In brief

Parasitic worm infections or soil-transmitted helminths (STH) are a serious health problem in the developing world, particularly in India, where around 250 million children are at risk of STH. It can lead to anaemia and malnutrition as well as affecting mental development and has a negative impact on school attendance. In order to address the problem, India has instigated National Deworming Day with the support of the Deworm the World Initiative: the first was held in February 2015 and treated 140 million children in 12 states; the second was held a year later and treated 270 million children in 36 states and union territories nationwide.

The challenge

Globally, over 870 million children are at risk of parasitic worm infection. More than 600 million of these children remain untreated. India has the world’s most acute parasitic worm problem. The World Health Organisation (WHO) estimates that 241 million children between the ages of one and 14 are at risk of parasitic intestinal worms in India.

“Worm infections interfere with nutrient uptake; can lead to anaemia, malnourishment and impaired mental and physical development; and pose a serious threat to children’s health, education, and productivity. Infected children are often too sick or tired to concentrate at school, or to attend at all. Worm infections are estimated to cause a loss of 200 to 524 million years of primary schooling.” [1]

The initiative

The first major Indian deworming programme was run jointly by the State Health Society Bihar, the Bihar Education Project Council and the Deworm the World Initiative (DtWI) to implement a school-based deworming programme in the state for treatment of soil-transmitted helminths (STH), or parasitic worm infection. This provided the basis for a nationwide initiative.

On 10 February 2015, India’s Ministry of Health & Family Welfare launched “the first 'National Deworming Day' – a massive school-based deworming effort in twelve states”. [2] It marked the start of “a groundbreaking national deworming programme to treat all children at risk for parasitic worms across the country. The Deworm the World Initiative, a coalition of organisations led by the NGO, Evidence Action, is providing technical assistance to this national programme”. [3] “National Deworming Day [treated] an initial 140 million children at risk for parasitic worms in schools and pre-schools”. [4]

This has now become an annual event.  The Indian Ministry of Health and Family Welfare observed National Deworming Day on 10 February 2016 across all 36 states and union territories. The exercise aimed at a massive target of 270 million children in 536 districts of the country.

The public impact

DtWI has been able to treat a large number of school-age children, treating more than 90 million children in the 2014/15 school year. This experience was invaluable in preparing the ground for India’s 2015 and 2016 Deworming Days. “Lauding India's National Deworming Day initiative, which was observed on Wednesday, the WHO said it would go a long way in improving the health of children as well as that of the country. ‘The deworming initiative, along with measures to address hygiene and sanitation, will go a long way in improving the health of children as well as that of the country,’ WHO Regional Director for South-East Asia, Dr Poonam Khetrapal Singh said in a statement. The official congratulated India for launching last year one of the largest public health campaigns to de-worm 270 million children in the age group of one to 19 years, on a single day across the country.” [5]

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What did and didn't work

All cases in our Public Impact Observatory have been evaluated for performance against the elements of our Public Impact Fundamentals.

Legitimacy

Stakeholder Engagement Strong

There is strong support from government and the private sector, providing funding and facilitating the necessary planning and implementation activities:

  • Evidence Action and DtWI coordinated with the Ministry of Health and Family Welfare to facilitate planning and implementation of the deworming round.
  • The deworming programme is funded by the Indian government the Departments of Health, of Education, and of Women and Child Development.
  • Additional support has been provided by the Children’s Investment Fund Foundation (CIFF), Dubai Cares, the US Agency for International Development (USAID), the Michael & Susan Dell Foundation, the END Fund, the Douglas B. Marshall Jr. Family Foundation, and by individual donors to Evidence Action.   
  • A connexion was also made between a representative from the Department of Basic Education and the Jameel Poverty Action Lab (J-PAL) team to establish links between a similar project in Kenya and the Indian policymakers.

Political Commitment Strong

India's national school-based deworming programme is funded by the federal government and the State Departments of Health, of Education, and of Women and Child Development.

India’s National Deworming Day on 10 February 016 was a major achievement, according to the WHO’s regional director: Dr Poonam Khetrapal Singh “said the scale of the campaign is unprecedented and reflects the country's resolve to address health issues related to STH.” [6]

Public Confidence Fair

The DtWI has a high reputation in the charitable sector: “GiveWell named the DtWI at Evidence Action one of its top-rated charities for a third year in a row, stating that it ‘offers donors an outstanding opportunity to accomplish good with their donations’.” [7]

This has assisted in the public support for the Indian Deworming Day, which showed high levels of cooperation, with 270 million children receiving deworming tablets.

Policy

Clear Objectives Strong

The main aim of National Deworming Day is to focus efforts to eradicate STH from India. This objective was stated at the outset of the project and will be maintained regularly in future.

Evidence Strong

The programme was extensively tested for effectiveness by consulting with key stakeholders DtWI and J-PAL who had extensive experience in deworming programmes:

  • “The Kenyan government, informed by the research on the effectiveness of deworming in their country, launched a school-based deworming programme in 2009 with technical assistance from DtWI. This programme treated 3.6 million children across 8,200 schools in its first year.” [8]
  • “In 2011, the State Government of Bihar, India conducted a massive deworming campaign, with technical assistance from DtWI and policy support from J-PAL. In September 2011, the government announced that over 17 million school-aged children in the state were treated that year for intestinal worms." [9]

Feasibility Strong

The previous deworming initiatives by DtWI and J-PAL in Kenya and the Indian state of Bihar indicated the logistical feasibility of mass deworming programmes.

For the deworming programme, schools were given a protocol to follow: e.g., providing clean drinking water and glasses, two spoons for crushing tablets, a well-ventilated and cool place and contact details for nearest healthcare centre and medical support.

The financial feasibility was addressed by the federal government and the technical support by NGOs such as USAID and the END Fund.

Action

Management Good

The National Deworming Day was the responsibility of the Indian government’s Ministry of Health and Family Welfare. It worked in collaboration with DtWI at Evidence Action (see also Strength of evidence).

DtWI has significant management experience and provides support to federal and local government officials.

Measurement Strong

The main metrics in school-based deworming programmes are the number of children who receive deworming medication and the number of states, UTs, districts schools where a deworming initiative took place.

In its deworming programmes, Evidence Action uses an independent monitoring agency to determine whether deworming is being implemented according to planned protocols.  The field teams assess issues, such as the availability of deworming tablet and the accuracy of the deworming data reported by schools.

Alignment Strong

In turn, the Indian government provides the funding for successive National Deworming Days, while the Department of Health and Family Welfare manages the programme on the government’s behalf.

The Department of Education ensures that all preparations and arrangements for the day are made in the nation’s schools.

The DtWI at Evidence Action provides technical assistance to the Indian government to rapidly scale up the national school-based deworming programmes.

Other NGOs are aligned with the DtWI and the federal government to provide technical support: CIFF, Dubai Cares, USAID, the Michael & Susan Dell Foundation, the END Fund, and the Douglas B. Marshall Jr. Family Foundation.