Tag Archives: APOC

New World Bank Video Shows an Amazing River Blindness Success Story



To celebrate the remarkable progress made against river blindness (onchocerciasis) in Africa since the formation of a tremendous public-private partnership to combat the disease forty years ago, global partners recently gathered at World Bank headquarters in Washington, DC. Leaders poignantly spoke about how this country-owned, community driven effort — the World Bank’s first health project — carried out through the Onchocerciasis Control Programme (OCP) between 1974-2005, and the African Programme for Onchocerciasis Control (APOC) between 2005-present, is now reaching 100 million people in 31 countries annually thanks to bold visions, clear strategies and the collaboration of partners.

To coincide with OCP/APOC’s 40th anniversary, a new World Bank video narrates the unlikely story of how insecticide and Mectizan (ivermectin) — a pill donated by Merck for free for as long as needed — have transformed the lives of millions of people. Generating blindness, impaired vision and severe itching, among other effects, river blindness once devastated entire communities. The disease left people unable to farm for sustenance and a living, inhabit land in river valleys and take care of their families.

But, with insecticide sprayed by helicopters, and eventually the distribution of ivermectin in all affected countries, some areas are free of the disease. 25 million hectares of arable land — enough to feed 17 million people — are now freed up for use.

By 2025, we can eliminate river blindness in Africa and end the cycle of poverty caused by this horrific disease. But, we must continue to mobilize and pool resources, increase country leadership and integrate efforts to accomplish this goal.

Congratulations to all of the APOC partners fighting for a brighter, healthier future!

Make sure to watch the full video:

The World Bank and Partners Celebrate 40 Years of Success in Controlling River Blindness



This Friday, the World Bank, the World Health Organization (WHO), Merck and other partners will celebrate 40 years of success in controlling river blindness in Africa. The African Programme for Onchocerciasis Control (APOC) is recognized as one of the most successful public-private health partnerships in Africa – treating 100 million people a year in 31 African countries with free medicines donated by Merck & Co.

The World Bank has a long-established history of fighting neglected tropical diseases (NTDs). In fact, the 1974 agreement by then World Bank President McNamara to establish a partnership to Control River Blindness was arguably the first World Bank health project.

To celebrate APOC’s 40 years of success, the World Bank will host a 40th anniversary learning event and summit this Friday, June 20 at the World Bank Headquarters in Washington, DC.

Friday’s event will highlight lessons learned from APOC’s 40 years of efforts to control onchocerciasis, the history of this historic partnership, and the impact of its programs and the future of NTD control and elimination. The day’s panels will be filled with distinguished experts in global health, nutrition and NTDs.

The learning panels will conclude with a celebratory summit and reception launched by World Bank President Dr. Jim Yong Kim. Her Royal Highness Princess Alexandra will also be in attendance as a guest of honor. Panelists at the summit will celebrate the history and future of APOC from the continental perspective.

We hope you’ll join the World Bank and its partners for this celebration. You may find more information about the event here. RSVP to rbsummit2014@gmail.com.

The day-long event will take place at 1818 H St. NW, Washington DC in the World Bank’s Preston Auditorium and Wolfenshon Auditorium – beginning at 9am and ending at 8pm.

For more information, and to view the live stream, click here. Be a part of the conversation by following #WBlive and #NTDs on Twitter. 

Can large scale disease control programs be sustained?

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.

Photo Courtesy of http://www.malariafreefuture.org/blog/?p=972

APOC started with a very clear vision of sustainability. APOC, a government entity (state, province, district, or country) and a non-governmental development agency (NGDO) would enter into a financial and programmatic 5-year partnership to establish community directed treatment with ivermectin (CDTI – see photo of CDTI in Cameroon at right). APOC’s financial contribution would be largest in the first year, when the overall budget would be largest because of start up costs.

Over time, program costs were to reduce, as would costs per person treated because of economies of scale. APOC’s share of the budget would decrease relative to that of the government partner, though the overall budget to maintain the program into the future was expected to be smaller and more manageable to the government partner with some continued support from the NGDO.

Free supplies of ivermectin from the 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

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

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