Today's pledge by President Bush to invest $350 million in fighting Neglected Tropical Diseases (NTDs) over the next 5 years is one of the wisest investments we can make in combating poverty around the world. This is particularly true when children are mass treated for common diseases through schools. While development initiatives are often driven by sentiment, school based treatment of neglected diseases is backed by rigorous evidence.
Over 400 million school-aged children are infected with parasitic worms (schistosomiasis and soil transmitted helminthes - two of Bush's neglected diseases) which leave them anemic and listless, and so they often skip school or find it hard to concentrate. Yet they can be treated with safe effective drugs for just 50 cents per year per child. Indeed, the evidence shows that mass treatment for these neglected diseases is both the most cost effective way to increase school participation of any intervention yet rigorously tested and one of the world’s most cost effective ways to improve health. These health and education benefits can have long run benefits on productivity and earnings.
Edward Miguel of UC Berkeley and I evaluated the impact of a school-based treatment program run by International Child Support Kenya (ICS). Due to administrative and financial constraints ICS randomly phased the program into schools over several years, providing the opportunity to rigorously evaluate the impact - much as in the randomized trials used in medicine. We found that treatment cut absenteeism from school by 25 percent. This means that children who attend primary school with regular deworming every six months end up receiving the equivalent of one additional year of education. With the higher incomes associated with more education, we estimate that for every dollar spent on deworming, society gains more than $30.
Very similar effects were found by Hoyt Bleakley of the University of Chicago's Graduate School of Business in his careful analysis of the impact of a Rockefeller-funded program that treated the same parasitic worms in the US South at the beginning of the 20th century (also see this article in the Chicago Tribune). As in Kenya, schooling went up. Bleakley traced the effect through to increases in productivity and wages in the areas that had been hardest hit by the worms before treatment, and estimates that 20 percent of the large gap in incomes between the northern and southern states of the US at the time was due to worm infections.
We now have the opportunity to have a similar positive impact on the lives of the poorest children and their communities around the world.
To maximize the impact of the funds, it is important to first target the most cost-effective delivery approaches. First and foremost, that is mass treatment through schools. The reason that school based treatment is key is simple. Children have by far the highest infection rates and the vast majority of children, even in Africa, now go to primary school. Schools collect large numbers of children in one place where they can easily, quickly and safely be treated en masse by teachers with some very basic training. The necessary drugs are cheap and safe - typically pennies per dose - while diagnosis is expensive, so in environments where worms are common, the WHO recommends school-based mass deworming without individual testing. Delivery through clinics is harder because in many areas worm infection is so widespread that most people consider it normal and don’t go to a clinic to be treated. Moreover, heath providers in many developing countries have very high absenteeism rates. Drug deliveries to schools can be made along with books, exams, or other teaching materials, reducing transportation costs. And programs can capitalize on existing administrative infrastructure at the Ministries of Education and Health to maintain low running costs. School-based treatment organized through Ministries of Education can cut costs by more than a third relative to sending out specialist medical teams to move from school to school treating children.
Bush and his administration are not the only people responding to the evidence. While the World Health Organization, the World Bank and groups like Partnership for Child Development, the Schistosomiasis Control Initiative and the Global Network for Neglected Tropical Diseases have been promoting deworming for many years, the evidence on its important impact on education is prompting more Ministries of Education to take note. Madagascar is working on a nation-wide school based program. Zambia, with support from USAID, is planning a large school based program, as is Kenya. The World Economic Forum's Young Global Leaders, of which I am a part, launched an initiative to promote school based mass treatment of parasitic worms under the banner of "Deworm the World."
For less than $300 million a year we could treat all 400 million school aged children who are infected with parasitic worms - if we do this through schools. If the rest of the G8 respond to Bush's call to join him in this initiative we could indeed deworm the world.
Additional information about the impact of investing in fighting soil transmitted helminthes and schistosomiasis can be found through the MIT Poverty Action Lab's Policy Briefcase (.pdf)
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CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.
