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  1. 1
    101027

    Support for treatment programs with Mectizan: the NGO experience.

    Foster A

    In: Mectizan (Ivermectin) and the Control of Onchocerciasis: Strengthening the Global Impact. A symposium sponsored by Merck and Co., Inc. marking the fifth anniversary of the donation of Mectizan for the treatment of onchocerciasis and held with the technical cooperation of the World Health Organization at the Hudson Theater in New York on September 23, 1992. Summary proceedings of the symposium. Rahway, New Jersey, Merck and Company, 1992. 57.

    Christoffel-Blindenmission (CBM) is an interdenominational Christian service organization for blind and disabled persons in many of the world's poorest developing countries. It supports more than 300 eye care programs in approximately 70 countries at an annual cost of US $15-16 million. Funded by many individual donors, fund raising activities are conducted in Europe, North America, and Australia. CBM operates through 8 regional offices: 3 in Asia, 3 in Africa, and 2 in Latin America. Program development and evaluation are the responsibility of regional representatives, each of whom uses the services of a medical consultant. CBM's program support is usually long term, based on a recipient's annual budget application and evaluation. Since 1988, CBM has been distributing 200,000 tablets of Mectizan each year to voluntary hospitals in 14 African countries to treat patients with onchocerciasis. CBM also supports community-based treatment programs in Ecuador and Zaire, and, in collaboration with OCP, in Sierra Leone. Plans for 1993 include establishing a program for 600,000 people in the Central African Republic (CAR) in collaboration with the CAR Ministry of Health and the River Blindness Foundation. As an organization, CBM identifies 5 specific barriers to be overcome in developing and sustaining programs of treatment with Mectizan: 1) Poor communication systems in the endemic areas, which require development of an appropriate infrastructure. 2) Lack of health knowledge, which requires a community awareness action. 3) Limited availability of financial resources in the worst-affected countries, requiring a mobilization of funds for long-term commitment. 4) Inadequately-trained personnel, requiring staff training as an integral part of all programs. 5) Affected communities have so many health problems that integration of distribution of Mectizan with already existing or developing primary health care activities is becoming increasingly important.
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  2. 2
    101029

    Support for treatment programs with Mectizan: the NGO experience.

    Pizzarello LD

    In: Mectizan (Ivermectin) and the Control of Onchocerciasis: Strengthening the Global Impact. A symposium sponsored by Merck and Co., Inc. marking the fifth anniversary of the donation of Mectizan for the treatment of onchocerciasis and held with the technical cooperation of the World Health Organization at the Hudson Theater in New York on September 23, 1992. Summary proceedings of the symposium. Rahway, New Jersey, Merck and Company, 1992. 61.

    Helen Keller International (HKI), founded in 1915, is the oldest US organization dedicated to blindness prevention in the developing nations. HKI's early work in xerophthalmia was followed by extensive programs in the provision of primary eye care and cataract services. More recently, the organization has become involved in onchocerciasis control programs. Their philosophy is to provide the kind of technical assistance that builds sustainable infrastructure within a national health program. They prefer to work in countries that have priorities in blindness prevention programs; and where those do not exist, they strive to develop them in cooperation with local authorities. In Burkina Faso and Niger, HKI is working with the local governments to implement surveillance systems that can detect reappearance of onchocerciasis in previously infected areas. In Mexico, HKI will be working with the existing onchocerciasis control program to develop an information system that can improve the efficiency of distributing Mectizan. In Cameroon, HKI is coordinating a program for distributing Mectizan in the Sanaga River Valley; and in Brazil, they are discussing a collaborative program of onchocerciasis control among Indians living on the Venezuela-Brazil border. In each country, they are trying to develop a cadre of persons at the national and local levels who can assume responsibility for programs of treatment with Mectizan as soon as possible. Previous experience with the distribution of vitamin A to control xerophthalmia taught that successful programs exist at the community level only when they involve the people themselves, as well as the health professionals. HKI believes that private, volunteer organizations are uniquely qualified to develop community-based interventions in cooperation with governments and multinational organizations. Such programs in the onchocerciasis-endemic areas will result in economic improvement, self-sufficiency, and improved health.
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  3. 3
    101022

    Support for treatment programs with Mectizan: the NGO experience.

    Thylefors B

    In: Mectizan (Ivermectin) and the Control of Onchocerciasis: Strengthening the Global Impact. A symposium sponsored by Merck and Co., Inc. marking the fifth anniversary of the donation of Mectizan for the treatment of onchocerciasis and held with the technical cooperation of the World Health Organization at the Hudson Theater in New York on September 23, 1992. Summary proceedings of the symposium. Rahway, New Jersey, Merck and Company, 1992. 49-50.

    For optimal treatment compliance, the large-scale distribution of a drug such as Mectizan presupposes a well-structured support system through both governmental and nongovernmental channels, together with proper education and awareness at the community level. Beginning at the international level, the purpose and effectiveness of programs of treatment with Mectizan in onchocerciasis-endemic countries must be publicized to all development agencies and the community of international nongovernmental organizations. Within the United Nations system and related organizations, the specialized agencies concerned, such as the United Nations Development Programme, the Food and Agriculture Organization of the United Nations, the International Labor Organization, The World Bank, UNICEF, and, in particular, the World Health Organization, are well placed to initiate programs of treatment with Mectizan as part of development work having a bearing on health. Nongovernmental organizations can play a very significant role in various contexts for development of treatment programs by means of: advocacy, at the international, national, and community levels; project expertise and experience from work in developing countries; flexible, grassroots approaches that allow for tackling practical problems in a pragmatic manner; valuable experience from training health personnel and working with local staff in a wide variety of settings; being efficient resource mobilizers; and the possibility and experience of working with the local community considering particular needs and resources. At the national level, it is important that there be proper awareness of the socioeconomic impact of onchocerciasis. The Ministry of Health should play the main coordinating role with respect to support from NGOs and agencies. A policy of integration with primary health care should be implemented.
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  4. 4
    101015

    Implementing treatment programs with Mectizan: reports from the field.

    de Raadt P

    In: Mectizan (Ivermectin) and the Control of Onchocerciasis: Strengthening the Global Impact. A symposium sponsored by Merck and Co., Inc. marking the fifth anniversary of the donation of Mectizan for the treatment of onchocerciasis and held with the technical cooperation of the World Health Organization at the Hudson Theater in New York on September 23, 1992. Summary proceedings of the symposium. Rahway, New Jersey, Merck and Company, 1992. 29-30.

    Developing a good drug is a great achievement. However, delivering a particular drug to a target population can be a complex and expensive undertaking. So is delivering a drug such as Mectizan, when the majority of its users live in developing countries where the economic, political and social determinants are unfavorable for health care services. The success or failure of drug delivery systems for tropical diseases depends on: 1) regular production, 2) adequate local administration and management, 3) timely ordering and supply, 4) appropriate storage, 5) good transport facilities, 6) reasonable case identification, and 7) correct prescription and use. Specialized drugs for tropical diseases are often produced in limited batches according to orders received. As a result, critical delays in delivery can occur. In the case of Mectizan, there seems to be no problem with prompt delivery by Merck & Co. once a request for donation has been approved. The multi-disease approach for delivering Mectizan may be one way of economizing on personnel and transport costs. In the Central African Republic, using the established transport network for immunization programs has produced good results. However, since the range of coverage for vaccination purposes does not extend as far as the village level, bicycles had to be provided to take over from the dispensaries. In Uganda, orderlies trained for sleeping sickness surveillance offer potential staff for distributing Mectizan, as do the staff of successful leprosy programs, which are beginning to show interest in combined approaches. In the meantime, the role of the World Health Organization (WHO) is mainly to set internationally acceptable technical standards applicable to the distribution and use of Mectizan and to support research through the UN Development Programme/World Bank/WHO Special Programme for Research and Training in Tropical Diseases.
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