Michael Forson
Case Study for
UNICEF/UPenn Social Norm Course
Pennsylvania University, USA
1 – 12 July 2013
The challenge - Guinea Worm disease in Ghana
 World Health Assembly resolution in 1986 to eradicate
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Guinea worm Disease
Ghana 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 tribe
Record 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
strategy
 Case 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 application
 Behavior change towards open water sources:
 filter all water before drinking
 don’t enter open source water with a guinea worm
disease
 report all identified cases to the village volunteer or
health center
The situation before the innovations
False 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
Social Dilemma
Society
• Lack of norms
• Lack of
sanctions
• No legal norms
Creation of the social Norm
Schema
and Script
Visibility actions
(demystify beliefs)
• Showing of cyclops in water
• Induced immersion
• Video show of patients having the
worms removed
•
we all agree to
report any guinea
worm case
(empirical)
•
Collective Norm
• Nobody goes into the water with a
hanging worm
• Build fetching platform
Legal norms and
sanctions
• Institutionalization of fines when caught
with worm in water
• Report anyone with a hanging worm
• Install dam guards to monitor the water
an individual
behavior to
contaminate the
water source will
affect the whole
community
(normative)
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 norms
 Garner political support
and the creation of legal
norms and rules
 The Donkey Boys
 The Dam guards
What did not work
A donkey boy in Savelugu Community at work
 The cash reward system
Creating the social network
 The social movement of the people was used to create
a social network
Diare Area
Gburimanu Area
Sang Area
Sibi Area
Map showing the 4 epicenters
*source: Ghana Guinea Worm Eradication Programme. 2004
Lessons learnt and recommendations
 Using visibility to change the beliefs is very powerful
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“seeing is believing”
The creation of legal and Social Norms, was the vehicle
that caused the shift
Need to put mechanisms in place to ensure and enforce
sanctions
Social movement of the people is very useful
Sustainability 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
worm
 The final fight with the innovations talked about
http://www.youtube.com/watch?v=ZmWKIQzRTow
The last guinea worm case in Ghana