Martinique and Guadeloupe
In 1981 an RHD control program was established in two French Caribbean islands, Martinique and Guadeloupe. The islands were middle income settings with relatively strong health systems with free access to health care and medication. The program had four key principles:
- Development of a register
- Health worker and community education
- Treatment of skin infections
A full time paediatrician dedicated to RF was employed in each island. By 1992 the incidence of RF had declined by 78% in Martinique and 74% in Guadeloupe. The cost to the health systems of RF reduced by 86%.
Recent analysis suggests that this program was cost saving and that outcomes were likely amplified by a primary and secondary prevention strategy.