Increasing government commitment: sustainability plans
Sustainability of control activities is a major challenge to eliminating onchocerciasis. Evaluation of over 50 projects in 10 countries showed that around 25% of the projects scored low on community participation and were compromised by inadequate government funding and weak local health systems.
Sustainability plans set out how APOC’s financial support will be devolved to the government. They are drawn up after a sustainability evaluation and describe how government commitment will increase on a yearly basis so they will still run efficiently even when the projects are no longer receiving APOC funds.
Phasing out of APOC support
Sustainability plans mark a key stage in the devolutionary process that enables APOC to reduce and gradually eliminate altogether its share in the financial support of a project.
The figure shows a timeline for the discontinuation of APOC financial support to CDTI projects. In 2008, for example, APOC will stop funding of 10 CDTI projects: one in Malawi, one in the United Republic of Tanzania, one in Uganda, four in Nigeria, two in Cameroon and one in Sudan. These projects will continue to run under the responsibility and financial support of the national governments, with input from non-governmental development organizations (NGDOs).
Before the responsibility of a project is completely transferred to the national health system, APOC will provide logistical support, including new equipment (e.g. vehicles, motorcycles, bicycles, computers, printers and accessories) to projects. This will help to sustain control and surveillance activities following withdrawal of APOC support.
Based on the evidence that the CDTI process has been fully integrated and will be sustainable after the withdrawal of APOC support, countries will have the capacity to maintain control for the foreseeable future.
Discontinuation of APOC financial support to CDTI projects, 2008–2015
Note: (1) In 2007, 108 CDT projects were financed and implemented. The total number of 110 shown in the figure represents the estimated number of CDTI projects to be implemented and managed in 2008.
(2) Three additional CDTI projects located in insecure areas of Angola, Democratic Republic of the Congo, and Uganda may be approved in 2008.
(3) Rapid epidemiological mapping (REMO) implemented after approval of the Gabon project revealed that onchocerciasis is hypo-endemic across the country, except for a few villages. APOC Trust Fund support was provided for one year in Gabon.