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Performance of predictors: Evaluating sustainability in community-directed treatment projects of the African programme for onchocerciasis control

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  • Amazigo, Uche
  • Okeibunor, Joseph
  • Matovu, Victoria
  • Zouré, Honorat
  • Bump, Jesse
  • Seketeli, Azodoga

Abstract

The predictors of sustainability of community-directed treatment with ivermectin (CDTI) at four implementation levels were evaluated in 41 African Programme for Onchocerciasis Control (APOC) projects, encompassing 492 communities in 10 countries. A model protocol provided information on indicators corresponding to nine aspects of a project that is likely to be sustainable at community level after the cessation of external support. Six of the nine aspects had components of community ownership as predictors of project sustainability. Quantitative and qualitative assessments were used to obtain individual community scores and an overall sustainability score for each project graded on a scale of 0-4. Of the 41 projects evaluated, 70% scored "satisfactorily" to "highly sustainable" at the community level. We found variations among countries and that health system weaknesses could hamper community efforts in sustaining a project, such as when ivermectin was delivered late. Community ownership was of primary importance to the community score, and the community-level scores correlated with overall project sustainability. The therapeutic coverage achieved in each project correlated with the ratio of volunteer ivermectin distributors per population served. Surprisingly, the performance of these distributors was not affected by the direct incentives offered, and coverage appeared to be highest when cash or in-kind compensation was not given at all. Although further research is required, anecdotal evidence pointed to diverse indirect benefits for distributors--political goodwill, personal satisfaction and altruistic fulfillment. The results demonstrate that community ownership is among the important determining factors of sustainability of community-based programmes.

Suggested Citation

  • Amazigo, Uche & Okeibunor, Joseph & Matovu, Victoria & Zouré, Honorat & Bump, Jesse & Seketeli, Azodoga, 2007. "Performance of predictors: Evaluating sustainability in community-directed treatment projects of the African programme for onchocerciasis control," Social Science & Medicine, Elsevier, vol. 64(10), pages 2070-2082, May.
    • Handle: RePEc:eee:socmed:v:64:y:2007:i:10:p:2070-2082
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    References listed on IDEAS

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    1. Korte, R. & Richter, Heide & Merkle, F. & Görgen, H., 1992. "Financing health services in Sub-Saharan Africa: Options for decision makers during adjustment," Social Science & Medicine, Elsevier, vol. 34(1), pages 1-9, January.
    2. Brieger, William R. & Oshiname, Frederick O. & Ososanya, Oladele O., 1998. "Stigma associated with onchocercal skin disease among those affected near the Ofiki and Oyan rivers in Western Nigeria," Social Science & Medicine, Elsevier, vol. 47(7), pages 841-852, October.
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    Cited by:

    1. Christian Tetteh Duamor & Fabrice Roberto Datchoua-Poutcheu & Winston Patrick Chounna Ndongmo & Aldof Tah Yoah & Ernest Njukang & Emmanuel Kah & Mary Sheena Maingeh & Jonas Arnaud Kengne-Ouaffo & Dizz, 2017. "Programmatic factors associated with the limited impact of Community-Directed Treatment with Ivermectin to control Onchocerciasis in three drainage basins of South West Cameroon," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 11(11), pages 1-18, November.
    2. Riki Savaya & Gerald Elsworth & Patricia Rogers, 2009. "Projected Sustainability of Innovative Social Programs," Evaluation Review, , vol. 33(2), pages 189-205, April.

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