Ideas to Action:

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Success Stories From "WHAT WORKS?" Working Group

January 30, 2004

The central objective of the "What Works?" Working Group is to document a series of implementation experiences in international health that are judged to be successful using a high standard of evidence. The working group has closely examined possible international public health "success stories." Of the sixty success cases submitted by Disease Controls Priorities Project authors, only twenty cases were selected.

Each case met the following criteria (and had sufficient evidence base):

  • Sustainability of at least five years
  • Cost-effectiveness
  • Intention to address a health concern of importance (judged by burden of disease estimates)
  • Impact (generally judged by disability-adjusted life years)

Polio elimination (The Americas)
A region-wide polio elimination effort led by the Pan American Health Organization reached almost every young child in the Americas, eliminating polio as a threat to public health in the Western Hemisphere.

Hib vaccination (Chile and the Gambia)
A national Hib vaccination program in Chile reduced the disease prevalence by 90 percent. In 1997, the Gambia introduced Hib vaccines (donated by Aventis Pasteur) into their national immunization program and has virtually eliminated the disease from the country.

Smallpox eradication (Global)
A massive global effort spearheaded by the World Health Organization led to the eradication of smallpox in 1977, and inspired the creation of the Expanded Programme on Immunization that continues today.

Measles Immunization (Southern Africa)
Measles vaccination campaigns in seven African countries has virtually eliminated measles as a cause of childhood death in southern Africa, and has helped reduce the number of measles cases from 60,000 in 1996 to just 117 four years later.

Onchocerciasis (West Africa)
The multi-partner, well-organized international effort delivered Merck’s donated “miracle drug” to dramatically reduce the incidence and impact of the blinding parasitic disease, and to increase the potential for economic development in large areas of rural West Africa.

Chagas disease control (Southern Cone)
Through surveillance, environmental vector control and house spraying, a regional initiative has helped Argentina, Bolivia, Brazil, Chile, Paraguay, Uruguay, and Peru decreased the disease burden of Chagas disease.

Trachoma (Morocco)
Incidence of trachoma, the leading preventable cause of blindness, has been cut by more than ninety percent in Morocco through a combined strategy of surgery, antibiotics, face washing and environmental controls.

Malaria control/ITNs (Tanzania)
A social marketing campaign has dramatically increased the use of insecticide-treated bednets in rural Tanzania and has increased child survival by nearly one-third.

Guinea worm control (SubSaharan Africa)
A highly targeted, multi-partner eradication effort focused on behavior change has resulted in the reduction of guinea worm disease prevalence by 98 percent in the twenty endemic African and Asian countries. The program’s success has placed guinea worm in line to be only the second disease to be eradicated.

DOTS/ TB control (China, Peru)
A ten-year World Bank funded TB program in China implemented a well-executed intensive short-course chemotherapy (using DOTS approach) that reduced TB prevalence by 40 percent in half of China’s provinces and dramatically improved the cure rate. Likewise, a national TB program in Peru halved TB deaths.

Oral rehydration therapy (NE Brazil)
In impoverished Northeast Brazil, the widespread use of oral rehydration therapy cut child deaths due to diarrheal disease from 13 to 4 percent.

HIV control program (Thailand)
In Thailand, the government’s “100% Condom Program” targeted at commercial sex workers and other high-risk groups helped prevent the spread of HIV/AIDS relatively early in the course of the epidemic. Thanks to the program’s success in promoting condom use among sex workers, Thailand had 80 percent fewer new cases of HIV in 2001 than in 1991 and has averted nearly 200,000 new cases. Cataract surgery (India) The introduction and widespread use of new surgical technique prevented the loss of sight to cataracts in India, improving success rates from about 10 to 90 percent.

Integrated nutrition intervention (Bangladesh)
A World Bank-financed program targeting poor, malnourished children in Bangladesh encompassed multiple elements – education, supplementation, growth monitoring and others – and has reduced severe malnutrition in children under five from 13 to 1 percent.

Salt fortification (China, Madagascar)
China’s introduction of iodized salt has significantly reduced the incidence of iodine-deficiency disease (particularly goiter among children, from 20 to 9 percent) and created a sustainable system of private provision of fortified salt.

Safe motherhood (Sri Lanka)
Despite relatively low levels of national income and health spending, Sri Lanka’s commitment to providing a range of “safe motherhood” services has led to a decline in maternal mortality from 486 deaths per 100,000 live births to 24 deaths per 100,000 live births over four decades.

Family planning (Bangladesh)
In Bangladesh, strong leadership of the family planning program, a sustained outreach strategy and a focus on access to services brought about increases in contraceptive prevalence from 3 to 54 percent (and corresponding decreases in fertility from 7 to 3.4 children per woman) over two decades, far in excess of what would have been predicted based on changes in economic and social conditions alone.

Use of fluoride (Jamaica)
Between 1987 and 1995 Jamaica’s National Salt Fluoridation Program demonstrated up to an 87 percent decrease in dental caries in school children and has been regarded as a model for micronutrient interventions.

Tobacco control (Poland, South Africa)
Starting in the early 1990’s, the transition to a market economy and a more open society paved the way for health advocates to implement strong tobacco controls in Poland, a country that had the highest rates of tobacco consumption in the world. In South Africa, an increase in taxes on cigarettes is credited with causing a significant reduction in smoking, from 50% in 1990 to 42 percent in 1998.

Overall child health through conditional cash grants (Mexico’s PROGRESA/Oportunidades)
Since 1997, Mexico’s PROGRESA program has provided a comprehensive package of nutritional interventions to rural communities through a conditional cash grants program, resulting in lowered rates of illness and malnutrition and increased school enrollment.