Performance of predictors:: Evaluating sustainability in community-directed treatment projects of the African programme for onchocerciasis control
Performance of predictors:: Evaluating sustainability in community-directed treatment projects of the African programme for onchocerciasis control
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DOI：
10.1016/j.socscimed.2007.01.018
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发表时间：
2007-05-01
影响因子：
5.4
通讯作者：
Seketeli, Azodoga
中科院分区：
文献类型：
--
作者：
Amazigo, Uche;Okeibunor, Joseph;Seketeli, Azodoga
在非洲盘尾丝虫病控制方案（APOC）的41个项目中，包括10个国家的492个社区，评价了伊维菌素（CDTI）在四个执行级别的社区指导治疗的可持续性的预测因素。一份示范议定书提供了与一个项目的九个方面相对应的指标信息，该项目在外部支助停止后可能在社区一级持续下去。九个方面中有六个具有社区所有权的组成部分，作为项目可持续性的预测因素。采用定量和定性评估，以获得单个社区的得分和每个项目的总体可持续性得分，得分范围为0-4。在评价的41个项目中，70%的项目在社区一级得到“令人满意”到“高度可持续”的评分。我们发现，各国之间存在差异，卫生系统的薄弱环节可能会阻碍社区维持项目的努力，例如伊维菌素交付较晚。社区所有权对社区得分至关重要，社区一级的得分与整个项目的可持续性相关。在每个项目中实现的治疗覆盖率与伊维菌素志愿分发者与所服务人口的比例相关。令人惊讶的是，这些分销商的业绩并没有受到所提供的直接奖励的影响，而且在根本不给予现金或实物补偿的情况下，覆盖率似乎最高。虽然需要进一步的研究，轶事证据指出，分销商的政治善意，个人满意度和利他主义的实现多种间接利益。结果表明，社区所有权是社区方案可持续性的重要决定因素之一。(c)2007爱思唯尔有限公司保留所有权利。
The predictors of sustainability of community-directed treatment with ivermectin (CDTI) at four implementation levels were evaluated in 41 African Programme for Onchocerciasis Control (APOC) projects, encompassing 492 communities in 10 countries. A model protocol provided information on indicators corresponding to nine aspects of a project that is likely to be sustainable at community level after the cessation of external support. Six of the nine aspects had components of community ownership as predictors of project sustainability. Quantitative and qualitative assessments were used to obtain individual community scores and an overall sustainability score for each project graded on a scale of 0-4. Of the 41 projects evaluated, 70% scored "satisfactorily" to "highly sustainable" at the community level. We found variations among countries and that health system weaknesses could hamper community efforts in sustaining a project, such as when ivermectin was delivered late. Community ownership was of primary importance to the community score, and the community-level scores correlated with overall project sustainability. The therapeutic coverage achieved in each project correlated with the ratio of volunteer ivermectin distributors per population served. Surprisingly, the performance of these distributors was not affected by the direct incentives offered, and coverage appeared to be highest when cash or in-kind compensation was not given at all. Although further research is required, anecdotal evidence pointed to diverse indirect benefits for distributors-political goodwill, personal satisfaction and altruistic fulfillment. The results demonstrate that community ownership is among the important determining factors of sustainability of community-based programmes. (c) 2007 Elsevier Ltd. All rights reserved.