Riverblindness in Africa

Book excerpt: The remarkable story of how a large public-private partnership worked to control and defeat riverblindness—a scourge which had devastated rural communities and impeded socioeconomic development throughout much of Sub-Saharan Africa for generations. Riverblindness (onchocerciasis)—a pervasive neglected disease, transmitted by the blackfly, that causes horrific itching, disfigurement, and loss of vision—is also known as "lion's stare" in reference to the fixed, lifeless glare of the eyes blinded by the disease. The disease has destroyed countless lives for generations, particularly in Africa. Its effects are so devastating that the areas where it is most common (large expanses of land around rivers where the fly breeds) end up abandoned as villages move farther and farther away to more arid environments in order to escape the fly-biting, and hence the disease. The disease devastates communities from multiple angles: a large portion of each stricken community's population is disabled, often permanently blind in the prime of life, placing a burden on the rest, and communities' efforts to escape infection force them to move to areas where farming is less productive. To defeat riverblindness would not only release these communities from the heavy toll of the disease, but would also open more fertile areas in Africa to be inhabited, thus alleviating extreme poverty. These were the goals of the World Bank, led by then-president Robert McNamara, when launching a partnership to combat riverblindness more than forty-five years ago. In this book, Bruce Benton tells the remarkable story of that partnership's success. An authoritative account of the launch and scale-up of the effort, the book covers the transformation of the fight from a top-down high-tech operation to a grassroots drug treatment program covering all of endemic Africa. How, Benton asks, did the effort become such a unique partnership of UN agencies, donors, NGOs, a major pharmaceutical company, universities, African governments, and the stricken communities themselves? Highlighting the importance of disease control in alleviating absolute poverty and promoting development, Benton examines the key developments, individuals, and notable qualities of the partnership in realizing success. He also extracts lessons from this particular story for addressing future challenges through partnership. Drawing on Benton's twenty years of experience managing the riverblindness program for the World Bank, along with extensive research and interviews with 100+ players in the program, Riverblindness in Africa is the first and only book of its kind. The story of the battle has an epic scale, both in terms of geography and the vast number of people and organizations involved. It provides a template for a broad range of global health efforts and is an excellent example of evolving, increasingly effective approaches to disease control and elimination.