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IDSB04 - Ch.13
Disease control’ as international health
• Smallpox eradication
• Malaria eradication failed
• Lessons learned plus favorable conditions helped in smallpox eradication effort
o Long experience with smallpox control
o Lack of non-human animal host
o Availability of effective vaccine
o Global campaign strategically divided into tree comprehensive phases: attack, consolidation,
o Despite limited financial support, plenty of institutional and scientific support, but…
• Very expensive for developing countries (although savings after eradication)
• Issues of coercion and divisions over approach and type of vaccine used
• What about other health issues that may have been more pressing?
• Child survival campaigns
• UNICEF proposed to vanquish common infections of early childhood using simple medical
• GOBI: Growth monitoring, Oral hydration therapy, breast feeding, and immunization against six
childhood diseases (TB< diphtheria, whooping cough, tetanus, polio, and measles)
• GOBI-FFF: Above plus family planning, female education, and food supplementation
• Limitation included:
o Ritualistic growth monitoring w/o addressing reason for poor nutrition
o Oral rehydration w/o addressing reason for childhood diarrhea
o Centrally controlled, top-down immunization programs
o Limited focus on individual behavior change
• Outcomes: reduced child mortality? - not really child mortality declines started well b4 the start
of UNICEFs child survival campaign
Box 13-1 *Scaling Up:
• taking a proj from pilot to broad application.
o a program is tested out in a local district and when the obstacles are ironed out it is applied to an
entire province or country.
• bottom up model
• concept fails to take into account the larger societal envir in which programs are operating
• term implies a narrow & precarious form of social service deliver.
-more politically contextualized metaphor might be “building stairs, bridges, & foundations”
implying that the programs are protected, solid, & connected to the larger community (ex; a
national public social welfare sys)
**Limitations of the single disease campaigns