Problems and perspectives of managing an onchocerciasis control programme: a case study from Plateau state, Nigeria.

The onchocerciasis control programme in Plateau state (now Plateau and Nasarawa states), Nigeria, was one of the pioneering Mectizan-distribution projects in Nigeria. Although initiated under the River Blindness Foundation (RBF) in 1991, in collaboration with the Ministry of Health, it was absorbed into the Carter Center's Global 2000 River Blindness Programme (GRBP) in 1996. The objectives of the programme were to support the delivery of Mectizan (ivermectin, MSD) to at least 80% of those living in communities where onchocerciasis was highly endemic, within the first 3 years of the project's inception, and to maintain this coverage for a period of 10-15 years. The programme has so far been successful, and much of this success is attributed to problem identification and problem-solving through continuous review and evaluation of programme activities, and implementation of strategies, when required, to ensure those programme objectives are met. The implementation steps of the programme, and some of the managerial problems identified during the course of the effort, are reviewed. The challenge now is to learn how to transform this functional, programme-designed and programme-directed effort into the new community-directed treatment being promoted by the African Programme for Onchocerciasis Control. The new challenges of the transition require middle-level managers and implementors with effective, efficient and indeed state-of-the-art management skills.