Research Article: Managing the Fight against Onchocerciasis in Africa: APOC Experience

Date Published: May 14, 2015

Publisher: Public Library of Science

Author(s): Grace Fobi, Laurent Yameogo, Mounkaila Noma, Yaovi Aholou, Joseph B. Koroma, Honorat M. Zouré, Tony Ukety, Paul-Samson Lusamba-Dikassa, Chris Mwikisa, Daniel A. Boakye, Jean-Baptist Roungou, Jeremiah M. Ngondi.

Abstract: None

Partial Text: Due to the socioeconomic impact of human onchocerciasis (commonly referred to as river blindness) in West Africa, the Onchocerciasis Control Programme in the Volta River Basin (OCP) was instituted [1]. This initial programme started in 1975 and covered seven West African countries: Benin, Burkina Faso, Cote d’Ivoire, Ghana, Mali, Niger, and Togo. However, later evidence indicated that endemic areas outside the initial area posed a threat to the achievement of the OCP and, hence, the Programme was extended southward and westward to include four additional countries, bringing the total number of countries covered by OCP to eleven. The formal name was then changed to the Onchocerciasis Control Programme in West Africa, retaining the acronym OCP.

The Programme is a unique partnership between the affected communities, governments, bilateral and multilateral agencies, foundations, non-governmental development organizations (NGDOs), the scientific community, and the private sector. The partnership is built on a legal agreement called the “Memorandum of the African Programme for Onchocerciasis Control” [13]. The APOC Secretariat is responsible for initiating the budget process, taking the lead in preparing a multi-year plan of action for APOC and using this to develop an indicative budget to implement the multi-year plan. APOC is governed by the JAF, consisting of representatives of (a) the participating countries; (b) the contributing development partners; (c) the sponsoring agencies; (d) members of the NGDO Coordination Group; (e) Merck & Co., Inc. representing the private sector as the donor of ivermectin; (f) intergovernmental regional or sub-regional organizations; and (g) other invited entities. The JAF decides on the overall policy and strategy of APOC, assesses progress review, approves the APOC Plan of Action and Budget, and assesses global financing requirements of the Programme. The JAF meets annually and is usually hosted alternatively by a participating country and a donor country.

APOC is one of the few programs that the WHO Regional Office for Africa implements directly. The WHO Regional Director for Africa ensures the overall guidance of APOC Secretariat, which is headed by the APOC Director. WHO Headquarters provides administrative and technical as well as operational research support. APOC maintains close collaboration with WHO offices of all participating countries and with National Onchocerciasis Task Forces (described below) in the implementation and monitoring of CDTi projects.

APOC’s broad partnership includes the poor in programmatic decision-making. This partnership involves over 146,000 local communities, African endemic countries, donor countries and institutions, over 16 NGDOs, Merck & Co. Inc., research institutions, and programs such as the WHO Special Programme for Research and Training in Tropical Diseases (TDR), as well as research institutions within onchocerciasis-endemic countries.

The APOC Technical Consultative Committee (TCC) ensures the technical oversight of APOC operations. Its main function is to review new CDTi projects plans and budget, annual technical reports from CDTi projects and operational research proposals. TCC thus contributes to establishing a research agenda for APOC. Its recommendations are addressed to the Programme Director or, if required, to the CSA. The TCC members meet twice a year. The TCC comprises 12 members which are selected through various mechanisms. One of the 12 TCC members is a representative from MDP and is appointed by Merck & Co. Inc. Eleven members are scientists/experts appointed by the WHO Director-General based upon the recommendation of the CSA. Among those, three members are proposed by the NGDO Coordination Group for the consideration of the CSA. The other eight members are suggested by APOC management to the CSA for their consideration. TCC members appointed by the Executing Agency hold membership for three years renewable for a maximum of another three years, on a staggered basis. However, since MDP oversees the donation of the drug ivermectin, the MDP representative has permanent tenure on the TCC.

The structure and management framework of APOC was determined based on the OCP experience. This mechanism has demonstrated efficacy in achieving APOC’s initial goal of establishing sustainable community-directed systems for ivermectin distribution that effectively controls onchocerciasis as a public health problem. In addition, the CTDi and CDI strategies have significantly contributed to scaling up other health interventions, such as control of lymphatic filariasis, distribution of insecticide-treated bed nets, and vitamin A supplementation, among others [20]. The success of APOC has prompted the JAF to extend the Programme beyond 2015, support countries in achieving elimination of onchocerciasis, use acquired expertise to benefit other targeted NTDs amenable to the PC strategy, and strengthen health systems at the community level across Africa. The evolution of APOC after 2015 is captured in the development and adoption of a concept note document and indicative budget to transform APOC into a new regional entity, provisionally named Programme for the Elimination of Neglected Diseases in Africa (PENDA) [23,24]. This new entity will have a mandate for “the coordination of the implementation of the elimination of onchocerciasis and lymphatic filariasis, and support interventions for other PC-NTDs in Africa” [24].