Community-directed interventions for major health problems in Africa
There is an urgent need to develop and scale up strategies that can ensure improved access of poor populations to existing, efficacious health interventions.
One strategy with an already-demonstrated track record of success in reaching rural African populations is community-directed treatment with ivermectin (CDTi). In a little more than a decade, CDTi, in which community members themselves lead the process of drug delivery and treatment, has extended annual ivermectin treatment to nearly 60 million Africans, significantly ensuring sustained high treatment coverage and advancing the process of disease elimination.
The experience with CDTi, coupled with the larger need to improve overall access for Africa’s poor to other critical health care tools, prompted the Board of the African Programme for Onchocerciasis Control (APOC) to commission a study examining whether an expanded strategy of “community directed interventions” (CDI) might be used to combat other diseases in communities with prior experience with CDTi. Health ministers of 19 onchocerciasis-endemic countries are represented on the APOC Board, and the study was thus viewed as having significant relevance both to national level policy-makers as well as to health professionals in the field.
In 2005, the three-year multi-country study was launched, examining to what extent the CDI process can be used for the integrated delivery of other health interventions with varying degrees of complexity, alongside ivermectin.
The study was remarkable for its demographic scope covering a total of 2.35 million people with an average of 380 000-530 000 people living in the area defined by each study site. The results from seven research sites in three countries (Cameroon, Nigeria and Uganda) are reported here.