title: Mectizan delivery systems and cost recovery in the Central African Republic.
abstract: The Central African Republic (CAR) has a serious onchocerciasis problem. The disease is endemic in three quarters of the country and there is considerable onchocercal blindness in the north-west. The low population density and extreme poverty (the CAR being one of the 20 poorest countries in the world) combine to make mass treatment with Mectizan (ivermectin, MSD) a challenge. Although planned, primary health care (PHC) is not widely developed in the country. Mectizan distribution was carried out in 1993-1994 by mobile teams in order to address the most urgent need, particularly in the north-west. Since then, the strategy has been one of community involvement, using village health workers, chosen by their own communities, to do the treatment. The system has been a stimulus to the development of PHC in some areas, as the co-ordinators of the Mectizan programme are often the only health personnel to visit every village. The long distances between health centres, with a mean of 45 km, are likely to be an obstacle to the population collecting their own Mectizan, within the self-treatment system otherwise in place. Operational research is planned to examine ways in which the population can contribute to cost recovery without there being a reduction in treatment coverage.
authors.affiliation: Programme National de Lutte contre l'Onchocercose et la Cécité, Bangui, Central African Republic.
authors.forename: A D
authors.initials: AD
authors.lastname: Hopkins
mesh_terms: D002488:Central African Republic / Q000453:epidemiology; D005369:Filaricides / Q000191:economics / Q000600:supply & distribution*; D017048:Health Care Costs; D005102:Health Expenditures; D006301:Health Services Needs and Demand / Q000191:economics; D006801:Humans; D007559:Ivermectin / Q000191:economics / Q000600:supply & distribution*; D009855:Onchocerciasis / Q000188:drug therapy
chemical_list: D005369:Filaricides; D007559:Ivermectin