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| CDI: Maximizing the benefits of a successful regional heath initiative
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Ouagadougou, Burkina Faso (PANA) -
The world of public health is in continual motion especially with the global health community battling
multiple crises, including the burden of emergent and resurgent diseases, the consequences of climate change and the global economic slow
down.
Populations in developed and developing countries alike are in serious danger as
governments struggle to share limited resources among competing
basic needs.
For Africa, where national health systems are weak, understaffed, under-resourced and decimated by migration and illness, the health or wellness prognosis
is grim, to put it mildly. As a result of the high level of poverty of many countries on the continent, health services are either non-existent, inaccessible, inequitable,
or skewed disproportionately in favour of urban populations, leaving rural communities marginalized and highly vulnerable.
These deep-rooted problems continue to hinder efforts at improving public health
, while lack of funds, bureaucratic red tape and lack of political will prevent
governments from making the necessary investments in health-system strengthening.
Similarly, inadequate health education, prevention and disease-control strategies keep millions of people at risk of contracting otherwise preventable diseases
such as malaria and river blindness, even when tools to bring these diseases under control are available.
The fact that many communities at the end of the road and beyond in poor countries cannot access health services means the attainment of the health-related
Millennium Development Goals (MDGs) by the target date of 2015 cannot be assured.
But there is a glimmer of hope from one public health programme, which started as a scientific research topic but has since been transformed into an exemplary
private-public sector partnership initiative and is now widely acknowledged as a
remarkable success in public health service delivery even in Africa’s difficult
conditions.
The Phase I Onchocerciasis (river blindness) Control Programme (OCP), which was
launched in the early 1970s, effectively brought this disabling and blinding
disease under control in 11 West African countries. Before the programme wound up in 2002, its success encouraged the global health community and partners
including UN agencies, the World Bank, governments, the private sector and the endemic communities in the rest of Africa to set up the Phase II control Programme
in 1995, known as the African Programme for Onchocerciasis Control (APOC).
APOC has demonstrated the effectiveness of a model of community involvement through which health systems have been supported from the bottom-up to
achieve commendable outcomes even in resource-poor and post-conflict settings.
Onchocerciasis is a microfilarial worm disease transmitted to humans by the black fly. The disease causes unrelenting itching, rashes, destruction of the skin and
severe disability. In Africa, it constitutes a serious obstacle to socio-economic development.
As the world’s fourth leading infectious cause of preventable blindness, onchocerciasis is endemic in some 30 African countries where more than 120 million are
a
t risk.
The World Health Organization (WHO), through APOC, countries, donors and partners, has invested close to US$$2.5 billion in the control of this disease over the
past 30 years. The fruits of the investment are many, including the development
of human capital (capacity building), strengthening of health systems, increased
agricultural productivity
and the large network of more than half a million trained drug distributors and
health workers involved in the Community-Directed Intervention (CDI) strategy be
ing used to fight the disease across Africa.
Building on the success of the OCP in West Africa, which used mainly the spraying (larviciding) of the fly breeding rivers with environmentally safe insecticides
as its main
control tool, APOC in 1997 introduced the CDI strategy, encouraging active community participation in the control partnership and harnessing the desire of communities to help themselves.
Through the programme’s trademark strategy of Community-Directed Treatment with
Ivermectin (CDTI), which is a CDI approach, more than 120,000 communities in 23
Africa countries, including former OCP countries, are treating close to 55 million people annually for river blindness with the drug donated by the pharmaceutical company Merck
& Co Inc.
This is more than 37 times the 1.5 million people treated by non-governmental organizations and ministries of health before the introduction of the CDTI by APOC
in 1997, and
at a low cost of less than US$0.53 per person per year.
Other measurable achievements and impact of the programme include the yield of more than 17% economic rate of return, reduction by 25% annually of disability-adjusted life years (DALYs) that would have been lost without APOC control activities.
Furthermore, some 27 million people in seven countries have benefited from other
health interventions co-implemented with CDTI, including home management of malaria,
distribution of insecticide-treated bed nets, vitamin A supplementation and management of HIV/AIDS.
Because of the simplicity of its application and cost-effectiveness as a primary
health service delivery tool, the CDI strategy is now being advocated for use by
other health intervention programmes, especially those targeting neglected tropical diseases (NTDs) as well as promotion of maternal and child health.
Recent scientific studies have shown that communities in Mali, Senegal and Kaduna State, Nigeria have been able to achieve elimination of transmission of river
blindness in some previously endemic areas using the CDTI strategy.
These successes formed the basis for a recent international meeting held in Abuja, the Nigerian capital, organised to promote the incorporation of CDI into the
curricula of Medical and nursing schools throughout Africa, using a training module on the CDI strategy developed by APOC in collaboration with the West African Health Organization
(WAHO) and the WHO Regional Institute for Public Health based in the Republic of
Benin.
A major highlight of the meeting was the unanimous agreement by Vice-chancellors
and senior academics of 18 Universities and medical schools in 11 African countries to
introduce the CDI strategy into their curricula. This will contribute towards broadening the knowledge and use of the CDI to strengthen health systems especially
in resource-poor
countries.
“It has been proven that health interventions succeed better when community members are involved in the planning and implementation,” Nigerian Minister of State
for Health,
Dr Aliyu Idi Hong, told participants while declaring the Abuja meeting open.
“Now that the effectiveness of the (CDI) strategy is proven, we should see how it can be used for other health interventions and be more widely propagated,” declared Dr Peter Eriki,
the WHO Country Representative in Nigeria, who represented the WHO Regional Director for Africa, Dr Luis Gomes Sambo, at the meeting.
The APOC Director, Dr Uche Amazigo, acknowledges the significant contributions of community distributors in the fight against river blindness, malaria and other
diseases. Calling the
distributors the “unsung heroes,” she noted: “If Africa’s doctors of tomorrow are to make a significant improvement in the health of the poor and the rich alike
,
policy and decision-makers in health need a new strategy – one that acknowledges the people
as the heart beat of the health system. All clinical and preventive programmes
should be people-oriented.”
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| Ouagadougou - 21/07/2009 |
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