Academic journal article Bulletin of the World Health Organization

Report of the Workgroup on Disease Elimination/ Eradication and Sustainable Health Development

Academic journal article Bulletin of the World Health Organization

Report of the Workgroup on Disease Elimination/ Eradication and Sustainable Health Development

Article excerpt


Eradication initiatives have been both applauded for their successes (smallpox, poliomyelitis) and criticized for their failings (malaria, smallpox). The Workgroup on Disease Elimination/Eradication and Sustainable Health Development tried to identify the critical components of policy development, human resource utilization, financing and sustainability that contribute to prospects for success. Subgroups worked on each of the topics against a set of core questions (see Table 1).

Table 1: Disease eradication and sustainable health development

Subgroup concentrations

* Overall health policy (international,     Group A
  national and local): strategic
  planning, organization of systems,
  management processes

* Finance and resource mobilization         Group B

* Human resources: training and social      Group C

* Health services: provision, management,   Group D
  and performance

Core questions

* What does eradication strengthen?

* What does eradication risk?

* What synergies can be developed in eradication activities?

* With the shift from public sector service provision for primary
  care and maternal and child health be significant for
  eradication activities?

* Given decentralization of responsibilities for public health, how
  will the momentum be achieved for eradication activities, when
  the central public health role has diminished?

* When responsibilities for resource allocation are delivered at
  the local level, in line with local health needs, how will global
  eradication priorities be "imposed" when they are not perceived
  as locally important?

* Will the greatest challenges to eradication activities come from
  those whose services are least well developed?

  -- Will industrialized countries compromise eradication
     activities because they do not perceive the need to
     divert resources to diseases of little consequence to

  -- How will they be influenced to accept the real and
     opportunity costs when they see little direct personal

  -- How can commitment be assured in advance of establishing
     eradication goals?

  -- Can we identify a set of prerequisites or preconditions
     that must be satisfied, before a new eradication goal is
     set? Is this worthwhile?

  -- How can we ensure that quality is improved by the
     achievement of eradication?

  -- Are there essential requirements that should already be
     in place before eradication activities begin?

  -- What might such indicators be?

  -- How can we encourage those for whom eradication
     activities might be the most difficult to be in the
     forefront? Should they be?

  -- Can we make specific recommendations that will ensure that
     health care systems achieve the maximum benefits from
     eradication activities?

Policy and strategy

General principles

Disease eradication is distinct from disease control. Terms such as "elimination" or "elimination as a public health problem" are often confusing and are best understood as subcategories of disease control. Their use should be avoided as far as possible, which leaves only eradication initiatives and ongoing disease control programmes as alternatives.

Because eradication programmes differ, it is difficult to generalize about them. Some diseases for eradication are of global importance, while others may be of regional or local importance. How much emphasis is accorded to health system strengthening as an objective of eradication may vary depending on this fact and other features described by other work groups.

Eradication programmes cannot correct the deficiencies of existing health systems. Their objectives should be: 1) reduction of the target disease to zero incidence, and maintaining this when all interventions have ceased; and 2) strengthening and further development of health systems so that other disease control programmes and health system functions (e. …

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