The onchocerciasis control program in West Africa : a long-term commitment to success

Onchocerciasis is a devastating African parasitical disease that causes severe debilitation and intense itching. By the time its victims are in their late twenties, they experience impaired vision, often blindness. Millions continued to succumb to the disease until the onchocerciasis control program, a large multidonor-supported effort initiated in 1973 at the instigation of Robert McNamara, then head of the World Bank, was implemented. Today, 95 percent of the original seven country area is virtually free of the disease. This paper identifies the main reasons for the program's success as: (i) limited, achievable, clearly defined objectives and a realistic 20-year timeframe; (ii) use of the best technology available for any task; (iii) contracting out highly specialized tasks such as aerial spraying; (iv) operational research (considered an equal partner in program implementation); (v) program autonomy, which allowed flexibility in responding to strategic and technological issues; (vi) delegation of authority to those most closely involved in the program, thus assuring a clear focus and flexibility; (vii) long-range planningto sustain donor commitment; and (viii) transparency, made possible by a comprehensive flow of information and the program's openness to evaluation and review.