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Deworm the World

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Published: March 2011

We contacted Deworm the World because it focuses on deworming, a program that appears both proven and cost-effective.

Our review of Deworm the World consisted of reviewing materials Deworm the World submitted to us and two phone conversations with Alissa Fishbane, Deworm the World's Managing Director. After completing our review, we have remaining questions about Deworm the World's activities and impact (see below).

What do they do?

With a budget of about $687,000 in 2009, Deworm the World engaged in the following activities:1

  • "Technical assistance" to Kenya and India for school-based deworming programs. This includes help with "policy development, prevalence surveying and mapping, training, strategic development of evidence-based plans and budgets, awareness and community awareness campaigns, logistical support, drug distribution, [and] monitoring and evaluation."2 Deworm the World has also engaged in advocacy activities in India to encourage additional states to implement the program,3 and is providing technical assistance to these states to launch school-based deworming deworming programs.4 Assistance to Kenya and India accounted for 70% of Deworm the World's expenses in 2009.5
  • "Strategic support," including facilitating drug donations from the charity Feed the Children in 24 additional countries, and providing, in some countries, more limited technical assistance than it provides to Kenya and India. Technical assistance includes supporting disease mapping, training master trainers,6 "coordinat[ing] partner action," "developing plans," "testing...a tool to measure impact," "development of proposals for...funding," etc.7 Deworm the World told us that facilitating drug donations means linking donor organizations with "effective programs that have funding gaps for pills."8 This program accounted for 15% of Deworm the World's expenses in 2009.9
  • Advocacy. Deworm the World told us that it advocates for greater support for school-based deworming programs and that advocacy primarily takes place on the national level with Ministers of Education and at regional meetings.10 Deworm the World also works at the global level to advocate with education initiatives such as the Fast Track Initiative, donors such as the World Bank and implementers including the World Food Programme.11 This program accounted for 5% of Deworm the World's expenses in 2009.12

As of mid-2010, Deworm the World had 3 full time and one part time staff members in Kenya, 3 full time staff members and a few interns in India, and 3 staff members in the U.S.13

Does it work?

After our conversation with Deworm the World, we have the following remaining questions about Deworm the World's impact:

  • Program quality. Are the programs Deworm the World supports of high quality? Are drugs administered to at-risk populations according to accepted dosage and timing recommendations? How are programs monitored?

    Deworm the World told us that "all drugs administered in the programs we support are the World Health Organization recommended drug type and dosage to treat these worms" and that it is able it "track activity at the country level."14 Deworm the World also told us that is works "with governments to develop a robust monitoring and evaluation system to assess key process and performance indicators. For example, in Bihar, India [it's] supporting the government to roll out a new school-based deworming program, which is being monitored by an independent team of monitors trained and regularly used by the World Health Organization for other major health campaigns such as polio.”15

    We have not seen reports to support the claim that programs are consistently and credibly monitored and that World Health Organization recommendations are followed in practice.

  • Sustainability. We believe it is important that deworming programs are sustained over time, as reinfection is rapid and a one-time treatment may have little long-term effect.16 Are the programs supported by Deworm the World sustained over time?

    Deworm the World told us that it shares our belief in the importance of sustainability in deworming programs and seeks to encourage sustainability through advocacy and capacity building (training and establishing distribution and monitoring and evaluation systems).17 In particular, Deworm the World told us that it works in countries where there is a strong demand for the program to help them "institutionalize school-based deworming into education sector plans and budgets and foster the transition to a program that is entirely managed and financed by the government."18 As of February 2011, the program in Andhra Pradesh, India was being managed by the government and had implemented two rounds of deworming.19

    Deworm the World was started in 2007,20 and has not been in existence long enough to establish a full track record on program sustainability.

  • Impact of technical assistance. What is the impact of Deworm the World's technical assistance on country programs? How do country programs change after receiving assistance from Deworm the World? Why do countries require Deworm the World's assistance to access drug donations?

    Deworm the World has provided information on what form of technical assistance it has provided to each of the countries it has worked with,21 and has told us:22

    In each country that requests our assistance, we assess how much support the government needs to develop, implement, and sustain an effective program. In some countries, the governments already have partners or the capacity themselves and are just experiencing a shortage of funding for medication. An example of this is Sierra Leone, which has effective programs and partners, but has a shortage in drugs to treat soil-transmitted helminths. Here, we work with country partners and drug donors to fill this gap so that national coverage can be reached, and through these efforts 700,000 additional children were dewormed last year.

    In other countries, programs are moving ahead but assistance is requested for specific components. For example, in The Gambia we trained their master trainers for teacher training and lab technicians for surveying. We also coordinated technical assistance for prevalence surveying, and with the results constructed a five-year strategic implementation plan. The first round of the plan was implemented last year, reaching over 265,000 school-age children.

    Finally, in some countries we are invited to provide longer-term assistance to support the government. For example, in Kenya, surveys had been conducted and the Government had developed a policy and allocated funding. However, certain key challenges remained and working together we overcame these and launched the program. As a first step, the existing data was collated and mapped in relation to schools, allowing the program to be designed to strategically target at-risk schools and be implemented cost-effectively. After strengthening these plans, we continued providing critical support in a variety of ways, including: assisting with the development of work plans, budgets, and implementation schedules; providing general operational support for drug distribution and other components; advising on the design of national training cascade, training materials and community awareness campaigns; and coordinating and contributing to the collection, entry, and processing of monitoring data. Over 3.6 million children have been dewormed through the Kenyan national deworming program.

    In Andhra Pradesh, India, together with the World Bank, we successfully advocated for the adoption of school-based deworming. We then supported the development of a new statewide school health policy and continued providing assistance in program planning and implementation. In our work to build capacity, we helped to set up a cross-sectoral school health committee to oversee the program, and the Government has since embedded our coordinator into their school health department, paving the way to full government ownership of the program. This program marked the first school health collaboration between the health and education departments, and school-based deworming was a springboard to a more comprehensive school health program, which they are jointly launching this year. Over 2.1 million school-age children were treated in the initial round, and deworming activities will be scaled up throughout the state in coordination with the broader school health program.

    We have not seen evidence connecting Deworm the World activities with specific outcomes.

  • Advocacy. Has additional funding for deworming resulted in (a) more government funding for deworming with no offsetting cuts, i.e., increases in total medical budgets; or (b) more government funding for NTD control at the expense of other health spending? If (a), how has the increase in funding been financed? If (b), where have cuts been made, and to what extent has funding shifted from other worthy health spending?

    Deworm the World told us that funding for school-based deworming programs school-based deworming programs are implemented by Ministries of Education in coordination with Ministries of Health and that most of the funding comes from education budgets, rather than health budgets. Education ministries may be able to receive funding for deworming programs from the Fast Track Initiative,23 a multi-donor global education initiative, and the World Bank.24 We have not seen data on whether this is how programs are funded in most or all of the countries Deworm the World has advocated in.

Room for more funding?

Deworm the World told us:25

We are currently raising funds to hire additional staff to support our in-country operations in Africa and India, and there is also room for funding to help start up essential new programs. Typically for each government program where we provide in-depth support, we raise between $200,000-500,000 per year (depending on program scale and needs) to cover technical assistance and outstanding program costs. This translates to about $0.03-$0.10 per child per year, and leverages the much greater government investment (up to $.50 per child) in the program. Funding to begin the initial policy and planning work and undertake surveying and mapping for program targeting is often the most challenging to raise, and donations from our supporters are what enable us to expand our work to new areas and begin launching new programs.

For example, over the past year we've been working with the governments of Bihar and Delhi, India to launch new programs. The program in Delhi will roll out later this year, and deworming is currently underway in Bihar, which will be one of the largest school-based deworming programs in the world. The essential support from our donors is what allowed us to begin working with these governments while raising long-term funding, and we're now seeking additional funding to expand and help more governments start new programs.

We do not know how much in additional funding (i.e., above and beyond what it currently expects to receive) Deworm the World would could productively absorb or how it would expect its results to differ were to receive additional funding.

Sources

  • 1.

    Deworm the World, "Annual Report (2009)," Pg 14.

  • 2.

    Deworm the World, "Edits to GiveWell Review (March 2011)."

  • 3.

    Deworm the World, "Breakdown of activities (July 2010)."

  • 4.

    Deworm the World, "Edits to GiveWell Review (March 2011)."

  • 5.

    Deworm the World, "Annual Report (2009)," Pg 14.

  • 6.

    Alissa Fishbane, phone conversation with GiveWell, December 29, 2010.

  • 7.

    Deworm the World, " Breakdown of Activities (July 2010)."

  • 8.

    Alissa Fishbane, phone conversation with GiveWell, December 29, 2010.

  • 9.

    Deworm the World, "Annual Report (2009)," Pg 14.

  • 10.

    Alissa Fishbane, phone conversation with GiveWell, December 29, 2010.

  • 11.

    Deworm the World, "Edits to GiveWell Review (March 2011)."

  • 12.

    Deworm the World, "Annual Report (2009)," Pg 14.

  • 13.

    "GiveWell: How many staff members do you have and where are they located?
    Deworm the World: ...In Kenya, we have about 3.5 full time staff including our Regional Director for Africa. In India, we currently have 3 full time staff including our Regional Director for South Asia plus some interns. In the U.S., we have 3 staff members."
    Alissa Fishbane, phone conversation with GiveWell, June 17, 2010.

  • 14.

    Deworm the World, "Reply to GiveWell."

  • 15.

    Deworm the World, "Edits to GiveWell Review (March 2011)."

  • 16.

    "Single-dose oral therapies can kill the worms, reducing ... infections by 99 percent ... Reinfection is rapid, however, with worm burden often returning to eighty percent or more of its original level within a year ... and hence geohelminth drugs must be taken every six months and schistosomiasis drugs must be taken annually." Miguel and Kremer 2004, Pg 161.

  • 17.

    Deworm the World, "Reply to GiveWell."

  • 18.

    Deworm the World, "Edits to GiveWell Review (March 2011)."

  • 19.

    Deworm the World, "Edits to GiveWell Review (March 2011)."

  • 20.

    Deworm the World, "What Deworm the World Does."

  • 21.

    Deworm the World, "Breakdown of Activities (July 2010)."

  • 22.

    Deworm the World, "Edits to GiveWell Review (March 2011)."

  • 23.

    "Under the EFA-FTI framework, these countries are now eligible to receive financial and technical support for school-based deworming programs." Alissa Fishbane, phone conversation with GiveWell, June 17, 2010.

  • 24.

    Fast Track Initiative, "About FTI."

  • 25.

    Deworm the World, "Edits to GiveWell Review (March 2011)."

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