A 20-year, AID-supported Onchocerciasis Control Program (OCP) initiated in 1974 by WHO, the World Bank, FAO, and UNDP, and currently covering portions of seven affected West African nations, is evaluated. Program results have been impressive. In 90% of the program area, onchocerciasis transmission has been interrupted, resulting in marked decreases in the incidence of blindness, disability, and debility; some 27,000 cases of blindness have been prevented in Burkina Faso alone over the past decade. The program’s economic benefits are potentially large: an estimated 15 million ha of tillable land have been opened up in formerly endemic regions. Additional investment is required, however, to exploit the liberated areas. Further, although the reserves of the parasite have been reduced, the movement of people from infected into freed areas could spark a resurgence. Program experience has shown that such a program would not have achieved its level of success without the long-term financial commitment of donors at the outset. Other lessons learned are that: (1) complex disease control programs may require time for experimentation before they can become fully operational; (2) vertical disease control projects may play a useful role in helping to reinvigorate primary health care delivery programs; (3) undertaking development assistance programs within a multilateral framework and implementing them through established international structures can greatly facilitate success; (4) vigorous, sustained research efforts are crucial for the program’s ultimate success; (5) aggregate economic and social welfare benefits are difficult to calculate precisely; (6) international support is imperative at early stages for regional disease control efforts; (7) initial high-technology control methods must be gradually replaced by low-technology methods and local capacity building; (8) highly specialized project components should be contracted out; and (9) socioeconomic development in freed lands depends on initiatives from outside the OCP organization.
