In rural Ugandan communities the traditional kinship/clan system is vital to the success and sustainment of the African Programme for Onchocerciasis Control

In rural Ugandan communities where onchocerciasis is meso- or hyper-endemic , control of the disease is now being carried out using a strategy of commu nity-directed programmes for the annual distribution of ivermectin to all p ersons eligible to take the drug. I;or these programmes to achieve their an nual target coverage of at least 90% of the population eligible to take ive rmectin, and to continue to sustain themselves for 10-15 years or more, eve n after external donor funding ceases, it has been found essential to repla ce the initial community-based strategy, imposed from outside, by a communi ty-directed strategy developed by the community members themselves. Further more, it is essential for success that full use be made of the traditional social system, which is very strong in all rural communities in Uganda. Thi s system is based on patrilineal kinships and clans, governed by traditiona l law, and in it women pay an important role. If this system is ignored or by-passed by government health personnel or by the sponsors and promoters o f the programme, the communities are likely to fail to reach their targets. When rural communities increase in size and complexity, following developme nt and the arrival of migrant families, they become semi-urbanized. The kin ship/clan system is then weakened, community-directed drug distribution is much more difficult to organize, and coverage targets are not often achieve d. This effect is of minor importance in a rural disease, such as onchocerc iasis, but is likely to be of greater significance in the control of diseas es, such as tuberculosis and lymphatic filariasis, which thrive in urban en vironments.