The primary goal of APOC and its partners is the establishment of sustainable, community-directed drug distribution systems. All parties recognize that even when extensive coordination occurs to ensure uniformity of purpose and priorities, the role of individual NGDOs in the community is time limited due to resource constraints. Accordingly, the most important legacy of the Program will be the empowerment of endemic communities to take ownership of their own health care needs on a sustainable basis. In order to do so, implementation in the field relies upon ComDT with ivermectin whereby local community members choose who will distribute the drug, how it will be distributed, and other strategic components. For this reason, NGDOs dedicated to promoting local capacity establish linkages between local health ministries and their constituents to ensure that even the poorest gain access to the health care necessary to be economically and socially productive.

The State of APOC. 26 donors and 19 African countries have signed a multilateral agreement, bringing the Program legally into force since April 1996. To protect the people at risk, APOC will require US$180M, of which US$135M will be supplied by the donor community and the remaining US$45M will be assumed by NGDOs and the African countries. APOC’s Phase I, concluded in 2001, has been fully funded . Together, Phase II (2002–07) and the Phasing-Out period (2008–10) require US$79M. Of this, donors have pledged US$58.2M. A funding gap of US$20.8M remains. Financial requirements of the NGDO Group are not reflected in this $26 million gap. Funding shortfalls among NGDOs have become increasingly acute in recent years and now threaten to curtail APOC expansion. Currently, some projects in Angola, Burundi, Cameroon, Democratic Congo, and Ethiopia have been placed on hold because partner NGDOs, though otherwise qualified and willing, have not been able to secure the required funds. No treatments have been stopped thus far, despite the financial collapse of the sole international NGDO serving rebel held, highly endemic Southern Sudan. Another of APOC’s partner NGDOs is preparing to move in, and numerous local NGDOs have valiantly sustained Mectizan delivery and community support.

APOC is intended to achieve several important results:

• Protect 109M people from contracting blinding Riverblindness and disfiguring skin disease;
• Prevent 43,000 cases of blindness annually;
• Alleviate unbearable itching and eliminate unsightly skin disease throughout the nineteen countries;
• Build national capacity and empower affected communities to sustainably address many diseases and health issues via ComDT;
• Safeguard the US$600M investment in the Riverblindness Control Program by eliminating the threat of re-invasion of Riverblindness from neighboring countries, notably Nigeria ;
• Eliminate Riverblindness as a public health problem in all of Africa, where 99% of the world’s cases occur.

Over the past eight years, all preparatory operational research has been completed. All constituent bodies of the Program are in place and meeting periodically. APOC, unlike most global programs, is governed by a series of six-year legal agreements to enact six year planning phases. These agreements are signed by all the donors and participating countries. They serve as a binding commitment among the various partners over the specified timeframe regarding their obligations. The Program is co-sponsored by UN agencies and has an important partnership arrangement with the private sector (Merck & Co., Inc.) and Non-Governmental Development Organizations (NGDOs), both of which are members of the highest Governing Board, the Joint Action Forum (JAF), and participate on the Program’s steering committee known as the Committee of Sponsoring Agencies (CSA). Affected communities, which are the beneficiaries of the Program, have wide leeway in implementing APOC project activities.

APOC, supported by the global partnership, ensures that donated drugs reach the infected populations, primarily consisting of the poorest Africans in the most remote regions. Through its efforts, the program has positively influenced the health services in the participating countries in a variety of ways. Capacity has been built; resources provided; enthusiasm and motivation generated. APOC has also established a large number of partnerships at different levels, between Ministries of Health, NGDOs, donors, private sector and civil society, where stakeholders pool their ideas and resources in planning and executing the common program. Each partner contributes to the Program in its respective area of expertise, fostering an environment of increased resource allocation efficiency based on the exploitation of economies of scale and the principles of comparative advantage.

World Bank analysis, updated by Emory University in September 1999, estimates that APOC has a lower-bound economic rate of return of 25% -- highly respectable in net of economic returns for any type of development project.