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Pages from World Bank History: The Fight Against Riverblindness

March 14, 2003—On Wednesday, March 19, President Jim Wolfensohn will be hosting a tribute to former President Robert S. McNamara, celebrating his contribution to the World Bank. As part of the tribute, a photo exhibit featuring key moments in McNamara's presidency will be unveiled Thursday, March 20. Bank staff are invited to visit the exhibit at the President's Gallery, MC13 Mezzanine, through April 4. 

The World Bank Group Archives and Bank’s World Today are pleased to present the first of two articles that focus on McNamara’s legacy.

One of the great success stories in the history of the World Bank has been its role in the control of onchocerciasis, commonly known as riverblindness. The Onchocerciasis Control Programme (OCP) was created in 1974 with two primary objectives: the elimination of Onchocerciasis as a public health problem and as an obstacle to socioeconomic development; and enhancing both country and regional capacities to control the disease and counteract its impact on development.

The riverblindness campaign involved a complex partnership, as it involved an eleven-country area: Benin, Burkina Faso, Cote d'Ivoire, Ghana, Guinea, Guinea-Bissau, Mali, Niger, Senegal, Sierra Leone, Togo. The program was sponsored by the United Nations Development Programme (UNDP), the Food and Agriculture Organization (FAO), the World Bank, and the World Health Organization (WHO). It brought in a host of private sector companies and non-governmental organizations.

The riverblindness program represented a bold and visionary new path for the Bank, and has been pursued with determination under five presidents. But it was the initiative and decisions of Bank President Robert McNamara that secured its launch.

Five key points emerge from McNamara’s willingness to charter unexplored territory. For the Bank, McNamara’s vision entailed much risk and uncertainty—there were many who said the campaign was simply impossible under the circumstances, that it was too complex. The program’s undeniable success underscored the value of thinking outside the box and committing to a bold vision. Second, the Bank was not engaged in health at the time, and the decision to tackle riverblindness pushed the Bank into a critical sector that continues today. Third, the program has required institutional persistence – a willingness to stick to a decision over decades. Fourth, the program called for an extraordinary partnership, and McNamara’s conviction that this was possible reflects his confidence in the developing world and in the Bank as a leader. Finally, the Riverblindness program called for a combination of technical excellence (with adaptations along the way) and people/management inputs that were new areas for the Bank during the 1970s.

In 1994 Mr. McNamara recalled the beginnings of the effort to control Riverblindness:

"I remember vividly those days in what was then called Upper Volta and is now Burkina Faso, when we decided that the World Bank should embark on a bold new program to conquer Onchocerciasis.

"Roger Chaufournier, [World Bank Vice President for the Africa Region], my wife Marg, and I visited Ouagadougou together in 1972. Ouagadougou seemed as far from Washington as any place on earth, and the challenge of poverty there seemed almost insurmountable. Prospects looked grim for the people, and each hurdle facing them was immense. To make things worse, the region seemed gripped in an unrelenting cycle of devastating droughts that defied solution.

"We had heard, before and during the visit, about the terrible disease called riverblindness, and some had suggested that the World Bank should play a role in doing something about it. We could hardly pronounce the name of the disease, much less spell onchocerciasis, but we were horrified by what we heard about it. Literally millions of people were at risk of a fate that could be worse than death in that society and time. The catch, though, was that we had only shadowy ideas about how to combat this disease. There was no good cure, and it covered a vast area of land, so any solution would need to be on a vast scale, in areas without real institutions and hardly any infrastructure.

"As we talked about the disease in Ouagadougou, Roger and I heard about two French scientists who were said to have some ideas and some answers. So we chartered a plane, and Roger, Marg, and I went to Bobo Dioulasso, a town to the southwest of Ouagadougou. There we met the scientists, and they convinced us that they indeed knew what should be done, and had answers to the questions we had wrestled with.

"The disease, caused by a parasitic worm, was spread by a fly that bred only in fast-flowing water. So by treating the flowing water courses, breeding could be stopped, and hence transmission of the disease leading to the elimination of the disease itself.

"There were two ‘catches’, though. First, because the parasitic worm lived so long in its human hosts, the control program would have to be maintained for 20 years. And second, because the fly could travel such long distances the program had to be launched and maintained over a vast area involving many countries, some of which were hardly on speaking terms.

"So Roger and I, then and there, determined that we would do something about the disease. We worked out a collaborative arrangement, letterhead and all, that brought together key partners, and we launched a campaign on the spot from Ouagadougou."

The Onchocerciasis Control Program has halted transmission and virtually eliminated Riverblindness throughout the eleven participating countries. Currently, 34 million people are protected from infection by the disease, with 600,000 cases of blindness prevented by 2002. Since OCP’s inception, 15 million children born within the programme area have been spared the risk of contracting riverblindness. And 25 million hectares of arable land—previously shunned due to their susceptibility to riverblindness—have become available for agricultural use.

Without records there is no history. Courtesy of ISG’s World Bank Group Archives

 


Robert S. McNamara
President of the World Bank (1968 – 1981)

 

 


Roger Chaufournier

 

 


An elderly man, blinded by onchocerciasis, is led through a village in Burkina Faso. The Onchocerciasis Control Program has led to the near eradication of the disease.

 

 


The Onchocerciasis Control Program initiated an aggressive program of insecticide application to prevent the proliferation of blackflies responsible for spreading the disease. Here a helicopter sprays a breeding ground in Burkina Faso.

 

 


Villagers being examined by a member of the Onchocerciasis Control Program.

 




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