Chapter 3 Sociocultural factors and the research and control of trypanosomiasis

Background and justification

Most of the failures of development projects occur when the communities concerned have been left out of the processes related to the design, formulation and implementation of the projects. In recent years, opinions have become somewhat polarized between proponents of the "areawide intervention" approach and the "community-based" approach (PAAT, 1999) in promoting cost-effective, sustainable T&T control. Up until the mid-1980s, control had been achieved primarily by bush clearing and insecticide spraying, implemented by public agencies with little or no involvement of the local beneficiaries. The high costs and complexity of these operations have recently proved to be beyond the capacity of national organizations without extensive technical and external financial support. In addition to concerns over environmental safety and natural resources conservation, the financial crisis that affected most countries in sub-Saharan Africa has put traditional veterinary systems under severe difficulties necessitating cuts in the operating budgets of delivery systems (Leonard, 1993). Several solutions have been attempted after considerable prodding from international donors, and questions about the possible transfer of economic functions from the public to the private sector have extended to the delivery of animal health services in general (Leonard, 1993; Umali, Feder and de Haan, 1994) and trypanosomiasis in particular.

The debate about public, private and communal roles in controlling trypanosomiasis gained interest and momentum with recent developments in the bait technologies that are proving to be increasingly popular because of their cost effectiveness, technical efficiency and low environmental impact. Since bait technologies are logically suitable for local populations, donors and governments are looking at programmes with community participation and especially cost-sharing programmes as the ideal solution to the problem of sustaining T&T control activities (Barrett and Okali, 1998b). This development triggered the farmer/community-based approach promoting participation and the integration of T&T control activities into general rural development activities (Dransfield and Brightwell, 2001). Emerging community approaches to the management of T&T control are now based on the recognition that needs and perspectives of local people have to be understood, and their aspirations accounted for (Mwangi, 1996; Ssennyonga, 1998). Community participation has not only been an important element of African governments' policies and programmes, it also reflects current donors' policies towards more participatory approaches to rural development, with the hope that some of the costs of T&T programmes can be "passed over" to the community (Barrett and Okali, 1998a; Echessah et al, 1997).

In this paper, community participation and related notions in T&T control programmes are advocated in the context of a more effective approach to sustainable rural development, whether an areawide or a farmer/community-based approach is envisaged.

Definitions and models of community participation

Several definitions and concepts have been devised to represent common views that are held about the notions of "community" and "participation". Swallow, Echessah and Kamuanga (1996) and Mwangi (1996) reviewed these definitions and the following notions are presented in an effort to expand the concepts with specific reference to a degree of participation in the decision-making and implementation of T&T control programmes.

In its sociological sense a community is defined as an informally organized social entity that is characterized by a sense of shared identity and common bond, membership in a group holding something in common esteem, coupled with an acknowledgement of rights and obligations.

Community participation is a social process whereby specific groups with shared values, living in a defined geographical area, actively pursue identification of their needs. Thus, where a programme is introduced from outside, efforts are taken to sensitize the community to the issues to enable its members to understand the programme and make informed decisions. The notion reconciles outside objectives with local priorities, and provides an environment for community mobilization to enable active and sustained participation.

Community-based programmes necessarily imply that decisions, activities, resources and programme organization emanate from the community. However, community-participation and community-based programmes may be interdependent. Either way, involvement of a community is a cost-effective way of expanding a health-care system to include communities that have least access to services; and those that invest labour, time, money and materials into programmes are those most likely to retain a commitment to ensure programme sustainability. Where a community is involved, services can be provided at lower cost, and participation has an intrinsic value for participants, which increases their commitment to a given programme. It serves as a catalyst for further development efforts, leads to a sense of responsibility for the project, guarantees response to needs identified by the community, ensures things are done in the right way (in community terms), makes use of indigenous knowledge and expertise, frees the community from dependence on outside professionals, and raises its awareness of issues being addressed by the programme.

Community involvement refers to the degree of participation in setting priorities and objectives to ensure an active and sustainable programme. It ensures a sense of ownership and control and appears to be an important factor in the implementation of any programme. Like other development projects, T&T control requires strong community involvement in the diagnosis of local problems, in the formulation of an appropriate set of action, and in the implementation of the agreed action plan.

A common feature in the literature on community participation is the debate on the use and meaning of the term "participation". Some development workers have argued that because participation is now used in such a wide range of settings and for varying purposes, the use of the term per se can be confusing or even misleading. Over the years several authors have tried to overcome this problem by defining different ways in which people participate in projects or programmes, and relating the different levels of participation to the project's impact and sustainability. Thus, a number of scales ranging from token participation on the one hand, to full participation and empowerment on the other, have been developed.

White (1996, in Dransfield and Brightwell, 2001) describes different types of participation. These extend from minimal or "nominal" participation to instrumental, "representative" and "transformative" participation. In recent papers (Pretty, 1995; Catley, McCauley and Delaney, 1998; Olubai and Woodhouse, 2001), an operational typology of participation, useful in research and development activities, has been developed and comprises seven categories.

1. Manipulative participation: participation is simply a pretence, with unelected people's representatives on official boards who have no power.

2. Passive participation: people participate by being told what has already been decided or has already happened. It involves unilateral announcements by project management who do not listen to people's responses. The information being shared belongs only to external professionals.

3. Participation by consultation: people participate by being consulted or by answering questions. External agents define problems and information-gathering processes, and so control analysis. There is no sharing in decision-making and professionals are under no obligation to take account of people's views.

4. Participation for material incentives: people participate by contributing resources, for example labour, in return for food, cash or other material incentives. Often they will have no stake in prolonging the technology or practice when the incentives end.

5. Functional participation: this is seen by external agencies as a means to achieve project goals, especially reduced costs. People may participate by forming groups to meet predetermined objectives; their involvement may be interactive but it tends to be after external agents have already made the major decisions.

6. Interactive participation: people participate in joint analysis, development of action plans and formation or strengthening of local institutions. The process involves interdisciplinary methodologies. As groups take control over local decisions and determine how the available resources are used, they have a stake in maintaining structures and practices.

7. Self-mobilization: people take initiatives independently of external institutions to change systems. They develop contacts with external agencies for resources and technical advice, but retain control over how the resources are used.

Swallow and Bromley (1994) propose the term co-management when expertise is provided externally, on the reasoning that a project cannot be community based if information has to come from outside.

Theorists also distinguish between top-down and bottom-up programmes in community participation. The weakness of the top-down approach, initiated and directed by central government or affiliated agencies, is that there is a tendency for a uniform strategy that does not reflect local social, cultural or political conditions. There is often a lack of respect for traditional knowledge and individuals vested with authority. On the other hand, bottom-up strategies are difficult to implement because very often members of the community (farmers, labourers, local opinion leaders) must accept enhanced responsibilities in decision-making actions to fulfil their dreams and aspirations.

A related concept is participatory research, an approach often referred to as participatory rapid appraisal as a specific form of the rapid rural appraisal. This technique was developed in the late 1970s and early 1980s by researchers in international development as an alternative and a complement to conventional sample surveys (Chambers, 1992). Participatory rapid appraisal is a way of learning from, and with, community members to investigate, analyse and evaluate constraints and opportunities and to make informed and timely decisions regarding development projects. It can be used for needs assessment, feasibility studies, identifying priorities for development activities, implementing development activities where new information needs to be collected, and for monitoring or evaluating development activities.

Selected case studies of community participation in tsetse and trypanosomiasis control

Much has been written on several T&T control projects using both areawide and farmer/community-based approaches. However, few hard data are available regarding "success stories" and how problems and sustainability of T&T programmes have been approached. To date, most extensive reviews are available only for the eastern and southern regions of Africa, for example Barrett and Okali (1998b) and Brightwell and colleagues (2001). The following case studies were selected to represent situations in West/Central Africa and East/ Southern Africa; they are reviewed to illustrate the implementation of strategies that incorporate sociocultural factors to promote community involvement in T&T control activities. The review is based on an analysis of documented information on community-based control programmes and a situational assessment of T&T control projects in Burkina Faso, Côte d'Ivoire and Kenya.

West Africa and Central Africa

The idea of farmers participating in T&T control has long been established in West and Central Africa, particularly in areas where local people have been actively involved in the control of riverine species of tsetse where they transmit human trypanosomiasis (Laveissière et al., 1990; Okoth, Kirumira and Kapaata, 1991; Gouteux and Sinda, 1990). Active involvement by farmers in tsetse interventions against animal trypanosomiasis is relatively recent as noted for Burkina Faso (Bauer et al, 1992) and Côte d'Ivoire (Kientz, 1993). It can be traced back to the mid-1970s when Fulani pastoralists began to migrate from drought-prone, northern semi-arid zones into the more humid, tsetse-infested savannahs of southern Burkina Faso and northern Côte d'Ivoire (McMillan, Nana and Sawadogo, 1993; Bassett, 1994). The governments of both countries encouraged settlement of pastoralists at sites where assistance could be provided for secure livestock production. However, in areas of mixed farming settled by agropastoralists, local residents have often articulated their problems with tsetse flies and demonstrated an interest in active participation in control activities (Kamuanga et al., 1997).

FIGURE 1 Selected countries and sites of T&T socio-economic studies in Africa

TABLE 2
Tsetse and trypanosomiasis control in Burkina Faso: overview, questions and approaches at the sites

¹ Glossina morsitans.
² African animal trypanosomiasis.
³ Deltamethrin
Source: Adapted from Kamuanga and McDermott, 2001.

Community-based tsetse and trypanosomiasis control in Burkina Faso

In government-assisted settlements such as the agropastoral zone of Yale, Sissili and the Samorogouan ranches - with initial populations of more than 300 households each - sedentarization of migrant herders provided an opportunity for the production system to evolve gradually from extensive pastoralism to intensification of livestock production. Herders, raising mainly trypanosusceptible Zebu cattle, settled alongside schemes for infrastructure development, i.e. small bridges, wells, water pumps and cattle contention crushes. Livestock owners were organized in producers' groups to foster community interests in animal production and marketing of farm products. Producers' groups became the vanguard of community participation schemes to maintain the infrastructure (e.g. fire breaks) and animal-health services. Development of livestock production in the agropastoral zone and on the Samorogouan ranches was seriously hampered with the outbreak of trypanosomiasis in 1989. Residents started to express interest in active participation in tsetse control.

Control programmes started in 1989 and 1993, respectively, in the Samorogouan and Sissili areas as summarized in Table 2. For tsetse control to be sustainable, there was a need for some level of participation from the intended beneficiaries. Follow-up studies to examine the constraints to and opportunities for profitable livestock production were organized along with tsetse control operations. These included an assessment of the settlers' capacity to pay through contributions of labour for impregnated traps and targets, their deployment, surveillance and repair, and financial contribution for the purchase and replacement of the materials.

The results of the study indicate that farmers willing to contribute only money (23 percent) pledged to pay CFA 184.32 (US$0.26) per month; those willing to contribute only labour (37 percent) pledged to participate at the tune of 5.2 work-days per month; and the remaining group willing to contribute in both forms of payment (40 percent) pledged to pay CFA563.2 (US$0.86) per month and contribute 7.8 work-days per month. Thus, farmers contributing only money or only labour were contributing less of each than farmers who were contributing both. The actual contribution of labour by the last two groups at the start of the tsetse control programme was less than a third of the amount pledged (Kamuanga et al., 2001a).

In general, Fulani pastoralists in Burkina Faso settled in new areas where infrastructures were built under government subsidies, and parts of the area were set aside for pasture. Although no land-tenure constraints are reported under these settlements, farmer - herder conflicts with neighbouring villagers have emerged over grazing rights and crop damage. Sustainability is based on voluntary contributions of labour and money to finance the purchase and delivery of animal-health inputs and the organization of the control programme. However, the approach is viewed as basically top-down as government agencies and research and development institutions (such as the Centre International de Recherche-Développement sur l'Elevage en Zone Subhumide [CIRDES]) continue to play a major role. Failure to sustain the benefits of T&T control resulted from the suboptimal organization of livestock owners to contribute resources. Frequently, schemes for labour contributions were halted beyond the period of active control, and money contributions were below the level necessary to pay for the investment in control materials (traps and targets). Payment schemes for pour-ons have ended because fewer animals are brought for treatment. The role of private veterinarians has remained ambiguous.

In areas of mixed farming and indigenous agropastoralists (Satiri-Bekuy and Padema), tsetse control was undertaken between 1986 and 1995 and between 1993 and 1998. There are two production systems in each area: a cotton-based mixed farming with animal traction practised by indigenous and migrant (Mossi) crop farmers, and a pastoralist system practised by in-migrant (settled) Fulani. Historically these are areas of low population density, shaped by waves of in-migration from the 1970s to the 1980s. Stretching within the loop of the Mouhoun River, these areas have a favourable ecosystem for a high density of tsetse flies and high risk of trypanosomiasis. Severe land-tenure problems (because of the presence of protected natural reserves) and ensuing farmer-herder conflicts are frequently reported.

Control operations began with careful consideration of partnership obligations involving several institutions (parastatals, research and development institutions, livestock owners' associations and private veterinarians). Despite the success of tsetse campaigns, several mechanisms put in place to ensure the sustainability of control operations have failed. Although the strategy had elements of a bottom-up approach to facilitate the implication and commitments of community leaders, too much responsibility rested with the community participants with regard to the management of collected funds, deployment of traps and targets including impregnation, repairs and replacement, applications of pour-ons to cattle and sensitization to involve even more people. In the case of the Padema scheme, the main sponsoring agency - the Projet de Développement Rural Intégré - proved its efficiency only at the preparatory and negotiating phase for technical decision support, assignment of tasks and responsibilities among all partners. Much less was invested in the follow-up of actual control operations. The participation of private veterinarians was an innovative action in the tsetse control programme. However, their involvement brought new problems to the surface as profit motives overran concerns for efficiency and sustainability of control operations. Finally, little account was taken of the latent conflicts between agriculturalists and pastoralists. The nature of the relationships between technical personnel and community action leaders changed over time without further incentives given to the former to continue providing quality service and advice.

In summary, T&T control schemes in Burkina Faso, in areas of mixed crop and livestock systems where agropastoralists are indigenous farmers or in-migrant livestock keepers, have shown elements of an original and innovative approach. There are lessons here to be learned on overloading communities with responsibilities as being some of the constraints of bottom-up strategies. There were new and complex problems that emerged from well-intended participation of several partners, motivated by conflicting objectives and approaches to rural development. Settlements of Fulani in agropastoral zones were also an example of the problems that pastoralists face when they settle in tsetse-infested isolated reserves where new infrastructures had to be built. Implementation of the control programme introduced elements of a heavy top-down approach that led to suboptimal organization of the beneficiaries and reduced the efficiency of built-in mechanisms that were intended to improve sustainability of the benefits.

Community-based tsetse and trypanosomiasis control in Côte d'Ivoire

The Tsetse and Trypanosomiasis Control Service (SLTAV), under the Ivorian Ministry of Agriculture and Animal Resources, benefited from long-term external funding (FAO, GTZ) and technical assistance to promote community-based tsetse control and support livestock development activities in the northern and central regions (Kientz, 1993). Since 1978 the project evolved through several phases including:

1. tsetse surveys and mapping in the northern savannahs;
2. research and development of most suitable bait technologies;
3. pilot tsetse control interventions based on odour attractant devices; and
4. extension of the intervention zone in the north and central regions.

Currently, SLTAV operations cover 80 000 km² where some 12 000 to 14 000 traps and targets - the main control technique - have been deployed every year since 1994. More than 80 percent of the national cattle herd are reared in the project area. Implementation of the structural adjustment programme from the early 1990s led the government to disengage from public investments, legalize the veterinary profession and facilitate empowerment of local communities in Côte d'Ivoire. Thus, the current phase that started in 1994 focused on community participation in terms of both labour and financial contributions to sustain the benefits of tsetse control with the participation of the private sector in the delivery of veterinary inputs (Krüger et al., 2001).

From 1996 to 1999 the SLTAV initiated a series of participatory experiments in tsetse control in the northern savannah areas with varying degrees of success. Pilot experiment areas represent about a third of the total project intervention zone with a cattle population of 790 000 of which 80 000 are draught cattle. The majority of the beneficiary population are Senoufo agropastoralists, who are primarily cotton farmers using animal traction and raising a small herd of cattle. The transhumant production system comprises some 3 000 Fulani herders who raise mainly Zebu cattle holding nearly 50 percent of the region's herd.

A recent assessment of the impacts of the sensitization campaign for increased community participation in more than 350 villages indicated that:

1. 26 818 people attended village meetings of whom 34 percent were owners of oxen and only 3 percent were transhumant herders; and

2. full participation by the villagers (purchase, installation, maintenance, repairs and surveillance of traps) was noted in 86 percent of the villages for 5 913 traps and targets out of a total of 6982(Krüger et al., 2001).

The Côte d'Ivoire experience is impressive in the longevity (nearly 20 years) of external assistance to the community for developing a sustained T&T control programme. The biggest concern today turns around the question of cost recovery in the use of traps and targets as control techniques. There are legitimate questions as to what will happen when external funding comes to an end.

East Africa and Southern Africa

Kenya: Busia district

The Busia project was designed to assess comprehensively the feasibility of community participation in tsetse control. The project was to offer insights into the behaviour, aspirations and motivation of individuals and communities during attempts to involve them in tsetse control in order to provide recommendations leading to an appropriate design and improved implementation. The project undertaken by the Kenya Trypanosomiasis Research Institute (KETRI) from 1992 to 1995, was started on the premise that traps and targets had been shown to have the potential for successful and sustainable T&T control by the local communities (Dransfield, Williams and Brightwell, 1991; Okoth, Kirumira and Kapaata, 1991; Leak et al, 1996). However, in the absence of socio-economic and cultural considerations, participation in T&T control remains largely rhetoric.

Busia District in western Kenya is adjacent to the Uganda border to the west and Lake Victoria to the southwest, with the tsetse fly belt of southeastern Uganda extending into the District. The area experienced a severe outbreak of human trypanosomiasis (1987-1990) that remained endemic at a low level (Kamara and Echessah, 1994). Bovine trypanosomiasis is also an important problem with Glossina fuscipes fuscipes as the main species of tsetse involved, and cattle act as a reservoir of human sleeping sickness.

In phase one of the project, the objective was to examine the sociocultural and economic bases of support for community participation in tsetse control in Busia District. Six villages within the district were selected for the study to elicit information on the feasibility of starting the research project in the area, on community-level variables such as social structure and organizations, and on the design and execution of subsequent in-depth investigations. This was followed by community education regarding tsetse, trypanosomiasis and the need for community-based tsetse control. Visual aids and role-play were used. The willingness of households to contribute labour and/or money to tsetse control was assessed (Kamara and Echessah, 1994; Echessah et al, 1997). In phase two the project implemented a pilot programme in two of the six villages - Rukada and Apatit. Several activities were successfully implemented including a series of village barazas (public meetings) to introduce the objectives of the project, further community education, election of tsetse committees, mobilization of the community to contribute resources, training of selected people, trap-site selection, manufacture and deployment of traps. KETRI collected the contributions as payment for the traps.

One of the major impacts of trypanosomiasis as reported by farmers was a reduction in agricultural production because of the reduction in the number of draught animals and manure for use on crop farms. As a result, people reduced their cropped areas, shifted to hand cultivation, and experienced further reduction in crop yields. Loss in income was larger for households that were dependent on the sale of livestock products such as milk, live animals and other farm produce. This affected the nutrition of the farm family, with children being the most vulnerable group. Trypanosomiasis also had a negative impact on the social life of communities, for example on a family's ability to make a dowry payment.

In their review of the Busia case study, Barrett and Okali (1998b) noted that the project was a research rather than a control programme, intended to be a community-based project with a commitment to this objective. Indeed, the community education and dissemination efforts prior to trap deployment successfully increased knowledge about T&T but failed to deliver the message that this was a community-owned programme. There was no apparent sense of ownership of the scheme among the community as the project was seen as belonging to KETRI, and nothing had been done once KETRI withdrew from it.

Kenya: Lambwe Valley

The Lambwe Valley has a total land surface of 324 km² of which 120 km² comprise the Ruma National Park. The Valley is ringed by undulating hills and drained by a number of mostly seasonal rivers. The climate is hot and humid and rainfall ranges from 1 400 mm in the eastern escarpment to between 700 and 800 mm on the western side bordering the lakeshore. The vegetation consists mainly of continuous thickets with dense undergrowth that is particularly suitable as a tsetse habitat. There are about 50 000 to 60 000 head of cattle and a smaller number of sheep and goats within the Valley. Cotton and sunflower are grown as cash crops. Surplus food crops consisting mainly of maize and sorghum are sold for cash. The community living in the Valley is predominantly Luo-speaking River-Lake nilotes. Each family unit has a piece of land usually 3-5 ha for arable farming while cattle of the Zebu type are grazed on communal land not suitable for farming. Such communal grazing land also happens to be a breeding ground for tsetse flies that have moved out of the park.

Both men and women herd cattle with assistance from children during the vacation or when they are not in school. They share all agricultural tasks. These activities bring people into contact with tsetse flies, thus exposing both livestock and people to the risk of infection. Lambwe Valley is an endemic sleeping sickness area in which several attempts to control the vector of the disease have reported success, but this success has been thwarted by recrudescence of residual populations of tsetse (Glossina pallidipes). Lack of sustainable technologies appears to have been the major contributor to failure.

All past control attempts in reducing the tsetse fly population (bush clearing, ground spraying and limited aerial spraying) have reported various levels of success resulting in a decrease in the incidence of both animal and human trypanosomiasis. However, the success was short lived because the residual population of tsetse flies always recrudesced and repopulated the Valley in periods of less than one year. With the advent of bait technology, impregnated targets have been shown to be effective in other areas of Kenya. A variant of this technology is the Nguruma (NGU) trap, developed by the International Centre of Insect Physiology and Ecology (ICIPE) for the control of Glossina pallidipes, and tested since 1988 within the Lambwe Valley. The NGU trap, considered by ICIPE as appropriate for use by local communities, is odour baited with cow urine and acetone and no insecticides are used.

The ICIPE project started in 1992. The project area covered 100 km² in the southern part of the Valley, adjacent to the Ruma National Park. The community referred to in the project has a total of approximately 12 000 people in 1 800 homesteads and 44 villages, of which Mangunga is the largest. The local population was impressed with the apparent success of the NGU trap and approached ICIPE for a permanent trapping programme to be established in the area (Barrett and Okali, 1998b).

The main objective of the trial was to demonstrate that the community could, relying on its own resources, manage T&T control using the NGU trap. Other project objectives included the provision of a framework for dissemination of the trapping technology, crop production and land use, and the training of extension workers. Since the major focus of the project was community participation, ICIPE personnel were to mobilize the community, and provide training and technical assistance; the community would be responsible for purchasing the trap materials, and for making, deploying and maintaining the traps. The community decided to set up a dedicated organization (Kisabe) to manage the control activities.

With regard to community participation, Barrett and Okali (1998b) have shown that there were 720 registered members in the Kisabe organization from a total population of 12 000 in the study area (one member per 2.5 homesteads). The overall project profile was high and its social impacts significant, although there was a clear recognition that non-members have been "free-riding" on the contributions of members. Community time spent on trap maintenance appeared to be considerable and labour demand in tsetse control conflicted with peak labour demand for cropping activities, particularly during the dry season. The homestead capitation fee of KSh150, almost always paid in kind (chickens), could not be collected annually as initially agreed. A widely held view among committee members was that in the long term, the community would be unable to sustain contributions at a sufficient level to ensure cost recovery.

The influence of ICIPE on tsetse trapping activities of the community has been extensive. It is anticipated by the community themselves that their own implementation of trapping activities will become more difficult. At the same time, there was also a determination within the membership that tsetse-trapping activities would continue without ICIPE (Barren and Okali, 1998b).

Community participation and human disease control

An overview of experiences in community participation in the control of diseases other than animal trypanosomiasis is provided as further evidence of the importance of sociocultural factors in ensuring that the benefits society derives from well-designed technical control programmes are sustained.

Tsetse and human trypanosomiasis control with effective and successful community participation has been reported for the forest zones of Côte d'Ivoire (Laveissière et al., 1994) and the Congo (Gouteux and Sinda, 1990). There is consensus that tsetse flies that transmit sleeping sickness can cover very large distances, requiring large-scale utilization of adapted traps (e.g. pyramidal, Lancien and Vavoua types). The success of the Vavoua T&T control programme in Côte d'Ivoire rested on:

1. intensity of the sensitization campaign that took account of socio-ethnic and cultural differences among the beneficiaries groups;

2. technical efficiency of the programme based on the principle of simplicity in design, speedy deployment and low cost of the materials;

3. commitment of the community for long-term organization for servicing and maintaining the traps and targets; and

4. concurrent running of efficacious diagnostic tests and treatments of known cases of human trypanosomiasis.

It is reported that a high level of sensitization and an efficient organization of beneficiaries are among the factors explaining the success of the human trypanosomiasis campaign. Those who have worked with communities in tsetse control in the forest zones of the Congo and Côte d'Ivoire have also warned that once the tsetse population declines appreciably, the interest of the community may wane in the false belief that the war against tsetse is won (Laveissière et al., 1990; Gouteux and Sinda, 1990; WHO, 1999).

Sustainability in T&T programmes to control human trypanosomiasis will depend upon preventive measures to deal with areas where the disease is recrudescent. In addition to financial requirements, it is advised to set up multidisciplinary teams of epidemiologists and socio-anthropologists to sensitize the beneficiary population, plan and execute interventions where necessary, identify and deal with sociocultural constraints impeding implementation of planned programmes and ensure adequate training of personnel (Laveissière et al, 1994).

Community participation is considered to be one of the most important elements for the control of endemic diseases in poor countries, particularly for prevention and epidemic logical surveillance. Mainly affecting the poorest segments of the population, endemic diseases are costly and require specific government action aimed at efficient, egalitarian, universal health systems where community participation acts in a guardian, monitoring capacity and entails other tasks. Several studies were examined for the contribution of sociocultural and behavioural factors in the prevention, transmission and treatment of other human diseases.

Maher and colleagues (1997) evaluated current tuberculosis care in community health-care organizations in sub-Saharan Africa. They found that the strong points of community care organizations that favour a potential role for community participation in tuberculosis control were accessibility and staff motivation. Aryeetey and colleagues (1999) studied the role of health education and community participation in the control of urinary schistosomiasis in southern Ghana. Alves and colleagues (1998) discussed various elements in the analysis of popular views of schistosomiasis in the State of Bahia, Brazil. Both studies concluded that health education was useful in changing community perception on bilharzia, which had often not been considered by the majority as a disease. Rojas, Botero and Garcia (2001) reported the success of an integrated malaria control programme on the Pacific coast of Colombia as largely a result of efforts to mobilize the community in the efficacious use of insecticide-impregnated bed-nets to reduce malaria transmission. The studies reported by Tridech and Liumwarangkul (2000) and Pessoto, Nascimento and Heimann (2001) have provided empirical evidence of how tasks can be appropriately defined and allocated among members in a community participation project to sustain a health programme, for example a rabies vaccine fund in Thailand and local health councils in Brazil.

The scope for public involvement in planning and managing the state's health and social service system can be limited for a developed country situation, particularly in rural areas as public policy moves increasingly towards a retrenchment of the welfare state. Halseth and Williams (1999) examined the case of Elgin, a rural community in Ontario, Canada, that established Guthrie House, a community-based resource centre for health and wellness services. Community participation in this case involved a level of control whereby local citizens together defined the health and social care services that they saw as best meeting the needs of their community. This approach has been perceived as representing a critical link to "empowering" the local community as partners in health care. It was shown as a policy option in health care to which governments should be paying attention.