Bill Gates writes about a recent trip he made to Tanzania to stop a terrible disease. https://www.gatesnotes.com/Health/Mass-Drug-Administration-in-Tanzania

“Lymphatic filariasis is one of the worst of these diseases. It’s caused by a parasite that’s spread by mosquitoes, and in the severest cases people may develop swollen limbs, a thickening of the skin known as elephantiasis, or other severe disfigurements. Beyond the pain and disabilities they experience, people affected by the disease are often ostracized by their communities and are unable to work, sinking them deeper into poverty.

To combat lymphatic filariasis, health officials could test everyone and then treat only those people who are infected. But testing the population for these diseases would be expensive and slow. The medicines used for treatment (ivermectin and albendazole), however, are inexpensive and have no side effects, making mass treatment a more effective approach to protect people from the disease. (And thanks to thegenerosity of the many pharmaceutical companies, billions of doses of these and other medicines combating neglected tropical diseases are being donated for free.)”

At the end of the blog post Bill shares the secret to success.

”Walking from door to door in the village with the health workers, I was struck that perhaps the most important element of the program is trust. Taking the medicine is strictly voluntary, making it important that the health workers distributing it earn the confidence of the community. The health workers I met certainly had. They were knowledgeable, passionate about their work, and clearly cared about the community they were serving.”

For so many of the systems I have worked on I focus on the “trust.” As trust increases everything works better. Without trust everything gets harder.