The Role of Community Participation in Fighting Schistosomiasis: Lessons From Akka Oases (Southern Morocco)

Introduction

Human communities have an extraordinary capacity to adapt and be resilient to their environments, for example by limiting their exposure to hazards and parasites and to take collective measures to protect themselves against hostile conditions (Schaefer 1993:1). Community involvement is one of the principles of the primary health care framework formulated at the Alma Ata conference in 1978 (WHO and UNICEF 1978). Besides, community participation is a fundamental principle of Agenda 21, the action document of the 1992 United Nations Conference on Environment and Development (UNCED), which specifies “mobilizing communities for action as essential in solving health, environment and development problems” (Schaefer 1993:19). Community involvement is well-recognized as an important tool for creating a healthier and more sustainable planet by both environment and health fields (Chu 1997). Moreover, several disease elimination campaigns achieved success due to the significant role of community involvement (Atkinson et al 2011) such as the elimination of schistosomiasis in Morocco.

Foci of schistosomiasis were widespread in Morocco. Urinary schistosomiasis was the form of schistosomiasis that spread in the country, which was caused by the Schistosoma haematobium blood parasite (Doumenge, et al. 1987: 22). Schistosomiasis had been endemic in the oasis zone of southern Morocco for a lot of years. Oasis regions of Morocco, by their geographical position, climatic conditions, demographic, and socio-economic system, have a lot of the conditions associated with the development of endemic neglected tropical diseases (NTD) such as urinary schistosomiasis and cutaneous leishmaniasis (Karmaoui 2018).

Since 1982, the schistosomiasis control program was integrated into the Moroccan health system and started operating in 1983 in all 20 provinces where schistosomiasis foci were reported (Laaziri and Benouna, 1982). A program to eradicate schistosomiasis over all the endemic geographic regions started in 1994. The disease was eradicated at the national level after ten years: no new cases have been reported since 2004. In 2009, schistosomiasis disease was considered to be eliminated by the World Health Organization and the Moroccan Ministry of Health in all previously endemic provinces (Laaziri 2012). This achievement wouldn't have been possible without effective participation and engagement of local communities.

Akka oases in Southern Morocco were known to be an ancient foci site for urinary schistosomiasis since 1937 (Direction de la santé public 1940:20). After a long struggle for the local community, combined efforts between health officials and local community have achieved the elimination of this NTD, where the last cases in these foci were recorded in the early 2000s. The aim of this study is to review community participation strategies for schistosomiasis used to control the disease in Akka oasis. The resulting information can be used to increase awareness of the need for community participation in controlling neglected tropical diseases.