MECTIZAN DELIVERY SYSTEMS AND COST RECOVERY IN THE CENTRAL-AFRICAN-REPUBLIC

The Central African Republic (CAR) has a serious onchocerciasis proble m. The disease is endemic in three quarters of the country and there i s considerable onchocercal blindness in the north-west. The low popula tion 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 (P HC)ris 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, c hosen by their own communities, to do the treatment. The system has be en a stimulus to the development of PHC in some areas, as the co-ordin ators 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 collec ting their own Mectizan, within the self-treatment system otherwise in place. Operational research is planned to examine ways in which the p opulation can contribute to cost recovery without there being a reduct ion in treatment coverage.