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.

APOC’s mandate will end in 2015, by which time it aims to complete the transfer of full responsibility for onchocerciasis control to ministries of health of affected countries, and encourage the ministries to provide ongoing financial support.  As such, the overall goal of APOC’s phasing-out strategy is to establish a country-led system capable of eliminating onchocerciasis as a public health problem in all endemic countries in Africa.