PRE VENTING NEGLEC TED TROPIC AL DISEASES OF POVERT Y JUNE 2014 Working in Partnership 88850 The Impact of River Blindness Control Programs in Africa: Better Health, More Wealth In 1974, the Onchocerciasis Health System is a form of capacity-building that will Control Programme (OCP) was Strengthening and benefit many other community health launched in West Africa to combat programs in the future. Enhanced Program the devastating effects of river Sustainability through River blindness programs have blindness. A disease of the neglected poor, river blindness locked large Community Action made important contributions to strengthening the health systems numbers of people into poverty Volunteers deliver medicines to at-risk of West Africa. The OCP helped by affecting not just their health, populations through the Community- strengthen disease-surveillance but also their educational and Directed Treatment with ivermectin capacity, drug-distribution systems, earning opportunities. It placed an (CDTi) approach. Through the CDTi and health information and overwhelming economic burden strategy, the African Programme reporting systems. It also supported on households, national economies, for Onchocerciasis Control (APOC) a model for decentralization and and the region as a whole. The reaches many neglected, ‘end-of-the- integration of disease control activity most severe consequence of road’ communities that have limited for district level to community river blindness is total vision loss, or no access to basic health services. level engagement. APOC has which affected one-third of the With this platform, geographical and helped Ministries of Health build adult population of the most therapeutic coverage have increased administrative and technical highly affected communities. substantially; in most areas, to the capacities in health services delivery, While blindness is the most stark levels required to eliminate river and especially community programs consequence of infection, skin- blindness as a public health problem. that reach the poor. Involving both related problems were the most The CDTi approach now serves peripheral and district health services significant cause of substantial as a platform for the integration in the implementation of APOC has morbidity among affected of other health interventions, resulted in the general strengthening populations. Persistent and severe such as delivering bed nets and of the health sector. itching not only caused psychosocial micronutrients, and providing medicines for other preventable NTDs problems related to ostracism and Disease Control and stigma but also had a demonstrably and seasonal malaria control. Elimination negative secondary socioeconomic One of the legacies of APOC with impact on agricultural productivity, In the 11 countries covered by the respect to vector elimination is the breastfeeding, and school OCP1, the combined application training of local health workers in the attendance. Today, loss of vision due of vector control and ivermectin multiple tasks associated with vector to river blindness has been pushed treatment has led to the virtual control. With the CDTi approach, back in large swathes of Africa, elimination of river blindness as endemic communities are able to and because 100 million people a public health problem and as take full responsibility for the drug- are treated, severe skin problems an obstacle to socioeconomic delivery process; they decide how, are rare. With these improvements when and by whom treatment should 1 Countries which participated in the OCP in health, better socioeconomic be administered, and oversee its program included: Benin, Burkina Faso, Cote d’Ivoire, Ghana, Guinea, Guinea Bissau, Mali, outcomes have followed. implementation and follow-up. This Niger, Rwanda, Senegal, Sierra Leone, and Togo development. APOC2 has successfully Impact on Health, is now largely averted. Today, more expanded and accelerated treatment Human Development, than 1.5 million people originally with ivermectin in participating and Agriculture infected are free of the disease. countries, thereby relieving the skin Promoting Agriculture and manifestation and intolerable itching Return on Investment Human Development: In the past, in severely infected individuals, and Since 1974, the budget for OCP communities avoided cultivating the preventing an estimated 40,000 and APOC totaled US$1.2 billion in best fertile land near rivers because new cases of blindness each year. In donor financing. When the OCP was of fear of infection with the parasitic most advanced APOC projects, the operational, the cost of protection for disease. In countries benefiting from prevalence of infection is already each individual per year was well under OCP and APOC programs, these close to zero. US$1. The cost per treatment is about communities have now developed Blindness from this cause occurs US$0.15 for APOC, with the cost per greater market-oriented land use, after many years of infection with the person treated continuing to fall over which in turn has helped improve parasitic disease. Taking ivermectin time. Key reasons for this substantial access to electricity and telephone value for money are that the medicines annually kills the juvenile worms that services, markets, and education. are donated and the CDTi process is cause the various symptoms associated These investments have made 25 low cost. with river blindness. As a result of the million hectares of arable land safe to successful river blindness partnerships, cultivate, with the potential to feed 17 The economic rate of return here has the once common scene of a child million people. been estimated based on the increase leading a blind adult with a stick no in the labor force due to prevention Preserving Sight: As a result of longer occurs. of blindness, and the increased land the river blindness partnerships, use. The 18-20 percent economic Research now shows that ivermectin blindness from onchocerciasis no rate of return estimated for OCP from treatment can not only control but, in longer occurs in communities where the inception of Phase 1 in 1975 up many areas, eliminate river blindness regular treatment is available. Sixteen to 2002 compares well with other infection and interrupt transmission. million children born after 1974, development projects, including those Treatment can safely be stopped when OCP activities began, are free outside the health sector. where interruption of transmission of river blindness, and more than has been demonstrated. In Senegal 200,000 cases of blindness have been Looking Forward and Mali, the transmission of river prevented. The control of river blindness has blindness has been successfully Improving Health: The impact of been a remarkable success story. Now, interrupted, with treatment the river blindness partnerships on focus has shifted to a more ambitious suspended since 2009. Following improving health and quality of life goal: the elimination of river blindness this model, transmission has been has been substantial. APOC activities in addition to other preventable interrupted in six countries in Africa: are estimated to result in almost 10 neglected tropical diseases (NTDs) Burundi, Mali, Nigeria, Rwanda, million discounted healthy life-years from Africa. To help countries achieve Senegal, and Uganda. The continent is being added between 1996 and this aim, plans are underway to on track to eliminate the disease from 2017 or 27 healthy life-days being transition APOC into the regional NTD nearly all endemic countries by 2025. added per US dollar invested in Programme for the Elimination of APOC activities. In terms of Disability- Neglected Diseases in Africa (PENDA). 2 Countries added by the APOC program were: Angola, Burundi, Cameroon, Central African Adjusted Life Years (DALYs), the total It is hoped that PENDA will help Republic, Chad, Congo, Democratic Republic of Congo, Equatorial Guinea, Ethiopia, Gabon, burden of human river blindness in ensure that future generations live Kenya, Liberia, Malawi, Mozambique, Nigeria, Africa had resulted in approximately free from the threat of debilitating Rwanda, South Sudan, Sudan, Uganda, and Tanzania 884,000 DALYs lost annually, a loss that diseases of poverty.