External review of the onchocerciasis control program

Interim evaluation covers the project through 10/90. In spite of serious obstacles, the Onchocerciasis Control Program (OCP) has achieved remarkable success in the past 16 years. Onchocerciasis has ceased to be a public health problem in all of the original program areas: over 30 million people are now protected from the disease. Since the program began, about 7 million children have been born virtually free of risk of onchocercal blindness; about 1.25 million people who were seriously affected are today completely free of the parasite, and about 100,000 who would otherwise have been blind still have their sight. The program's success can be attributed to its: (1) clearly defined objectives; (2) realistic time frame; (3) right choice of technology; (4) contracting out of highly specialized aerial spraying operations; (5) strong emphasis on operational research; (6) high degree of autonomy from the World Health Organization (WHO) and its bureaucratic procedures; (7) clear delegation of authority allowing operational flexibility; (8) medium-term planning and sustained donor commitment; (9) unrestricted flow of information among all concerned parties; and (10) strong management and high quality staff. Protection of the OCP's achievements will require continued donor commitment to the program strategy, which is based on vector control for a minimum of 14 years from the start of larviciding in any given area. Critical areas are the sources of re-invasion in the Western Extension and selected pockets in the core and Southern Extension areas. The OCP has virtually eliminated transmission in the core area of the program, overcoming the major obstacles of resistance and re- invasion. It has made significant advances in vector control and larviciding, ecological monitoring to minimize environmental impact, entomological research on the vector species, epidemiological monitoring and assessment, and disease treatment. The program and its sponsors, donors, and participating countries must now turn their full attention to devolution. OCP can contribute through the creation of a new devolution unit, as part of its overall effort to strengthen the institutional capabilities of participating countries.