Integration of yaws control and primary health care.

Where a primary health care (PHC) system (e.g., a community health worker and a health center as the first referral level) is fully operational, control activities for yaws should be part of PHC. Where the whole population is adequately covered, the PHC system is responsible for early detection of cases of active clinical yaws, treatment and follow-up of these cases, treatment and follow-up of contacts, and health education related to yaws control. In circumstances where PHC is not as yet fully implemented, the structure for a yaws control program must be different. In areas with adequately functioning static health services or with a nascent PHC system, yaws control could be started as a vertical program--initial treatment survey and resurvey by a yaws team working in close collaboration with a health worker selected by the community. Subsequently, active yaws surveillance is taken over by that worker who also assumes the other functions of primary health care. In areas with nonexisting or poorly functioning static health services, a program for yaws control should not be implemented because control and effectiveness are likely to be poor.