What are the lessons to be learned from the success of the work done by the Carter Center over the past twenty years to get very close to eliminating the Guinea Worm parasite. Some 2.5 million cases 20 years ago are now down to about 2,500 ... great progress. Eliminating the parasite is now within reach.
(1) The program has always been done with a deep respect for the local community. The science had to determine what was done ... but culture was allowed to guide how things were done, to remove the constraints to acceptance of the treatment and the behavior changes needed.
(2) Low tech practical interventions that did not need expensive ongoing expatriate support. A focus on the spatial characteristics of the disease.
(3) The involvement of President Carter helped to get acceptance at high levels of the political structures ... on top of very practical community interventions that were able to get the job done and deliver progress.
(4) Enough money to do the work ... but not so much money that the funds attracted a whole lot of non-performing overhead
(5) Commitment to do the work over a long period of time ... the success has been achieved by working at it for more than 20 years.
(6) Low level of PR and high level of very solid field work
These are good lessons for other works that need to be done in global health. President Carter is neither and MD nor a cost accountant ... but it seems he has got both right in this program