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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