October 19,2012

Going Far Together - CWW Technical Assistance Workshops

Read David Addiss's report on CWW's Technical Assistance Workshops.

Regional Technical Assistance Workshops for Soil-Transmitted Helminthiasis Control

“If you want to go quickly, go alone. If you want to go far, go together.” - African Proverb

Attendees of the South East Asia Regional Technical Assistance Workshop, Dhaka, Bangladesh, Sep. 25-27 

Earlier this year, the World Health Organization (WHO) announced a bold new goal of eliminating soil-transmitted helminthiasis (STH) as a public health problem in children by 2020. Achieving this goal will require annual deworming of 900 million children worldwide, as well as significant improvements in sanitation and hygiene. Unprecedented levels of coordination and collaboration are needed among a growing consortium of partners, including national Ministries of Health and Education; U.N. agencies such as WHO, the World Bank, and UNICEF; non-governmental organizations (NGOs); pharmaceutical companies; private foundations; and bilateral donor agencies, to mention a few. Together, we face significant logistical, technical, and programmatic challenges – as well as a monumental opportunity to improve child health.  

Many of the ingredients required for success are already in place. Johnson & Johnson (J&J) is scaling up its donation of mebendazole, a deworming drug, to 200 million treatments per year, while GlaxoSmithKline (GSK) has pledged 400 million treatments of albendazole per year to treat STH. WHO has released new technical guidelines on school-based deworming as well as a strategic plan to eliminate STH in children by 2020. The emerging global “STH community” is experiencing a virtual explosion of interest, commitment, and support for STH control.

In such a dynamic environment, with the ambitious 2020 goal not far over the horizon, opportunities for in-depth planning, sharing of experience and know-how, and strengthening technical capacity are critical for building a solid, cohesive global STH control program. As the well-known African proverb teaches, if we want to go far, we must go together. 

Since 2008, Children Without Worms (CWW) has organized workshops in Nairobi, Phnom Penh, Vientiane, and Kampala to provide technical assistance to countries receiving J&J mebendazole. This year CWW facilitated expanded workshops for the Western Pacific and South East Asia Regions of the WHO to provide an opportunity for STH-endemic countries in these regions to plan and develop their STH control programs. In June, 47 representatives from Ministries of Health and Education, NGOs, WHO, and other partners from six countries participated in the Western Pacific Regional workshop held in Manila, Philippines. (Details of this workshop are described in the August 2012 Quarterly Dose.) In September, 49 representatives from eight countries participated in the South East Asia Regional workshop in Dhaka, Bangladesh.

In both the Philippines and Bangladesh, the presence of government officials, WHO, and donors displayed strong support for the goals and objectives of the workshops. The Assistant Secretary of Health of the Philippines opened the Western Pacific Regional workshop, which included representation from USAID, Johnson & Johnson, and GlaxoSmithKline. In Dhaka, the Minister of Health of Bangladesh provided a keynote address during the opening ceremony alongside other high-ranking officials from the Ministry of Health and Family Welfare, USAID, and WHO.

Although workshops in Manila and Dhaka differed based on regional needs, they shared several key features:

  • Strong collaboration with WHO
  • Practical sessions on program monitoring and evaluation
  • Emphasis on the WASHED framework (Water, Sanitation, Hygiene Education and Deworming) for comprehensive, long-term control of STH
  • Teams of at least two people from each country, from both the health and education sectors
  • Representation from NGOs involved in STH control, school health, and WASH
  • In-depth discussions on collaboration between national governments and NGOs

The workshops in Manila and Dhaka provided valuable lessons to CWW and the STH control community. First, they highlighted the importance of shared experience and opportunities for relationship-building and creating a cohesive, multisectoral global STH control program—i.e. ‘going together.’ In the words of Dr. Antonio Montresor of WHO, “These workshops are really important to maintain the momentum of the global STH control effort; they enable WHO to establish and reinforce direct links with STH control program managers in the regions.”

Second, the degree to which STH is being controlled varies considerably among regions, within regions, and even within the same country. Therefore, 2020 goals for morbidity reduction and sustainability are likely to differ depending on location. For countries with high levels of STH, poor sanitation, and weak infrastructure, reaching the 75% treatment-coverage objective, established by WHO, will be a significant achievement. In countries with experienced programs and sufficient improvements in WASH, it may be possible to devolve mass drug treatment for STH into routine individual care through the health system.

The workshops emphasized that STH program managers face major challenges of coordinating mass drug treatment across three at-risk groups (preschool children, school-age children and women of childbearing age), which are targeted using different channels of the health or education systems (e.g., immunization campaigns; schools; and maternal health clinics, respectively), often using drugs procured from more than one source. Further, for sustained control, they need to work across several governmental agencies and NGOs engaged in WASH activities. Therefore, broad inter-sectoral collaboration and a systems approach are required to ensure that efforts to control STH in all three at-risk groups make forward progress towards global goals for control. 

Finally, as community-based lymphatic filariasis (LF) elimination programs intensify evaluation activities and begin to scale down, opportunities exist for assessing the impact of the LF program on STH and for collecting data to guide STH treatment decisions in the transition to school-based STH control programs. 

In his book Good to Great, author Jim Collins describes “going together” by using the metaphor of the flywheel, the heavy cylinder on some engines that builds momentum gradually and then serves to maintain it. In describing “great,” high-functioning organizations, Collins says, “When people begin to feel the magic of momentum—when they begin to see tangible results and can feel the flywheel start to build speed—that’s when they line up, throw their shoulders to the wheel, and push.” 

The STH flywheel is beginning to turn. Expanding technical assistance workshops to the regional level is both a result of this increased momentum and, we hope, a catalyst to even greater momentum. Each conversation, every exchange of practical advice and experience, and every logistical challenge overcome help to create the momentum that will lead to successful STH control worldwide.

- David Addiss, Director, Children Without Worms
October 2012

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