In Bahari, a fictional country in East Africa, many people are infected with intestinal worms. As recommended by the World Health Organization, the country’s focus has been on administering deworming medications to children in primary schools. However, as a result, many adolescents and adults have not been dewormed. The number of worm infections in Bahari is not decreasing and government officials believe it may be due to ongoing infections in these older age groups. The Ministry of Health (MOH) has decided that it will launch a new community-wide deworming campaign to make sure that everyone in the population—children, adolescents, and adults—is dewormed. The government’s goal is to stop the spread of intestinal worm infections and to improve the overall health of the community.

Jane Daktari, the director of MOH in Bahari, expressed hesitancy that the community-wide campaign will be successful. She said, “How do we know that providing deworming to all of the members in our community will be effective? We should be focusing on interventions that improve water and sanitation and not just deworming alone.” Mary Kitenge, a County-level MOH office, added, “Local health system personnel have their own concerns. We will try our best to make sure that there is high coverage in all targeted villages but it will be difficult because people will not feel interested in dealing with worms. I’m not sure there is buy-in at the local level.” John Kanga, the Neglected Tropical Disease Programme Manager in Bahari said, “We have been relying on technical partners to implement the school deworming campaign for several years now. We at MOH will have to learn how to do the community-wide campaign on our own so that we can make sure it is a success. That could be challenging” Mr. Kanga will be transferred to a different department within the Ministry soon and there will be a new NTD manager who needs to manage the campaign. “The first thing this person will need to do is ensure that we have all of the necessary resources to make sure that everyone is reached. The national MOH has not allocated funding in its annual budget to include the community-wide deworming campaign. Also, I am concerned that we do not have enough deworming medicines in the country for such a large-scale campaign,” said Mr. Kanga. Ms. Kitenge added, “We do not have enough existing community health workers who are ready to begin administration. Even if we hire enough, we will first need to focus on the immunization campaign that the MOH has prioritized before we can think of deworming,” said Ms. Kitenge.