COMMUNITY DIRECTED INITIATIVES IN DISEASE PREVENTION AND CONTROL The True Spirit of Alma Ata Declaration on Primary Health Care Apr - Jun 04 Achievements, Challenges & Strategies - Some Spotlights on Onchocerciasis Control in Uganda Peace Habomugisha* Introduction “Onchocerciasis endemic districts will continue in partnership with other in- stitutions and individuals committed to fight the disease. They will endeavor to make sure that the people know and un- derstand their roles in this battle.” This was said by the LC V Chairperson of Kanungu District, Mrs. Josephine Kasya, while opening a meeting of the political and technical leaders of “phases 3 and 4 districts”, which was held on 29 April 2004 in the district’s council hall. Present also were such other resource persons as Dr. Andrew Byamungu and Peace Habomugisha. This text’s pages bring us the briefest of summaries of what was the most out- standing dimension of the seminar. Namely the addresses that were given by Kasya, Byamungu, Habomugisha and various District Onchocerciasis Some of the participants who attended sustainability workshop in Kanungu district Coordinators (DOCs), which we present in that order. Our highlights close with • A budget has been allocated for activi- I. Execution of the activities is very a list of challenges typical of almost all ties of the program. expensive. She therefore appealed the different districts in question, a roll • A radio talk show has been sponsored to the workshop participants to of proposals for the road ahead and an on the local FM station (Radio Kinkizi) look for ways of sustaining the overview of the workshop. Before delv- to educate people about the matter; and work. ing into the particulars, let us note that the response, judging by the many II. There is need for concerted effort Kanungu lies in Western Uganda. On phone calls during the programs, has to inform people about the treat- its northern and eastern ends it is bor- been good. ment of onchocerciasis, especially dered by Rukungiri, by Kabale to the • The council works hand in hand with where and how they fit in this South, Kisoro in the Southwest and the the technical staff to realize the activi- scheme. Democratic Republic of Congo on its ties. III. Achievements made so far stand western front. threatened by the possible pull out, The Chairperson, however, cited and elabo- Focus on Major Speakers rated on challenges they were faced with: Pg 2 Kasya against her Background as Po- Published by: Global 2000 litical Leader In this Issue: River Blindness Program Despite that Kanungu District was only Achievements, Challenges & Strategies and Vector Control Division, about 3 years old, said Kasya, it had (Habomugisha)…Pg. 1 Ministry of Health, Plot 15 Bombo Road managed to carry out a number of on- Community-Perceived Benefits Typeset by: Global 2000, chocerciasis-related activities, to wit: (Ndyomugyenyi)... Pg. 4 River Blindness Program; • The DOC has sensitized the News Flash...... Pg. 7 P. O. Box 12027, Kampala district’s council members about Treatment Updates ... Pg. 7 Tel: 256-41-251025 the magnitude of the problem. Fax: 256-41-349139 * An earlier draft of this compilation received from Julie Gipwola much-needed support. For this help, the compiler is most grateful. This newsletter is supported by The Carter Center, Global 2000 and Ministry of Health - Uganda by some parties, from the partner- CDTI within the primary health care (PHC) Projects, which are likely to be sustain- ship. She appealed to such bodies, structure means implementation of CDTI ac- able, she said, are judged not only ac- however, not to withdraw abruptly tivities using resources earmarked for other cording to their effectiveness, efficiency, but gradually so that the district PHC interests such that limited or no re- simplicity and integration into the rou- council can best plan how to inte- sources would be required exclusively to tine running activities of health services. grate the onchocerciasis program fulfill CDTI goals. Their potential also is considered in into its routine. terms of two other things: staff willing- Byamungu said that it is therefore impor- ness to accept CDTI as a regular activ- Byamungu on Sustainability and In- tant for district health managers to integrate ity, which they would continue to do even in the absence of additional mate- tegration CDTI activities in the PHC structure both rial rewards; and readiness, by a given In his opening remarks, Dr. Andrew at the planning and the implementation lev- community, to see, as their own, the Byamungu, of Uganda’s onchocerciasis els, highlighting areas within the structure control department, under the Health onchocerciasis project in their area and where integration is feasible. Furthermore, Ministry, hailed Kanungu district for her to assume responsibility for it. he made mention of the many opportunities high level of commitment, by word and deed, to the control of onchocerciasis. that the health systems and service mangers Sustainability, according to He called upon other Ugandan districts, could exploit to have CDTI integrated within Habomugisha, is promoted by several where the disease is also to be found, to the PHC edifice. As examples, he cited de- interrelated factors, among them the emulate Kanungu. centralization and poverty eradication and following: our individual and corporate action plan (PEAP) as well as the existence understanding of health care, adminis- trative and community structures and A paper, “Sustainability of CDTI in the of community-based organizations (CBOs) their functional linkages, our guarantee Post-APOC Era – Challenges of Inte- and other community programs that offer that each level in the health care system grating CDTI within the Primary Health health-related services. He, however, noted Care Structure”, was presented by him. is committed to the responsibilities with that there were various threats and weak- The objective of the African Program which it is charged, our use of a moni- nesses within and outside local governments, for Onchocerciasis Control (APOC), by toring tool annually to collect data and the end of the project’s 5th tyear, he said, which could seriously hamper the prospects learn from it what works and what does is to establish an effective and self-sus- of CDTI integration into the PHC order. not (in order to do such things as gener- taining community-based ivermectin Such, clearly, are constraints that can ob- ating new ideas), our integration of com- distribution system throughout on- struct CDTI sustainability for years long munity-based health care services and chocerciasis endemic societies. The after APOC’s withdrawal. development programs into community- project aims, if possible, to eliminate the directed approaches, as well as ensur- blackfly, and hence the disease, by us- Habomugisha with More on Matters of ing bi-annual or annual meetings, which ing environmentally safe vector-control Sustainability include stakeholders at higher and lower methods in selected foci. Also speaking at the Kanungu conference, levels of different administrative, health the Uganda Country Representative of The care and community structures. Sustaining CDTI after APOC has ceased Carter Center Global 2000, Peace to fund it, noted Byamungu, was going Habomugisha, commended the district lead- On evaluation of CDTI projects, she to be a real challenge to the national and ers, attending the gathering, for their hard explained the need for doing so as a way district health system managers because work. Because they are policy makers and of ensuring sustainability once APOC of limited resources, considerable lack implementers, she expressed concern about funding comes to an end. A style of plan- of political will, poor community mobi- their low participation in advocacy meetings, ning, it facilitates mobilization of re- lization, and limited technical manage- however. She wondered how the Kanungu sources and sets in place the routines ment of the program, especially at the and similar meetings could make big impact that ensure the continuation of on- district level. Integration of CDTI pro- without input from the majority of leaders chocerciasis control. According to grams, in the mainstream routine of the of the different onchocerciasis-infected dis- APOC, projects can successfully be district health team (DHT), was certainly tricts. evaluated using specific monitoring in- the way forward for the sustainability of dicators. These are some of the traits of these activities in post-APOC time, he Sustainability of CDTI, during the post- CDTI – challenges, weaknesses, fail- emphasized. APOC epoch, was the subject of ures, strengths and successes included Habomugisha’s study, which she delivered – as it is implemented and as it grows The speaker observed that integration is to the workshop. Following APOC’s defi- or diminishes in size and viability terms, a dynamic and fluid process that requires nition of sustainability, she explained that namely: planning, leadership, observa- constant innovations so as to address the “CDTI activities in an area are sustainable tion and supervision, health mobiliza- challenges of the day. During the post- when they continue to function effectively tion (by education and sensitization), APOC period, he underscored, CDTI for the foreseeable future, with high treat- Mectizan procurement and distribution, execution was likely to differ from area ment coverage, integrated into available training, financing, transport, human re- to area and, at times, from the recom- health care services, with strong community sources and coverage. mendations stipulated in the CDTI ownership, using resources mobilized by the implementation guidelines made by community and the government” (APOC, Habomugisha revealed that APOC APOC. He noted that integration of Feb. 2004). would not support problematic projects 2 beyond five years after taking them on. Integration of onchocerciasis activities ciasis control, at every health unit. Those that show progress towards in PHC is in evidence. This has enabled the program to be sustainability will, however, not be One focal person at each health sub- more effective.