Deworming Delhi: A project-management perspective

On February 21, the government of Delhi 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. A “mop up” day on February 27 sought to administer deworming pills to any kids who were missed in the initial round of distribution.

Deworming may not be the most glamorous of health intervention efforts. But from our perspective, its benefits are undeniable. Deworming is simple, safe and cost effective. It offers one of the biggest “bangs for the buck/rand” of any public health initiative. Children need 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. Moreover, the benefits of the treatment extend beyond health and into education. One Kenya-based study showed that deworming programs reduced student absenteeism by 25 percent and increased classroom participation by seven percent or more.

One of the key takeaways from the Delhi program is that mass, school-based programs are possible. But given how daunting the task of coordination might seem, we thought it would be worthwhile to outline the key elements of the Delhi project that, from a pure project management perspective, made the exercise possible:

  1. Basis in research and data – The Delhi program (like a similar Bihar effort that reached 17 million children) was initiated after detailed studies estimated the prevalence of worm infections in the area and made the case for mass deworming efforts.
  2. Stakeholder buy-in and coordination – Rolling out deworming at an unprecedented scale required buy-in from and close coordination amongst all the stakeholders (government, drug companies, funders). In Delhi, a committee with key representatives from the government and a technical agency, Deworm the World, was set up and served as the anchor for all aspects of program implementation. (NOTE: The time and perseverance required for ensuring sustained coordination cannot be underestimated. The Delhi project required a year of intensive partnership and coordination before the first deworming tablet was ever handed to the first child.) Deworm the World, the grantee we helped fund to coordinate the logistics of Delhi project, had previously worked with the Bihar government to successfully launch its successful deworming program. The organization excels in terms of having the technical know-how and commitment to help governments execute on a grand scale.
  3. The ability to leverage and streamline existing structures – Instead of putting in place a parallel system, Deworm the World partners with governments to identify and use existing infrastructures and resources for teacher training, community sensitization, drug delivery and monitoring.
  4. Independent monitoring – There’s a wealth of impact data to show the effectiveness of mass deworming from a health perspective. So the objective of monitoring should be to assess the effectiveness of a given implementation and confirm that every child receives a deworming pill.

The benefits of deworming are proven, and the Delhi government – together with Deworm the World – has successfully modelled the implementation methodology for mass, school-based, urban health interventions. Now it’s time to expand on what we’ve learned. In the wake of the successful Delhi effort, we hope state governments throughout India will weigh the significant benefits and low costs of deworming efforts against the high costs (in terms of our children’s health and educations) of inaction, and commit to mass programs of their own.

Part 2 of 2: The first blog in the series focused on the health effects of intestinal worms, the challenges of implementing effective programs, and the successful launch of the Delhi program.