ERADICATION OF GUINEA WORM DISEASE IN GHANA

HOW A SOCIAL NORM WAS CREATED

Michael ForsonCase Study for

UNICEF/UPenn Social Norm CoursePennsylvania University, USA

1 – 12 July 2013

The challenge - Guinea Worm disease in GhanaWorld Health Assembly resolution in 1986 to eradicate

Guinea worm DiseaseGhana started the National programme in 1989 with a

nationwide case search – about 180,000 cases were found

The Northern Region accounted to over 50% of the cases

Northern region was the problem spot – Dagomba tribeRecord with the fast decline to zero cases after a

decade of stagnation. 85% reduction between 2007 (3,358 cases) and 2008 (501), and a 97% reduction between 2009 (242 cases) and 2010 (8 cases).

Last case of the disease was reported in May 2010 from Diare community

Map of Ghana showing the Incidence of GW Cases

Northern

Region

What is Guinea Worm disease?

The programme implementation strategyCase detection and containment: all cases

must be detected within 24 hours of emergence (including the pre-emergence) of the worm

Safe water provision and abate applicationBehavior change towards open water sources:

filter all water before drinkingdon’t enter open source water with a guinea

worm diseasereport all identified cases to the village

volunteer or health center

The situation before the innovationsFalse beliefs• Hereditary• witchcraft

Preference to relieve

pain

Customs(Wading into water)

• Habitual individual action of wading into water affected the

society, but society did not sanction it

Society• Lack of

norms• Lack of

sanctions• No legal

norms

Social Dilemma

Creation of the social Norm

Visibility

actions

(demystify

beliefs)

•Showing of cyclops in water

•Induced immersion

•Video show of patients having the worms removed

Collective

Norm

•Nobody goes into the water with a hanging worm

•Build fetching platform

Legal norms

and sancti

ons

•Institutionalization of fines when caught with worm in water

•Report anyone with a hanging worm

•Install dam guards to monitor the water

• we all agree to report any

guinea worm case

(empirical)

• an individual behavior to contaminate

the water source will affect the

whole community (normative)

Schema and

Script

Pictures of visibility actions

Miss Ghana 2007 (Lamisi Mbila) being assisted by members of the GGWEP to identify Cyclops in the filtered water during a community

campaign

Innovations that fostered the creation of social normsGarner political support

and the creation of legal norms and rules

The Donkey BoysThe Dam guards

A donkey boy in Savelugu Community at work

What did not workThe cash reward system

Creating the social networkThe social movement of the people was used

to create a social network

Map showing the 4 epicenters*source: Ghana Guinea Worm Eradication Programme. 2004

Gburimanu Area

Diare Area

Sang Area

Sibi Area

Lessons learnt and recommendationsUsing visibility to change the beliefs is very

powerful “seeing is believing”The creation of legal and Social Norms, was the

vehicle that caused the shiftNeed to put mechanisms in place to ensure and

enforce sanctionsSocial movement of the people is very usefulSustainability of the norms after the end of the

programme need to be studied.Social norms is very useful and practical and is

being recommended for other eradication programmes such as the Trachoma Control as it is also water borne and depends on people’s behavior to break the cycle.

Ghana is now free from Guinea wormThe final fight with the innovations talked

about http://www.youtube.com/watch?v=ZmWKIQzRTow

The last guinea worm case in Ghana