Sleigh A, Jackson S, Li X, Huang K
Tropical Health Program, Australian Centre for International and Tropical Health and Nutrition, Medical School, University of Queensland, Australia.
Bull World Health Organ. 1998;76(5):497-508.
Reported are the results of a study of the political economy, management, and costs of the successful Guangxi schistosomiasis eradication programme, spanning 40 years from 1953 to 1992. For this purpose we analysed all government data and memoranda on the policy, management, technical support, finance, and the control strategy of the programme. We also interviewed many local staff involved in the programme over the 40-year period and obtained cost data from annual county-level records on seven major categories of variable costs. Schistosomiasis control in Guangxi began with one of the first examples of community participation and rapid assessment in public health history--the use of pre-franked envelopes to return disease questionnaires and suspect snails from rural areas. This approach quickly and accurately delineated the endemic area. This was Mao Zedong's "mass line", incorporating ideas and knowledge from peasants directly into services run for and by them, here the schistosomiasis control programme. Recognition by China's leaders that schistosomiasis was a great economic burden, steadfast prioritizing of the programme over 40 years, local innovative scientific study, agricultural and environmental focus on eradicating the snail hosts and boosting rural production, and mass community education and support were all key factors in the final success. Local leaders motivated programme staff and everyone involved knew the objectives. The programme was always multisectoral, with policy developed centrally, and strategy and collaboration encouraged and rewarded at the grass-roots. These features explain how a very poor autonomous region such as Guangxi finally eradicated schistosomiasis, spending less than US$ 0.50 per protected citizen per year; it is remarkable that the disease and snails were initially found across a large area of complex environments and modern drugs such as praziquantel were not available for most of the 40-year period. The lessons from Guangxi can be adapted elsewhere and should encourage other areas to control endemic schistosomiasis using methods devised to suit the local culture and geography.
本文报告了一项关于1953年至1992年期间成功的广西血吸虫病消除计划的政治经济、管理和成本的研究结果。为此，我们分析了所有关于该计划的政策、管理、技术支持、财务和控制策略的政府数据及备忘录。我们还采访了40年来参与该计划的许多当地工作人员，并从县级年度记录中获取了七大类可变成本的成本数据。广西的血吸虫病防治始于公共卫生史上最早的社区参与和快速评估实例之一——使用预先付费信封返还农村地区的疾病调查问卷和可疑钉螺。这种方法迅速而准确地划定了疫区。这就是毛泽东的“群众路线”，将农民的想法和知识直接融入为他们服务并由他们参与的服务中，即血吸虫病防治计划。中国领导人认识到血吸虫病是一个巨大的经济负担，40年来坚定地将该计划列为优先事项，开展当地创新性科学研究，以农业和环境为重点根除钉螺宿主并促进农村生产，以及进行大规模社区教育和支持，这些都是最终取得成功的关键因素。当地领导人激励计划工作人员，每个参与的人都清楚目标。该计划始终是多部门的，政策由中央制定，基层鼓励并奖励战略制定与协作。这些特点解释了像广西这样非常贫困的自治区最终如何根除血吸虫病，每年为每位受保护居民的花费不到0.50美元；值得注意的是，该病和钉螺最初在大面积复杂环境中被发现，并且在40年的大部分时间里都没有吡喹酮等现代药物。广西的经验可以在其他地方适用，并应鼓励其他地区采用适合当地文化和地理条件的方法来控制地方性血吸虫病。
