Abstract
Onchocerciasis, a neglected tropical disease, continues to affect millions in low- to middle-income countries, despite evidence of successful elimination efforts in some regions. The persistence of the disease is mainly due to suboptimal implementation of community-directed treatment with ivermectin programs, a critical component for achieving elimination. To address this issue, we propose increasing ivermectin coverage through health facilities to reach individuals who missed ivermectin during community-directed treatment with ivermectin campaigns. In addition, expanding ivermectin distribution through schools could further improve coverage among children. Health facilities could also play a key role in rapidly detecting onchocerciasis cases and identifying disease resurgence in areas where Onchocerca volvulus transmission has been eliminated. Moreover, health facilities and schools could serve as platforms for health education. Adapting these strategies to local contexts could strengthen the sustainability and impact of national elimination programs.