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• W2082066978 abstract "New campaigns on community-based treatment or control measures are being launched against several major endemic diseases in less-developed tropical countries. Most campaigns are being sponsored by the World Bank and executed by the WHO, in partnership with ministries of health in the affected countries, major pharmaceutical companies, national and international donor agencies, and non-governmental development agencies. Among these campaigns are the African Programme for Onchocerciasis Control, the Global Programme for the Elimination of Lymphatic Filariasis, the Roll Back Malaria Programme, the Leprosy Elimination Programme, and other programmes to control schistosomiasis and tuberculosis, and to promote reproductive health. We have played an active part in the African Programme for Onchocerciasis Control since its inception in 1995. In essence, all these programmes are increasingly relying on community participation, control, and direction in the execution of the treatment or control measures concerned. For a programme to be successful, a sense of community ownership must be instilled from the beginning. The provision of monetary incentives (usually provided by external donors or national government health sources) is thought to motivate individual community members to treat their communities. However, our experience in programmes of community-directed ivermectin annual treatment for the control of onchocerciasis in Uganda over the past 7 years, has shown this belief to be a fallacy.1Katabarwa M Mutabazi D The selection and validation of indicators for monitoring progress towards self-sustainment in Community-Directed Ivermectin Treatment Programmes (CDITP) for onchocerciasis control in Uganda.Ann Trop Med Parasitol. 1998; 92: 859-868Crossref PubMed Scopus (12) Google Scholar, 2Katabarwa M, Mutabazi D, Richards F Jr. The community-directed ivermectin treatment programmes for onchocerciasis control from 1993–1997 in Uganda: an evaluative study. Ann Trop Med Parasitol (in press).Google Scholar In districts of Uganda where the community-directed distributors (CDDs) of ivermectin were given monetary incentives by the district health services, the communities failed to achieve the desired coverage of 90% of their annual treatment objective. We found that CDDs who received externally derived incentives were continually seeking increased remuneration with the threat of withholding their services. In addition, CDDs were not accountable to the community leaders, but identified themselves as agents of external donors or of government departments, thus alienating themselves from the community.3Katabarwa M Modern health services versus traditional ENGOZI system in Uganda.Lancet. 1999; 354: 343Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar, 4Keesing RM Strathern AJ Cultural anthropology: a contemporary perspective. (3rd edn). Harcourt Brace College Publishers, Orlando, Florida1998: p 288-p 301Google Scholar By contrast in districts where the responsibility for remuneration of CDDs was left to community members, the required 90% coverage rate was generally achieved. The CDDs were selected so that most treatment centres were conveniently located near the community that they were intended to serve. The numbers of people treated per CDD rose, with annual treatment being completed more quickly. Since CDDs were relatives or neighbours, they were interested in providing a community service rather than profiting financially from the exercise. CDDs were provided the necessary facilities to carry out their duties. For example, the community provided the CDD with a bicycle and food while he or she went to collect the ivermectin from the nearest designated centre and, if the need arose, community members would provide free labour in the CDD's home or farm to make up for the loss of time spent on distribution activities. The use of subtle and unwritten social legal codes in a community is essential to the design of an effective community-based health programme, and mobilisation of these systems must be from within the community. Unsatisfactory programmes result from ignorance and distortion of the local social support systems that should be the engines for social development.4Keesing RM Strathern AJ Cultural anthropology: a contemporary perspective. (3rd edn). Harcourt Brace College Publishers, Orlando, Florida1998: p 288-p 301Google Scholar, 5Mutabazi D Duke BOL Onchocerciasis control in Uganda: how can self-sustaining, community-based treatment with ivermectin be achieved?.Ann Trop Med Parasitol. 1998; 92: 195-203Crossref PubMed Scopus (11) Google Scholar Our experience may be helpful to others charged with designing new community-directed programmes of this nature, especially in rural areas." @default.
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• W2082066978 title "Monetary incentives and community-directed health programmes in some less-developed countries" @default.
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• W2082066978 doi "https://doi.org/10.1016/s0140-6736(05)76878-1" @default.
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