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River Blindness: Africa on track towards eradication

ByPAUL EJIME
The international health community – health ministers, donors, non-governmental development partners, UN agencies, health experts and the media – converged recently at the Transcorp Hilton, Abuja, the Nigerian capital, united in one purpose – how to rid Africa of the River blindness scourge.

After three days of deliberations (7-9 December, 2010), participants at the 16th session of the Joint Action Forum (JAF), the Governing Board of the World Health Organization African Programme for Onchocerciasis Control (WHO/APOC) reaffirmed commitment toward ending the socio-economic and human devastation of the blinding disease in Africa.

River blindness, a vicious parasitic worm disease transmitted by the bite of black flies causes intense itching, skin disfiguration, vision loss, and blindness.

The adverse impact of the disease on Africa, which bears the greatest burden of Neglected Tropical Diseases (NTDs) include reduced agricultural productivity, recycling of poverty and an impediment to development.

The urgency in tackling river blindness and other NTDs cannot be over-emphasized with just five years to 2015, the date set by world leaders for the attainment of the Millennium Development Goals (MDGs) including halving extreme poverty worldwide.

Mectizan, the “miracle drug”

The JAF session officially opened by Nigeria’s President Goodluck Jonathan, represented by Health Minister Prof. Onyebuchi  Chukwu, was attended by health ministers or their representatives from 19 WHO/APOC participating countries, representatives of 20 donor countries and institutions, 15 NGDO partners, UN agencies including UNICEF and the World Bank, the fiscal agent of the programme.  Also in attendance were officials of WHO, the executing agency of APOC, the pharmaceutical company, Merck & Co Inc., and officials of some of the 11 former Onchocerciasis Control Programme in West Africa (OCP) countries.

International donors  committed US$31 million to support WHO/APOC’s efforts to control and embark upon focal elimination of river blindness from Africa.  Among the new commitments was a first-ever individual donation of US$1 million announced by a Nigerian philanthropist and survivor of river blindness General T.Y. Danjuma.

Danjuma, a special guest at the meeting and grand patron of local NGDO MITOSATH, which supports Nigerian government in the fight against river blindness and other NTDs, recounted his experience as a young military officer.

“I have had a personal experience with this disease and live with relatives and friends who are victims,” he said, and urged the Nigerian government to also contribute more toward eliminating the disease.  More than 120 million people worldwide are at risk  with about 90 percent or more than 102 million of the at-risk population in Africa.

Nigeria accounts for an estimated 30 million of the population at risk scattered in 31 of the country’s 36 states and in the Federal Capital Territory.

In an apparent response to Danjuma’s plea, Prof Chukwu reiterated Nigeria’s commitment to step up support and contributions toward the elimination of the disease in line with the theme of the Abuja meeting: “Join forces to make River Blindness history.”

Over the past decade, Nigeria’s Federal, state and local governments have intensified the fight against river blindness and other NTDs with the support of development partners and NGDOs, using APOC’s cost-effective and innovative Community-Directed Treatment with Ivermectin (CDTI) strategy.

This strategy also known as the Community-Directed Intervention (CDI) is a bottom-up approach to public health care delivery whereby communities play a leading role in the management of their own health.

Results of recent multi-country research have shown that the strategy does not only empower communities by giving them a say in the decision-making and implementation of public health care delivery, but also strengthens health systems and provides an entry-point for the management of other diseases including malaria and delivery of vitamin A supplements.

With strong leadership from Africa, and support from donors and NGDO partners, 146,000 local communities in 15 of 19 APOC countries treated about 70 million people in 2009 with Ivermectin (Mectizan), a safe drug for the treatment of the disease donated by Merck & Co Inc.

Since 1995 donors have contributed about US$186 million to the APOC Trust Fund and the pledges in Abuja add US$31 million to that total for the next two years.

The programme has also created a network of close to one million trained community-directed drug distributors majority of whom supporting the Ministries of Health in the delivery of other health interventions.

There is good news from recent studies showing that for the first time in Africa there is possibility of eliminating transmission of the disease in some foci (in Guinea-Bissau, Mali, Senegal and Kaduna, Nigeria), using existing tools – the CDI. “We have reached the stage that Africa can get rid of river blindness, and the APOC partnership, with the support pledged by donors and governments in Abuja can make this happen,” said Dr Uche Amazigo, WHO/APOC Director.

Underscoring this sentiment, Dr Donald Bundy, Coordinator of APOC affairs at the World Bank, said: “APOC’s unique community approach to implementation places the programme in the hands of its beneficiaries,” especially communities beyond and at end of the road, which are usually not covered by the conventional health system.

Dr Luis Gomes Sambo, the WHO Regional Director for Africa, called for more efficient management of health resources and urged African governments to ensure adequate allocation of domestic resources to the health sector.

“Given the laudable achievements of OCP (1974-2002) and APOC, we must ensure that eliminating river blindness from Africa is a success,” he added.

By reaffirming their commitment in Abuja, donors and development partners have allayed the fear about the closure of the APOC programme by the preset exit date of 2015.

*Ejime is Communication/Media Consultant to the WHO African Programme for River Blindness Control.


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