PRESIDENT CARTER NOTES PROGRESS AND EMPHASIZES

UNCLAS SECTION 01 OF 02 ACCRA 000505

SIPDIS

STATE FOR AF/FO, AF/W, AF/PD

SIPDIS

E.O. 12958:N/A
TAGS: EAID PGOV GH
SUBJECT: PRESIDENT CARTER NOTES PROGRESS AND EMPHASIZES
NEED FOR VIGILANCE IN GUINEA WORM ERADICATION


1. Summary: Former United States President Jimmy Carter
visited Ghana March 31-April 1, 2008 to review the
successes of the Guinea worm eradication program as well as
to begin discussions on the potential role of the Carter
Center as election monitors for the upcoming Presidential
election in Ghana. President Carter was accompanied by his
wife Roslyn Carter, Cousin Don Carter, and Carter Center senior
staff Don Hopkins and John Hardman. Over the past year,
collaborative efforts between the Carter Center, UNICEF,
the National Guinea Worm Eradication Program (GWEP),USAID,
WHO and other donors and partners reduced the number of new
Guinea worm cases in Ghana by 91 percent over the past
year. End Summary


2. During the two-day visit, President Carter and his
delegation met with a variety of partners, Ghanaian and
U.S. government officials, NGOs as well as Carter Center
staff and their implementing partners. President Carter
began his visit by meeting President of Ghana, John Agyekum
Kufuor and complimented his country's efforts against
Guinea worm by noting that the 91 percent drop of new cases
in Ghana was the largest reduction seen in the world.
President Carter underscored the need for surveillance and
early case detection to ensure that no new cases are
missed. He also called for a scale-up of safe water systems
by August.. President Carter outlined 2009 as the target
year for complete Guinea worm eradication in Ghana.


3. President Kufuor highlighted 45 million euros of recent
support from development partners for improvements in water
systems and noted the assistance empowered districts to
improve their own water supply. President Carter closed his
comments by offering Carter Center election monitoring to
support Ghana's December elections but reached no concrete
agreement with President Kufuor on his proposal.

President Kufuor tasked his Minister of Health to further
discuss with President Carter challenges and opportunities
regarding access to primary health care as well as a
potential training program for community-based health
extension workers.


4. President Carter held follow-up discussions with the
Minister of Health along with senior staff of the National
Guinea Worm Eradication Program to discuss the details of
Ghana's efforts. The Minister emphasized his commitment to
"waging war on Guinea worm." The Minister also highlighted
some best practices of the Guinea Worm Eradication Program
including meetings with chiefs, local leaders and other
cross-sections of the population. The Minister noted that
the eradication program enlisted support from development
partners and civil society but needed to involve local
government and water/sanitation officials outside the
health sector to ensure broader coverage. President Carter
reiterated the importance of vigilance to ensure that all
at-risk communities have access to an adequate supply of
safe drinking water.


5. Discussions also centered on the prevalence of malaria
within Ghana as a public health problem. The Ghana Health
Service Deputy Director related that the entire population
of Ghana was at risk to contract this disease. While
support for bed nets is growing, the Deputy Director called
for more support in the areas of treatment, diagnostics,
education, and implementation. The Minister also stated
that a recent economic modeling exercise showed that Ghana
loses approximately $762 million in labor productivity each
year to malaria. The Ghana Health Services also reported
that
4 million bed nets had been distributed to Ghana's
population of 22 million but that another 4 million were
necessary to provide two bed nets per household. They
called for additional focus on indoor residual spraying and
possibly insect sterilization as well as
improvement of procurement and distribution channels.
President Carter raised concern over the high cost of
latrines in the country and asked if the Ministry of Health
could work with the water program to help reduce these
costs.


6. Following President Kufuor's advice, the Minister and
President Carter discussed the idea of community health
extension workers similar to community health nurses. This
program would aim to fit into the currently existing
Community-based Health Planning Services (CHPS) program
with the overall goal of one nurse per 500 persons. The
Minister stated that there are currently at least 22,000
nurses in the country who are working towards this goal.
(Comment: USAID disputes this number as well as some

ACCRA 00000505 002 OF 002


of the claims made around health extension workers, and has
promised President
Carter to follow-up with additional information on this
topic. End Comment.)


7. During the discussions, it was noted that the Ghanaian
Parliament has proposed free medical care for Guinea worm
patients, provisions to support mobile clinics, and
legislation to control contamination by infected
individuals. The Ministry of Health has also committed to
double the budget for Guinea worm to one million Ghana
Cedis (approximately one million USD) from its previous
2007 total of 500,000. Ghana currently reports only 195
Guinea worm cases with 94% of all cases in the Northern
Region.. During the last transmission cycle, 60% of cases
were distributed among a population of 35,000 people
(approximately 4-5 townships). UNICEF also notes that 60%
of cases occur in children under age 5.


8. President Carter met with all other relevant
development partners working on Guinea worm eradication.
There are currently 180 villages with Guinea worm and
President Carter discussed the need to be careful about
over-confidence. He also stated that countries that have
eradicated Guinea worm do not want to see a return of
cases. Ghana has had some set backs when poorly managed
water provision, caused a breakdown in the system. He
encouraged everyone to learn lessons from these
experiences.


9. Partners agreed that areas of achievement included
improvement in surveillance and containment as well as
better supervision and expanded water control. There was
also consensus on many of the remaining challenges
including maintaining a "security program" to guard dams
against access by infected individuals (until they are
treated),monitoring program discipline, ensuring there is
an adequate water supply, implementing surveillance for
non-endemic areas (to ensure no new cases are introduced),
making sure volunteers stay motivated, and improving
Behavior Change Communication (BCC) and better coordination
with other sectors.


10. Comment: Overall, President Carter was very impressed
with the huge success of the Guinea worm eradication
program in Ghana. The Partners collectively agreed that
there is a strong-shared vision and commitment to eradicate
the disease and that coordination and vigilance are
essential to the success of Ghana's final push towards
complete guinea worm eradication. End Comment.

BROWN