Abstract
The control of onchocerciasis is not only a major success story in global health, but also one of the best examples of the power of public-private partnership at the international level as well as at the national level. The onchocerciasis story is also a leading example of the contribution of a group of called Non-Governmental Development Organizations (NGDO) to operational research which resulted in important changes in treatment strategies and policies.The four case studies presented here illustrate some key contributions the NGDOs made to the development of “community directed treatment with ivermectin” –CDTI, in Africa, which became the approved methodology within the African Programme for Onchocerciasis Control (APOC). The partnership between the international, multilateral, government institutions and the NGDO Coordination Group was the backbone of the APOC programme’s structure and facilitated progress and scale-up of treatment programmes. Contributions included piloting community–based methodology in Mali and Nigeria; research, collaboration and coordination on treatment strategies and policies, coalition building, capacity building of national health workforce and advocacy at the national and international level. While the Onchocerciasis Control Programme (OCP) and APOC provided leadership, the NGDOs working with the national health authorities played a major role in advocacy evolving the community methodology which led to achieving and maintaining- treatments with ivermectin for at least 20 years and strengthening community health systems.
Highlights
The onchocerciasis story has been widely documented [1,2] and reviewed by e.g. the Center for Global Development [3] and Bush and Hopkins[4], it is important to highlight the strategies that have made it so effective
In this publication we focus on the role that Non-Governmental Development Organizations (NGDO) played in the early 1990s in empowering the communities affected by the disease in Africa to take charge of their own treatment programmes, which may be necessary to sustain for 20 years or more
This paper combines a review of published literature from a PubMed search using combinations of the terms “onchocerciasis”, “community based”, “Non-governmental organization (NGO)” and Loaisis, unpublished documents from Sightsavers archives the Non-Governmental Development Organization ( NGDO) Coordination Group for ivermectin distribution meeting reports, and structured interviews with 28 key stakeholders from national onchocerciasis programmes, NGDOs, Onchocerciasis Control Programme (OCP), African Programme for Onchocerciasis Control (APOC), Tropical Disease Research (TDR) and The World Bank
Summary
In contrast to the policy debates which took place in Cameroon, Uganda embraced community involvement in ivermectin distribution relatively . The pilot programme The seriousness of the disease and the need for action in Hoima and Masindi are highlighted in the November 1990 report of the Sightsavers River Blindness Coordinator’s visit He visited the two districts during the initial distribution of ivermectin, met with health staff and community members, and noted widespread itching of the skin. The TDR research on Community-directed interventions for major health problems in Africa [28] included a study site in Uganda (Arua, Sironko, Kyenjojo, Kanungu and Nebbi districts) This multi-country study looked at the use of CDTI methodology pioneered in the onchocerciasis programmes to address other health interventions, namely Vitamin A distribution, insecticide-treated bed nets and homemanagement of malaria, and directly observed treatment for TB (DOTS), managed alongside ivermectin treatment.
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