The Organization of schistosomiasis control programmes.
A major constraint to the control of communicable diseases in developing countries is the lack of adequate institutionalization of public health activities. The usual political perception is that the public will benefit more from economic and social development than from public health interventions. Planners and politicians generally hold that investment in rural electrification, roads and education will bring more long-term benefit than equivalent investments in public health. Sadly therefore, public health interventions have usually been designed and implemented as short-term, high-return activities in an atmosphere of unrealistic optimism. This criticism can be applied to most tropical diseases, but the potential of new weapons against many of the most widespread parasitic diseases places some urgency on an analysis of the most effective way to implement these interventions. In an attempt to identify and begin to resolve some of these issues, The World Bank, WHO and McConnell Clark Foundation sponsored a workshop on the Organization and Management of Schistosomiasis and other Tropical Disease Control Programmes. The meeting addressed general issues of the organization of public health services, but focused on schistosomiasis where the development of effective, single oral dose chemotherapy (using oxamniquine or praziquantel) is seen as a realistic intervention for large-scale control throughout the 74 endemic countries. In this article, Bernhard Liese reviews the institutional questions, drawing examples from the often cited control programmes in Brazil, Ghana, Egypt, Morocco, Sudan and the Philippines.