Rural Ugandan communities: the traditional kinship

In rural Ugandan communities where onchocerciasis is meso- or hyper-endemic; control of the diseases is now being carried out using a strategy of community-directed programmes for the annual distribution of ivermectin to all persons eligible to take the drug. For these programmes to achieve their annual target coverage of at least 90of the population eligible to take ivermectin; and to continue to sustain themselves for 10-15 years or more; even after external donor funding ceases; it has beenfound essential to replace the initial community-based strategy; imposed from outside; by a community-directed strategy developed by the community members themselves. Furthermore; it is essential for success that full use be made of the traditional social system; which is very strong in all rural communities in Uganda. This system is based on patrilineal kinships and clans; governed by traditional law; and in it women pay an important role. If this system is ignored or by-passed by government health personnel or by the sponsors and promoters of the programme; the communities are likely to fail to reach their targets. When rural communities semi-urbanized. The kinship/ clan system is then weakened; community-directed drug distribution is much more difficult to organize; and coverage targets are not often achieved. This effect is of minor importance in a rural disease; such as onchocerciasis; but is likely to be of greater significance in the control of diseases; such as tuberculosis and lymphatic filariasis; which thrive in urban environments

The onchocerciasis elimination program for the Americas: a history of partnership

The decision in 1987 by the pharmaceutical firm Merck & Co. to provide Mectizan (ivermectin) free of charge to river blindness control programs has challenged the international public health community to find effective ways to distribute the drug to rural populations most affected by onchocerciasis. In the Americas, PAHO responded to that challenge by calling for the elimination of all morbidity from onchocerciasis from the Region by the year 2007 through mass distribution of ivermectin. Since 1991, a multinational, multiagency partnership (consisting of PAHO, the endemic countries, nongovernmental development organizations, the Centers for Disease Control and Prevention in Atlanta, Georgia, as well as academic institutions and funding agencies) has developed the political, financial, and technical support needed to move toward the realization of that goal. This partnership is embodied in the Onchocerciasis Elimination Program for the Americas (OEPA), which is supported by the River Blindness Foundation (RBF) and now by the Carter Center. OEPA was conceived as a means of maintaining a regional initiative to eliminate what is otherwise a low priority disease. Since its inception in 1993, the OEPA has provided more than US$2 million in financial, managerial, and technical assistance to stimulate and/or support programs in Brazil, Colombia, Ecuador, Guatemala, Mexico and Venezuela, so as to take full advantage of the Merck donation. Now halfway into a five-year, US$ 4 million grant provided through the Inter-American Development Bank, the OEPA's capacity to support the regional initiative is assured through 1999