Deworming Delhi: A low-cost, high-impact approach to public health

India has over 250 million school-age children, a significant number of whom suffer from intestinal worms. For these children, the consequences of worm infection range from malnutrition (since worms abscond with the bulk of nutrients) and iron deficiency to permanently stunted growth, impaired learning ability and high rates of absenteeism from schools. And the consequences don’t stop at the level of individual children; some estimates claim that the physical and cognitive disabilities associated with iron deficiency alone cost less developed economies as much as 4 percent of their GDP.

The good news is that the treatment for worms is simple, safe and cost effective. Children need to receive a single dose of a deworming drug. Administered annually or bi-annually, depending on the prevalence of worm infections in a particular area, each dose costs only pennies per child. Rigorous research has demonstrated that the impact of deworming on children’s health and education outcomes is substantial.

Moreover, administering this treatment in schools (where children are found in large numbers) through teachers has been identified as one of the most cost-effective developmental interventions. The bad news is that mass deworming programs aren’t yet widespread. Given the enormity of the problem and the simplicity of the solution, the obvious question to ask is why? There are a lot of reasons, of course, not least among them competing public health priorities. India has no dearth of health issues to deal with. But one of the biggest reasons is the logistical challenge of reaching out to several million children.

Over the past couple of years in India, the foundation has been taking a long hard look at how to most effectively tackle the many health issues affecting the millions of children who live in poverty in the country’s major cities. The questions we asked were simple:

  • What are the baseline conditions that affect the greatest number of children?
  • How can we make sure each dollar we commit has the biggest possible impact?
  • And who can help us do the hard work of coordinating mass programs that reach millions of children?

As we continued to evaluate the landscape, intestinal parasites – a chronic underlying condition that affects hundreds of millions of kids, but that’s also easily treatable –  began to emerge as a clear candidate for consideration. Mass deworming is clearly possible. The efforts of Deworm the World, a technical agency that works directly with governments and other stakeholders to launch, strengthen and support school-based deworming programs, have made that clear.

In India, the state government of Bihar, supported by Deworm the World, recently conducted the largest school-based, deworming initiative in the world. The Bihar example, which reached some 17 million children, has paved the way for several state governments, like Delhi’s, to follow suit with mass deworming programs of their own. In fact, on February 21, the government of Delhi – supported by Deworm the World – kicked off a massive, school-based deworming effort, administering a single tablet to each of an estimated 3.5 million children.

One of the largest health initiatives of its kind in India’s capital city, the effort was the culmination of more than a year of coordination and partnership. The intervention, which had foundation support, comes at a time when a study has revealed that nearly 70 percent of children in Delhi’s government schools are anemic. There will be a “mop up” day on February 27 to administer deworming pills to any kids who were missed.

Based on the existing body of evidence about the effectiveness of the treatment, we’re confident that the Delhi project will have significant positive effects on children’s health and school performance. But we also have a bigger goal in mind: Our hope is that this effort serves as the catalyst for a more comprehensive school-based health program in Delhi, and that it becomes a model for other Indian cities seeking to embark on public health programs with the potential to help millions of children get healthier and stay in school.

Part 1 of 2: The next blog in the series focuses on the ingredients critical to the success of government-sponsored, mass-deworming programs.