In the face of many obstacles, Nicaragua’s history in ensuring a national deworming program has shed light on the potential for success.  Former Global Network intern, Frankie Lucien, and fellow George Washington University Masters student Cara Janusz, traveled to Nicaragua and investigated the challenges and achievements of the Nicaragua experience and developed a case study with support from Children Without Worms.

This week End the Neglect will be featuring a six-part series of blog posts covering interesting elements of the Nicaragua experience highlighted in the case study, entitled “Worms and WASH(ED)”.

Running a national public health campaign is a big undertaking and often, multiple partners must work together to bring all the necessary resources and know-how to the table. National programs aim to reach the country’s entire population in need, but often financial and human resources end up clustered around urban centers and specifically targeted populations. Smaller organizations, which often have longstanding relationships with communities and a particular expertise in a given area, fill in program gaps.  In the case of deworming programs, this means ensuring treatments are between campaigns.

In a unique public-private partnership, Johnson & Johnson’s donated deworming treatment mebendazole is distributed to governments through the Children Without Worms program with the support of the nonprofit Task Force for Global Health. Children Without Worms works in eight countries, including Nicaragua, to distribute treatments and address sanitation, water and hygiene challenges that contribute to the prevalence of intestinal worm infections.

With more than 1.3 million children at risk for intestinal worm infections, Nicaragua’s Ministry of Health decided to focus on school-age children in its national deworming program and counts on NGOs to fill in some of the gaps and other community needs. The national program harnesses existing infrastructure – the national school-based Expanded Program for Immunization (EPI) – and takes advantage of a drug donation program, Children Without Worms, to target school-age children.

Nicaragua, with the help of Children Without Worms, has scaled up its deworming program to better control outbreaks. Nicaragua exceeded the WHO coverage target in 2010, reaching 87 percent of all school age children, and treated another 1.5 million in 2011.

Before Children Without Worms’ involvement, other NGOs provided donated treatments and worked at the local level, in line with the country’s earlier system of decentralized health clinics. Now equipped with a strong national healthcare program and large drug donations direct from J&J, these organizations – which include Save the Children, World Vision, CARE and others – have stepped in to reach the niche populations that are not targeted by Nicaragua’s national school-based donation program, such as children younger than five. These smaller NGO-based donations also stock local health clinics for treatment (mebendazole or albendazole) between mass drug campaigns, and can be used by anyone in the community. Reaching the entire population at risk of worms is essential to reduce the likelihood that worms will be transmitted from person to person.

With multiple partners and multiple sources of drugs, Nicaragua has worked hard to coordinate drug donations and mass drug campaigns to make sure that all in need receive appropriate treatment. Still, some medicines reach the country outside of government-coordinated channels, and can cause problems if the donations are not matched with the target populations’ needs. For example, preschool-age children must receive a chewable form of mebendazole, so it is essential that the right formulation is sent to the right partner. Nicaragua’s reliance on NGOs to cover niche populations means that the country is working hard to address these challenges head on, and given its history of adapting to changing resource and distribution systems, the future looks bright.

To read more about the case study “Worms and WASH(ED)” please click here.