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)”.

As mentioned in previous posts in this series, Nicaragua has had great success in reaching children with the deworming medicines they need to be free of intestinal worm infections and to live more healthy, productive lives. The country has surpassed the World Health Organization’s mandate to reach at least 75 percent of school-aged children with regular deworming treatment, actually achieving 87 percent coverage in 2010.

However like many countries in the region, Nicaragua lacks a strong monitoring and evaluation (M&E) framework to confirm the effectiveness of deworming programs in reducing the disease burden of STH infections. How well is high treatment coverage keeping kids from getting worms or decreasing the number of worms? In what regions are more or less resources needed to best sustain effectiveness of treatment programs? Unlike other developing regions, Latin America and the Caribbean (LAC) has not carried out extensive mapping of STH infections and thus has no baseline to measure success or identify gaps.

M&E is identified in the case study as the “lynchpin of sustainability and effectiveness of deworming efforts in Nicaragua and the broader region”. Sustainability and possibly disease elimination will require increased country ownership to scale-up deworming activities and enact long-term preventative measures such as WASH(ED), but the kind of financial support needed for those kinds of changes depends on real impact numbers.

The good news in Nicaragua is that progress is being made to ramp up M&E efforts, and in some cases Nicaragua is serving as a leader in the region. In 2011 Nicaragua launched new immunization cards which include a category for deworming treatment. This program is unique to Nicaragua and will hopefully lead to more successful M&E programs throughout the region. Additionally, guidelines were developed in 2010 for projects funded by the LAC NTD Initiative- a partnership between the Pan American Health Organization, the Inter-American Development Bank and the Global Network- to help standardize M&E activities and to find ways to incorporate data collection and disease surveillance into existing programs. The local PAHO office is looking at these and other opportunities to support the ministry in continue building M&E activities.