As the world marks the centenary of the International Women’s Year, women in Africa, the unsung heroes who bear the brunt of poverty, disease, deprivation and the excruciating burdens of unending socio-economic and political upheavals for which Africa has become synonymous, have a reason to celebrate one of their own.
Amazigo after her decoration with the Medal of Knight of the National Order of Burkina Faso in Ouagadougou
After several decades of illustrious service including the last 15 years at the World Health Organization African Programme for Onchocerciasis (River blindness) Control (WHO/APOC), it is time for Dr Uche Amazigo, a university teacher, health management expert, mother, researcher and humanist to count her blessings having written her name in the golden chapter of world history.
Since her retirement on 1 April, as Director of WHO Africa’s River blindness control programme, the former senior lecturer and parasitologist with specialization in tropical diseases and public health has been receiving a torrent of accolades for her selfless commitment to serving the needs of the poorest of the poor in Africa. While she comes across as unassuming, Amazigo’s strong leadership character and passion for the poor are qualities that stand her out in the international health community.
To cap her distinguished service, the Government of Burkina Faso recently bestowed on Amazigo the distinguished Medal of “Knight of the National Order of Burkina Faso,” a rare achievement for a non-native. WHO Regional Director for Africa Dr Luis Gomes Sambo, on behalf of the WHO Director General Margaret Chan, also lauded Amazigo for “her excellent work” as Director of APOC. The tributes have been pouring in acknowledging the elegant African woman, noted for her exceptional candour, humility, compassion and stickler for detail.
For ages, River blindness, a parasitic disease caused by worm and transmitted to human by the bite of a black fly had been wreaking havoc in Africa leaving in its trail an army of blind otherwise productive adults. In some cases, whole villages had been forced to abandon large hectares of otherwise fertile land by the unrelenting bites of the vicious insects. Thirty-two states of Nigeria are affected, mostly the food basket states of the country. The consequences include drastic decline in agricultural productivity, exacerbation of poverty and an impediment to development.
Initial efforts by the international community led to the establishment of the Onchocerciasis Control Programme (OCP) of West Africa in 1974. That programme succeeded in ridding 11 West African countries of the disease, but the control method - aerial spraying of black fly breeding sites with environmentally safe insecticides - was expensive and therefore unsustainable. But as part of their unrelenting efforts in the battle against River blindness even before the closure of the OCP in 2002, the international health community, donors and African governments set up the African Programme for Onchocerciasis Control (APOC) in 1995 to expand the disease control activities to an additional 19 African countries as well as maintain control either through surveillance or continued treatment in the 11 OCP countries.
With the registration of Ivermectin in 1987, as a safe drug for the control of River blindness, Non-Governmental Development Organizations (NGDOs) involved in the control of the disease had began distributing the medicine on a relatively small scale. And encouraged by the decision by the US-based pharmaceutical firm Merck & Co Inc to donate ivermectin free of charge for as long as needed the critical challenge became how to develop a cost-effective method for the mass distribution of the drug by non-medical personnel given the weak or non-existent health systems and paucity of health workers in the remote villages where the disease is usually endemic.
As WHO and partners sought scientific and practical solutions to the River blindness scourge, Amazigo, back in her native country Nigeria after studies abroad had developed more than an academic interest in the disease. In the early 1990s she had the responsibility of teaching parasitology to medical students of the renowned University of Nigeria, Nsukka, but because of her burning interest and zeal for addressing the myriad challenges of the poor, Amazigo would not be content with just imparting the knowledge of an aspect of medicine in young medical professionals. She complemented her classroom teaching with research and field work. It was during one of such field visits to an antenatal clinic in Etteh village, Enugu State in South-eastern Nigeria that Amazigo’s career world changed, and not just for public health interventions but for the good of Africa.
During a chance meeting with a woman afflicted with River blindness at the antenatal clinic, Amazigo resolved to make a difference. She did not only undertake to pay for the treatment of the woman scabbed with scars and rashes who had been abandoned by her husband because of the stigma of unrelenting itching and discoloration of her skin by this disease, Amazigo also decided with funding by the WHO, to research into the social impact of the disease.
It was the result of that research that formed the scientific basis for the launch of WHO/APOC in 1995, and changed the international perceptions about morbidity from River blindness. A member of the Consultative Group on Women's Health for the 1993 World Development Report, one eloquent testimony to Amazigo's well-documented work in communication, advocacy, community mobilisation and partnership is the UNFPA-UNIFEM-sponsored film "Broken Wings," which she produced for the World Conference on Women in Beijing 1995. The 2005 nominee for the Global Champion of Health award by the US WGGH/NOVA Science has also produced and edited several training modules on engaging communities in healthcare delivery, with her works appearing in international publications, including the medical health journal Lancet and the Annals of Tropical Medicine and Parasitology.
With scientific evidence showing that communities can deliver results on their own health issues capitalizing on the entrenched indigenous self-help practices, a novel strategy was soon devised by the UNICEF/UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases (TDR) Task Force on Onchocerciasis, of which Amazigo was a member.
Consequently, WHO/APOC in 1997, adopted its revolutionary Community-Directed Treatment with Ivermectin (CDTI) strategy which enables communities to decide when, where and how to distribute ivermectin tablets, with assistance from Ministries of Health and NGDOs, and with generous financial support from donors provided through the APOC Trust Fund, managed by the World Bank.
From inception until now the overarching objective has remained empowering communities to take over responsibility for distribution of ivermectin using selected community members, known as Community Drug Distributors (CDDs) and driven by a strong African leadership, the WHO/APOC programme has since become one of the world’s broadest and most successful Public-Private health partnerships.
The programme has not only proved that preventive chemotherapy is a viable strategy for the control of Neglected Tropical Diseases (NTDs), but its trademark CDTI strategy also known as Community-directed intervention (CDI), a bottom-up approach to health care delivery, has also become an irresistible model in the delivery of multiple health interventions combining global and community resources, innovation, expertise and advocacy as well as multi-sector engagement.
Thirty-four African universities, medical science and nursing schools are pre-testing the CDI strategy for incorporation into their curricula. This will no doubt expand the knowledge about the strategy with an exponential increase in the number of young medical professionals equipped with the requisite expertise for effective engagement of rural communities in public health interventions.
Described in superlatives as “the pride of Africa,” “a scientist with a large heart for the poor in Africa,” “passionate, articulate and scholarly,” Amazigo’s is indeed an amazing story of a role model. Following her ground breaking research, Amazigo had to move to WHO/APOC headquarters in Burkina Faso in 1995 to avail the programme of her expertise, and to help translate the research findings into deliverable products/services. In 2005, she was appointed the first female Director ever to lead the multi-million-dollar multi-stakeholder regional WHO/APOC programme.
From its inception to date the programme has recorded 86% reduction in severe unrelenting itching, 33% reduction in prevalence of the disease, prevention of more than 500,000 cases of blindness and an estimated Economic Rate of Return of 17% on invested funds. Annual treatment with ivermectin in APOC countries has multiplied from 1.5 million in 1997, to 68 million in 2009, nearing the projected target of 90 million by 2015.
With dwindling donor funding as a result the global economic crisis and with many countries struggling to meet the Millennium Development Goals the need for better ways to provide and deliver cheaper and accessible health care to remote populations, cannot be more compelling. And no doubt, WHO/APOC’s CDI strategy holds a great promise for improving Primary Health Care among Africa’s most disadvantaged and needy rural populations.
With a solid network of scores of dedicated and intrepid scientists and more than one million trained community-selected drug distributors and over 70,000 health workers who are currently engaged in multiple disease interventions, WHO/APOC has generated an irreversible momentum in public health care delivery in member countries. Its operations now cover an area of 13.45 million km2 of hard-to-reach terrain encompassing a population of 567 million people, making the coalition of 146,000 local communities, 19 African countries, 20 donor countries/organizations, 14 Non-Governmental Development Organizations (NGDOs), and Merck & Co. Inc, very unique.
The programme has also shown remarkable leadership in disease mapping providing vital scientific data for evidence-based disease control system and bringing remote neglected villages into demographic equation for national planning and development.
At the last meeting of the Joint Action Forum (JAF), the governing board of WHO/APOC programme in Abuja, Nigeria, last December, international donors and partners renewed their commitment to the programme, with additional US$31 million over the next two years, including the first ever individual donation of US$1 million by Nigerian philanthropist General T.Y. Danjuma.
Yet, Amazigo, in her typical modesty would not claim credit for the internationally-acknowledged achievements of the WHO/APOC programme, insisting that it was all down to team effort and that much work was still required.
“The achievements by WHO/APOC would not have been possible without the unwavering commitment and support of donors, NGDOs, Ministries of health, dedicated scientists, health workers and strong community involvement,” she stressed. Even so, the Nigerian scientist has demonstrated that with industry, commitment and determination Africans can excel in any human endeavour. Her strong advocacy for the poor and their needs has seen her travelling across the globe from the most remote African villages to the White House in Washington DC, where she participated in a summit on International Development under President George Bush’s administration.
This is indeed a moment of deserving honour to a distinguished African Lady who has exhibited a unique and strong leadership giving expression to the popular statement by Canadian self-help author Brian Tracy that “Leadership is the ability to get extra-ordinary achievement from ordinary people.” The major challenge now confronting all stakeholders in the “Oncho family” is to move the River blindness battle from control to elimination of the disease. Amazigo has played her own part, and pledged more contributions even in retirement. The greatest tribute to her untiring efforts is the continuation of the battle until Africa is freed, not only of River blindness but all neglected diseases for that matter, so the continent can realize its full development potentials.
Dr Margaret Chan WHO DG with Dr Uche Amazigo in Geneva just before her retirement
*Ejime is a Communication/Media Consultant