African Programme for Onchocerciasis Control Revitalising health care delivery in sub-Saharan Africa The potential of community-directed interventions to strengthen health systems AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL

The potential of community-directed interventions to strengthen health systems " C o m m u n i t y-d i r e c t e d t r e a t m e n t not only advances health promotion a nd disease control, it also strengthens basic health system structures… helping countries w o r k t o w a r d s t h e i r M i l l e n n i u m Development Goal commitments. " National health systems in many African countries are weak. Understaffed, under-resourced, and decimated by migration and illness, these service provisions are also skewed heavily in favour of urban populations so that rural areas have few, if any, health facilities. All over Africa, public-health expertise is badly needed but is in short supply. And inadequate health education, prevention, and disease-control strategies keep millions of people at risk of illness due to preventable vector-borne tropical diseases—including onchocerciasis—that should, with currently available tools, be under control. Effective vaccines and drugs exist to cope with the most common and devastating health threats. But the ineffectiveness of many African health systems, particularly in the sub-Saharan region, means these solutions do not get applied on the ground. Many of the challenges centre on integrating disease-focused programmes with primary care provision, scaling-up delegation to community workers , and creating public health strategies for disease prevention—all essential components of countries' commitments under the Millennium Development Goals. These deep-rooted problems have long hindered efforts to improve public health, while lack of funds, bureaucratic red tape, and political inertia prevent governments making the necessary investments in health-system strengthening. However, one public health programme has not only achieved good results in these difficult conditions, but has also demonstrated the effectiveness of a model of community involvement through which health systems, even in the most impoverished and conflict-ridden countries, can be supported from the bottom up. The African Programme for Onchocerciasis Control (APOC), which was set up in 1995, began with a substantial challenge: how to organise mass administration of a drug, provided for free to all those in need, to all en-demic areas, many of which are far from urban health centres. The World Health Organization (WHO), UNICEF, UNDP and World Bank-sponsored Special Programme for Research and Training in Tropical Diseases (TDR), working with African scientists, came up with a solution whereby communities in affected areas take charge …