An analysis of the many conditions, factors, plans, policies, decisions, and never failing support that have contributed to the striking success of the Onchocerciasis Control Programme in West Africa (OCP), a major public health initiative now entering its twenty-first year. Throughout its history, OCP has been distinguished by its large size, the complexity of its operations, the long time frame needed for success, and the degree of commitment required by donors and participating countries alike. The Programme has also been distinguished by its explicit aim to eliminate a disease which has been a major obstacle to socioeconomic development as well as a cause of great disability and suffering. In examining the Programme's many successful features, the author, who has directed OCP since late 1980, draws upon extensive personal experience, supported by the results of several external evaluations, to show how international collaboration, careful planning, and well managed field operations can overcome what may seem to be insurmountable obstacles. Throughout this analysis, an effort is made to extract lessons useful in the management of other large public health programmes. The book also gives careful attention to managerial principles that will be important when OCP ceases operation and participating countries take over responsibility for the surveillance and management of recrudescence. The book has two parts. Chapters in the first part give a detailed account of the history, structure, operation, and achievements of OCP. While some of the Programme's structures and aims were dictated by the unique features of onchocerciasis as both a disease and an impediment to socioeconomic development, these chapters show how many other innovations represent solutions to problems faced by almost any large public health campaign. Such problems include the need to gain and maintain the confidence of donors, the potential conflict of interests between the "givers" and "receivers" of aid, the constant need to demonstrate results, on time and on target, and some potentially devastating technical setbacks. A chapter devoted to achievements cites the successful interruption of transmission, drastically lowered morbidity, the protection of some 30 million people, including children who will grow up without the risk of onchocercal blindness, and the availability of millions of acres of fertile land for resettlement and cultivation. Part two deals more specifically with the management of OCP. In these chapters, the author analyses the issues faced in conducting a large-scale field operation, examines the human factors involved, and describes the structural and operational elements of the Programme. Chapters explain how sound budgeting, detailed plans, time-limited goals, task-focused training, and careful computation of costs worked to maintain well-organized operations, keep staff motivated and efficient, and make the Programme's accomplishments clearly visible. These chapters also identify a number of factors that can either contribute to success or doom even the most well-intentioned, technically sound project to failure. Lessons learned range from ways to motivate staff and train them to apply the principles of good management, to the importance of working together with industry, from the need to keep the "owners" of a project fully and frankly informed of any setbacks, to advice on what to do when an established routine becomes an obstacle to the adoption of new, more cost-effective methods. Since the ultimate success of onchocerciasis control will depend on the extent to which the Programme's achievements are maintained by participating countries, the final chapter draws a number of lessons that can help ensure that the problem of onchocerciasis in West Africa remains negligible in the century to come.

DC.HQ

eng fre.

WHODOC

WHO monograph

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