Oncho; a concerted effort / by Alastair Anderson

Oncho: a concerted effort For the Onchocerciasis Control Programme, intersectoral action is not an abstract ideal but a practical working fact. Says OCP director Ebrahim M. Samba: "We are doing it!" by Alastair Anderson The Onchocerciasis Control Programme (OCP), which marked its tenth anniversary in December 1985 , is the inter- sectoral programme par excellence. It is a prime example of an activity which, in WHO's parlance , appears to be essentially a "vertical" programme but, by succeeding, has become thoroughly " horizontal". It is international, because it em- braces at present 11 countries of West Africa afflicted by the blackfly vec- tor of "river blindness", as well as 14 donor countries. It is inter-regional, because its suc- cesses are being watched by-and are being used by-other onchocerciasis- affected areas of the world, notably central and eastern Africa, Central America and the Southern Arabian peninsula. It is inter-agency, because it involves four sponsoring agencies of the UN system: the UN Development Pro- gramme (uNDP) , the Food and Agri- culture Organization (FAO)-both of these concerned with social and economic development-the World Bank as fiscal agency , and WHO as executing agency . It is inter-disciplinary. Besides the obvious physicians and entomologists, it involves chemists , biologists , hy- drologists , meteorologists, agro- economists, ecologists, zoologists, ich- thyologists , communications experts, sociologists, engineers, pilots and mechanics . (This is only a short list). It is inter-sectoral. OCP activities call for close collaboration, not only 14 with ministries of health of the coun- tries involved , but also with ministries of planning, finance , cooperation and development, interior , agriculture, civil aviation, very often the office of the President, and always the civil authorities at every level down to the village itself. For OCP, Intersectoral Cooperation is not an abstract ideal but a prac- tical , working fact. In the words of OCP Director Dr Ebrahim Samba: Even the art of casting a fishing net plays its part in the oncho programme. Photo WHO/J. Bland "We are not just discussing inter- sectoral cooperation-we are doing it. " At the macro level (the Presiden- cy) and at the micro level (the village -itself an integrated intersectoral body), OCP is intersectoral from top to bottom. It acts as a catalyst to set off a whole variety of activities in an almost unlimited number of inter- related fields. Some examples: Research: The two major fields of research in which OCP is engaged are insecticides/larvicides and chemo- therapy-drugs to beat the filariae in the human body. More than 50 chemical industries offer their col- laboration either directly to OCP, or through WHO's Vector Biology and Control Division, or through the Spe- cial Programme for Research and Training in Tropical Diseases. Re- search activities are being carried out in the Programme area, and this in turn is preparing nationals for research work in other diseases. But other parts of Africa are ben- efiting from this research , and send their nationals to be involved and to get training. In addition, OCP research reaches into the developed world. Many large pharmaceutical companies are col- laborating with OCP for developing and field testing drugs. The academic world in both de- veloping and developed countries is watching closely what emerges from the OCP's researches, for instance, the biology of the vector, and an increas- ing understanding of the parasite's life-cycle. Training: Training is not confined to operational staff of the Programme, although its officials are proud of their record for " Africanisation " of the staff; 96 per cent of the staff are Africans. But in addition, young scien- tists and technicians from all parts of the world are coming to the OCP to get African experience. A training in dealing with onchocerciasis is, by ex- tension, a training in other tropical W oRLD HEALTH , March 1986 diseases such as trypanosomiasis , schistosomiasis , and guinea-worm. Technology: Other than the actual spraying of rivers from helicopters and fixed-wing aircraft, the Programme is not on the face of it "high techno- logy". But there is increasing use of telecommunications-to determine prevailing wind directions (this has relevance to the problem of reinvasion by the blackfly), to gauge the precise flow of rivers (vital for determining the most cost-effective use of larv- icides) , and to obtain reliable meteorological forecasts. OCP is even making use of space technology. Fixed depth- and flow- gauges in eight rivers of the pro- gramme area are fitted with transmit- ters which beam the readings to the Argos satellite as its orbit carries it overhead. Argos beams back the read- ings to a central computer , where they can be read off and used to work out the optimum concentrations of chemi- cals for spraying operations. Some of these teletransmitters are installed and being used by the OCP countries for meteorological and hydro-agricultural purposes. Thus OCP and the govern- ments use these facilities each for its own ends. Bird's-eye view Meanwhile FAO is also undertaking a series of aerial photos of the area. By comparing "before" and "after" photographs , agronomists and other scientists can observe the effects of the ten-year-old programme on human demography , crops, farm animals and land-use in general. The Decade: Onchocerciasis is a water disease. The integration of the surveil- lance and control of this disease within a strengthened PHC system leads naturally to the control of other dis- eases such as schistosomiasis, guinea- worm and malaria. Where areas have been cleared of the blackfly and resettlement is occur- ring, people will need wells and ag- ricultural lands. The wells have to be made safe for human use . A further step will be to build latrines so that drinking water will not be polluted. Already , the action has moved from the diseases already mentioned to the diarrhoea} diseases. OCP has a special W oRLD HEALTH, March 1986 interest in the health risks of small- scale water developments, such as dams and irrigation channels. So the repercussions of OCP are immediate for the International Drinking Water Supply and Sanitation Decade. Examples such as these could be multiplied indefinitely. OCP has a bearing on food and nutrition , rural development in general,desertification and reafforestation , and of course on primary health care in all its aspects from health education to immuniza- tion and maternal and child care. When the Onchocerciasis Control Programme is concluded-in approxi- mately 12 years' time-the blackfly pest will not have been eradicated. OCP activities involve all levels of the West African community, from village chiefs to heads of state. Photo WHO/J. Turner That is not the purpose of the pro- gramme. But the parasite-host-vector cycle of the disease will have been broken. People will not enjoy being bitten by the fly but they will no longer be at risk of going blind. Better still, the skills and the tech- nology which have gone into the pro- gramme will be available to tackle other diseases, to solve development problems in other sectors. In the field of health , there is probably no other enterprise with a better claim to be " the intersectoral programme " . • 15