Segment 1

DALJIT DHALIWAL

Across Africa, millions of adults and children die every year from treatable diseases. Sometimes all that is needed is one shot or a single pill. But with the majority of Africans living in remote areas, the question becomes: how to get these potentially life-saving treatments to the sick? A bold new endeavor may just be an answer.

VOICEOVER

No, this is not a political rally or a religious gathering. It is an innovative new way to deliver health care in remote, African villages. Begun almost 15 years ago with one disease and one drug, this community-led process is now being explored to deliver much more, for more diseases. But let's start at the beginning, in one of many small villages in Nigeria, where Esther is trying to make a living selling cassava. Money isn't her only problem. There are numerous diseases that are always a risk: like malaria, which kills mostly children and pregnant women; and a parasitic worm that damages the skin and eyes causing terrible itching and, in the worst cases, blindness. When she was younger, Esther was infested with the parasite.

ESTHER

My father actually went blind from this disease. I was afraid that I would lose my sight as well.

VOICEOVER

This disease is called onchocerciasis, or river blindness, because the black flies which spread the parasites to humans breed in rivers and streams. River blindness affects 30 countries in Africa alone. The World Health Organization estimates that half a million people are blind because of it. Fortunately, there is a drug which can prevent the disease. But getting Ivermectin to all the people who need it is a massive task. A radical new method of drug distribution was needed, a method that would work in the demanding conditions of rural Africa, where there aren't enough doctors and nurses to serve in these remote areas. So it was decided to unite rural people living here to do the job themselves. Cleophas Bakari is one of these volunteers. He's a Community Drug Distributor for his village, Garbachede. Cleophas isn't just liked by his community, he was chosen by them. That's essential to the success of the program, says Professor Oladele Akogun, local Research Coordinator for the project.

PROF. OLADELE AKOGUN

It is absolutely important and it is actually the foundation of community participation because they need somebody they trust, somebody that reports to them, somebody that obeys and agrees with their culture.

VOICEOVER

Community meetings like this discuss and decide on all aspects of the Ivermectin distribution program. Today, they are reviewing how well the distribution went this year. This man complains that households near him didn't get any Ivermectin. A representative from the health clinic asks him to be more specific: who missed out and where? The volunteers are trained by local, qualified medical staff and are carefully followed by research scientists and the African Programme for Onchocerciasis Control. At first, the professionals were skeptical that unqualified and often uneducated villagers could carry out drug distribution correctly and safely.

DR. HANS REMME

You give a drug to a community they will kill everybody, they will sell the drug, it will be a mess.

VOICEOVER

Tropical Disease Research Coordinator at the World Health Organization, Dr. Hans Remme.

DR. HANS REMME

So we did some first studies to find out and address that question, and the answer was communities had no problem whatsoever of doing this. They were very good at it. Actually, they took it very seriously.

CLEOPHAS BAKARI

At first I had doubts about it. But later when I went for the training, and as the training went on, I learned that I could do the job well.

VOICEOVER

Sixty million Africans are now being treated for river blindness by volunteers like these in four different countries in Africa. But now they have been asked to take on a much bigger challenge: treating up to five different diseases, including malaria, which kills more than two and a half million Africans every year. Esther is now a fully trained community drug distributor. She wants to help those who suffer most from malaria: pregnant women and children under five. Just then, Esther's neighbor arrives. She's very concerned about her baby, who's got a high fever. The mosquito bites are worrying. Fortunately, Cleophas has been trained not only to prevent malaria but also to diagnose and treat it.

PROF. OLADELE AKOGUN

They mainly use symptoms. The CDD touches the head to compare the temperature of the head with his own and see the difference in temperature, and that tells you that this child has fever. About 90 percent of every fever case is malaria in Africa.

VOICEOVER

The treatment is very straightforward: Coartem, a combination therapy which includes the most effective anti-malaria compound, artemisinin. But it's vital it's taken as soon as possible. That's why Esther wanted to be trained. At home and in the market, she's always available when mothers and their children need help. Esther now keeps a stock of Coartem in her own home so neighbors can come for anti-malaria drugs day or night. A three-year study just released shows that community drug distributors like Esther are having a huge impact.

DR HANS REMME

The results were really dramatic. We found without this community pressure the cover, say, for proper treatment for malaria was around 20 percent of the children. With this approach we jumped to 50 percent.

VOICEOVER

The volunteers are keen to take on more and more responsibility.

ESTHER

We live in a very remote, rural area and there are so many diseases here which affect us. So, if more interventions are introduced, we will have fewer sick people in the community.

VOICEOVER

The challenge now is to see whether other communities across Africa can achieve the same success.

DALJIT DHALIWAL

That's all for this edition of 21st Century. I'm Daljit Dhaliwal. We'll see you next time. Until then, goodbye.

TITLE

21st Century a production of United Nations Television Department of Public Information