A. Sleigh et al., Eradication of schistosomiasis in Guangxi, China. Part 2: Political economy, management strategy and costs, 1953-92, B WHO, 76(5), 1998, pp. 497-508
Citations number
21
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Reported are the results of a study of the political economy, management, a
nd costs of the successful Guangxi schistosomiasis eradication programme, s
panning 40 years from 1953 to 1992. For this purpose we analysed all govern
ment data and memoranda on the policy, management technical support, financ
e, and the control strategy of the programme. We also interviewed many loca
l staff involved in the programme over the 40-year period and obtained cost
data from annual county-level records on seven major categories of variabl
e costs.
Schistosomiasis control in Guangxi began with one of the first examples of
community participation and rapid assessment in public health history - the
use of pre-franked envelopes to return disease questionnaires and suspect
snails from rural areas. This approach quickly and accurately delineated th
e endemic area. This was Mao Zedong's "mass line': incorporating ideas and
knowledge from peasants directly into services run for and by them, here th
e schistosomiasis control programme. Recognition by China's leaders that sc
histosomiasis was a great economic burden, steadfast prioritizing of the pr
ogramme over 40 years, local innovative scientific study, agricultural and
environmental focus on eradicating the snail hosts and boosting rural produ
ction, and mass community education and support were all key factors in the
final success. Local leaders motivated programme staff and everyone involv
ed knew the objectives. The programme was always multisectoral, with policy
developed centrally, and strategy and collaboration encouraged and rewarde
d at the grass-roots. These features explain how a very poor autonomous reg
ion such as Guangxi finally eradicated schistosomiasis, spending less than
US$ 0.50 per protected citizen per year; if is remarkable that the disease
and snails were initially found across a large area of complex environments
and modern drugs such as praziquantel were not available for most of the 4
0-year period. The lessons from Guangxi can be adapted elsewhere and should
encourage other areas to control endemic schistosomiasis using methods dev
ised to suit the local culture and geography.