CASE 10: Controlling trachoma in Morocco

Health Condition: Trachoma is the second leading cause of blindness in the world, and the number one cause of preventable blindness. More than 84 million people in 55 countries have trachoma. Economic development and improved hygiene have eliminated the disease from North America and Europe. But it plagues millions in hot, dry regions where access to clean water, sanitation, and health care is limited. In 1992, a national survey found that just over 5 percent of Morocco’s population had the blinding dis­ease trachoma. Nearly all the cases were concentrated in five poor, rural provinces in the southeast of the country where 25,000 people showed a serious decline in vision due to trachoma, 625,000 needed treatment for inflammatory trachoma, and 40,000 urgently needed surgery.

Intervention or Program: In 1991, Morocco formed the National Blindness Control Program to eliminate trachoma by 2005. Between 1997 and 1999, the program implemented a new strategy called SAFE (surgery, antibiotics, face washing, and environmental change), giving Morocco the distinction as the first national-level test of the four-part strategy.

• Mobile teams have performed simple, inexpensive surgeries in small towns across the provinces;
• 4.3 million treatments of the antibiotic azithromycin have been distributed;
• Health education efforts promoting face washing and hygiene have been conducted; and
• Latrines have been constructed and safe drinking water supplied.

Impact: Overall, the prevalence of active disease in children under 10 has been reduced by 99 percent since 1997.

Cost and Cost-Effectiveness: The Moroccan government has provided the bulk of the financing for the program, with ex­ternal support from the United Nations Children’s Fund and a public-private partnership called the International Trachoma Initiative. Through this partnership, the pharmaceutical company Pfizer has donated over $72 million worth of its antibi­otic Zithromax®.