The preparatory stage is perhaps the most important, and time spent on collecting baseline data, trying to forecast problems and assessing the feasibility of the proposal is always time well spent.

Surveys are made of the disease to measure its prevalence over as wide an area as possible. A good sample survey might be sufficient to measure the endemicity, but this will not reveal the foci of infection, which normally cause the most problems. In addition, a surveillance system needs to be established, if there is not one already, to continually collect data on cases as the programme proceeds.

The population will need to be enumerated and it might be justified to spend money on carrying out a census if one has not been done recently. Maps are essential and if suitable ones are not available, then they need to be drawn. They must contain up-to-date village locations, preferably with the population marked on them. Figure 4.2 is an example of a map prepared in this way.


Fig. 4.2. Part of a village location map prepared for a disease control programme.

All weather roads Other roads

Q965) Tenende

_ International boundary

_ District boundary

Village with census population

Dispensary Swamp Bridge Ford

Every level of society must be committed - from the senior administrative head, through divisional chiefs and influential people, to the established health worker. This will require regular meetings, with the establishment of key contacts. Without the complete and continued cooperation of the people, any special effort is doomed to failure.

Planning of the persons, money and materials (logistics) to be used in the programme is often the easiest part to initiate, but one of the most difficult to maintain. Utilizing existing staff who retain all their usual functions and continue in an established pattern of service is preferable to recruiting special staff, but this should not be at the expense of existing services. If special staff need to be recruited, then conditions of service must be carefully worked out so that no conflict arises with existing staff.

Adequate funding is required, as no disease control programme has remained within estimates; they nearly always cost more than expected. Additions arise that were not foreseen, inflation increases faster than allowed for and the programme takes longer than planned. If adequate finances cannot be secured and the programme has to be abandoned, then the net result is worse than doing nothing in the first place. More serious is the damage done to the existing health services by diverting funds from them.

Included in the preparatory stage is a pilot programme to try out the techniques and organization in a limited area. The pilot programme is a scaled down version of the full programme, not a special effort to show what can be done. The area chosen should be fully representative of the larger area to be covered. If there are marked variations, then several pilot studies of differing criteria may be required.

The pilot programme can be for a set period of time, or continued into the full programme after it has been assessed. If there are major difficulties, then the programme should proceed no further, but the whole strategy reworked. If there are minor problems, then these are indicators of major problems in the future.

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