Last month, the Delhi Government rolled out a mass school-based deworming program targeting 3.6 million children.  The Government of Bihar launched a program reaching over 17 million children last year.  These trailblazing initiatives are shown to be among the most promising solutions to global poverty. Now it’s time to institutionize them.

Worm infections are now seen as a proxy for poverty. The World Health Organization estimates 800 million preschool and school-age children are at risk.[1] These parasites can cause children to regularly suffer from anemia, diarrhea, and abdominal pain, and harm physical and mental development. Poor health and nutrition are large impediments to children’s education. With worms, the already daunting challenge of basic education to vulnerable, disadvantaged children becomes even more formidable.

The silver lining: worms can be eliminated by a safe and simple pill, given once or twice a year. For pennies per dose, treating a child results in 15 additional days of school attended per year. Even classmates who miss treatment gain 7 more days of school each year, simply from reduced transmission. The impact of this straightforward exercise, if implemented year after year, results in 20% higher earnings and 12% more hours worked as these children grow into wage-earning adults.

Mass deworming through schools can be quickly scaled by enlisting teachers to deliver this safe medication. Leveraging the existing education infrastructure reaches the highest number of children at an extremely low cost of less than 50 cents per child per year.  Last month, the Delhi Government rolled out a mass school-based deworming program targeting 3.6 million children.  The Government of Bihar launched a program reaching over 17 million children last year. In 2012, the Government of Kenya will expand its national program to reach all at risk children, totaling over 5 million.

The potential of programs at scale is powerful. Lessons from the field provide valuable insight.  First, political support and collaboration across education and health sectors is essential to sponsor, spearhead, and rollout the initiative – a challenge when in some cases officials have never worked together before and priorities compete for relevance and resources. Educating parents, teachers and the local community on the benefits of deworming is crucial to increase awareness and acceptance, generating public support and demand. However, the most important challenge is the institutionalization of these programs, since without regular treatment children are easily re-infected and cannot fully benefit from deworming.

It is essential that school-based deworming becomes standard practice, and that institutional mechanisms are created to support this. Even the most effective social programs are sometimes forgotten or discontinued due to a change in administration, deficits in funding, or even fatigue among donors or policymakers who favor the latest project over investing long-term in what is proven to work. Institutionalization, a process that begins once the initial success of programs has been achieved, involves attention to key questions such as: How do we formally integrate deworming into the national/state policies and budgets over the long-term? How do we maintain strong buy-in from key stakeholders over time? How do we continuously evaluate and improve the program for increased effectiveness?

Deworming works. It’s a highly proven solution that can be scaled rapidly and cheaply. Deworm the World, a YGL initiative, plays a key role in initiating and sustaining school-based deworming programs by providing technical assistance to governments, including Delhi, Bihar and Kenya.  Join us to spark widespread adoption and support the institutionalization of these programs. Our attention must focus on improving the lives of these 800 million vulnerable children.

[1] WHO. Soil-transmitted helminthiases: estimates of the number of children needing preventive chemotherapy and number treated, 2009. Weekly Epidemiological Record 2011; 25(86):257-268.