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Community-directed interventions are practical and effective in low-resource communities: experience of ivermectin treatment for onchocerciasis control in Cameroon and Uganda, 2004-2010.

BACKGROUND
The community-directed intervention (CDI) approach has improved treatment coverage in onchocerciasis-affected communities. However, there is still a lot to learn. This study assessed its performance and highlighted the lessons learnt so far.


METHODS
Representative samples of households were selected from Cameroon and Uganda program areas through multi-stage random sampling. An adult male and female from every selected household were interviewed separately on their involvement in CDI activities every year between 2004 and 2010. Community health workers (CHWs) were interviewed and treatment records reviewed to determine whether 90% treatment coverage was attained within 2 weeks. Records related to training of CHWs and their supervisors were analyzed.


RESULTS
Decision making decreased for community leaders and health workers, while it increased for community members. The proportion of CHWs attaining 90% treatment coverage within 2 weeks improved as their demand for monetary incentives, and number of persons they served, reduced. The number of CHWs supervised by a community supervisor remained low, but increased for the health workers. The cost of training a CHW and a community supervisor reduced to about US$1 and US$4.8, respectively.


CONCLUSIONS
The CDI approach was effective, culturally appropriate and probably less costly in delivering health services in low-resource communities.