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| The
Onchocerciasis Control Program (OCP) |
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 OCP
has been hailed as one of the most successful partnerships
in the history of development assistance. Founded
in 1974, OCP has an unprecedented collaboration
between UN agencies. The World Bank served as the
fiscal agent and WHO was the executing agency. FAO
and UNDP took the lead in development planning.
The Program was created with the dual mandate of
controlling the disease as a public heath problem—and
building local capacity to ensure continued control
indefinitely—and boosting socio-economic development
through long-term increases in agricultural production.
The OCP has halted transmission and virtually eliminated
Riverblindness throughout the eleven participating
countries, and has made a major contribution towards
alleviating poverty of the rural poor throughout
a major sub-region of West Africa. OCP fulfilled
this mandate and was closed in December of 2002,
though operations continue in five Special Intervention
Zones (SIZs). WHO and the World Bank will continue
to serve in their respective roles. By far the largest
of these zones is Sierra Leone, where operations
were interrupted by a just-ended, decade-long civil
war. OCP has virtually stopped transmission within
the other ten West African countries where it operated.
The wide-ranging benefits of this achievement include:
OCP Governance.
Overall executive authority for OCP was vested
in the Joint Programme Committee (JPC), composed
of participating country representatives, donors,
and sponsoring agencies. The independent Expert
Advisory Committee (12 scientists) carried out
annual evaluations of OCP operations, and gave
technical and scientific advice to the JPC and
Program Director. The Committee of Sponsoring
Agencies (CSA, made up of the UNDP, FAO, WHO,
and World Bank) monitored Program operations
and acted as an executive secretariat, making
interim decisions on behalf of the JPC throughout
the year.
The
Program headquarters, stationed in Ouagadougou,
Burkina Faso, were comprised of 4 units: Vector
Control, Epidemiological Evaluation, Bio-statistical
Analysis, and Information Systems Support Administration
and Support Services. Program activities were
broken-down as follows: Vector Control (66%),
Management and Administration (17%), and Planning,
Evaluation and Transfer (PET: Devolution support
activities including epidemiological evaluation,
Operational research, Bio-statistics and Information
systems) (17%).
A
5-member independent Ecological Group advised
national teams of hydro-biologists on the monitoring
and evaluation of the effects of vector control
on rivers. The vector control unit, in collaboration
with the national teams of hydro-biologists
and the Ecological Group, succeeded in protecting
the environment while eliminating Riverblindness.
Twenty years of larvicide spraying on rivers
and streams has had no appreciable impact on
the fish and invertebrate communities living
within them. Studies have also shown that the
number of aquatic species did not change as
a result of this spraying.
Economic
Rate of Return.
With the steadfast support of the international
donor community and effective collaboration
among the African participating countries as
well as the sponsoring agencies, OCP has become
recognized as one of the most successful programs
in the history of development assistance. A
cost-benefit analysis of OCP was performed in
terms of net present value (NPV) and internal
rate of return (IRR). The actual expenditures
from 1974 through 1993 and projected expenditures
from 1994 to 2002-which is the year in which
OCP was brought to conclusion-are US$556 million
in nominal terms and US$571 million in 1987
constant dollars.
 OCP
was able to produce several benefits in the
region including improved health among adults,
improved living environment, and additional
agricultural output as a result of the extra
oncho-freed labor force and land. The NPV of
labor and land-related benefits together (assuming
85% labor participation and land utilization)
over a 39 year project horizon (1974-2012) ranges
between US$3,729 million and US$485 million
in 1987 constant dollars at discount rates of
3% and 10%, respectively. Further, the estimated
IRR under the same assumptions is on the order
of 20%. Using a shorter project horizon (1974-2002)
of 29 years yields an IRR of about 18%. These
are highly respectable IRRs and represent some
of the best economic returns among Bank projects
over the years in virtually any sector.
Success.
The
wide-ranging benefits of OCP include the following
achievements:
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600,000
cases of blindness prevented
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40 million people are protected from infection
by the disease
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18 million children, born in now-controlled
areas, spared the risk of Riverblindness
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25 million hectares of land made safe for
cultivation and resettlement
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5 million years of productive labor have been
added to the economies of the eleven OCP countries
(using traditional farming techniques and
existing technology, this land can produce
enough food to feed 17 million people)
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Estimated economic rate of return of 20%
OCP's
success was built on:
- a
clear objective
- sound
management
- capable,
knowledgeable staff
- effective
and feasible control methods (proven before
operations began)
- strong
commitment of donors and participating countries
over a long-term (20-year) and
- decentralization
by gradually delegating tasks and authority
to lower levels, promoting ownership and commitment,
contracting technical services to private companies,
and gradually devolving control efforts to the
affected countries
SIZs
& MDSC.
To ensure control maintenance and to safeguard
past achievement, OCP beneficiary countries
relied on multi-disease surveillance, vector
control, and ComDT. Through continuing donations
of Mectizan by its manufacturer, Merck &
Co, Inc., as well as financial support from
a large pool of donors, OCP maintains reserve
funds to continue operations in the five SIZs
for the required five more years. Monitoring
activities have been devolved to the national
authorities, to be assisted through the establishment
of a sub-regional multi-disease surveillance
center at OCP Headquarters. The center will
participate in the training of national epidemiologists,
assist in the creation of national surveillance
systems and collaborate with countries for operational
research concerning surveillance. Currently,
the remaining OCP staff, which is 99% African,
is providing technical and logistical support
to participating countries during this transitional
period to ensure that they are capable of continuing
residual Riverblindness control activities within
the framework of their own national health systems.
OCP's
headquarters and infrastructure are now being
used for the West African Multidiesease Surveillance
Center (MDSC). The intention of this center
is to survey West Africa for Riverblindness
and other prevalent diseases in the region,
such as HIV/AIDS, malaria, and cerebral spinal
meningitis. It will be responsible for communicating
information for the control of epidemics, providing
data for management of communicable disease
programs, providing quality assurance to labs
and diagnostic services, coordinating studies,
offering specialized training, and providing
continuous surveillance in support of the achievements
of OCP.
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