COMMUNITY-BASED APPROACH TO SCHISTOSOMIASIS CONTROL

With few exceptions, efforts to control schistosomiasis have relied up on ongoing community cooperation with 'outsiders' rather than creating within the community the capacity and means for carrying out ongoing disease control measures with minimal external support. Offered as a u seful model is a program in Kaele subdivision, Extreme North Province, Cameroon designed to establish and integrate within the primary healt h care (PHC) system the control of urinary schistosomiasis, hyperendem ic in the region. At the community level, and with minimal dependence upon external resources, culturally appropriate and effective health e ducation was instituted, the capacity to diagnose and treat schistosom iasis was created, diagnosis and drug therapy (praziquantel) was made available conveniently and at low cost, and, on a very limited basis, snails were controlled. Efforts were made to build upon and strengthen existing community structures and institutions rather than create new ones. The impact of the interventions was measured in terms of change s in knowledge and behavior, prevalence and intensity of infection, ut ilization of health services, and the ability to finance the control a ctivities within the context of a generalized cost recovery system. Pr ogram successes and failures are discussed, as well as lessons learned and their implications.