drinking water to affected comnmunities and by the application of the insecticide Abate (temephos) to selected unsafe sources of drinking water.

The objective of this paper is to report on a cost-benefit analysis of GDEC: expenditure on GDEC activities is compared with the economic benefit resulting from the campaign. The emergence of the Guinea worm is a painful and debilitating process causing serious disability in infected individuals for weeks -- thereby seriously constraining their income-generating capacity. Therefore, the major benefit of GDEC is considered to be the prevention of this period of infection-related economic incapacitation.<sup>6</sup> Based upon the resulting augmentation of agricultural production, this economic benefit is accorded a monetary value and then compared with the costs of the campaign. This "human capital" approach enables an assessment of the economic viability of large-scale public health programs such as GDEC which are demonstrably successful in controlling and/or eradicating disease incidence.

The economic assessment of GDEC entails the following. First, we examine the strategies for eradication under the auspices of GDEC and the associated costs of the campaign. Second, we elaborate the projected benefits from the eradication program, focusing specifically on the prevention of economic incapacitation resulting from incidence decline. Finally, we contrast the costs with the projected economic benefits in order to estimate the economic returns of the campaign.

# **Dracunculiasis Eradication: Strategies and Costs**

There are several characteristics of dracunculiasis transmission that make the disease amenable to eradication<sup>7</sup> : there is no human carrier state beyond the one-year incubation period; there is no known animal reservoir; transmission is seasonal; active detection of individuals with worms protruding from skin lesions is a sensitive means of assessing the presence of the disease in villages; and the methods for controlling transmission (as subsequently elaborated) are relatively simple. Beginning in 1986, 1987, and 1988, the Global 2000 Project of the Carter Presidential Center, in collaboration with the Center for Disease Control (CDC), assisted national Guinea worm eradication campaigns in Pakistan, Ghana, and Nigeria, respectively.<sup>8</sup> The strategies for eradication in these three

- Other benefits -- difficult to quantify in economic terms -- include the alleviation of suffering and social stigmatization, improved school attendance, better child care, and elimination of infectionrelated expenditures.

- It is important to note that GDEC is an _eradication --_ and not a _control --_ campaign. Consequently, some of the operational requirements reflect the fact that the goal of an eradication campaign is to reduce the incidence of disease to zero in all affected communities by a certain target date. In contrast, the goal of a control campaign is usually the reduction of disease incidence in selected communities (e.g., those with the highest disease incidence) over a period of time to a level that is considered "tolerable" by public health authorities.

- India independently initiated its national Guinea worm eradication program in 1983.

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