African Programme for Onchocerciasis Control (APOC)

Monitoring and evaluation of community-directed treatment with ivermectin (CDTI) projects

External evaluation for sustainability

To eliminate onchocerciasis as a public health problem in Africa, the community-directed treatment approach must be sustainable. A method to evaluate the sustainability of CDTI projects was established in response to the first external evaluation of APOC, which expressed concern about the sustainability of activities once APOC funding comes to an end.

In its third year, every CDTI project undergoes an external evaluation to assess its ability to continue functioning after the withdrawal of APOC support.

The evaluation team includes members from another participating country, and members of another CDTI project in the same country.

Criteria for evaluating sustainability

The sustainability of a project is based on the following.

  • Integration: projects that have become integrated into the routine running of the health care system are more likely to be sustainable.
  • Community ownership: projects are more likely to be sustainable if the communities support the CDTI process and are willing to take responsibility for it. Simplicity: projects that use simple, uncomplicated routines and procedures are more likely to be sustainable.
  • Health staff acceptance: projects are more likely to be sustainable if health staff have accepted CDTI as a routine activity, which they will continue even in the absence of material rewards.
  • Efficiency and effectiveness: projects that are functioning efficiently and run cost-effectively are more likely to be sustainable.
  • Resources: projects are more likely to be sustainable if they have enough human, financial and material resources to support what they are trying to do.

The evaluation team assesses the likelihood of the projects achieving sustainability, and reports any weaknesses in a project that are likely to undermine its sustainability.

Developing a sustainability plan

Following an evaluation, a sustainability plan is drawn up by local government health officials, health care staff, staff from non-governmental development organizations (NGDOs), and members of the evaluation team. A sustainability plan commits the government to taking over the financial management of certain activities, previously funded by APOC. These activities include training of community-directed distributors (CDDs), training of health workers, and project supervision.

The sustainability plan marks a key stage in devolving APOC’s financial support to the government. It helps all partners to prepare for the end of APOC’s mandate in 2015.

Monitoring the implementation of sustainability plans

One or two years after establishing a sustainability plan, each project undergoes a further monitoring exercise by a small team of independent experts. The aim is to verify how well the government is implementing the plan at district and community levels.

  • Read article
    Amazigo U et al., (2007). Performance of predictors: evaluating sustainability in community-directed treatment projects of the African programme for onchocerciasis control. Social Science & Medicine, 64: 2070–2082.

Monitoring and evaluation of CDTI projects: status

As of December 2007:

  • 64 projects have undergone independent participatory monitoring
  • 60 projects have been evaluated for sustainability
  • 27 projects have been monitored for the implementation of their sustainability plans.

The majority of projects show good progress – particularly at community level – towards attaining sustainability.

Related links