiseases/Pages/working-to-eradicate-guinea-worm-disease.aspx

Treatment

Project Guidelines

http://www.sudan4jesus.com/2013/01/guinea-worm-s-sudan-worlds-most.html

Linkage (integration) of Water Supply, Sanitation and Hygiene

Maximizing project sustainability and ability to replicate

The role of the community/role of community women

http://www.globalnetwork.org/water-and-sanitation

Why the need for

Guinea Worm Eradication?

Starting Point to Assess Whether Integration is Possible or Desirable

1. What type of service integration, if any is needed?

2. To what extent should services be integrated?

3. What steps are needed to establish and sustain high-quality integrated services?

4. What information is needed to measure success and inform improvement, replication,

or scale-up?

-Economically Crippling

-Effects mostly women and children

-Preventable Disease

http://www.npr.org/blogs/health/2013/01/19/169694721/inching-closer-to-the-demise-of-a-stubborn-parasitic-worm

Primary Interventions

-Surveillance

-Community education and action

-Water supply improvements

-Water supply and sanitation (WS&S) projects

-Case management

Integrated Service Packages

http://blog.cartercenter.org/2010/02/10/southern-sudan-guinea-worm%E2%80%99s-final-frontier/

Guinea Worm Eradication Video

Integrated Planning Elements

Community Involvement

Essential for successful integration:

1. Planning and budgeting

2. Organization of health services

3. Staffing

4. Training

5. Supervision

6. Logistics

7. Community Outreach

8. Referral Services

9. Monitoring, evaluation, and research

Essential component of the eradication campaign was to empower the community members—the people at risk have the responsibility for fighting the disease.

Global Campaign was managed and delegated to the national levels through the Health Ministries.

“Village Volunteers”

http://www.gatesfoundation.org/neglecteddiseases/Pages/working-to-eradicate-guinea-worm-disease.aspx

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