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Case study: Onchocerciasis treatment


Two of the three lectures of the fourth week reflect on various attempts to combat Onchocerciasis – the so-called river blindness (see explanations below). This parasitic disease can be treated with the drug Ivermectin, which has to be applied long-term (for about 15 years) to be effective. This means, that any really successful treatment programme has to be sustained for 15 years (with one dose of the drug given per year and person) even in remote villages in sub-Saharan Africa. Against the background of this problem, Prof. Brieger examines the differences between a community-based and a community-directed treatment programme.

Community-based programmes: A community-based health programme follows the social policy planning approach discussed during the second week of this course. An outside NGO (such as the APOC – the African Programme for Onchocerciasis Control) basically plans the intervention from the outside and then comes into the community to carry it out. The members of the community are therefore simply recipients of an outside service, but have no “ownership” of the programme. This reduces the commitment to and the interest in the programme and therefore its effectiveness. It is also noteworthy, that outside health workers are usually under some pressure to present positive statistics to their superiors and are thus inclined to “push” measures on community members.

Community-directed programmes: A community-directed programme is initiated from outside the community by a NGO or government organization, but is then – sooner or later – gradually passed over to the community itself. Such community ownership means e.g. that the members of the respective community can decide among themselves, which community members shall receive health worker training by the NGO, who shall be responsible for the distribution of the drugs and when and how the drugs shall be passed out to the community members. The outside agency is simply acting as a facilitator to this process, providing the drugs itself as well as advice and outside resources needed for a successful project. Such community ownership practically guarantees that local issues and sensitivities are respected and that the programme is better accepted. Additionally, running a community-directed programme builds up skills and organizational structures within the community, that can prove to be very useful for future health- and non-health-related projects.

About Onchocerciasis / river blindness

The lectures of the fourth week center around efforts to combat Oncochericiasis in sub-Saharan Africa. Oncochericiasis – or river blindness – is a severe parasitic disease caused by a roundworm (Onchocerca volvulus). This specific parasites spreads to humans via the bite of the black fly and can cause severe infection in the eyes, leading – at least in some cases – to permanent blindness. The WHO estimates that about 18 million people worldwide are currently suffering from river blindness – with about 270.000 cases of actual permanent blindness caused by the disease:

http://www.who.int/water_sanitation_health/diseases/oncho/en/

These lecture notes were taken during 2012 installment of the MOOC “Community Change in Public Health” taught by Prof. Dr. William R. Brieger of the Johns Hopkins Bloomberg School of Public Health at Coursera.org. Prof. Brieger blogs under www.malariamatters.org and can be found on twitter as @bbbrieger.
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