Posts Tagged APOC

Can large scale disease control programs be sustained?

June 10th, 2010

Reprinted with permission from: Malaria Free Future

By: Bill Brieger

Roll Bank Malaria (RBM) was launched in 1998, but actual scale up to universal coverage is only happening in 2010. By Comparison, the African Program for Onchocerciasis Control (APOC) took off in 1996 and has been scaled up for several years in all but a few of its endemic countries. Granted, APOC has a relatively smaller target area, but it now regularly reaches over 127,000 African villages with annual doses of ivermectin.

Both programs have in common the need to sustain their scaled up for many years into the foreseeable future if disease elimination is to be achieved.

This need for a long term perspective causes concern when one reads about a threat to continued funding for APOC’s Borno State, Nigeria project, and raises speculation whether malaria efforts may face the same threat a few years down the line.

Mectizan Donation Program would continue as long as there was need, but by the sixth year of operation, it was hoped that countries could sustain their own CDTI efforts. Apparently this has not been easy.

Evidence of problems with Borno’s CDTI project surfaced in 2007 at a meeting of APOC’s Technical Consultative Committee where the following report was shared. “Borno has maintained a good geographic and therapeutic coverage. However, the project has the following challenges:

* Non-release of funds by state and LGAs * Inadequate number of FLHF staff * Selection and training of more CDDs * Obtaining funds from the government

IRIN now reports that after 11 years of operation “The (Borno State) government was supposed to provide counterpart funds to run the river blindness programme, but it has not done so, (according to) Borno State’s onchocerciasis coordinator Galadima.” Hellen Keller International (HKI) is Borno’s NGDO partner for CDTI and has been trying to make up the slack.

Unfortunately “HKI funding has been hit by the global recession, says (a representative). ‘Since the recession our donors have turned their attention elsewhere with little consideration for Africa and this affects the volume of funds for intervention projects like the onchocerciasis.’

Project staff complained to IRIN that, “We have been crippled financially due to lack of state counterpart funding. We sometimes find it hard to fuel our vehicles and go for supervision in the affected communities.”

There were hopes that another four years of government funding would put Borno within reach of elimination goals, but project staff lament that, “If the project stops at this stage, the effects will be devastating. It will turn the tide of the success we have achieved which will be quite disastrous.”

Let’s move this scenario forward to 2015 and change the disease to malaria. Let’s assume that talk of funding ceilings by donors has become a pressing reality and countries need to contribute more to sustain malaria interventions and achieve elimination. Let’s hope we don’t wind up again like malaria control did in the 1950s and ‘60s – eliminating the programs, not the disease.

PS The IRIN article does have some potential technical problems. It referred to the CDTI as a program to create ‘immunity’ to onchocerciasis, whereas ivermectin actually is a drug to kill the microfilaria of the parasite and keep infection at a low level until such time as adult worms die and transmission in the community stops. There is also concern about the figure of $18 per person treated. Normally at this advanced stage of the program we should be talking in terms of cents, not dollars. These technical problems with the article do not detract from its serious financial message.

Bill Brieger is currently a Professor in the Health Systems Program of the Department of International Health at Johns Hopkins University as well as the Senior Malaria Adviser for JHPIEGO, JHU’s family and reproductive health affiliate. He was a Professor in Health Education at the African Regional Health Education Centre, University of Ibadan, Nigeria, from 1976 to 2002. His research interests have focused on the social and behavioral aspects of tropical disease control, and in the area of malaria research, funded by the Unicef/UNDP/World Bank/WHO Tropical Disease Research program (TDR) and USAID implementing partners, this has included acceptability of pre-packaged antimalarial drugs, urban malaria, role of patent medicine sellers in malaria treatment, and community and cultural perceptions of malaria as a basis for village health worker training and health education.

Night 5: Onchocerciasis

December 16th, 2009

Onchocerciciasis, one of the most common neglected tropical diseases known as “river blindness”, is a major contributor to visual impairment and blindness in sub-Saharan Africa.  Onchocerciasis also causes lesions, skin depigmentation, and debilitating itching, all of which foster stigmatization and social isolation.  Beyond its health impacts, onchocerciasis has also instilled a fear of blindness in affected communities, prompting them to abandon fertile river valleys in Africa, thereby reducing agricultural productivity and increasing poverty.

Approximately 37 million people around the world are infected with onchocerciasis; over 102 million people are at risk for the disease in 19 countries.  500,000 of those infected with onchocerciasis are severely visually impaired, and another 270,000 have been rendered permanently blind from the disease.

Fortunately, there are African-led efforts underway to control and eliminate this disease that can serve as a model for community-led health interventions and health systems strengthening efforts around the developing world.  The African Programme for Onchocerciasis Control (APOC) was established in 1995 to eliminate onchocerciasis as a disease of public health importance in Africa.  At the core of APOC’s strategy to eliminate the disease is community-directed treatment with ivermectin (CDTI), a strategy largely pioneered by APOC’s dynamic director, Dr. Uche Amazigo.

In 1997, APOC formally adopted the CDTI strategy to deliver ivermectin to infected and at-risk communities, and in the years since it has rapidly scaled up and expanded its efforts. Over 600,165 trained CDDs have been trained and engaged in CDTI projects since APOC’s inception, and they have delivered nearly (965,000,000) ivermectin tablets in 11 years (1997-2007).  Millions more have benefitted from other health interventions implemented simultaneously with CDTI, including home-based management of malaria, distribution of insecticide treated bed nets, Vitamin A supplementation, and management of HIV/AIDS as well as awareness campaigns involving the support of CDDs.


A map of health interventions delivered through the CDTi mechanism across Africa

Read more: Night 5: Onchocerciasis

NTDs Are Focus of Tonights NewsHour with Jim Lehrer

September 16th, 2009

Tonights episode of the NewsHour with Jim Lehrer focuses on a community-based program to eliminate onchocerciasis (river blindness), one of the seven most common neglected tropical diseases, in Tanzania. Watch this video for a preview of tonights show.

The episode will include an interview with Dr. Uche Amazigo, and will highlight the community drug distribution program she has championed through the African Programme for Onchocerciasis Control (APOC). APOC has become a successful model of how effective public-private partnerships can leverage local community members to support the health needs of their friends, families and neighbors.

Talea Miller with the NewsHour team also put together a great slideshow of her photos from the Tanzanian trip, available on Flickr.

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