Monitoring community-directed treatment programmes for sustainability: lessons from the African Programme for...

Area of Science:

• Public Health
• Tropical Medicine
• Community Health

Background:

• Community-directed treatment with ivermectin (CDTI) was adopted by the African Programme for Onchocerciasis Control (APOC) in 1997 for large-scale ivermectin distribution.
• Onchocerciasis, also known as river blindness, is a debilitating disease prevalent in many African countries.

Purpose of the Study:

• To assess the process implementation and sustainability predictors of the CDTI strategy.
• To evaluate the effectiveness of community-directed drug distributors (CDD) in ivermectin distribution.

Main Methods:

• Participatory monitoring of 39 CDTI projects from 1998-2000.
• Analysis of data from 14,925 household interviews, 183 treatment records, 382 focus-group discussions, and interviews with community leaders, CDDs, and health personnel across four countries.
• Statistical analysis to identify predictors of treatment coverage and sustainability.

Main Results:

• CDD dispensed ivermectin to 65.4% of the total population (71.2% of eligible).
• Treatment coverage varied by country, from 60.2% in Cameroon to 76.9% in Uganda.
• No significant relationship was found between CDD incentives and coverage; Cameroon had the highest refusal rate (29.2%).

Conclusions:

• There is a need to enhance communication strategies and community ownership in CDTI programs.
• Addressing issues of absentees and treatment refusal is crucial for program success.
• Understanding 'predictor indicators' of sustainability can help APOC improve project performance and guide future interventions.