At Evidence Action, we are all about scaling effective, evidence-based interventions that benefit millions of people. That's a big goals that takes a community of committed people. Our Deworm the World staff and partners in Ethiopia and Kenya have been working together to ramp up a successful national school-based deworming program in Ethiopia, accelerating the work and sharing lessons.

A sunrise view from the road into Adama town.

A sunrise view from the road into Adama town.

In Kenya, Ethiopia’s neighbor to the south, Evidence Action started providing technical assistance to the government in 2009. Since then, we have continued to work with partners in the Ministries of Health and Education who launched Kenya’s National School Based Deworming Program in 2012. There we learned a lot about what works and doesn't work. 

In Ethiopia, we started to support the Federal Ministry of Health (FMoH) about a year ago, laying the groundwork for a new national-scale deworming program in Ethiopia's schools as well. From the very beginning, our Kenya team was very involved, providing examples of field-tested materials and strategies to adapt for use in an Ethiopian context. We now have formal partnership agreements with the FMoH and the Schistosomiasis Control Initiative (SCI) to provide technical assistance to the country’s deworming program.

Regional health administrators discuss and practice filling in treatment coverage forms.

Regional health administrators discuss and practice filling in treatment coverage forms.

Getting Ready in Ethiopia 

In late August 2015, work in Ethiopia kicked off with a Training of Trainers. Regional health officers from nine regions travelled to the town of Adama for a 4-day training about the public health problem of soil-transmitted helminths and schistosomiasis, the cost-effective and safe solution of mass drug administration through schools, and their own roles in implementing school-based deworming.

Since the program is owned and run by the FMoH, Ethiopia’s Neglected Tropical Diseases team led the training and convened sessions on training officials at lower administrative levels in the country, drug distribution channels, and budgeting for these activities.

Evidence Action staff from the Kenya and global deworming teams led sessions covering independent monitoring, community sensitization, and public mobilization. We had productive discussions about common challenges that may hinder children and families from participating in deworming. It was clear that a lot of myths surrounding mass drug administration campaigns, such as fears of harmful side effects or not knowing the true purpose of the medication, are common in both Kenya and Ethiopia. Kenyan colleagues have found creative ways to counter these myths that they relayed to their Ethiopian counterparts. We also stressed the benefits of monitoring activities in real time to respond to issues as they arise to prevent negative impacts on public perception and participation.

Localizing Materials and Tools  

Since we already provide technical assistance to other large-scale government-run deworming programs, the Deworm the World team has produced, tested, and refined a battery of planning and implementation tools. For instance, our team worked closely with the FMoH to adjust forms to Ethiopian needs that teachers and district-level health administrators use to record how many children are treated. We also shared examples of the community sensitization posters, fliers, and banners that are used to raise awareness about deworming days in India.

The basic structure of the materials was helpful, but they needed to be customized to a new set of administrative levels (i.e., counties and sub-counties in Kenya vs. woredas and kebeles in Ethiopia). Some of the materials needed to be translated from Swahili or Hindi to Amharic or otherwise changed to reflect local customs. Indian flyers and posters that remind children to wash their hands before eating show rice, dal, or mangoes, while in Ethiopia, kids will more readily recognize and accept the same message if accompanied by pictures of rolled-up injera (bread) and familiar stews.

The Power Of Learning By Doing

Although PowerPoint and lecture-style presentations are necessary, there is no substitute for hands-on learning. Led by a Kenya program manager and modeled after methods we use in Kenya, we coordinated a deworming day role play. After a couple of days focused on learning the ins and outs, dos and don’ts of deworming day in a school setting, the regional officials split up into four groups and put their knowledge to the test. Each group designated individuals to fill the roles of students, non-enrolled school-age children, teachers, health extension workers, and parents.

Some groups moved furniture and made signs to simulate a school setting, even crafting paper “tins” of albendazole and praziquantel, to mirror reality as much as possible. The groups took turns presenting their role play, demonstrating the correct order to administer drugs, how to treat children who experience side effects from the medication, and how to complete the treatment coverage forms distributed by the FMoH. The audience gave feedback and pointed out anything the performers forgot, in a spirit of friendly competition.

During the deworming day role play, regional health and education officials show how to use a dosing pole to determine the correct dose of praziquantel based on a child’s height.

During the deworming day role play, regional health and education officials show how to use a dosing pole to determine the correct dose of praziquantel based on a child’s height.

When the regional officials had a chance to physically move through the actions we had all been talking about for so long, they were excited to realize how much they’d truly learned. The simulation also brought up new, detailed questions in the subsequent group discussion. For instance, how has Kenya responded to children who want to take medicine home to their family members? Or, what do they tell parents who want to treat their non-eligible infants with praziquantel? Just how often do other program teams encounter adverse events on deworming day?

It was incredibly helpful to have experienced team members from Kenya present to provide clear and immediate answers to these questions, personalized with insights from their own observations and knowledge. From these in-person, peer-to-peer exchanges, the Ethiopian participants were reassured of the successful program model and felt more prepared to handle some of the unforeseeable but inevitable challenges in the road to program implementation at scale.

Future Plans

In 2016, leaders from the FMoH’s NTDs team, representatives from the Ministry of Education, and SCI partners will visit Kenya’s National School-Based Deworming Program. Policy leaders and implementation teams from the two countries will compare experiences and talk through common challenges and successful tactics in scaling up school-based deworming nationwide.

Just a few weeks ago, Ethiopia’s training and preparations to date culminated in the first national school-based deworming day that will reach 16.5 million children at risk for parasitic worm infection. Our teams in Kenya, India, and the U.S. are so proud to support the governments of both Kenya and Ethiopia as they make significant progress toward scaling up deworming treatment for children in the communities that need it most. 

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