First Category Prize 2008

For projects by UN, international and regional organizations.

Founded in 1915, Helen Keller International (HKI) is among the oldest international nonprofit organizations devoted to fighting and treating preventable blindness and malnutrition. HKI has programs in 22 countries in Africa and Asia. It builds local capacity by establishing sustainable programs, and provides scientific and technical assistance and data to governments and international, regional, national and local organizations around the world.

HKI programs combat malnutrition, cataract, trachoma, onchocerciasis (river blindness) and refractive error. The goal of all HKI programs is to reduce suffering of those without access to needed health or vision care and ultimately, to help lift people from poverty. It develops technical and operational capacities of local governmental, non-governmental, private sector and community-based partners to increase the scope of effective health interventions and to advocate for policy change at the regional, national and international levels.

HKI recognizes that efficient Ministries of Health and well-trained local health workers are best able to make decisions regarding the health of the populations for which they are responsible.
HKI actively promotes local responsibility, autonomy, and sustainability to establish sustainable delivery of the interventions within partner and community structures, and works continuously with local ministries of health to research new methods of intervention. HKI has demonstrated the capacity to leverage operations research and small-scale program models into national-scale programs.

The Sustainable Control of Onchocerciasis project, winner of AGFUND Prize, has operated surveillance, education and treatment projects in ten endemic countries -Burkina Faso, Cameroon, Cote d'Ivoire, the Democratic Republic of Congo (DRC), Guinea, Mali, Niger, Nigeria, Sierra Leone, and Tanzania. HKI's work to combat this blinding disease began in Cameroon in1992. A major milestone was accomplished in 1995, when HKI and other non-governmental organizations successfully lobbied the World Bank to launch the African Program for Onchocerciasis Control (APOC). APOC currently reaches people in 19 countries and seeks to eliminate onchocerciasis as a public health threat and barrier to socio-economic development in Africa through sustainable mass administration of the drug Mectizan®, which is donated by Merck & Co, Inc. HKI also worked closely with the Onchocerciasis Control Programme (OCP) throughout much of West Africa for many years until it officially closed its operations in December 2002.

Sustainable Control of Onchocerciasis project aims to:

• Control the infectious disease, onchocerciasis, the second leading infectious cause of Blindness in Africa (after trachoma).
• Support ivermectin (Mectizan®) distribution via Community-Directed Treatment with Ivermectin (CDTI) in order to reduce onchocerciasis transmission and progression into vision loss. (Ivermectin is the generic name of Mectizan®)
• Improve information, education, and communication (IEC) strategies in support of ivermectin distribution in order to create demand for the long-term treatment of onchocerciasis.
• Establish effective monitoring, evaluation and reporting systems for CDTI activities and outputs.
• Integrate onchocerciasis control with other eye health interventions.

The project’s innovation and creativity;

In order to control onchocerciasis with mass distribution of Mectizan®, it is necessary to treat all eligible people in endemic areas with a single dose once a year. The needed duration of ivermectin treatment is not yet known, but it is believed to be required for approximately twenty years. To meet this long drug treatment horizon, it was necessary to establish a sustainable delivery mechanism. After conducting pilot studies, HKI, APOC and other NGOs, developed the Community Directed Treatment with Ivermectin (CDTI) strategy in order to reach the 102 million people at risk for onchocerciasis. The strategy mobilizes and empowers communities to choose their distributor(s) and to determine the distribution method (house-to-house or at a central location in the village). The approach is forward thinking in its placement of the power to control a blinding disease in the hands of community members themselves. The community distributor is trained to perform a census in the community, to determine the number of treatments needed, collect the medications from the nearest health center, calculate the correct dose, and keep records of the distribution statistics. In addition, communities are trained to monitor and analyze their vermectin distribution activities.

The CDTI model builds partnerships between communities and health care systems that can be sustained for 15 to 20 years with minimal resources after initial technical assistance and training are provided. HKI systematically monitors and evaluates the program design and activities over the life of the project to ensure optimal efficiency for delivery of the needed eye health services. This innovative strategy has been shown to be cost-effective and to increase treatment compliance by the community in HKI-supported projects.

One of HKI's strengths is creating and disseminating high quality information, education and communication materials to control onchocerciasis. The IEC campaigns are targeted to Community-Directed Distributors (CDD) and focus on the necessity of annual Mectizan distribution, how to recognize infected persons, information about treatment methods and how to educate the community that the return of the blackflies does not mean that the disease is coming back (because the blackflies in these areas are no longer infective). In the case of Niger where the disease has already been controlled, IEC materials emphasize compliance with surveillance measures, which will identify the potential recurrence of the disease.

The Project Sustainable Control of Onchocerciasis is a good example of expert use of the public health approach in prevention of a serious infection in poor countries. Together with its many collaborators it has successfully enticed the most powerful organizations at the international level and governments in each country to join the efforts. For years it has supported the local, regional and nationwide functions to make them sustainable. Because the worm (black fly) may live 15 years in a person, treatments are long and re-infections possible until the whole population is free of the disease. This project has become a model program for many infective diseases. Its relatively low costs make it possible in poor countries because the functions are based on voluntary workers in the community. Creation of good public information, comprehensive training manuals and effective follow-up on all levels of activities have made it one of the best projects in combining primary and secondary prevention of blindness.

HKI’s Sustainable Control of Onchocerciasis has been a remarkable success in helping to control onchocerciasis. There are specific targeted countries as well as new areas that may become infected with the blinding disease that can benefit from their work. It would appear however that HKI has already developed a system of tremendous support that is already in the pipeline for this worthwhile endeavor.

The Sustainable Control of Onchocerciasis project started in 1992 as a pilot in Cameroon and is now a mature Program in ten endemic countries. The fight against onchocerciasis is based on:

1. investigations on the life cycle of the worm.
2. effective collaborative work with the governments, numerous NGOs, WHO, IAPB, and several Foundations.
3. development of a new approach of distributing the medicine, the cost-effective Community-Directed Treatment with Ivermectin (CDTI) and information, education and communication (IEC) strategies.

Mass distribution of ivermectin (donated by Merck) has reached 60 million people in 117000 communities in Africa in 2006 preventing 600 000 cases of blindness. In each community the activities are: planning, development and production of IEC materials, training of health workers and distributors of the medicine, supervision, monitoring and evaluation. Based on these classical components of primary and secondary prevention the Program has remained successful, despite conflicts in several countries, in combating Onchocerciasis, or river blindness, which is the world's second leading infectious cause of blindness. Although it is rarely life-threatening, the disease causes chronic suffering and severe disability, constituting a serious obstacle to socioeconomic development, especially in Africa. Through this project, HKI plays a significant role at the international, national and community levels to achieve results for children related to blindness prevention.