African Programme for Onchocerciasis Control (APOC)

Community-directed distributors (CDDs)

APOC has built up a network of 472 972 community-directed distributors, who are trained to deliver drugs, help educate their peers about health issues, and participate actively in other disease control activities.

Community-directed distributors (CDDs) are the men and women volunteers selected by their communities to distribute ivermectin. Ivermectin has to be taken once a year, and is such a safe drug that WHO has deemed it safe for non-medical people to administer the tablets with minimal training.

The people selected to become CDDs are generally perceived by the community as being honest and trustworthy, having good conduct, integrity and literacy. As volunteers, their motivation is mainly by gains in recognition, self-esteem and knowledge, rather than cash incentives.

A community-directed distributor
A distributor with a measuring stick, notebook and ivermectin on her way to a village

CDD tasks include:

  • conducting a village census to determine the number of ivermectin tablets required
  • administering the correct dosage of ivermectin tablets based on people’s height
  • excluding pregnant and breastfeeding women, very ill people, and others who are not eligible for treatment
  • keeping an inventory of ivermectin, noting how much has been used, how much is unused and how much has been lost
  • referring people with severe adverse reactions to the nearest health facility
  • treating minor adverse reactions
  • keeping records and reporting to the health workers
  • delivering other health interventions such as insecticide-treated bednets to prevent malaria, vitamin A tablets and albendazole to treat worms.
A community-directed distributor
A community-directed distributor

To carry out their duties effectively, community-directed distributors are trained and re-trained every year or every two years, depending on the level of skills reported by health workers during supervision.