12 3 4 JOINT PROGRAMME COMMITTEE ONCHOCERCIASIS CONTROL PROGRAMME IN WEST AFRICA Eleventh session, Conakry, Guinea 3-6 December 1990 REPORT CONTENTS OPEI.{ING OF lHE SESSION ELECTION OF OFFICERS ADOPTION OF THE AGENDA ADOPTION OF THE REPOBT OF THE TEIfTTI SESSION OF THE JOINT PROGRAMME COMMITTEE REFLECTIONS OF THE COMMITTEE OF SPONSORING AGENCIES PROGRESS REPORT OF THE IiORLD HEALTH ORGANIZATION FOR 1990 - REPORT OF THE EXPERT ADVISORY COMMITTEE REPORT OF THE EXTERNAL AUDITOR PLAN 0F ACTIoN AND BUDGET FoR 1gg1 AND rTS APPRoVAL FINANCING OF THE ONCHOCERCIASIS CONTROL PROGRAMME 10. EXTERNAL REVIEI{ 0F I"HE ONCHOCERCIASIS CONTROt ppggRr{MME 11. PLAN OF OPERATIONS FOR THE FOURT}I FINANCIAL PHASE(1992-1997) L2. DEVOLUTION 13. PROGRESS REPORT OF THE ONCHOCERCIASIS CHEMOTHERAPY PROJECT(ocr) FoR 1gg0 JPC/Lt Page 2 3 3 4 45 6 7 8 9 5 14 14 L6 t9 2L 14. t5. L6. L7. 18. 24 29 32 37 38 39 t+z SOCIOECONOMIC DEVELOPMENT OTHER MATTERS DATE AND PLACE OF THE TWELFTH SESSION FINAL COMMT]NIQUE CLOSURE OF THE ELEVENTH SESSION OPENING STATEMENT BY DR R.H.HENDERSON, ADG, ON BEHALF OF THE DIRECTOR-GENERAL ANNEX I ANNEX ANNEX ANNEX II III IV AGENDA LIST OF PARTICIPANTS ONCHOCERCIASIS F"IJND 43 46 4t 55 JPC/77 page 2 1. OPENING 0F THE SESSION: Agenda item 1 1.1 The eleventh session of the Joint Programme Committee (JPC) of the Onchocerciasis Control Programme in l,Jest Africa (OCP) was held at the Palais des Nations in Conakry, Republic of Guinea, from I to 6 December 1990. Thefollowing members were represented: the African Development Bank, Belgium, Benin, Burkina Faso, Calouste Gulbenkian Foundation, Canada, COte d'Ivoire, France, Ghana, Guinea, Ita1y, Japan, Luxembourg, Mali, Netherlands, Niger, Norway, Republic of Korea, Saudi Arabia, Senegal, Sierra Leone, Switzerland, Togo, United Kingdom of Great Britain and Northern lreland, and United States of America; also represented were the Sponsoring Agencies: the Food and Agriculture Organization of the United Nations (FAO), the United Nations Development Programme (UNDP), the World Bank and the World Health Organization(WH0), which is the executing agency for the Programme. Two representatives of the Government of Spain attended as observers. WHO was represented by Dr R.Henderson, on behalf of the Director-General of WHO, and by Dr G.Monekosso, Director of the WHO Regional Office for Africa. Members of the Expert Advisory Committee (EAC) and its Ecological Group and two members of the External Review Team attended as ex officio members. Representatives of the Organization for Coordination and Cooperation in the Control of Major Endemic Diseases (OCCGE), the French Institute of Scientific Research for Development through Cooperation (ORSTOM) and of the Mectizan Expert Committee were also present as observers. The list of participants is attached as Annex III. 7.2 The session was opened by Mr I.M. de Jong, Director, Multilateral Development Cooperation, Ministry of Foreign Affairs of the Netherlands, the outgoing Chairman, who began by thanking the Government of Guinea for its hospitable welcome. He congratulated the Programme on its remarkable success inprotecting over l0 million people from onchocerciasis and on its excellent and dedicat.ed nanagement. However, problems still subsisted and it was essential to ensure that residual onchocerciasis activities devotving on the national health authorities after transmission had been interrupted were carried out as part ofhorizontally structured disease control systems with adequate operational budgets. Donors should seriously consider supporting Participating Countriesr efforts to strengthen their primary health care systems. Other important problems were the need to develop an effective macrofitaricide, the adequate financing of the fourth Financial Phase and the environmental repercussions of the Programme's success. 1.3 His Excellency Captain Bago Zoumanigui, member of the "Comit6 militaire de Redressement national", Minister of Youth and Sports, welcomed participants on behalf of the Government of Guinea. The importance of onchocerciasis had been emphasized as early as 7962 by a nission from the Federal Republic of Gernany. In the period 1966-t976 WHO had sent specialists and Canada had supplied equipment that made it possible to determine the geographical extent of the disease and suggest methods of containing it. 1.4 In L977 Guinea sent an observer to the meeting of the JPC in Kuwait and at Bamako in 1978 laid the basis for cooperation on health matters between countries in the Senegal River basin, particularly with a view to incorporating Guinea-Bissau, western MaIi, Senegal and Guinea itsetf in the Programme. 1.5 From 1978 to 1984 Guinea attended all OCP meetings. Field tearns carried out feasibility studies and the Government gave every facility for OCP specialists to carry out their work in Guinea. In December 1985 Guinea was accepted as a menber of the Programme. JPC/tt page 3 1.5 Over two million Guineans were at risk of contracting onchocerciasis and amoD8 them !00 000 parasite carriers and 20 000 cases of blindness had beendetected. The ravages of the disease had 1ed to an abandonment of fertile valleys with severe effects on the economy, particularly in Upper Guinea. L.7 OCP operations had reduced vector density and annual transnissionpotentials. Ttrere h,as a high rate of participatlon in ivermectin distribution canpaigns. As a result farmers had begun to return to the onchocerciasis- controlled valleys. An Environnental Action Plan, backed by the World Bank, was being camied out by the Governnent in an attempt to find ways and neans of ensuring better management of the onchocerciasis-controlled zones. 1.8 Guinea hoped that cooperation and solidarity between the Participating Countries would be maintained through OCP so that they would be able in a fewyears to neet recurrent expenditures after the cessation of external operations. The Government would continue to give high priority to onchocerciasis control in Guinea and would nake every effort to lay a solid foundatlon for devolution byintegrating onchocerciasis control activities into the natlonal health progranne. t.9 He thanked the Progra.nne Director and his staff for the excellent work they were carrying out in the Progranne area in general and Guinea inparticular. He wlshed the participants every success in their work and declared the eleventh session of the Joint Programne Comnittee open. 1.10 rn a personal nessage read by his representative, Dr R.H. Henderson,Assistant Director-General of WHO, Dr Hiroshl NakaJina, Director-Generalr expressed his regret at being unable to attend a session of the JPC that was of special inportance in that it would set the scene for a new and critical phasein the existence of a Progranne which he held in high esteen and whose progress and achievements he followed with great interest. (Ttre furr text of theDirector-General's message is attached to this report as Annex I). 2. ELECTION 0F OFFICERS: Agenda item 2 2.L Dr Madigbe Fofana, Minister of Public Health and Population of the Republic of Guinea, was elected Chairman, and Dr Abdullah Al Owedi, representative of the Government of Saudi Arabia, Vice-Chairman. 2.2 The Chairnan thanked the Committee for the honour they had done his country in electing him to this high office. Onchocerciasis, by reason of itsprevalence, severity and socioeconomic consequences, occupied an important placein communicable disease control in Guinea. His Government would do all in itspower to bring the disease down to a 1evel at which it would no longer pose apublic health problem. 3. ADOPTION 0F THE AGENDA: Agenda item I (document JpC11.1, Rev.l) 3.1 The representative of a Donor Country asked leave to lntroduce under agenda item 16 ("Other mattersrr) the question of earmarking funds for specificpurposes' such as chemotherapy or devolution. In the absence of objections, it was so decided. JPC/L7 page 4 3.2 There being no other comments the agenda was adopted (Annex rr) 4. ADOPTION OF THE REPORT OF THE TENTH SESSIoN oF THE JOINT PRoGRAMME COMMIfiEE: Agenda item 4 (document JpCl1O) 4.f The report was adopted without comment. 5. REFLECTIONS 0F THE COMMITTEE 0P SPONSORING AGENCIES: Agenda item ! 5.L The representative of the world Bank, speaking as chairman of theCommittee of Sponsoring Agencies (CSA), said that over the years OCP had been moulded into a highly effective and efficient operation which had virtually eliminated onchocerciasis transmission in the Original area and showed everypromise of achieving the seme success in the extension areas. 5.2 He wourd like to focus, however, on the question of how to bring the Progremne to a successful conclusion as it evolved from a blackfly conirotprogramme into a multidimensionat development enterprise. 5.3 First and foremost, it lras essential to sustain commitnent to the Programme until it coul-d be brought to completion. The External Review had confirmed the EAC's conclusion that fulI-scate vector control operations in the extension areas would have to continue for at least 14 years after operations were begun; that fact had financial inplications that must be carefully considered at the present session. 5.4 Secondly, the achievenents of the programme nust be safeg,.rarded by neansof an effective devolution process based on developing the healih systems of theParticipating Countrles. OCP was committed to facilitating that process but the magnitude of the efforts required went far beyond what the Programme could reasonably be expected to undertake. The najor responsibility must 1ie with theParticipating Countries, acting in partnership with the WHO Regional Office forAfrica, which had a mandate to improve general heaLth systens. As for ocp, it could perhaps base its transfer of the ski1ls developed in operating a highty specialized programme to the disease surveillance and treatment systems of theParticipating Countries on the establishment of a small Devolution Unit, as hadbeen recommended by the External Review. 5.5 In addition to determining the efficacy of ivermectin treatment over along period and conducting further research on potential resistance to thatdrug, the search for a safe and effective macrofilaricide, must continue.Consolidation of the Onchocerciasis Chemotherapy Project with the filariasis component of the Tropical Disease Research Progrnmme into a single MACROFILproject had been an important step in that direction. Even if a macrofilaricide rdas not developed until after the Progranme had come to an end, it would sti1Ibe an invaluable tool for the participating countries in controlting recrudescence. 5-6 With the second large regional study, the Land Settlement Review, and theinitial round of CSA consultation missions to each of the OCp countries, the CSAprogramme of preparatory socioeconomic development activities, endorsed by theJPc at Accra in 1p86, had now been compreted. cSA should switch over to monitoring the progress of socioeconomic deveropment, including its environmental aspects, and promoting the flow of information so as to support new national- initiatives. The time had now come to move decisively from 5JPC/tL page 5 preparations to actlon. The responsibility for socioecononic developnent nust rest squarely with the lndividual Particlpating countries, supported bylndividual Donors, including the sponsoring agencies. PROGRESS REPORT 0F TIIE trlORLD HEALTH ORGANrZATrON FOR 1tg0: Agenda irem 6(document JPCLL.2) REPORT 0F THE EXPERT ADVISORY COMMITTEE: Agenda item / (document JPC11 . 3 ) 6.t Ttre Prograntre Director said that a feature of the year had been the visitto the Progranne headquarters of the External Review Team, fron whose members he and hls staff had learned a great deal. 6.2 Other speakers had stressed the Programme's successes; he himself wouldtherefore concentrate on the problems it faced, sone of which he had discussed with the President of the Wor1d Bank during his recent visit to OCP and some ofthe villages in the oncho-controlled areas in Burkina Faso. 6.3 A prine source of anxiety had been the faI1 in the exchange value of theUnited states doIlar. when the budget had been adopted, the parity had been 338 CFA francs to the dollar; that had now fa1len by some 25fr to Zit Cpe francs.As over half of all OCP expenditure hras in CFA francs, such a sharp fal1 wasparticularly disturbing. 5.4 The Director had also felt concerned at the inpression he had receivedduring his vislts to Donor countries and contributing agencies that they feltthat OCP had been so successful that it could safely switch to other priorities.However, the President of the tJorld Bank reassured him on that point by pledgingthat support to OCP would continue untll its aim had been conpletely attained. 5.5 The third problem he had nentioned was in regard to what would happen once the Programme cane to an end. 0cp's mandate wis not to eradicate onchocerciasis but to bring it down to a 1evel at which it would cease to be apublic-health or socioeconomic problen. Resldual disease would therefore renain and provision had to be made to ensure that there would be no recrudescence ofonchocerciasis like the recrudescence of malaria in areas fron which lt had beenalmost completely eradicated. Responsibility for that would rest with theParticipating Countries but OCP had contributed by training nationals (over 2OOin Burkina Faso alone), by developing a technology ttat torked (surveiltancetogether with ivermectin treatment) and by work on more sensitive diagnostictools, such as immunodiagnosis, for surveillance purposes, and on finding amacrofilaricide for the purposes of chemotherapy. 6.6 However, the frustrations of devolution were well exenplifled by BurkinaFaso. That country had first subnitted a devolution plan to jpc in f9b5 inAccra; the plan had been approved with provisos and a revised version had beensubmitted in Rome in_1987; more suggestions had been incorporated and finallythe plan was approved by acclanation at Dakar in 1988. Two more years had nowpassed and stil1 no funds had been forthcoming. JPC/tL page 6 Vector control 6.1 1tp0 had seen the cessation of larviciding in 60-70l of the Original Progrnmme area. Vector control operatj.ons were being carried out in the whole of the southern extension together with Guinea and Sierra Leone in the western extension, treated because they contai.ned extensive hyperendemic zones and had been sources of reinvasion for the Original Progrnmme area. In the north of the western extension no larviciding was being carried out, since there were only two sma1l hyperendemic zones, population density was 1ow, there were numerous animal filariae, there was no source of reinvasion and the cost of aerial operations would be prohibitive. Intensive ivermectin treatment was being given instead. 6.8 Temephos was still usable in larvicide rotations in nost of the treated area (801) but the number of cycles had to be restricted because of resistance. phoxim had replaced chlorphoxim. Its short carry, however, made it expensive, although it could be used to advantage for medium discharges in rotation with temephos and pyraclofos. Pyraclofos, a new organophosphorus insecticide, had an excellent carry, thus making it relatively cheap to use despite its high cost per litre. Carbosulfan and permethrin were very effective larvicides but were relatively toxic for the non-target fauna so that they could only be used 1n times of spate and for a small number of cycles Bacillus thuringiensis H-14, which had a short carry and needed to be used in large amounts, vras completely non-toxic and particularly useful for treating strerms with low discharge (Iarge rj.vers in the dry season or smaI1 tributaries in the rainy season). 6.9 An example of larvicide rotation was that practised on the Sassandra at Bac Semien in the COte d'Ivoire. During the low-water period up to the end of May B.t. H-14 was used. When discharge was about !O-100m3/sec chtorphoxim and then permethrin were used. At higher discharges larviciding was stopped because the high-water level submerged the larval breeding sites. lrlhen water leveLs fell again in October-November temephos treatment was resumed. Transmission 6.10 In the dry season out of 1184 females caught in the same week in the whole of the Progrnmme area, 12 were infective. In the rainy season (during the last week of October) only 1p infective females were found smong a total of 3805 caught. Reinvasion 6.LL Larviciding in Guinea and Sierra Leone had resulted in a spectacular fa11 in the number of reinvading flies, bringing the annual transmission potential(ATP) down to practically zero at the classical reinvasion points in Mali and COte d'Ivoire. ldestern Extension 6.12 The results of 18 months' larviciding in Guinea had been satisfactory on the whole. In Sierra Leone there had been only six months of continuous larviciding and while it was expected that the northern part of the country would be clear by the following year, the situation in the forest zone of the south would no doubt be more difficult, since before larviciding began ATPs of 15 000-20 000 infective larvae per person per year had been recorded and Simulium soubrense B transmitted between 10 and 30 times more infective larvae than the savanna species. JPC/LL page 7 Initial Progranme area 5.13 Ttre parasite reservoir in the initial Progra.mne area had been reduced to almost zero. Post-treatnent surveillance had shown, for instance, that atFolonzo on the Upper Cono6, where larviciding had stopped in 1989, the number ofbiting fenales had returned almost to lts former level of about 13 O0O flies perperson per annun but the ATP had falIen to 5 from the former figure of 600infective larvae per person per annum. No transnission had been found anong the 30 000 flies caught in 1990. Epidemloloei evaluation 6.f4 During the past year the Epidemiological Evaluation Unit (EpI) hed either evaruated or treated with lvernectin a total of 2246 villages. 6.t5 Evaluation in the fol1ow-up villages had shown that vector control hadbeen excellent in the Orlginal OCP area, except for the Dienkoa and Kulpawnfoci. Detailed surveys in six river basins in Burkina Faso, C6te drlvoire andGhana had shown successful vector control except in the southern section of theBlack Volta, where sone residual transmission was detected, and in the easternpart of southern C6te drlvoire, where transmission on the lower Bandama had notbeen interrupted. 5.16 In the western extension area the collection of baseline data with a viewto evaluating the long-term effects of mass ivermectin treatment continued. Twovillages with very high community nicrofilarial loads (CMFLs) in the Sankaraniriver basin in Guinea ldere surveyed before the beginning of large-scareivernectin treatment. 6.t7 Seven nore villages in southern and eastern Sierra Leone were surveyed and the results analysed in order to deternine the comnunity pattern of ocular onchocerciasis as a basis for operational decisions on larviciding. It wasfound that the pattern in southern Sierra Leone differed from thal recorded elsewhere in the Programne area, being Inore severe than forest patternsdescribed hitherto but less severe than the savanna pattern. 6.18 The areas found to be at high risk of onchocercal blindness were the upper Niger basin in Guinea, the central southern part of Sierra Leone and threelimited foci on the Ga.mbia, Bakoye and lower Niger rivers. 6.L9 In the h,estern extension some 1.! nillion people were estimated to beinfected, with about 250 000 cases of blindness, qmeng a rural population ofjust under 4.5 mi.ttion. In the southern extension the corresponding figureshrere some 500 000 infected and 12 !00 cases of blindness emongt a ruralpopulation of roughly 1.t mil1ion. 6:?0 Large-scale ivermectin treatnent had covered 257 ooo peopre during l2Sgtgo as against 63 ooo rn 1988/89. coverage in h5perendemic areas was over63/,. en this has been achieved with collaboration and fu1l participation ofnationals fron the Participating Countries. Treatment continued to producedranatic falls in ocular nicrofilarial loads at the outset but after a certai.ntime loads began to climb again. Post control study 6.2L Analysis of evaluation and research data, particularly in regard to epidemiological trends in indicator villages in the initial OCp area, had been anajor activity during the year, with a view to deternining the risks of recrudescence now that larviciding had been stopped. JPC/LL page 8 6.22 Detailed epidemiological mapping fotlowing continuous entomological evaluation and evaluation of the incidence of infection and epidmiological trends in indicator villages provided a basis for tentative cessation oflarviciding. rf after two years vector infectivity hras found to beinsignificant, larviciding would be definitively stopped but epidemiological vigilance would still be essential. 6.23 Models had been devetoped for post control study and provided charts that could be used as a basis for deciding whether or not to continue larviciding in any particular area. 5.24 During the first year post control study, the dissection of parous flieshad shown the level of vector infectivity to be low enough for it to be safe todispense with vector control activities in most of the core area. 6.25 In large parts of the Original oCP area the parasite had been virtually eliminated and larviciding had been halted. The vector had returned but so fartransmission had been insignificant. Adm tration and Services 5.26 The costs of personnel, supplies, utilities and transport had continuedto rise during the report period. 6.27 Personnel costs had risen for various reasons : an increase of 5l inbasic professional salary rates (the first for severat years), regular rises inthe remuneration of general service staff in various countries, post adjustments, pronotions and long-service allowances, an increase in the employer's contribution to the pension fund (a rise from 141 to 15.9,1 of salaryin three years) and increases in various allowances, travel costs, etc. not to speak of the fa1l in the exchange rate of the US dollar. For 1990 the totalcost increase had been 9.1. To meet the escalation in personnel costs, abalanced progremme of staff cuts had been implemented. 6.28 The faIl in the exchange rate of the uS doIlar (by roughly 271 in cFAterms, the cFA franc stiIl being the main currency used I 5tl in 1990) had hadserious repercussions on the progra.mme's budget in 1990. Nevertheless theyear's books would be baranced without any call for extra funds. 6.29 Management seminars held since 1987, the year of the financial crisis,had imbued the whole staff of OCP with a desire io rationalize the working ofthe Programme and reduce its costs to the minimum consonant with efficiency. EAC comments 6.30 The report of the EAC (document JPc11.l) was introduced by the chairmanof that Committee, who said that its June meeting had been preceded by a seriesof field visits over the year and intensive brieiings by ocp staff. 5'3f The Committee had noted with satisfaction that operations had gone fairlysmoothly throughout the year despite rising personnel costs, the fal1 in thepurchasing power of the united States dolIar and the need to buy a moreexpensive larvicide to replace chlorphoxim. JPC/tt page 9 5.32 Larviciding in the extension areas had neant a considerable increase ingeographical coverage, despite the reduction of vector control operations in theOriginal OCP area, yet there had been considerable decreases in the amounts ofinsecticides used and the number of flight hours spent on spraying operations.Strict rotation of larvicides had reduced resistance to a minimun and vector reinvasion had been arrested by larviciding Guinea and in northern Sierra Leone. 6.33 The Conmittee noted with satisfaction that a new aerial contract had been entered into without major problems. 6.34 The epideniological napping in the western extension that was essentiaLfor deternining the communities requiring ivermectin treatment had been completed. 6.35 As had been made clear the previous year, vector control had to renainthe backbone of Progranme operations until such time as an effective macrofilaricide becane available for mass application. That neant that in parts of the extension areas vector control would need to be continued until or aroundthe end of the decade, since 14 years' larviciding were needed to ensure theelinination of the human reservoir of the parasite. 6.10 Epidemiological nodelling had provided a means of predicting the long- term effects of larviciding and ivermectin distribution and of conditions under which a recrudescence uight possibly occur. 6.37 The Committee considered it essential to intensify research on means ofdiagnosing onchocerciasis early enough to detect and forestall recrudescence at a very early stage. 6.38 Ivermectin had been distributed to over 250 OOO people in the course ofthe year. Follow-up studies had reconfirmed that it was safe for nass use andthat annual treatment caused regression of some ocular lesions, but that it wasincapable of preventing or blocking transmission. 6.39 EAC agreed that ivermectln should be distributed for six years in communities in vector-controlled extension areas with a community microfilarialload of over ten, with a vi.ew to preventing or amesting eye disease. Duringthat period, which should be sufficient to reduce the risk of eye disease to aninsignificant Ievel, OCP would continue to provide ivermectin on behalf of theParticipating Countries. 6.40 In the fuII day devoted by EAC to discussing devolution, emphasis waslaid on the important role ocp and wHo/AFRo should play in supporting thecollection and analysis by Participating Countries of information reievant totheir devolution activities. 6.41 Since onchocerciasis surveillance and control following devolution woutdbecome part of an overaLl public health progremme, CSA and IiHO/AFRO would havean iEportant role to play in bringing together Participating Countries andDonors in support of devolution. EAC therefore welcomed WHO/AFRO's increasinginvolvement and urged ocP to continue helping participating countries inpreparing their devolution p1ans. 6.42 ocP had a vitar ror-e to pray in training for devor.ution, since onchocerciasis surveillance was essential for detecting and controlling anyrecrudescence. In that connection the urgent need for a simple, reliable andspecific diagnostic test could not be overemphasized. JPC / tL page 10 6.43 Equally important was the development of a macrofilaricide. CGP 6140 was unlikely to prove suitable for field use because of its toxic side-effects and cumbersome administration schedule. Work was continuing on a potentially superior analogue, which should be available for clinical testing on volunteersin 1!t1. 6.44 After a lengthy discussion EAC had agreed that the 0nchocerciasis Chemotherapy Project (OCT) should become involved in a limited amount of research on biochemical targets in adult worms to facilitate the necessary approaches to industry. The proposal for a combined chemotherapy project between OCP and TDR was welcomed, as vras the suggestion that representatives ofpharmaceutical companies be encouraged to attend meetings of the OCT's Strategic Working Group and Steering Committee in cases where there was no obvious conflict of interest. 6.45 EAC had been presented with a draft PIan of operations for the fourthFinancial Phase (t992-L997 ), which included five policy options. The Committee reviewed the options and decided that only the least expensive variant should befurther considered. That varj.ant provided for an nmount of roughly US $153 million for the six-year period, plus an additional US $2 3OO OOO annually for OCT proposed by OCP, bringing the total cost very close to that of the thirdFinancial Phase. 6.46 EAC considered the PIan of Operations sound, but noted that it was based on no larviciding in the northern part of the western extension area and on the assumption that all OCP general service staff in the Original Programme area andthe southern extension area would be employed and paid by the ParticipatingCountries concerned. 6.47 EAC considered that any lower 1evel of funding would jeopardize attainment of the Progrcmme's objective. 5.48 EAC wished to emphasize once more the need to pursue the search for newlarvicides and improved fornulations of existing ones, and to intensify effortsto develop an effective nacrofilaricide and a sensitive and specific diagnostictest to detect infection at an early stage. 6.49 Final1y, EAC recommended that the Programme objective be redefined as "toeliminate onchocerciasis as a dj.sease of public health importance and as an obstacle to socioeconomic development throughout the Progremme area and to ensure that the Participating Countries are in a position to maintain this achievement. rl 6.50 The Chairman of the Ecologicat Group reported that at its February meeting the Group had examined the results of the monitoring of the aquatic environment carried out by OCP and the national teams and had concluded that thelarviciding operations carried out by OCP had had no detectable long-term adverse effects. 6.5L The Group had been particurarly pleased with the work done by the national tenms and with the interest they had shown in monitoring the aquatic environment. To enable the national hydrobiology teems to do their work evenbetter, institutions other than OCP should contribute to research and training on a multilateral or bilateral basis. JPC/Lt page 11 6.52 OCP was to be congratulated on its efforts to safeguard the non-targetfauna. Close cooperatlon wLth VCU would help to reduce the impact on the sprayed areas of the insecticides used. 6.53 The Group echoed EAC's reconmendation that the search for new effective and safe larvicides should continue and would particularly welcome improvedformulations of B.t. H-14. 6.54 After examining the first results of spraying with pyraclofos the Group had recommended its use in the field but had urged OCP to undertake intensified monitoring of its effects at selected monitoring sites. 6.55 Since the pyrethroids ldere generally toxic for the non-target fauna, the Group recommended that permethrin be used only in the rainy season and for alimited nunber of cycles. The prolonged use of permethrin in special circumstances in certain zones had shown that it represented a real danger tothe aquatic environnent. 6.56 0n the Group's reconnendation, monitoring data were now being compiled and analysed at ouagadougou. That meant that biostatistical skills had to be availabLe and that consultants would be needed to undertake Eore detailed analyses at 0uagadougou in liaison with the national tenms and the ocphydrobiology tean. 6.ll The Group had been pleased to note that OCP was now publishing a regular annual survey of the results of aquatic monitoring. However, the Group also considered that OCP should publish the results of research on insecticidetoxicity for blackfly and the non-target fauna so that the knowledge and experience gained could be put to good use by other vector control progremmes. 5.58 Atthough the Group's mandate restricted it to evaluating the effect ofthe pesticides used on the non-target aquatic fauna, it could not remainindifferent to general environmental issues, such as the impact on the rivers of agricultural chemicals and the deforestation that sometines accompanied resettlements of the onchocerciasis-controlLed valleys. While it was not for OCP to finance studies of such environmental impacts, the Group would welcome any initiatives in that direction from Participating or Donor Countries thatfollowed the excellent exa.nple set by the Netherlands, which at the beginning of 1990 had sent a nission to the Programme area to study the secondary effectsthat onchocerciasis control activities might have on the environment. Role of WHO/ AFBO in devolution 6.59 The hlHO Regional Director for Africa said that for over three years theReglonal Office had been actively seeking for ways and means of collaborating with OcP on devolution. rt was partry with that in mind that Sub-region 1 headquarters had been established at Banako. 6.60 He proposed that until such time as the suggested Devolution Unit hadbeen established, OCP should appoint a task force to discuss practical aspects of devolution with AFRO. He himself would appoint an epideniologist to nanage cooperation with ocP on devolution, to be based either in Bamako or in Ouagadougou. JPCILL page t2 6.6t Ways must be found of gradually transferring OCP's costly and complex technology to the peripheral health services in the Participating Countries so that the process could be completed by the time the Programme cnme to an end. That meant that efforts to strengthen those services, already actively pursued by the Regional Office for the past six years, would have to be further intensified, with particular emphasis on conmunity participation and multisectoral coordination. 6.62 The health teams at the periphery were already responsible for EPI, diarrhoeal disease control, schistosomiasis control and many other activities. Their assumption of responsibility for onchocerciasis surveillance would make it essential to give them a solid grounding in epideniology and the chief physicians of the health districts would also have to receive supplementary training. 6.63 The WHO country teaos which had been established contained a certain number of specialists who would cooperate with national personnel in carrying out the devolved tasks already defined by OCP with the support of the OCP devolution task force in the areas where it was decided to implement surveillance activities first. Those areas would be gradually expanded until the whole of the country concerned was covered. 5.64 Obviously the Participating Countries would need financial support, technical advice and aid in training from Donors. He hoped that by the twelfth session of the JPC it would be possible to present concrets s>(qmples of how devolution was working in practice. Discussion 5.65 Following discussion of the Progress Report of the World Health Organization for 199O and the Report of the Expert Advisory Committee and in reply to questions fron JPC participants, the following comments and clarifications were made. 6.66 I'Jith regard to the environmental impact of the Progrnmme's success, it was pointed out that while the Ecological Group r,eas empor,r,ered to deal only with the aquatic environment, it was nevertheless very concerned with the environmental effects of population pressure in the oncho-controlled va11eys, with its potential for increased erosion and deforestation, and with the wider problem of depletion of the groundhrater reserves and the tendency for the rivers and streams in West Africa to dry up. 5.67 The Chairman of the EAC stated that the Committee had not yet been able to discuss the report of the External Review Team, but his personal view was that it reinforced EAC's belief that the Progremme was going the right way towards attaining its objectives. On the specific point of including in the EAC three or four experts on various aspects of devolution, he himself thought it might be preferable for them to work as a separate group in close liaison with EAC instead of an integral part of it. 6.58 It was explained that only one option for the fourth Financial Phase out of the five put forward had been tabled for discussion by the JPC, because it was felt that the cost of the other four would have been unrealistically high. 6.69 With regard to the budget for OCT in Phase IV it was felt that OCT could use to advantage much larger sums than those at present envisaged, in the search ?';r 'an effective macrofilaricide as could the search for DNA probes and other)'ali'caLic too1s. Although in research nothing h,as guaranteed, more money would ncqts. pr.)bably increase the chances of success. JPC/L7 page 13 6.lO 0n the question of whether it would not now be more rational and economical to eschew costly larviciding operations in favour of nass ivermectin distribution, it was pointed out that ivermectin did not interrupt transmission. Epidemiological modelling had shown that at least 14 years' larviciding was needed to achieve that end and to reduce the risk of recrudescence to a minimum. Moreover, larviciding had been calculated to cost between fifty cents and a dollar per beneficiary per year, as against at least US $3 for ivermectin, and could be Linited to 14 years, whereas if ivermectin alone was used it would need to be administered regularly for an unlimited time. 6.7L With regard to "black spots" at Asubende and in the Kulpawn basin, it waspointed out that once larviciding had been resumed after an interval for testing the effects on transnisslon of ivernectin distribution a1one. the problem at Asubende had been eliminated. In the case of the Kulpawn basin, larviciding in the southern extension had put an end to reinvasion and therefore to thedifficulties previously encountered there. 6.72 It was very unlikely that foci of onchocerciasis could subsist inisolated remote villages and thus possibly give rise to recrudescence. The OCP's aerial mapping operations pinpointed the rapids on streans throughout the OCP area and ground reconnaissance was carried out in the dlstricts round everypotential breeding site, thus making it unlikely that even the most remote village would be nissed. 6.73 Concerning operations in northwest Ma1i, it was stated that although the annual transmission potential was high, the population r,ras sparse and cattle nurnerous, with the result that blackflies took their blood meals uainly from animals and the risk to hunans was Iow. It had therefore been decided to stoplarviciding, which was not cost-effective, and rely on ivermectin distribution alone. Localized larviciding on the ground could prove a cheap and effective supplementary method. 6.74 It was considered unlikely that reinvasion could take place from a focusin Nigeria along the Benin border. A close watch was being maintained on the situation. 6.75 It was stated that the aerial contract had been put out to international tender and that costs would be higher than with the superseded contract. Pilot turnover had decreased and a great deal of effort had been put into making conditions more attractive for the contractors' staff. 6.76 It was explained that the vehicle accident rate always increased at thebeginning of operations in new areas but were brought down by enlisting the cooperation of national governments, introducing allowances for years of safedriving, etc. 6.ll Assurance was given that the reduction in personnel by 3Ol in three yearshad been at no cost in efficiency. Sone of the savings had been nade by contracting out activities, particularly those of a seasonal nature. The staff was now working to the absolute limit of its capacity and it rivas to be hopedthat no nore cuts in personnel costs would be cal1ed for. 6.lg rt was explalned that the proposed redefinition of the programme objective was intended to make it more logica1. The Programre corrld not ensurethat recrudescence woutd not take place but it could make certain that countries were in a position to deal with it if it arose. JPC/rL page 14 6.79 It was pointed out that onchocerciasis control would continue to be considered as a priority in the Participating Countries because of its importance for the prevention of blindness and the promotion of socioeconomic development. 6.80 It was felt that an inventory of existing disease control programmes into which onchocerciasis surveillance could be flitted after devolution would be useful. Likewise, ways of intensifying information exchange between the Participating Countries themselves and between them and the Donors and Sponsoring Agencies nust be found. 6.81 trt was stressed that national teams had indeed made a praiseworthy and capital contribution to census-taking, epidemiological surveying, ivermectindistribution and subsequent monitoring and evaluation. The Participating Countries were doing sterling work in seconding national staff, despite the constraints laid on them by economic structural adjustment plans. 6.82 It was pointed out that when larviciding operations ceased and btackflies were allowed to repopulate the rivers, it was not within the mandate or budgetary capabilities of OCP to conduct nuisance abatement operations. Local ground control could be conducted by the Participating Countries if it was considered necessary to alleviate such nuisance. REPORT 0F THE EXTERNAL AUDITOR: Agenda item 8 (document JPC11.6) 7.1 The External Auditor had examined the Status of Funds Statement and Annexes of the Onchocerciasis Control Programme and found them to be in order. 7.2 The Director of the Programme expressed his gratitude for the continued cooperation of both external and internal auditors and their invatuablefinancial advice to the Programme. 7.3 JPC noted the report of the External Auditor. PLAN 0F ACTION AND BUDGET FOR 1991 AND ITS APPROVAL: Agenda item !(document JPC11.4) 8.1 The Chief of Administration and Management said that the proposed budgetfor 1tp1 was the last budget of the third Financial Phase, whose financial objective had had to be revised from US $133.6 million to US $182.5 nillion(Iater brought down to t8O mitti.on) in view of temephos resistance in the savanna b1ackfly, the falI in the purchasing power of the United States dollar and the increased cost of goods, services and personnel. An economy drive in all domains had ensured that, although the 1991 budget h,as higher than its predecessors, the forecast expenditure of US $180 million for the third Financial Phase as a whole would not be exceeded. 8.2 There was no change in the structure and presentation of the budget document. In Chapter 4 figures were presented first by Progranme activity, then by category of expenditure. A table in paragraph 4.10 summarized the staffingposition throughout the phase and showed a decrease in personnel numbers from a peak of 789 in L9B7 to 553 in 1991, a reduction ot 3O'1. The figures referred to !iHO/OCP staff in the Original Programme area and the southern extension. PersonneL in the western extension were paid by their governments but received from OCP a flat allowance as well as per diem when they travelled outside their duty stations. Chapter ! presented an analysis of each Programme activity, with an explanation of the sums required. 8 JPC/tL page 15 8.3 One of the factors responsible for the increase in the budget for 1991 was the dollar exchange rate, particularly in relation to the CFA franc, which in 1tp0 was the currency used for 5tl of OCP's expenditures. Personnel costs had also risen, notably because of the increase of 5l (the first for a considerable tine) in professional base salaries and regular increases in the rates for general service personnel in various countries. Ttre US dollar exchange rate also affected personnel costs (more dollars being needed to maintain salaries at their existing local levels), as did increased employer contributions to the Pension Fund, post adjustments, promotions and travel and other accessory expenditures. 8.4 The value of larvicide stocks in 1990 had been the lowest for any year in the third Financial Phase and increased expenditure would be needed in 1tt1 to maintain reserves at a safe operational leveI. Discussion 8.1 The Progranme Director thanked the participants for their appreciative remarks regarding the clarity and transparency of the docunent before them andfor their declarations of general approval for the budget. During the discussion a number of points were brought up and answers were provided to a series of questions. 8.6 As regards the possible use of a basket of cumencies for budgetary purposes instead of the united states dollar alone, the representative of the World Bank explained that such a solution would cause nany problems, nulticurrency management belng reserved for funds of a billion dollars or more. He would undertake, however, to raise the question of elininating the double levying of exchange fees that occurred when contributions in national currencies rdere converted into US dollars upon receipt by the World Bank and then later reconverted into CFA francs or other cumencies used by the Progra.mme. Fo1lowing an intervention by Legal Counsel, it was agreed that the currency problem could not be solved by OCP alone but was a natter for discussion by the multilateral agencies and the World Bank. Also it was explained that unused balances were retained by the World Bank as a contingency reserve and could be rolled over into the fourth Financial Phase. 8.1 The decrease in the amount allocated for socioeconomic development tas due to the fact that the JPC in 1985 had decided that Progrnmrne support to activities in this field would become the responsibility of the CSA, OCP therefore retaining only one person for liaison work. In respect of such developnent the country offices of the World Bank, FAO and LJNDP were in fact much more conpetent and much better endowed with resources than OCP could ever hope to be. 8.8 Concerning the low percentage of women on the staff of OCP, the Progranme Director stated that he had again appealed to the Participating Countries to propose more hlomen candidates but the response had been poor. The sane applied to the scholarships available, although the scope and number of training opportunities were discussed between OCP and the Participating Countries withparticular emphasis on devolution-oriented disciplines. Discussions had been held with a Donor country on h,ays and means of strengthening training in epidemiology in !'lest Africa. JPC/tL page 16 8.9 The Director of the Programme confirmed that the supplement payable to staff placed at the disposal of OCP by the governments of the countries in the Western extension area would continue to be paid during the fourth Financial Phase. Moreover, it would be necessary to harmonize employment conditions of Progranme staff in the Original OCP area with those applying in the Western extension area. In the Original area the staff was employed by WHO under the sane conditions as those offered by other UN agencies in lrJest Africa. Such harmonization would mean less advantageous employment conditions for the staff concerned. The Progranme Director indicated that it would not be an easy task as OCP work was extremely demanding and Programme staff in the Original OCP area coming under these new conditions of employment might choose other options than working for the Progromme. He would willing1y undertake an in-depth study of the situation. 8.10 Assurance was given that means were being explored of combining ivermectin distribution with other health activities, such as the EPI, vitamin A di.stribution, leprosy and tuberculosis control, etc., with a view to reducing costs to a minimum. B.ff Regarding the increase in the allocation for stocking larvicides it was recalled that permission had previously been granted by JPC to order larvicides in advance for the coming year. It was impossible to forecast with precision what arnounts would be needed, since much depended on the weather, the heaviness of the rains, resistance and other unpredictable factors. Some latitude was therefore necessary in order to guard against the unexpected. 8.tZ It was explained that the Participating Countries contributed to the oCP in cash and in kind and that it was often very difficult to express in dollars the contributions made in kind. However, an attenpt would be made to reflect such contributions in future budget documents. 8.13 Recently a particular effort had been made to work out an informationpolicy with the National Onchocerciasis Committees. A document would be submitted to the JPC at its twelfth session. The vacancy for an information officer that appeared in the budget was due to internal technicalities: the post was actually filled. 8.14 Concerning the 1evel of support costs, Chief, Administration and Management, stated that it was their percentage expression that had risen from 1987 to 1p8p, not actual amounts. If operational costs decreased, as had been the case in 1989 when the number of hours flown in larviciding operations had been much less than forecast, the budget percentage represented by support costs was artificially magnified. He had calculated figures of 11.61 for 1990 and 77.5/. for 1991. 8.15 The Plan of Action and Budget of US $ 34 355 OOO for 1tp1 was approved 9. FINANCING 0F THE ONCHOCERCIASIS CONTROL PROGRAMME: Agenda item 10 9.1 The representative of the grlorld Bank said that the total financing available for the third Financial Phase was projected to amount to US $180 million by the end of 1!t1 on the basls of recent exchange rates. Expendituresfor Phase three were projected to reach the sane amount. Provided. therefore, that all Donors fulfilled their commitments, the third Financial Phase would befuI1y financed. 9.2 The Donors were to be congratulated on having provided since 1p8/ some US $30 million in additional funds, thus overcoming the major shortfall that had occurred in the first half of the Phase because of the emergence of blackfly resistance, the falI in the doflar's exchange value and the extra money needed JPC/LL page 17 lras also to be congratulated for having economized to such an extent as to keep within the estimated expenditures laid down in the revised Plan of Operations adopted ln Dakar in 1988. Finally, congratulations were also due to theParticipating Countries for retaining the Progranme as one of their highestdevelopment priorities, thus reinforcing Donor commitment to OCP and helping to ensure full funding. 9.3 The total funding available for the third Financial Phase was obtained by adding together Donor contributions, expected to emount to US $1!p million bythe end of 1991, interest of $8.! million to be earned on cash balances duringthe phase, and $12.! million drawn fron the reserve in the course of the sixyears. 9.4 - Expenditure during the third Financial Phase was expected to total US $180 million. In 1989 OCP had underspent its budget by nearly US $5 millionbut the savings had been largely offset by increases in the 1!!1 budget. 9.5 The fact that the total cost for the third Financial Phase had been some 301 hisher than the cost forecast in 1985 had been largely due to unforeseen and unavoidable circumstances. 9.6 Moreover, OCP could be considered a cost-effective programme, sinceprojections continued to show that average costs of OCP ope"aiiorrs per personprotected per year over the life of the Programme were below one dollar. 9.7 It was estinated that the reserve balance at the end of 1!!1 would be atleast US $10 nillion, provided that there h,ere no wild currency iiuctuations or unforeseen emergencies. It was hoped that it could be retained as a safety netduring the transition between phases three and four and would ultinately becomethe contingency reserve for the fourth Financial phase. 9.8 It was encouraging to note that 14, or three-quarters, of the 1! originalDonors had made supplementary contributions and five new Donors had joined theProgramne since 1987, the latest being Portugal, to whose representalives he extended a warn wercome. He extended a warm wercone arso to the tworepresentatives of Spain who were attending as observers and hoped the programne would soon be welconing Spain as a new Donor. 9'9 As pledged in 1988, the World Bank would maintain its contribution at thehigher level- of US $2.! million for 1!g1, thus bringing its total contributionto the third phase up to US $14.! million, as againit tt. US $13 nillion pledgedat the beginning of the phase. 9'10 The representati.ve of the Netherlands congratulated the world Bank on itshandling of the crisis caused by the funding stroitratt and announced that hiscountry's final contribution to the third Phase would be paid during the currentweek, bringing the total for the phase up to l2 million guirders. He urgedDonors to pay their contributions promptly. 9'7L The representative of Norway confirmed that, subject to parliamentaryapproval, Norway would provide one million Norwegian kroner for 1991, thusbringing lts totar contribution to the third phale up to 22 million Norwegiankroner. 9'L2 The representative of the Calouste Gulbenkian Foundation said that itscontribution for 1t!1 would be US $75 OOO. JPC I tr page 18 9.L3 Ttre representative of the United Kingdom of Great Britain and Northern Ireland said that, although changes in the budgetary cycle made it impossible to give an exact figure, the contribution for 1991 would at least equal the 1990 level of t900 000. Moreover, he could confirm the United Kingdom's continuing commitment to the Programme during the fourth Financial Phase. Finally, like the World Bank, his government hras strongly opposed to the earmarking of contributions for specific OCP activities. 9.14 The representative of the United States of America pledged a sum of$2.5 million for 1991, bringing its contribution to the third Financial Phase to some US $21 mi11ion. He was convinced that the United States would continue its support at the seme or even a higher leve1 in the fourth Phase. 9.15 The representative of ltaly confirmed that his Government would be contributinB 3.3 billion Italian lire, or roughly US $3 million, for the year l99O-799L of the third Financial Phase. 9.L6 The representative of the World Health Organization said that it was committed to contributing US $500 O00 per annum during the third Financial Phase. The Organization was facing a profound budgetary crisis for the t99O-L99t budget period and had fallen behind in its contributions. In the Director- General's statement, read at the opening session, emphasis had been laid on WHO's continuing technical and financial commitment to the Progranme. Aflter the neeting he would be discussing with the Director-General how the Organization could honour its financial commitments despite the severe current budgetary constraints. 9.17 The representative of the Grand-Duchy of Luxenbourg announced a contribution of 8.5 mittion Luxembourg francs for 1991, bringing the total contribution during the four years Luxembourg had been a menber of the Progremme up to 25.5 million Luxembourg francs. 9.18 The representative of Switzerland said that her country's final contribution for the third Financial Phase had already been paid, bringing the totat for the Phase to 2O.5 million Swiss francs, as pledged. Switzerland would continue its support for OCP during the fourth Financial Phase. 9.t9 The representative of Canada said that her Government hoped to maintainits 1991 contribution at roughly the sane level as that for 1990, which had already been higher than envisaged at the beginning of the phase. 9.2O The representative of Belgium said that her Government would contribute 3.2 million Belgian francs for 1991, subject to parlianentary approval. 9.27 The representative of France said that his country's contribution for 1pp1 had already been paid, bringing the total for the third Financial Phase to 4.5 mi-tti.on French francs. France would continue to support the Programme, in addition to considering support for devolution on a bilateral basis. 9.22 The representative of the Republic of Korea ptedged a further US $50 000 as his country's symbolic contribution to a highly successful and well-managed Programme. 9,23 The representative of Saudi Arabia announced a contribution of US $2 mlllion for 1991, making a total for the third Phase of 10 million US dollars. 9.24 The representative of Japan said that a precise figure for his country's 1991 contribution would be announced later. JPC/Lt paSe 19 9.25 The representative of the African Development Bank said that it would maintain its total contribution of about 1.58 million units of account for the third Financial Phase, payable at the rate of 280 000 units of account per annum. He ca11ed upon countries with devolution plans to submit requests for the strengthening of institutions, to which the Bank would give close consideration. 9.26 The representative of UNDP said that it had provided US $7 750 OOO duringthe third Phase, making OCP one of the largest beneficiaries of the African Regional Programme, and would continue its support during the fourth Phase. 9.27 The representative of FAO said that although his organization nade nofinancial contribution to OCP, it would continue to support the Progranme by all the means in its power. 9.28 The representative of the World Bank announced that the Commission of European Communities had pledged a sum of 900 000 ECUs for 1991. In addition,Portugal, a new Donor Country, had pledged US $50 000 for 1990. Fron the information at present available, therefore, it seemed that the thlrd Financiat Phase would be ful1y financed. 10 EXTERNAL REVIEW OF THE ONCHOCERCIASIS CONTROL PROGRAMME: Agenda iten 11 (document JPC11.9) 10.1 Ttre Leader of the External Review 1sam, introducing the report, said thatprotection of the oCP's very considerable achievements would require continued conmitnent of the Donors to a Progra.Eme strategy based on a ninimun of 14 years' vector control operations fron the start of larviciding in any given area and the future targets for vector control wouLd be the extension areas with the double purpose of protecting the populations concerned and controlling the sources of reinvasion into the Original Progranne area. LO.2 The Progrnmme's success could be ascribed inter alia to the clear def'inition of its objectives, a realistic time-frnme for attaining them and ajudicious choice of the technolog.y required. 10.3 The Programme, the Sponsoring Agencies, Donors and the Participating Countries should now turn their attention to devolution and especially to thefinancing and institutional strengthening required for carrying it out. OCP should thus establish a new Devolution Unit, with a staff of three or fourprofessionals, to assist Participating Countries in preparing plans for the development of human resources, providing training in multi-disease surveillance and drug distribution, planning for the eventual absorption of OCP-trainedpersonnel in national structures and giving technical assistance in regard to many other aspects of onchocerciasis control- after cessation of transmission. 10.4 A number of research topics in regard to devolution should be studied, such as the impact of ivermectin on transmission if real recrudescence occurred, the relative effectiveness of alternative schemes of ivermectin distribution, the safety of the drug if it were adninistered more frequently, the effect of more regular treatments on transmission, potential ivermectin resistance and ways of detecting it, general health systems research in the Participating Countries and the development of a highly specific and sensitive immunodiagnostic test to detect low 1eve1s of infection. The impact of the results of such studies on computer models shoutd atso be studied. JPC/7L page 20 tO.5 The gnchocerciasis Chemotherapy Project (OCT) had been of great value in bringing about the use of ivermectin in humans, including arranging for field trials in preparation for selective large-sca1e treatment of onchocerciasis.gCT's primary objective, however, lvas to search for an effective and safe macrofilaricide and as nany compounds as possible from as many pharmaceutical sources as possible should be screened. The new OCP/TDR MACROFIL Project was a positive step but nust not be allowed to water down OCT's basic objective or to reduce its present flexibilitY. 10.6 When OCP was drawing to a close, an intercountry facility would be needed to ensure intercountry cooperation and undertake tasks beyond the capacity of individual Participating Countries. It would, for example, monitor epideniological trends throughout the Progranme area, coordinate the efforts of regional institutes conducting onchocerciasis research, assist in data processing and storage, help countries determine needs and priorities, arrange for training, review research and disseminate information. 10.7 Since the capacity of the Participating countries to develop the onchocerci.asis-controlled areas was limited, the CSA, interested Donors and the Participating Countries, on the basis of the socioeconomj.c reports produced by the CSA, should jointty support socioeconomic development planning and progrannes for those areas and ensure their integration into the broader national development strategies of the individual countries. 1O.B The growing importance of sociat and nanagement issues for the future of onchocerciasis control in the region should be reflected in the compositlon of EAC, which should be strengthened by the addition of new members with extensive experience in public health programmes (especially drug delivery systems), training and institutional development and the social sciences (particularly in regard to community mobilization) . Discussion 10.9 Attention was drawn to the probable long time-sca1e for developnent of a macrofilaricide, possibly going beyond the turn of the century. as such a weapon would stil1 be needed after the Progranme had come to an end in order to deal with any recrudescence of the disease. 10.10 The inportance of the radio network used to maintain contact between OCP headquarters and all operational centres was stressed and it vras suggested that the network be kept in being after the end of the Programme as part of a coordinated system for monitoring surveillance activities and detecting recrudescence. Similarly the computer systems and databases could be used for many purposes in addition to the storage of hydrological data and predictive epidemiologicat modelling. They would provide invaluable information for the Participating Countries and research institutions in the region and elsewhere. The proposed intercountry facility could take over responsibility for maintaining the equipment and systems on the basis of an international agreement. 10.11 The epidemiologist of the ExternaL Review Team emphasized that in the Team's view there was no antithesis between larviciding and ivermectin distribution - both were essential to the Programme's success. He also stated that the Team had been struck by the excellence of the work done by the Ecological Group. More decentralization would probably be beneficial and field workers should be given better means of interpreting the data obtained, a point that would be particularly important in the context of devolution. Furthermore, it was essential from the ecological point of view not to yield to the tenptation in times of financial stringency to purchase larvicides that were cheaper but more toxic for the fauna. JPC/tL pase 21 LO.t2 Ttre epidemiologist of the External Review Team, finally, stressed the role played by information. The excellent systen established by BIS, with itslong-tern series of validated scientific data of high quality, would probablylong outllve the Programme itself. It gave an overall view and should be expanded to cover the health situation as an aid to the decision-makers. The research Lnstitutions in the subregion would be strengthened by the availability of that system and by the skills developed under the aegis of QCP. They wouldthus be able to undertake contract work on onchocerciasis surveillanceintegrated into a horizontal systen of disease control services, on the ecological inpact of control tneasures and on other aspects of public health. 10.13 It was decided to accept the recomnendations of the External Review Tean in principle, on the understanding that modifications might be necessary when the budgetary implications had been clearly determined. Some of the recommendatj,ons would have to be considered when the legal instrument that wouldform the basis of the fourth FinanciaL phase was being discussed. 11. PLAN oF OPERATTONS FoR THE F0URTH FTNANCTAL PHASE (L992-t997)z Agendaitem 12 (docunent JpC11.10) 11.1 The Progrqmme Director said that the docunent before the menbers of theCommittee was a draft on which their comments were invited. The final plan ofOperations would be submitted to the JPC at its twelfth session and would takethose comments into account. 71.2 The Plan covered the period t99z-L997, in line with the long-termstratery, and its implementation would be flexible in order to meei any changesthat night occur in the operationar environnent during that period. operational and applied research wourd be continued for the purpose ofconstantly improving cost-effectiveness. Larviciding would remain theexclusive means of transmission control, and large-slale ivermectin distributionfor norbidity contror would be intensified in the areas selected onepidemiological grounds. 11.3 Larviciding would stop at the beginning of the fourth phase in the wholeof the Orlginal Progrnmme area except for the previously reinvaded area and afew clrcumscribed foci. In the extensions it would continue, except in thenorthern part of the western extension, where the najority of the larvaetransmitted were animal filariae, the cost of aerial operations was excessiveand the endemic foci were not sources of reinvasion. In that zone ivermectintreatment would be intensified. 11.4 Priority would be given to devolution and the comnents of the ExternalReview Tean and of those who had spoken on the subject during the previous trdodays would be given thorough consideration, as would the establishment of aDevolution Unit. 11'5 In that connection he confirmed that the radio-communication system couldbe of considerable assistance to subregional work in West Africa. AI1 its staffwere Africans from the Participating Countries, as were al1 the computer staffexcept for the Chief, BIS Unit himself. Acceptance of the radio "y"t", underdevolution wourd require poritical approvar, since it had been set upspecifically to meet OCp needs. 11'6 Every effort wouLd be made to harmonize employment conditions for staffthroughout the whore OCP area, a difficult problem tL solve which would requirethe cooperation of aI1 the participating Countries. JPC/Lt page 22 L7.7 The 1991 document on the fourth Financial Phase would include a concise summary, comprising costs, of what had been achieved in each of the first three phases, and the budget line on devolution that had been removed at the request of one of OCP's comnittees would be reinstated. 11.8 The estimated costs of aII the various activities had been tabulated in the document before them. CSA would be studying the reconmendations of the External Review Team and their financial implications. The figures in the Plan hrere not final and costs would be kept down to the lowest level compatible with efficiency. Discussion LL.9 In response to concern expressed about the high proportion of the budget spent on staff costs, it was explained that the proportion of these expenditures was likely to decrease throughout the fourth Financial Phase. Staff costs in absolute term would also diminish the increase in personnel costs as a percentage of the total was largely due to the decrease in the cost of larviciding. It was further pointed out that in any case salary levels were ultimately decided not by OCP but by the United Nations General Assembly. To alleviate the burden of staff cost every effort would be nade to dispense with posts when they became vacant by reorganizing the activities concerned and subsector offices woufd be closed th,o years after larviciding in their areas ceased. Harmonization of staff conditions throughout the Programme area should also produce savings. 11.10 OCP's conmitnent to harnonizing staff conditions throughout the Progranme area was welcomed by representatives of Participating Countries. The Programme Director underlined that the work being done by national staff had been highly satisfactory. He also stated that in countries with part of their territory in the core area and part in an extension area the present differences in staff conditions could be ironed out when the fourth Financial Phase began and the necessary statutory basis for harmonization had been laid. 11.11 It was explained that the Plan made no provision for the proposed Devolution Unit as the External Review Team's recommendations had not been to hand when the document was prepared. t1- .lz It was agreed that training facilities would have to be expanded in order to prepare for the insertion of residual onchocerciasis control in multi-disease progra$mes when devolution took place. In view of the need to strengthen training institutions and programmes in West Africa, a task that feII largely outside OCPs present mandate, it was nevertheless true that greater budgetary resources would be needed. 11.13 As for the r61e of the Regional Office in devolution, the Regional Director had just the previous week undertaken further commitments in that respect and AFR0 and OCP headquarters would be trying to define the activities involved. In addition, devolution activities would be coordinated with the health programmes of other agencies, such as UNICEF. 11.14 Insofar as health education of the public would become increasingly important as the flies began to return such education shoufd be based on enhancing community awareness of the facts. In this regard, continuing dissection of the blackfly by OCP staff would provide a safeguard against transmission. The Programme Director appealed to the Participating Countries to reactivate their national- Onchocerciasis Commj-ttees, one of whose statutory tasks was precisely to conduct public information campaigns on all aspects of onchocerciasis. JPCltt page 23 7L.L5 It was explained that an onchocerciasis control progranne was being carried out in the Sota valIey focus in neighbouring Nigeria and would help toprotect that flank. 11.16 The Comnittee was informed that reintegration of returning national staff in their countries' health systems, was guaranteed for all seconded OCP staff under written agreenents with the Participating Countries. Efforts would be made to resolve the question of how to guarantee the useful employment after devolution of locally recruited staff who had not been nembers of their national civl1 service. LL.L7 The problen of civil service cuts required by the hlorld Bank under structural adjustment plans was raised, cuts that were based on standard workloads and the number of persons employed at the tine of a population census in a given year, so that persons who had not been covered by the census could not be reintegrated on their return from OCP. Representations should therefore be made on the desirability of exceptions to the general rule for nationals returning hone after secondment to the Programme. The Programne Director added in this connection that seconded staff had shown a commendable willingness to return to their home countries on completion of their OCP contracts, despite the lower salaries paid there. 11.18 In response to worries expressed concerning WHO's arrears in its contribution to the Progra.ume, the representative of the Director-General of WHO reaffirmed WHO's strong commitment to OCP. He intended to take up the matter at the appropriate level of the Organization upon his return to Geneva and hoped that the problem would be solved in the near future. L7.L9 The need for more emphasis in the Plan of Operations on devolution andparticularly on socioeconomic developnent was stressed. It would be necessary for Ministries of Health to approach Ministries of Finance and Planning for support for their devolution plans in the national budget, but on the basis that disease control progrFmmes had enabled the river basin development authorities to bring large areas into economic use and hence to contribute generously to the national coffers; that contribution should be used to finance devolution, i.€. to fund multi-disease control programmes that included residual onchocerciasis control. lL.2O The representative of the Director-General of hlHO endorsed the view that health should be considered as an investment in development; the World Bank in several recent publications and UNDP in its Human Developnent Report published in June of the current year had upheld the idea that sustained and substantial investment in health, education and other social sectors would have a positive inpact on economic development. L7.2L He had some doubts, however, as to the feasibility of onchocerciasis- controlled areas being made financially responsible for devolution. They should be encouraged as microsystems to generate profit bu! it should be remembered that present capital flows as a whole were from the developing to the industrialized countries. A more generous approach to human development hras needed. JPC/lL page 24 tL.22 In conclusion, the Progrsmme Director thanked representatives for their general approval of the PIan of Operations. Their valuable suggestions and critical comments would be taken thoroughly into account when the final document was drafted for submission to the JPC at its next session. t2 DEVOLUTION: Agenda item 1l (documents JPc11.7, 7t.B(A), 11.8(B), 11.8(C) and 11.8(D) ) 72.7 The Progranme Director proposed that the representatives of Burkina Faso, Mali and Niger, whose devolution documents had already been discussed and approved, be asked to report on what had been achieved since approval. The representatives of Benin, COte d'Ivoire, Ghana and Togo could then be requested to introduce their devolution plans. 72.2 The representative of Burkina Faso recalled that initially B4l of the territory of his country had been under the constant threat of the most incapacitating type of onchocerciasis. After ten years of OCP control the country had been practically freed of the disease. L2.3 A feature of the results was that people had been able to reoccupy the fertile valleys fron which they had fled because of onchocerciasis. Resettlement had been partly spontaneous, partly organized, and involved also migrants from the countries to the south. 12.4 Burkina Faso had in 1985 launched the inplementation of a social and health policy that formed part of its five-year plan for socioeconomic development. Based on strengthening the health infrastructure and control of the major endemic diseases, it had resulted bV 1990 in the building or reconstruction of 150 health structures of varying size, ranging from regional hospital centres down to simple maternity posts at a cost of some US $20 mi1lion. During the same period measures to control trypanosomiasis, onchocerciasis, schistosomiasis and dracunculosis had eost over US $3 million. 72.5 A national devolution comnittee had been set up and had helped draw up the devolution plan. Two mobile entomological teans for surveillance of human trypanosomiasis had been set up in the centre and the southwest, while a third team rdas based in Ouagadougou. One hundred health workers, doctors and nurses had been trained or given refresher training on onchocerciasis and trypanosomiasis. Epidemiological surveys had involved 45 villages in respect of onchocerciasis and 55 in respect of human trlrcanosomiasis, covering over l0 000persons. In cooperation with oCP 18 000 persons had been given ivermectin treatment. L2.6 Burkina Faso's intention was to make the onchocerciasis-freed areas a zone of integrated economic development. However, the country was still awaiting funding to finance its residual onchocerciasis surveillance operations. Donors' reluctance to help was difficult to understand, since what had been achieved by OCP might be brought into jeopardy if surveillance and control lacked behind. For devolution to succeed, the financial inertia amonei potential donors should be overcome. 12.7 The representative of Mali said that his country's devolution plan had been approved by JPC only the previous year and, although it had been mentionedin the Programme Director's introduction and in the reports of EAC and the External Review Team, it had not yet been possible to put it into effect because no agreement had been reached as yet with the sources of bilateral funding approached. JPC/7L page 25 12.8 Although sone activities had been carried out, particularly in regard toinformation and ivermectin distribution, it hras essential above all to developperipheral health structures and services that would penetrate to the most remote villages, in order to detect cases of onchocerciasis while also assuminggeneral health functions and taking measures to control other endemic diseases.At the noment 7Ol of the population were not yet covered. 72.9 In the core area six technicians for onchocerciasis surveillance andivermectin distribution had been trained with OCP support. In three regionsinvolved in devolution activities, onchocerciasis surveillance had been takeninto account ln health programning at the cercle and regionat leveIs. The same was being done in two other regions. fn tfre Sit."so ".lion 14 cercle doctorshad already been trained in onchocerciasis surveillance and ivermectintreatnent. It had thus been possible to carry out active ivermectin treatmentin l0 villages in the reinvasion zone, as stipulated in the national devolutionplan. In the Mopti region awareness-enhancing canpaigns had been carried outthat were designed to facilitate the introduction of passive ivermectintreatnent, notably on the Dogon plateau. Steps had also been taken to ensurethat onchocerciasis was given the prominence it required in the national healthinformation system. 72.LO The representative of Niger stated that regular surveillance in sixindicator villages had confirmed the conplete intemuption of onchocerciasistransmission. Prevalence was everywhere under 1Ol and microfilarial loads werelow. The risk of onchocercal blindness was ni1. L2.LL With OCP support six epideniological workers, who would constitute thenational tean, had been trained in Banako. Th,enty-two health centres had beenbuilt and equipped in the onchocerciasis zone and the country had used its ownfunds to train 22 epidemiological workers in the detection of onchocerciasis andthe treatment of the disease with ivermectin. The 22 centres had been suppliedwith ivermectin. L2.t2 To contain immediately any recrudescence that might occur a vast health education canpaign had been launched Eunong the populations concerned, and anonchocerciasis information Eeeting had been held in Nia.mey with a view toenlisting the support of the multinationals. t2.L3 Although the disease hlas under contro], the persistence of a humanreservoir of infection, the problem of imnigration, and the considerable flight r€rnge of the blackfly all contributed to the same fear of recrudescence that hadbeen mentioned by preceding speakers. 72.L4 The representative of Benin said that her country,s devolution plan hadnot yet been launched. It would initially cover the northern endemic zone whichhad an area of sone !6 O0O km2 and would consist nainly in active and passivescreening of new cases, the mapping of the disease and the taking of tire stepsthe results necessitated. That onchocerciasis surveillance work would becombined, according to Ioca1 circumstances with surveillance of the other najorendemic diseases found in Benin. 7-2'15 The country would need bilateral and trultiIateraI funding and supportfrom NGO's if it was to implement the devorution pran successfuily. Total costof the plan would amount to some us $2 9oo 0oo, of which roughly Ls s6l6 ooowould be borne by Benin itself. JPC/LL page 26 t2.L5 Benin had a functioning health system in which locaI communities contributed labour and money to the building of health posts and naternity centres and to the purchase of medicaments. This system would ensure epidemiological surveillance of onchocerciasis and its integration into schemesfor dealing with the other major endemic diseases. She trusted that Donors wouldprovide the wherewithal for purchasing the equipment needed and getting theplan under way. L2.L7 The representative of C6te d'Ivoire said that after 1! years of uninterrupted vector control operations transmission had been stopped in the northern zone and larviciding would cease in 1991. Residual onchocerciasis control activities, including the treatment of new cases, would then be integrated into the existing services for controlling mycobacterial diseases and the health services of the rural health sectors. Village health workers in the core area would screen and treat suspected onchocerciasis cases in the rural areas. For that, they would require training and equipment. A national team would carry out annual surveys in indicator villages in formerly hyperendemic areas. lz.LB In the extension zone the only activity to be entrusted at present to the national health authorities would be ivermectin treatment of onchocerciasispatients while in the forest zone, not covered by OCP, reLiance would be placed on occasional surveys. L2.t9 The National Coordinator's office would need to be equipped for the collection of epidemiological data. The mobile teqms in the rural health sectors would also need field-visit and specimen-taking equipment. Training would have to be given to medical, paramedical and community workers involved in the onchocerciasis surveillance programme. L2.2O External- funding would be required to cover operating costs for fiveyears, exclusive of staff salaries. The total cost of the devolution programme was estimated at US $1 370 000. 72.2L The representative of Ghana said that his country's devolution plan would involve only the Upper East, Upper West and Northern Regions, which were in theOriginal Progrnmme area. Some 2 200 000 people in 24 health districts would be covered. 12.22 It was intended to combine onchocerciasis surveillance and control activities with efforts to control three other diseases of public health importance that were endemic in the area - leprosy, yaws (to be eradicated by 1995) and dracunculosis (to be eradicated by L993). A11 four diseases were obstacles to socioeconomic development and at1 four presented skin manifestations that made their differential diagnosis easy. t2.23 The devolution plan would give high priority to the training of healthpersonnel at all 1eveIs to camy out the integrated control plan and to the strengthening of health facilities in the area concerned. In particular, village health workers and traditional birth attendants would be trained to recogni.ze cases of the diseases concerned and report them to the "Level B" structures (health posts and health centres) for referral, where necessary, to the district health authorities ("Leve1 C"). JPC / Lt page 27 72.24 Annual parasitological surveys would be carried out in first-line villages to enable any recrudescence to be detected early. In communities with recrudescent cases large-scale ivermectin treatment would be given, whilepatients attending service delivery points (SDPs) would be screened and where necessary treated. Communities would be encouraged to report any new immigrantsto the nearest SDP so that they could be exanined for onchocerciasis and treatedif need be. Surveillance and control activities would be supervised and supported by a monitoring tenm consisting of two social scientists and twopublic health specialists. During the third and fifth year of the devolutionplan an OCP/MOH evaLuation team consisting of five specialists in pertinentfields would assess its progress and impact. 72.25 The total cost of the devolution programne would anount to sone US $2 840 000. Ghana would provide personnel whose total emolunents over thefive-year devolution period would Fmount to roughly six hundred and eightymiLlion cedis and construct or rehabilitate health infrastructures in ine ocp area at an estimated cost of about 4t5 mittion cedis. 12.25 The representative of Togo said that his country's devolution plan covered only the initlal Progrqmme area, a zone of 18 OOOkm2 with an Lstimatedpopulation of l!0 000. Transmission in the northern part of the zone had beeninterrupted but in its southern part reinvasion from further south was still apossibility, so that ivermectin treatment was necessary. L2.27 The onchocerciasis surveillance programme would be combined withprogrammes for controlling leprosy and tuberculosis. lrlhat OCp had already achieved would be safeguarded by the carrying-out of simple epidemiological surveys followed by active treatment of the cases detected, together withpassive screening of people attending health centres and evaluation of thesituation in serected front-line virrages every three years. Leprosy andtuberculosis control would be based on active and passive case detection bybacilloscopy, followed by multidrug therapy. 12.28 Devolution activities would be camied out by all the structures in thehealth systeE, including a mobile tean based in Kara. and the estinated cost ofthe devolution progrnmne, including expenditure on staff training, Iogistics,technicar equipment, infrastructure and recurrent items, wourd be routhry us $2 600 000. L2.29 A representative of the WHO Regional Director for Africa said that one ofthe reasons for siting the subregional office at Bamako had been to nake iteasier to coordinate devolution and other onchocerciasis-related activities withoCP. AFR0 staff members had attended a statutory OCP meeting in Ouagadougou,the Programme Director had been invited to take part in the Regional Committee meeting held in September, 1990, onchocerciasis control being one of the itemson the agenda, and had stayed behind after the meeting to discuss devolutionproblems with Regional Office staff. 72.30 In the coning weeks a devolution task force would be established withparticular responsibility for measures to strengthen the health infrastructurein the countries concerned. At the meeting of WHO Country Representatives to beheld in February 1tp1 there would be further discussion of the role to be playedby the country teams set up in the Representatives' Offices to support thedeveropment of the district health systems of the OCP countries in cooperationwith the national onchocerciasis coordinators. JPC/tt page 28 t2.3L A11 subregional institutions would be called upon to give help in trainlng and technical support. As for flnance, the Regional Office had already contacted the World Bank, the African Developnent Bank and UNDP in an effort to obtain funds for strengthening primary health care services at district leveI in line with its Three-Phase Health Development Scenario for Africa. Discussion 72.32 The representatives of several Donor Countries expressed their satisfaction with the multidisease approach adopted in the Participating Countries' devolution plans and the representative of a Sponsoring Agency promised that favourable consideration would be given to requests for funds to finance coordinated horizontal progranmes for tropical disease control. 12.33 As to the relative priority onchocerciasis would enjoy during devolution in relation to other health problems, it was explained by the representatives of Participating Countries which had submitted devolution plans that onchocerciasis surveillance and control would continue to have top priority. 72.34 In respect to the funding of devolution, it was suggested that 1ocal financial resources be tapped, for instance by taxing the increased income arising from the development of onchocerciasis-freed areas or the revival of the fishing industry. However, the representative of a Sponsoring Agency considered that such an approach was premature as these areas were only at the beginning of econonic exploitation of the freed areas and the added value generated was completely inadequate to finance devolution, which should be funded by Donors. The representative of the Director-General of WHO concurred; equity should be taken more fully into account, since the diseases to be tackled were largely those that occurred arnong inpoverished populations in remote areas "beyond the end of the road". Multilateral funding would allow more enphasis to be laid on equity considerations . L2,35 The representative of a Donor Country said that it could not make funds available for devolution as such, but counterpart funds could probably be foundfor components of devolution, such as the socioeconomic development of the onchocerciasis-freed areas. Simitarly, the representative of a Sponsoring Agency suggested that the infrastructure component of devolution plans could probably be funded from his organization's resources. 12.36 Although the Participating Countries had approached their Ministries of Finance and Planning for support when seeking funds for devolution, that approach had met with little success. Part of the problem was probably inadequate coordination in the Donor countries between the departments responsible for bilateral and multilateral cooperation with the developing countries. 12.37 The representative of UNDP said that he would send the devolution plans to its Resident Representatives in the countries concerned for their comments and suggestions. The Participating Countries and the Donors should find a common approach to the whole question of how to finance devolution. L2.38 As regards the flow of information to Ministries of Health on the status of devolution activities, it was stated that the same channels woutd be used as had already served for reporting on the progress of onchocerciasis activities. Fu1I use would be made of informatics and the support in that direction promised by the representative of a Donor Country was welcomed. JPC/LL page 29 t2,39 0n the questlon of whether the proportion of 15 to 251 of recurrent costs allocated to salaries and allowances was excesslve, lt wasl suggested that leveIs of renuneration were already inadequate, as one wage-earner night weII have to support as nany as twenty uenbers of hls or her extended fanily. 12.40 It was also suggested that operational research should be extended by establlshing pilot projects to deternine whether ivermectin treatnent could successfully contain onchocerciasis on its own, slnce it seemed that it r,ras the sole control nethod that would be used in countries with an onchocerciasis problen outslde the OCP area. L2.4t One participant felt that insufficient emphasis had been placed in the devolution plans on the role of national entomological teans in onchocerciasis surveillance, particularly in view of the dangers of reinvasion and possible subsequent recrudescence of the disease. Ttre role of the district health services ln surveillance and case detection should also be spelt out Eore cIearly. L2.42 Representatives of both Sponsoring Agencles and Donor Countries congratulated the countries concerned on the high quallty and clarity of the devolutlon docunents they had subnitted to JPC. 13. PROGRESS REPORT OF T}IE ONCHOCERCIASIS CHEMOTHERAPY PROJECT (OCT) FOR l99Oz Agenda item 14 (docunent JPC11.5) 13.1 Ttre Manager of 0CT, introducing his report, said that he was happy to report that Ciba-Geigy had indicated that they wished to register conpound CGP 5t40 for use against onchocerciasis in L992, thus suggesting that the clinical data the company had obtained fron Central Anerica trials had been favourable.If they proved acceptable, OCT could repeat nultiple-dose studies in West Africa under the MACROFIL project in 1991, possibly with prior ivernectin treatnent to reduce the Mazzottl reactions previously observed with CGP 6140. If successfulin onchocerciasis, the drug would probably also be trled out against lymphaticfilariasis in 1993. 13.2 In the case of ongoing clinical trials of albendazole, studies at the OCRC in Ghana had shown that while the drug danaged the adult worm it did notkill it. Combinations of albendazole with lvermectin would be tested in 1!!1. 13.3 Ten kilogremutes of CGI 18041, another Ciba-Geigy conpound, related to CGP 5140 but with better pharnacological properties and safety characteristics, had now been produced and conplete toxicological studies would be conducted inthe first half of 1991, the cost being fully borne by Ciba-Geig:y. If favourable results were obtained, Phase I studles in volunteers would be carried out in the second half of the year. 13.4 A benzimidazole derivative available as free base (UMF078) or soluble salt (uMF289) had been developed at the University of Michigan and when administered in muttiple doses had proved macrofilaricidal in dogs when injectedintranuscularry (IJMF078) or by mouth (uMF289). rncreased anounts of both compounds r,rere now being manufactured for downward titration and single-dosetesting in dogs. Fornuration studies would be necessary in t))l-)2 andtoxicological studies in 1992 before clinical trials could be envisaged. JPC I LL page 30 L3.5 Development would continue on active compounds from prinary and secondary s-rlening arrailable from the Walter Reed Arny Institute of Research (WRAIR) and Warner-Lnmbert. L3.6 Compounds were being obtained under operative screening agreements from Ciba-Geig1y, Lilly, WRAIR and the National Cancer Institute. Sinilar agreenents were being negotiated wlth Warner-Lanbert, Wellcone, Merck Sharp & Dohne and Beecham but were not yet operative. Screening agreements were under discussion with six other companies and he was also receiving conpounds he had requested following their mention in patent and scientific literature. L3.7 The Project now had available adequate facilities for in vitro and in vivo screening, compound reslrnthesis, drug assay developnent and pharmacokinetic stuaies. Work on preclinical toxicology was generally put out under contract. OCT had its own centres for clinical Erials. The Project needed a company that would undertake drug storage and shipments to laboratories. A part-time adviser was being sought on the computer storage of biological and chenical data. Research 13.8 Two biological studies were in progress to titrate in vitro sensitivity of Onchocerca microfilariae to ivermectin by reinjecting them into adult Ufactffies to see how many larvae would develop. Molecular biologists who had studied ivermectin-resistant veterinary helninths such as Haenonchus contortus or free-living nematodes such as Caenorhabditis species used as models were being asked whether the mechanism of resistance was single or multiple, the idea being to find a narker for ivermectin resistance in Onchocerca. L3,9 EAC and CSA had both recognized the need to reestablish a research base in order to determine potential targets for chemotherapy in filariae. A Scientific Working Group bringing together experts in parasite biochenistry and other pertinent areas of research would be neeting in May 1991 to discuss suitable targets and research proposats would subsequently be called for. 13.10 An agreenent had been reached between the Directors of OCP and TDR' u,ith the approval of EAC, to establish a new MACRQFIL proJect to develop a macrofilaricide for both onchocerciasis and lynphatic filariasis. 13.11 All TDR/FIL projects concerned with preclinlcal drug developnent would be transferred to MACROFIL, together with their current TDR financial allocation of US $4OO 000 per annum. MACROFIL would be eligible for professional and financial assistance from the TDR Product Developnent Unit and other units of TDR. If it developed a potential drug for lymphatic filariasis, it would be allocated by TDR the sane funding for carrying out clinical trials as that allocated by oCP for clinical work on onchocerciasis, vj-z. roughly US $425 000. Funds for temporary advisers etc. for joint neetings between IIIACROFIL and TDR/FIL might be forthcoming from the TDR Operational Support budget but no specific amounts had been mentioned. Funding OCT or MACROFIL L3.t2 In view of the immense importance for OCP of the search for an effective macrofilaricide, several representatives had questioned the adequacy of the funds allocated to OCT in the 1991 budget and the plans for the next financial phase. JPC/rr page 31 13.13 The a.uount finally allocated in the 1991 budget was equal to what had actually been spent in 1tp0, 1.e. US $1.68 nlllion, a sum snaller than the $1 9OO 000 actually budgeted for in 1990 because Ciba-Geigy had borne the cost of the preclLnlcal developnent of CGI 18041. However, the 1!!1 budget made noprovision for the preclinical development of the pronising WF0/8 compound, for research to deternine targets for chemotherapy (reconnended by EAC at lts June 1990 neetlng), for paylng a conpany to store and ship test coupounds, or fonpurchasing the additional conputer system that would be needed by the part-time consultant who was to start up and maintain chenical and biological databases. 13.14 However, Appendix 2 of docunent JPc11.! gave an optinal 1991 budset as abasls for predicting annual OCT expendlture for the fourth Financial Phase. That budget of US $2.275 miIIlon was the ninimun annual sun required to allow OCT to function effectively throughout the fourth Phase. If the MACROFILproject was approved, TDR would be adding up to $825 000 a year to that figrrre, naking a total budget for II{ACROFIL of just over US $3 nilIion, equivalent to OCT's mo<inun spending ln 1985, when lvermectin was being developed. L3.15 Moreover, while the costs for 1991-91 were reasonably predlctable, noreflexibillty would be needed in the subsequent years. He hoped that his comnents would receive due consideration when the overall budget for the fourth Financial Phase was being discussed. 13.15 Although increased expenditure would not guarantee success, lt would nakeit possible to increase the nunber of conpounds tested and to follow-up severalleads sinultaneously, not waiting for the results on one conpound before continuing with another. For instance, if CGI 18041 failed at sone point in its developnent, lt would be useful to have finished the toxicological evaluation of two related compounds that had already been shown to be active in the O.SibggE cattle screen. 13.L7 Increased funding would enable a sound research base to be re-establishedfor deternining chemotherapy targets in filariae. More compounds could be tested and those found to be more active could be resynthesized for tertiarytesting in the dog and cattle assays at an earlier stage. Mutagenicity and acute toxicology studies could be carried out at an earlier stage and on agreater number of pronising conpounds, so that those with poor safety characteristics could be rejected early in development. The use, wheneverpossible, of several centres simultaneously for clinical trials would reduce theperiod needed for carrying them out. If more work could be put out to contract,the Project Manager wourd have nore time to visit industry to encourage collaboration. 13.18 To increase the odds in favour of developing an effective macrofilarlcide, which were relatively poor, a greater number of candidate conpounds must be passed through the system at all stages and that was what additional funding would nake possible. Discussion L3.L9 Continued support of OCT was confirmed and it ldas agreed that the OCT budget during the fourth Financial Phase would need to be flexlble in order to speed up the developnent of pronising macrofitaricides. The MACROFIL project and the associated financiaL arrangenent arso received generar support. JPCltt paSe 32 t3.ZO The Project Manager h,as congratulated on the way in which he had enlisted support from many disparate sources - universities, private industry, think tanks, etc. - in pursuit of a connon objective and had involved African countrles in the drug-testing process. 13.21 In arrswer a speciflc questionr the Project Manager agreed that the t-sthg of a larger nunber of compounds would requlre nore extensive drug sc.eening facilities. An additional screening centre rras already in use and nore ,,ouid doubtless be needed. Research on chemotherapy targets in filariae might open up the possibility of autonated screening in vitro of sma1l anounts of large nunbers of conpounds. Ttre nore conpounds that were screened, the greater the likelihood of a nacrofilaricide being discovered. L3.22 Insofar as the sums already expended and those to be expended in the next Financial Phase on a search for a nacrofilaricide with no guarantee of success threw into stark relief the failure to flnd the relatively nodest funds required to implenent the devolution plans of the Participating Countries the question arose whether lt was possible to predict the length of tine required to develop a conpound that was found pronising. The reply was that Lvernectin development had tatcen six years but the average was probably ten years or nore. It should be renenbered, however, that an effective nacrofilaricide would still be trenendously useful after the Progranne had cone to an end. 14. SOCIOECONOMIC DEVELOPMENT: Agenda iten 1! (docunents JPC11/Inf.Doc.2 and JPC11/Inf. Doc.3 ) 14.1 The representative of LINDP, introducing the item on behalf of CSA, said that the Progrnmms Director had already emphasized that the econonic development of the onchocerciasis-controlled zones had been one of the attractions of the Progrnmme for the Donors. Health developnent should be seen as an investnent for greater productivity and econouic prosperity. The econonic development of the freed areas was already proceeding without the JPC's intervention but coordination of efforts would enhance its success. He called for greater attention to realizing the econonic potential of the onchocerciasis-freed areas, atthough onchocerciasis had been only one of nany constraints on economic development. 14.2 A representative of the World Bank, speaking also on behalf of CSA' recalled that the JPC at its seventh session in Accra in 1986 had endorsed a CSA Report on Mechanisns for Pronoting Socioeconomic Development in Onchocerciasis- Controlled Zones (known as the "Mechanisms" paper), which had proposed three activities for pronoting socioeconomic development, i.e. a regional preparatory study to single out within the regions already controlled or about to be controlled the areas with promising development potential, in-depth analyses in the individual countries to serve as a basis for formulating development plans in the controlled areas, and a regional land settlement review with reconmendations in regard to sustainable settlement-related development in onchocerciasis-control led areas . 14.3 The progranne set forth tn the "Mechanisns" paper had largely been completed. The regional preparatory study, known as the Hunting Report, had been conpleted in 1988 and discussed at the ninth session of JPC in Dakar. In- depth national studies were under way in nany of the Participating Countries. The Land Settlenent Review had been completed in JuIy of the current year. It assessed experience with land settlement in all the OCP countries and made recommendations on settlement policies in the onchocerciasis-controlled areas. JPC/tL paSe 33 14.4 A Land Settlenent Review Seninar, funded by IJNDP, and sponsored by FAO, UNDP, the World Bank and 0CP, had been held in 0uagadougou in Septenber 1990. Considerable discussion and interest had been aroused among the participants(senior officials fron planning ministries and ministries of agriculture and rural development from 10 Participating Countries) by the presentation of low- cost settlement techniques that offered the possibility of improved natural- resource managenent and sustainable agricultural production. 14.5 In nost of the onchocerciasis-controlled areas socioeconomic measures related to settlenent were already under way and details of many of the actlvities concerned could be found ln the CSA progress report. It was hopedthat contrlbutors, including the individual sponsoring agencies, would strongly support the governments of the Participating Countries, which of course bore theresponsibility for the planning and implenentation of such activities. 11.6 Concern regarding its environnental iupact had increased parl passu hriththe increasing socioecononic development of the onchocerciasis-controlled areas.Settlement was already resulting in some cases in increased deforestation andsoil degradation, threatening the sustainability of development. To preventirreversible environmental danage, nultidonor environnental action plans were already under way in sone PartLcipatlng Countries, such as the national plan inBurkina Faso which was particularly concerned with the onchocerciasis-controlledareas. One of its nain features was the establishnent of village land nanagement conmittees responsible for naturar resource management. L4.7 CSA needed to reexamine its role in pronoting socioecononic development which might be to nonitor the progress of settleneni-related socioeconomicdevelopment in the onchocerciasis-controlled area, including its environmentalimpact, by assisting individual countries in this field by iacilitating the exchange of lnformatLon on those subjects; by assisting in planning as needed; and by exaninlng a nechanisn for intercountry cooperation on matters of common concern. It was essential that planning the development of the onchocerciasis-freed areas should be fully integrated into national developnent strategies andinvestment prograrmes and that comnunity participation in decision-making be encouraged. 14.8 Although OcP through cSA had prayed a catalytic role in promoting socioeconomic development, that development itself fell outside OCp's mandate.Donors should be urged to step up their efforts in socioeconomic development, although the major responsibility for proposing specific progrnmmes wouldcontinue to lie with the African governnents. UNDP would therefore welcome theopportunity for its Resident Representatives to discuss with countries' planningauthorities what forlow-up measures courd be taken under IINDp countryprogramEes. The requirements of the onchocerciasis-freed areas could aLso beconsidered under the UNDP-sponsored national technical cooperation assessnentprogrammes (trNATcAPS") ana at UNDP Round Tables. The UNDp Africa Bureau wourdbe communicating with its Resident Representatives in the 11 participatingCountries. 74 '9 The Land Settlement Review Seminar had suggested the establishment of asmall secretariat to act as a clearing-house for iocioeconomi.c developmentinformation on settleEent policy, planning and implementation procedures andmonitoring and evaluation techniques. Before that could be done, objectives andstrategies should be clearly defined. UNDP Resident Representatives wouldbe asked to seek those governments' views on intercountry cooperation. Areas ofpossible intercountry cooperation included environmentaL protection, labourmigration' infrastructure strengthening and joint river basin developmentschemes' Some form of smal1 planning unit might be an appropriate coordinationmechanism. JPC/tL page 34 14.10 The Director of the Institute for Development Anthropology, introducing the Land Settlenent Review (LSR), enphasized the dynanics of land settlenent in critical areas where environnentally sustainable econonic development could take place at a cost within governnents' financial capacities and with significant spread effects. The review put forward lower-cost settlement strategies that were sufficiently general and flexible to be applicable to all the Participating Countries. 14.11 Ttre Review rejected prinary emphasis on either the unguided spontaneous or the government-sponsored types as inappropriate for the Participating Countries. The objection to unguided spontaneous settlernent was that it was of low productivity, had few spread effects and was environmentally unsustainable. Government-sponsored settlenent was costly and usually involved only snaI1 numbers of settler households; the Review advocated it only in conbination with government-guided spontaneous settlenent. L4.L2 The Review reconmended the choice of appropriate sites on the basis of soil and hydrological surveys and socioeconomic surveys anong the indigenouspopulation. The policy should encourage and ggide settlers to nove into areas of nigne" potential, with the governnent providing roads, water potnts and social and econonic services. 14.13 One way of combining guided spontaneous settlement with the governnent- sponsored type, was to have a land-settlement conponent in a national project in a- sparsely populated area (the construction of a dam, for instance), roith a core of government-sponsored settlers made up of those forced to relocate because of the construction progranme. Suitable sites for such conbined settlenent schemes existed in all 11 Participating Countries. 14.14 The Review had reconmended thit an appropriately funded, staffed and located international institution should be established to facilitate dissemination of information on lessons learned that related to planning' inplementations, rnonitoring and evaluating the developnent of OCP areas, and to assist Participating Countries in these fields; a reconmendation endorsed by theparticipating Countries at the LSR Seminar. Such an arrangenent would be consistent with the External Review's reconmendation that CSA and OCP studies should be integrated into national development strategies. Participating Countries would provide the expert staff and should have the benefit of advice from a conmittee of settlement experts and of close liaison with EAC. 14.15 The Director of the Institute for Development Anthropology completed his presentation by explaining why the Review recommended settlements in less isolated areas and by comnenting on such issues as the place of irrigation in land settlements, land tenure and the move of pastoralists towards a more sedentary life. 14.15 An FAO Assistant Director-General, Regional Representative of FAO for Africa, speaking in his capacity as Vice-Chairman of the Land Settlement Review Seminar, said the Seninar had felt that while it h,as necessary to integrate the onchocerciasis-freed zones into national planning, they must still be givenpriority as zones able to receive settlers and with the greatest economic potential sti1l unexploited. To develop the onchocerciasis-controlled areas it h,as essential to draw up an inventory of their resources, while the 1982 FAO study on the denographic pressure on natural resources in Africa could be updated and used in planning. JPC/tt page 35 14.U New settlers nust also be given security of land tenure to enable them tofarm ratlonally and reforest thelr land. Governments should intervene to apportion land falrly between lnrnlgrants and the indigenous populations. TtreSeminar had recommended that although settlers tended to favour areas where some schools, health posts, and roads already existed, guided resettlepent plans should also ain at reducing the isolation of remote areas by building roads, water points, health posts and so on in order to pernit settlenent and to enable exploitation of natural resources without danage to the natural environment.Furthermore, Iand-use zoning in the villages, though expensive to plan, was inthe long run the only way of ensuring a productive and sustainable- agriculturethat was not destructive to the environnent, particularly if village credits were available. While the Seminar advocated diversification, it falt that care should be taken to avoid moving to the service sector mErnpower that would bebetter employed in productive activities. 14.18 The Seminar hlas of the opinion that a mechanism was needed for the exchange of infornation and experience between the Participating Countries andalso to carry out monitoring and other activities in which econonies of scale wourd resurt from working in comnon. FAO would be preased to place at thedisposal of the Participating Countries the fruits of its accunulated knowledge and experience in the Region, such as the agricultural plan for the coning 2!years' which could be brought up to date for the OCP area, forestry studies,plans for rehabilitating and conserving the soils to enable Ean to 1ive withoutdestroying, and nany others. Ttre information thus avaitable could be conbinedwith that possessed by other agencies and institutions to forn a scientificbasis for the development of the whole OCp area. 14.19 Ttre Director of ONAT (ex. Volta Valleys Developnent Authority) said thatthe Authority and the Government of Burkina Faso had realized fron thebeginning, in 1974, that priority nust be given to developing areas that OCp succeeded in freeing from the threat of onchocerciasls, firsily to relieve thepressure on the Mossi Plateau, where overpopulatlon was leading to the wholesaledestruction of natural resources, and secondly to achieve self-sufficiency infood in cooperation with the population. 14.20 The Authority had therefore carried out a thorough analysis of the realpotential of the onchocerciasis-controlled zones by studying the socioeconomicbackground, mapping the soils and producing aerial maps of the areas concerned, so that a naster plan could be drawn up for the development of these zones andthe provision of social servj.ces and utilities therein. L4.2L That had been followed by the settlement of the controlled zones by volunteers who agreed to leave their areas of origin to take part in the newdevelopment. Centralized administratj.on of the scheme having proved too cumbersome, decentralization was carried out on the basis of "planning unj.tsr',sectors with homogeneous agrononic, soil and socioeconomic conditl,ons. The successes achieved by the first t'sponsored" settlers rapldly attracted "spontaneoustt settlers. 74.22 A national land-use register had been established. Some 400 villages hadbenefited from thoroughgoing land-use surveys, thus taying a basis for betterliving conditions for the immigrants from the Mossi Plateau and for integrating sponsored and spontaneous settlers with the indigenous population. JPC/tt page 35 L4.23 In terns of production, the onchocerciasis-freed zones in Burkina Faso produced cereals to a value of 10 billion CFA francs in 1988 and llvestock products to a value of some 540 mi[ion CFA francs. For a total investment over 15 years of 24 bllIion CFA francs, of which 8 Utttion had been provided by the State, an annual production worth Bore than 11 billion CFA francs had thus been achieved, not to speak of the value of connected activities. The Authority was now self-flnanclng, and had been nade responsible for carrying out development studies ln rural areas outside the onchocerciasis-freed zones. t4.24 The representative of the COte d'Ivoire said that 66/ ot the total area of his country was covered by the OCP and the socioeconomic development of the onchocerciasis-freed zones was therefore of vital importance and had been integrated into national development planning. A11 the large-scaIe development schemes currently in progress were in the freed zones. Since the beginning of 0CP, the C6te d'Ivoire delegations to the various meetings had always contained a representative of the Ministry of the Economy and Finance. The COte d'Ivoire fully supported the proposal to set up a smalI intercountry secretariat for the exchange of information and experience. L4.25 The representative of Ghana thought that an intercountry secretariat should deal inter alia with the management of the river basins, and particularly with the prevention of pollution. For instance, 60l of the Volta catchment area lay outside Ghana, yet his country received all its pollution. Care should be taken in all resettlement schenes to prevent deforestation. Also, large-scale farming was lnconpatlble lrith rational river basin nanagement L4.26 The proposed intercountry secretariat should lay down guidelines for monitoring sllt loads from erosion and the effect of agrochenicals on waterquality. In view of the intermittent nature of many African rivers dangerous concentrations of chemicals could easily accumulate. Agroforestry practices that had been superseded by nonocrop farming should be ]ooked at again for their possible value in soil and water conservation. t4.27 A representative of the Ecological Group welconed the wide interest in the environnent that had emerged from the discussions. lrlater as a renewable resource played a capital role in the OCP area and preservation of its quantity and quality was essential. Deforestation and erosion reduced river f1ows. A \dater assessment project with that in view was already under way in West Africa. One hundred thousand tons of fish worth US $80 mitlion were caught annually in the Niger river basin. The figure for the whole OCP area was estimated at US $200 million. Monitoring was needed to ensure that agricultural chemicals did not have the deleterious effects on the aquatic fauna and flora that OCP's policy had avoided. 14.28 Although the Ecological Group's mandate only covered the effects of larviciding for blackfly control, the Group would be glad to make its data and experience available to any body set up to nonitor other aspects of environnental protection. Environnental scientists would have to be trained and perhaps the Sponsoring Agencies or bilateral Donors could help in that direction. 14.29 The representative of a Donor Country stressed the investment side of socioeconomic development. Apparently the annual value of fish and fish products produced in the Participating Countries anounted to US $200 million per annum and of the food crops produced in Burkina Faso to some US $93 mil1ion. The aid authorities in his country saw a link between devolution and socioeconomic development. A tax of t/ on the sums nentioned would largely pay for devolution. Econonists had calculated that the internal rate of return on JPC/LL pa8e 37 investments in OCP had already been considerable. Instead of funding devolution, which could be paid for out of those internaL returns, his country would preferto invest in the socioecononic developnent of the onchocerciasis-freed areas. He hoped that the existing technical means in the OCP area for nonitoring waterflows and quality would be "devolved". Meanwhile, people should be willing topay for the water provided. Finally, the feasibility of the secretariat orintercountry secretariat should be assessed in the coming year. 14.30 The representative of FAO agreed with the statenent nade by the representatlve of Ghana to the effect that for solI and water conservation theinportant technical unit was the river basin, regardless of nationarboundaries. Ttrus, in regard to agrochemical poliution of watercourses,international progremmes ri,ere under way for lntegrated pest control. Much hadalso been done during the previous few years to introduce integrated plantnutrition. which used biological fixation of nitrogen and various othlr farmingsystems. 0f prime inportance also was the Code of Conduct for the Use andDistribution of Pesticides, a protocol which had been signed by nost if not allof the countries present at the Jpc. Finalry, the Netherrands, with FAo, hadtaken the initiative in convening a conference in April 1p!1 on sustainedagricultural and rural development and the environment. The conference was expected to deal with problens that would be of special interest to the Satreliancountries. 1a.St The representative of CSA welcomed the nany positive contributions to thediscussion and particularly the enphasis on the management of renewable resources and the training of people to assess the environnental impact ofdevelopnent. Ttre CSA had noted with satisfaction acceptance of its proposal oninformation exchange. L5. OTHER IrIATTERS: Agenda iten 15 L5'L Ttre representative of a Donor country said that her Government wished todiscuss the possibility of earnarking all or part of its contribution forcertain aspects of the Progra.mme to which it thought priority should be given.It had devolution particularly In mind. In view or tt" vitai inportance ofdevolution for the Programme's success her Governnent would like to channel itscontribution to one pilot project of devolution in each participating Country ina health district at high risk of recrudescence, thus testing in the field thefeasibility of the plans subnitted. L5'2 I'he representative of another Donor Country disagreed with the proposalfor earmarking contributions. The Jpc surely prlvided a forum in whichpriorities courd be set by common agreenent. He suggested that the whoLeconcept of earmarking versus undesignated funding b6-discussed at a Donors,meeting in 1!p1. L5'3 A representative of the liorld Bank said that the Bank, which administeredthe Trust Fund, had very strong reservations about the earmarking ofcontributions. rt would enormously complicate both fund raising and theflexibility of programne operations. 15'4 The representative of a Donor Country, while concurring with previousspeakers in believing that the Progranme's coherence would be best served bypreserving a flexibility which earmarking would impair, thought neverthelessthat the JPC's decisions should perhaps be taken in a more patentry democraticway than had so far been the rule. JPC/LL page 38 L5.5 A nenber of the External Review Tean thought that a conpromise night be reached when the Devolution Unit advocated by the External Review had been set up and given a budget and a precise nandate as part of QCP. It could then consider the question of pilot areas. L5.6 The representative of the Donor Country which had raised the issue found it difficult to understand why there ldas such reluctance to launch into devolution when there was such enthusiasm for socioeconomic plans. L5.7 The representative of the World Bank pointed out that the discussion was not on devolution, which the Bank supported, but on earnarking, which it did not support. When the Devolution Unit was set up, OCP funds would be channelled into devolution activities, without having been earmarked for that purpose by Donors. Meanwhile, the Bank rrras proposing to provide some of its own funds to assist devolution but not from the sums it contributed to the Programme. He urged other contributors to do likewise. In his opinion earmarking would impair the financial health of the Progranme. 15.8 The representatives of two Donor countries expressed their opposition to earmarking, which they thought would distort OCP planning and priorities. A bilateral approach to devolution funding !{as probably best, particularly as the devolution plans were ready and waiting. 15.9 The representative of a Participating Country understood and sympathized with the anxieties that had led to the earmarking proposal but thought the present system of undesignated funding to be preferable. 15.10 The Programme Director recalled that earmarking had been discussed in 1982 in Ba.mako. The discussion had ended in confusion when a nunber of delegations had all proposed earmarking their contributions for different purposes and it was realized that the system would not work. L5.LL He supported the idea expressed by the representative of the External Review. The recommendations of that Review to give special attention to devolution should be exanined ln detait The decisions taken by the JPC after that detailed examination could then be reflected in the budget. Earmarking would make his position difficult, if not inpossible. L5. DATE AND PLACE OF THE TWELFTH SESSIoN: Agenda item 1J 15.1 The representative of Saudi Arabia formally confirmed his Governnent's invitation to JPC to hold lts next session in that country. L6.2 The JPC accepted the invitation with thanks and agreed to hold its twelfth session in Riyadh fron 2 to 5 December 1991. t6.3 The JPC noted with appreciation the kind invitation from the Government of the Republic of Niger to hold the thirteenth session of the JPC in Niamey in December 1Pt2. JPC/Lt pace 39 L7. FrNAL CoMMUNTQUE t7.l The JPC adopted the followlng final comnunique. 1. The Jolnt Programme Comnittee (JPC) of the Onchocerciasis Control Progranme in West Africa (OCP) held its eleventh session in the Palais desNations, conakry, fron I to 5 December 1990. Ttre African Development Bank,Belgium, Benin, Burkina Faso, calouste GuLbenkian Foundation, canada, coted'rvoire, France, Ghana, Guinea, rtaly, Japan, Luxembourg, Mali, Netherlands,Niger, Norway, Republic of Korea, Saudi Arabia, Senegal, Sierra Leone,Switzerland, Togo, United Kingdon and United States of Anerlca were represented as merobers, as h,ere the Sponsoring Agencies - IJNDP, FAO, the ['lorld Bank and WHo. Two representatives of the Governnent of Spain attended as observers. WHO was represented by Dr R. Henderson, ADG, on behalf of the Director-General of WHO, and by Dr G. Monekosso, Director of the WHO Regional Office for Africa. Members of the Expert Advisory Committee (EAC) and of the Ecological Group and two members of the External Review Tean attended as ex-officio members. Representatives of the French Institute of Scientific Research for Developnent through Cooperation (ORSTOM), the Organization for Coordination and Cooperationin the Control of Major Endemic Diseases (OCCGE) and the Mectizan ExpertConnittee were also present as observers. 2. The session was opened by His Excellency Captain Bago Zounanigui, nenber of the Comit6 nilitaire de Redressenent National and Minister of youitr andSports. Dr Madigbe Fofana, Minister of Public Health and Population of theRepublic of Guinea and Dr Abdulah Al-Owedi, representative of the Governnent ofthe Kingdom of Saudi Arabia were elected chairman and vice-chairman, respectively. 3. After discussing the WHO Progress Report for 1!p0, the JPC complimentedthe Progranme Director and his tean for the very satisfactory results achieved.In particular, the JPC noted that with the gradual elimination of the parasite reservoir, larviciding in parts of the core area had been definitivery stopped. In the extension areas control operations had been in fulI swing.Larviciding throughout the southern Extension had been successful and had had a major impact, on previously reinvaded areas in northern Togo and Benin. In theWestern Extension there had been an intensification of the conbined use oflarviciding and ivermectin distribution in Guinea and Sierra Leone. Ivermectindistribution programnes, in the absence of larviciding, had been expanded andintensified in l{estern Mali, Senegal and Guinea-Bissau. In all these areas, the active participation of the Participating countries had been very satisfactory. Reinvasion of the core area had been prevented or reduced toinsignificant proportions, while larvicide resistance had been successfully overcome as a result of the Programme's larvicide rotation strategy. The Progrnmme had actively pursued its devolution-orientated training policy, andhad provided assistance, when necessary, to Burkina Faso, Mali and Niger for theimprementation of their devolution prans. Finarly, the Jpc noted with appreciation that rigorous nanagement and expenditure control procedures had remained in force to curtail costs and to compensate for the decline in the value of the US do11ar. 4. The JPC took fuIl note of the views of the Expert Advisory Comnittee(EAC) and of the External Review regarding the overall strategy of tne programmefor the foreseeable future. More specifically, the JPC endorsed the need forthe ProgranEe to maintain larviciding operations for a total period of 14 yearsin the extension areas, in order to block transmission and to a1Iow the parasitereservoir to die out, in the absence of any other means of attacking the adult worn on a large scale. The JPC approved the priority research topiis set forth JPC/7L page 40 by the EAC, its Ecological Group and the External Review and reiterated the lnportance it attached to the continued search for new types of larvicide and improved fornulations, to the intensive search for a macrofilaricide via the new OCP/TDR Macrofil proJect, and to the necessity of developing a highly selective and sensitive immunodiagnostic test. The JPC also endorsed an EAC recommendation that the Programme objective be redefined to take into account the need to ensure that the Participating Countries would be in a position to maintain Progranrne achievenents after the Progranme came to an end. 5. The PIan of Action and Budget for 1991, for a total nmount of USS 34 355 000, was reviewed and approved by the JPC. The Programme was conmended on the clear and precise way in which the Plan of Action and Budget had been prepared and presented, thus making it easy for the JPC to see that thepolicies, strategies and activities that had been highlighted during 1990 would be continued through 1991 but with greater emphasis upon devolution activities. 6. Ttre World Bank representative presented projections of the financing available and of expenditure estinates for the third Financial Phase. He reported that the major projected shortfafl of US$ l! million that had arisen during the first half of the phase had now been eliminated on the basis of contributions and expenditures to date and those expected through 1991. This was followed by Donor pledging for 1tt0 and 1991 which confirned that the third Financial Phase would be fu1ly financed. The JPC expressed its gratitude to the donor community and thanked the World Bank for its unfailing efforts to secure the full funding of the third Financial Phase. 7. The JPC congratulated the External Review Team on the report which it had submitted in response to a request by the JPC during its tenth session. The JPC agreed in principle to the concept of establishing a special devolution unit and approved the Review's other recomnendations, stressing the importance of those relatlng to strengthening the E:AC's capacity to address an increasingly broad spectrun of devolution issues, and to detailed research on ivermectin. The JPC requested the Comnittee of Sponsoring Agencies to determine the financial and operational implications of the Review's recommendations while the Progra.mne Director was asked to adjust the draft Plan of Operations for the fourth Financial Phase to take into account the Review's conclusions. 8. A draft Plan of Operations for the fourth Financial Phase (Lgg2-7997) with a tentative total budget of roughly US$ 185 million was reviewed by theJPC. Ttre key elenents of the Plan were: adherence to a larviciding strategyfor transnission control in the greater part of the extension areas; expansion and intensiflcation of ivermectin distribution, especially in endenic areas of the extensions; cessation of larviciding in the core area; expansion of devolution activities with lncreased emphasis on training; harmonization of staff structures and employment conditions throughout the Programme area; lncreased flow of information between Participating Countries; maintenance of cost-efficient and cost-conscious nanagenent policies. The JPC endorsed thedraft Plan in principle and made suggestions for its modification, mainly with regard to presentation of Progranme achievements during Phases I, II and III, the provision of a preview of the fifth Phase, and the budgetary forecasts.After suitable revislon in the light of the JPC's comments and suggestions and those of the External Review, the draft would be considered by the EAC and CSAbefore being subnitted to the JPC at its twelfth session. JPC/7L page 41 9. Ttre JPC was presented with reviews of devolution activities in BurkinaFaso, MaIl and Niger, and with a progress report of the activities of WHO/AFROin relati.on to devolution. The JPC reviewed and approved the devolution plans of Benin, COte drlvoire, Ghana and Togo. The JPC emphasized that successfuldevolution was of critical inportance to the sustainability of onchocerciasis control and that the prinary responsibility for it rested with the participatingCountrles. Ttre JPC acknowledged the inportance of commitnents and initial stepstaken by the Particlpating Countries thus far, especially those in the originalarea. Tfie Donors and Participating Countries were encouraged to malntainsolidarity in seeking ways of accelerating devolution activities, includingproviding increased financial support. 10. The Manager of the Onchocerciasis Chenotherapy ProJect (OCT) describedthe compounds that showed pronise as macrofilaricides in preclinical development and clinical trials and said that Anocarzine (CGP 5140) wtuld probably beregistered as a macrofitaricide for onchocerciasis control by Ciba-Geig.y int992. The adninistratlve and flnancial arrangenents by whlch OCT would becomeltnked to the drug development component of TDR/Filariasis to forn a neh,rJolntly funded "Macrofil" proiect, were outtined. The JPC congratulated the OCTon its perfornance to date and on its effective use of a wide spectrun ofinternational resources, and reconmended that its financi.al needs be netflexibly and without interruption. 11. The JPC discussed the Comnittee of Sponsoring Agencies' (CSA) progress report on socioeconomic developnent in onchocerciasis-controlled areas, notingthat the CSA progranrne would shift fron the execution and financing of studiesto nonitoring socioeconomic development and environmentat issues in the oncho-controlled areas and facllltating the flow of information anong participatingcountries and Donors. Ttre Jpc atso reviewed the finar report or " u"rraSettlement Review and annexed case studies for BurkLna Faso, Ghana, Mali andTogo, noting that the report had already been discussed by the participatingCountries and Sponsoring Agencies during a Land Settlenent Seminar held inOCP/HQ in September 1990. The JPC congratulated the authors of the LandSettLement Review Report, the Institute for Developnent Anthropology of the USA,noting the important contribution the report naa maae in facilitating socioeconomic development in the oncho-controlled areas. The JpC called forgreater coordination of efforts and greater attention to socioeconomicdevelopment. 72' The JPC expressed its appreciation to the Government of the Republic ofGuinea for the warn hospitality extended to it and the excellent arrangementsfor the eleventh session in Conakry. 13' The JPC accepted with thanks the kind invitation of the Government of theKingdom of saudi Arabia to hold the twelfth session of the Jpc in Riyadh from 2to ! December 1991. It noted with appreciation the kind invitation from theGovernnent of the Republic of Niger to host the thirteenth session of the Jpc inNia.mey in Decembec L992. JPC/Lt page 42 18. CLOSURE OF THE ELEVENTH SESSION 18.1 The representative of a Donor Country thanked the Republic of Guinea for the warm hospitality shown to all the participants and the excellent arrangements made for their deliberations. He congratulated the Programme Director and his staff on their continuing efforts and substantial achievements. The session had been as fruitful as their previous neetings and they lrent away with a renewed sense of the importance of a really worthwhile Progranme. L8.2 The session closed with renewed thanks to the Republic and people of Guinea for their kind hospitality and with the customary exchange of courtesies. JPC/LL pa8e 43 ANNEX I OPENING STATEMENT BY DR R.H. HENDERSON, ADG, ON BEHALF OF TTIE DIRECTOR-GENERAL Thank you Mr Chairman, The Director-Genera1 of hlHO has requested ne to express to you his sincere regrets for not being able to attend this session of the Joint Programme Committee, because of prior connitnents. He has therefore asked ne to read to you the following nessage: "Excellencies, Ladies & Gentlemen, r'Once again it is a privilege for me to express to you the high esteem in which I hold the Onchocerciasis Control Progremme in West Africa (OCP), and thegreat interest with which I foIlow lts progress and achievements. "I very much regret that I an unable to be with you in Conakry toparticipate in this particularly inportant session of the Joint Progrsmme Comnittee (JPC). Important, because, as we prepare to enter the final year of the third Financial Phase, we will be setting the scene for the continuation of the Progra.mne into a new and critical phase of its existence. "We cart all look back with pride at the Progrenmers achlevements over thelast five years of the current phase and can draw important conclusions which will stand us in good stead for the future. But above all, we can now look forward with confidence beyond the current phase and into the fourth Financial Phase, a first impression of which can be obtained from the draft Plan of Operations which is before you at this session. "Mr Chairman, in nry Eessage to you at your tenth session in Ttre Haguelast year, I had the opportunity to share with you sone of the inpressive acconplishments of the Progrqmme, both in the field of public health and in the important sphere of economic developnent. 0n this occasion, I would like to draw attention to a few of the more important aspects of the Progra.mme which, in my view, have been instrunental in carrying it forward to neet lts objective within the Original Programme area, so that onchocerciasis is no longer a problem of public health and socioeconomic importance in that area. "In my view, the nost significant contributions to the Programme's success have been: the thorough preparatory work carried out prLor to the launching of its operations; the application of a control technologl which, it was known from the outset, would be able to achieve the expected results; the adoption of a praguatic and operations-supporting nanagement system which is cost-efficiency conscious; a competent and devoted staff; and finally, the early approval of a reallstic timefrane. But, perhaps the most important factor has been the unfailing confidence which the Participating Countries and the Donor Community have placed in the Programme ever since its inception. Without thatfaith no undertaking of the complexity, magnitude and duration of OCP could succeed. Mr Chairman, later during this session consideration will be given to a report of the External Review Teem and, I an sure, at that time you will havefruitful discussions on the lessons which can be drawn from the OCP experience and which can be used to address other inportant socioecononic problems. JPC/LL page 44 Annexe I "Now, Mr Chairnan, please aIlow me to say a few words about the future of our Prograrnme. 1991 will be the last year of the third Financial Phase, andpreparations are already under way for the next, fourth Financial Phase which will take the Progranme up to l))l and welt on its way towards its end. During the fourth Phase, control activities will be centred on the Extension areas, where operations are already in fuII swing, in order to protect the poputations concerned and to safegrard the gains obtained in the Original Progremme area. As such, operations during the fourth Phase could be regarded as constituting a successor programme to that which has been completed in the Original area, although the two are intrinsically interlocked and interdependent for the urtimate success of the Progra.mne. The fourth Phase will be marked by an acceleration of the devolution process and a concomitant deceleration of OCP operations; developnents which are clearly described in the draft PIan of operations which is being presented to you during this session of the Jpc. "Mr Chairman, it is now universally agreed that vector control will remain the methodology for transmission control, thus allowing the Programme to reach its objective within the foreseeable future. But this approach should not, in any way, be allowed to detract from the importance of chemotherapy. I have therefore noted with satisfaction that, in the draft PIan of Operations, considerable inportance is attached to ivermectin distribution through joint endeavours involving national health administrations, OCP, nongovernmental organizations and private voluntary organizations. In the broader chemotherapy context, I must commend you on your continued support to the Programme in its search, in collaboration with the UNDP/WorId Bank/[iH0 Special Programme for Research and Training in Tropical Diseases, for a macrofilaricide which would have an immense inpact on the onchocerciasis situation, in particular in the control of recrudescence, even if such a drug only became available after the end of OCP operations. "Mr Chairnan, the second important issue connected with the continuation of our operations into the fourth Financial Phase is that of devolution. As has already been pointed out, the ultimate success of OCP will stand or fall on the extent to which future instances of recrudescence will be detected and controlled. It is therefore Eost satisfactory to see that, even at this early stage, all the seven Participating Countries of the Original Progranme area havedrawn up their individuat devolution plans, for which I congratuiate them. In all cases, those Countries foresee onchocerciasis detection and control as anintegral part of multi-disease surveillance which, obviously, implies the needfor strengthening national capacities for epidemiological surveillance. In this connectj.on, r wourd like to pledge wHO's entire support to the devolutionprocess' for whi.ch the full involvement of the Regional Office for Africa, as outlined in a document before you, will be of the greatest importance. "As Director-General of the Executing Agency of this importantintercountry enterprise r would rike, Mr chairman, to express ny fullest confidence in the future of the Programne and reiterate the World HealthOrganization's conmitnent to it, both ln ternos of technical and adnlnistrativebackstopping, and of financial support. r an convinced that the exenplary collaboration which has so constructively characterized OCP in the past wi.tt continue undiminished in the future. Alr of us, participating countries,Donors, Sponsoring Agencies and Programme staff, face the san- important charrenge: to naintain the momentun of ocp right through to its predicted, successful ending. And, nay I express the hope that the contribution made bythe Onchocerciasis Control Progrnmme to the overall health development of the JPC/rt page 45 Annex I West African region, nhich goes far beyond just onchocerciasls control, will become increasingly evident in time. "Mr Chairman, before I close I would like to express my sincere gratitude to the Participating Countries and the Donor community for their unstinted support to OCP. I deliberately placed these two groups together, because in many ldays their continuing constructive collaboration, which can serve as a model for nany other enterprises, make them appear as a single unit and not two separate entities. "I also wish to thank nembers of the Expert Advisory Committee and its Ecologlcal Group whose scientific and technical advice and support are of the utnost importance in steering the Progromme on the right course towards its set objective. ilMy warmest thanks are also extended to the Comnittee of Sponsoring Agencies (CSA) which, over the years, has shown that there ls such a thing as a Unlted Nations fanily, within which individual menbers can work closely and harmoniously together for a comnon purpose. The assistance of the cSA in supporting and monitoring Programme activities and in facilitating socioeconomic developnent studies, has been invaluable; not forgetting the crucia] role of the World Bank in administering the Onchocerciasis Fund and in ensuring that the Fund is continuously replenished. "Finally Mr Chairman, may I thank most sincerely the Governnent of the Republic of Guinea for hosting this session of the Joint Progranme Comnittee andfor the excellent arrangenents which, I an certain, will greatly facilitate yourderiberations. r wish the eleventh session of the Jpc every success.ff This Mr Chairnan, concludes the message of the Director-General of [iHO. Ttrank you. JPC/Lt page 46 ANNEX II 1 2 3 4 AGENDA Openlng of the session Election of officers Adoption of the agenda Adoption of the Report of the tenth session of the Joint Progremme Conmittee Reflections of the Conmittee of Sponsoring Agencies Progress Report of the hlorld Health Organization for 1990 Report of the Expert Advisory Comnittee Audit report Plan of Action and Budget of the Programne for 1991 and its approval Financing of the Onchocerciasis Control Programme External Review of the Onchocerciasis Control Prograrnme Plan of 0perations for the fourth Financial Phase (1992-1997) Devolution Progress Report of the Onchocerciasis Chemotherapy Project Socioeconomic Development 0ther matters Date and place of the twelfth session Closure of the eleventh session 5 6 7 B 9 10. 11. L2. 13. 14. L5. 16. L7. 18. JPC/tL page 47 ANNEX III LIST OF PARTICIPANTS PARTICIPATING GOVERNMENTS Republic of Benin Son Excellence Madame V6ronique Lawson Ministre de Ia Sant6 publique M. Thadd6e Boko Secr6taire admini.stratif du Comit6 national de Lutte contre lrOnchocercose Burkina Faso Dr Ambroise W. Tiemtor6 Coordonnateur national du Progrqmme Oncho/Trypano, Directlon du Contr6le des Maladies transmissibles, Ministdre de la Sant6 et de I'Action sociale Mme C6lestine A. 8616 L. Directrice des 0p6rations techniques/A.V.V., Ministdre de I'Agriculture et de I'E16vage M. Enmanuel Nikidma Directeur g6n6ra1 de 1'Autorit6 des An6nagements des Va116es des Volta (AW), Ministere de 1'Agriculture et de 1'El6vage M. Pierre Go Conseiller des Affaires 6conomiques, Ministdre du PIan et de Ia Coop6ration C6te d'Ivoire Dr Bouffard A. Bella Directeur des Relations r6gionales et internationales, Ministdre de 1a Sant6 publique et de Ia Protection sociale M. Seydou Traor6 Sous-Directeur du Budget drlnvestissement, Direction des Investissementspublics, Ministdre de 1'Economie et des Finances Ghana His Excellency Mr Larry Bimi Ghana Ambassador to Republic of Guinea Mr Fred Buatsi Executive Director, National Onchocerciasis Secretariat, Ministry of Finance and Economic Planning Mr Martin A. Odei Director, Institute of Aquatic Biology JPC/LL page 48 Annex III Guinea Son Excellence Dr Madigbd Fofana Ministre de Ia Sant6 publique et de la Population Dr Ousnane Bangoura Secr6taire g6n6ral du Ministdre de la Sant6 publique et de la Population Dr Mohaned Sylla Conseiller, Ministdre de 1a Sant6 publique et de la Population Professeur Mandy Kader Kond6 Directeur national de la Sant6, Ministdre de La Sant6 publique et de Ia Population Dr Mohaned Lanine Tour6 M6decin, Chef Division Pr6vention, Ministdre de la Sant6 publique et de Ia Population Dr L6onie Koulibaly Epid6nlologiste, Maladles transmissibles, Service national de Pr6vention Dr Yaya Kass6 Coordonnateur national, Programme de Lutte contre 1'Onchocercose MaIi Dr ZakarLa Maiga Conseiller technique, Ministdre de Ia Sant6 publique et des Affaires sociales Dr Issaka Nianb6l6 Coordonnateur national Equipe nationale Oncho, Division de 1'Epid6miologie et de Ia Pr6vention Niger Dr Baraze Assane Coordonnateur du Programme natlonal de Lutte contre 1'Onchocercose, Direction nationale de I'Hygidne et de Ia M6decine nobile Senegal Dr Abou Beckr Gaye M6decin-Chef, Service national Grandes End6mies, Ministdre de la Sant6 publique et de 1'Action sociale Sierra Leone Dr Abdul Rahman Wurie National Oncho Coordinator, Governnent Hospital Magburaka JPC/LL page 49 Annex III Togo Dr Ananou Edorh M6decin-Chef des Grandes End6nies Dr Tchasseu Karsa Directeur de la Division de I'Epid6miologie. Dlrection de Ia Sant6 CONTRIBUTING PARTIES Afrlcan Developnent Bank Dr Berhane Teoume-Lessane Princlpal Health Expert, Dlvision of Health and Education I Belgiun Mme Sonia Keppens Secr6taire drAdninlstration, Administration g6n6rale de la Coop6ration au D6veloppenent (AGCD) Dr Johan van MuIIen M6decin de 1'Ad.ministration g6n6rale de la Coop6ration au D6veloppenent Dr Jozef Weyns M6decin-Chef r6gional, Anbassade de Belgique, Dakar Calouste Gulbenkian. Foundation Dr Joao Forjaz Vieira Assistant to Director Canada Mrs Ginette Martin Senior Progranne Officer, Canadian International Development Agency France Dr Denis Mrejen Chef du Bureau de Ia Coop6ration sanitaire en Afrique de I'Ouest et Caralbes, Ministdre de Ia Coop6ration et du D6veloppement JPC/tL page 50 Annex III Italy Son Excellence F.M. Pennacchio Ambassadeur d'Italie A Conakry, Chef de d6l6gation Dr Gloria Gallippi M6decin, Gestion des Programmes de Sant6 pour 1'Afrique occidentale, Direction g6n6ra1e pour la Coop6ration au D6veloppement, M.A.E., Secteur Sant6 Dr Mohaned Abdirizak Expert de Coop6ration, Ambassade d'Italie, Conakry Japan Mr Osamu Ogata Second Secretary, Enbassy of Japan, Conakry Korea, Republic of Mr Dong II Jung First Secretary, Korean llmbassy, Dakar Llr4eqbou@ M. Gaston Stronck Secr6taire de L6gation, Ministdre des Affalres 6trangdres DII Netherlands Mr Ian M. de Jong Director, Multilateral Development Cooperation, Ministry of Foreign Affairs Mr Karel de Beer Head, UN-AID Section, Ministry of Foreign Affairs Mr Joannes Moerkerk Advisor, Ministry of Health Norway Dr Idunn Eidheim Head of Section, Directorate of Health Saudi Arabia, Kingdom of Dr Abdullah Al-Owedi Consultant Ophthalmologist, Government Eye Hospital, Jeddah Mr Sa.mi Al-Yousuf Economj.c Specialist, Ministry of Finance and National Economy JPC/tL page 51 Annex III Switzerland Mme H616ne Attinger Charg6e de Progranme, Direction de 1a Coop6ration au D6veloppement et de 1'Aide hunanitaire (DDA-DFAE) Professeur Andr6 Rougemont Conseiller technique, H6pital cantonal Unlversitaire. Gendve United Kinsdom of Great Britain.and Northern Ireland Mr John David Moye WHO Desk 0fficer, Health and Population Division, Overseas Development Administration United States of America Dr Janes Shepperd SenLor Medical Advlsor, Africa Bureau, Agency for International Development SPONSORING AGB.ICIES Food and Acr'iculture Ornaniz a of the United Nat tions FAO Mr C.G. Groon Assistant to Assistant Dlrector-General, Agriculture Departnent Mr Robert N'Daw Assistant Director-General, Regional Representative of FAO for Africa, Accra United Nations Developnent Programne ([INDP) Mr Benjamin A. Gurman Senior Regional Progra.mne Offlcer, Reglonal Bureau for Africa, New York World Bank Mr Florent Agueh Chief, Population and Human Resources, Sahelian Departnent, Africa Region, Washington, D.C. Mr Bruce Benton Onchocerciasis Coordinator, Population and Human Resources Division, Sahelian Departnent, Africa Region, Washington, D.C. Dr Bernhard H. Liese Director, HeaIth Services Department Dr John Elder Economist, Onchocerciasis Unit, Population and Human Resources Division, Sahelian Department, Africa Region, Washington, D.C. Mrs Suzanne Vervalcke Consultant, Onchocerciasis Unit, Population and Human Resources Division, JPC/Lt page 52 Annex III Professor Thayer Scudder Consultant, Director, Institute for Development Anthropology World Health Organization (WHO) Dr Ralph H. Henderson Assistant Director-General, representing the Director-General, WHO, Geneva Dr G.L. Monekosso Regional Director for Africa, Brazzavj-lle, Congo Dr C.-H. Vignes Legal Counsel, WHO/HQ, Geneva Dr Ebrahim M. Sanba Director, Onchocerciasis Control Progranne, Ouagadougou, Burkina Faso WHO Secretariat Dr D.A.T. Ba1dry Chief, OCP Ltaison Office, Onchocerciasis Control Progranme, WHO/HQ Dr D. Boatin Chief, Epldemiologlcal Evaluation Unit, Onchocerciasis Control Progrqmme Dr D.A. Carvalho Coordinator, Office of the Programme Director, Onchocerciasis Control Programme Dr 0.W. Christensen Consultant, Onchocerciasis Control Programne, WHO/HQ Dr P. de Raadt Associate Director, Division of Control of Tropical Diseases, WHO/HQ Dr C.D. Ginger Project Manager, Onchocerciasis Chemotherapy Project, Onchocerciasis Control Prograrnme, WHO/HQ Dr G. Imboua-Bogui WHO Representative, Conakry Mr G. Koulischer Chief, Administration and Management, Onchocerciasis Control Programme Dr D. Quill6v6r6 Chief, Vector Control Unit, 0nchocerciasis Control Progremme Miss M.L. Ravelonanosy Progrqmme Officer, Onchocerciasis Control Progranme Dr P. Reeve Scientist, Special Progranme for Research and Training in Tropical Diseases, l,JHo/HQ JPC/L7 page 53 Annex III Dr J.H.F. Remme Chief, Biostatistics and Infornation Systems Unit, Onchocerciasis Control Progrertme Mr E.J. Senghor Infornation Officer. Onchocerciasls Control progrnmme Mr A. Sounbey Blostatlstlcs and Infornatlon Systems Unit, Onchocerciasis Control programme Dr F.K. Wurapa Regional Advisor, Tropical Diseases, Brazzaville Mr J.B. Zongo chief, Socloecononic Developnent unit, Onchocerclasi.s contror programne EX OFFICIO PARTICIPANTS Expert Advisorv ttee Professor Alexander S. Mul1er Professor Tropical Health, University of Amsterdqm, Academic Medical Cent.reDeparttrent of Social Medicine Professor D.H. Molyneux Departnent of Biological Sciences, Unlversity of Salford Ecolosical Grouo Dr Christian L6v6que French Institute of Scientific Research for Development through Cooperation(ORST0M), Paris OBSERVERS Mectizan Expert Commlttee Dr H. Bruce DuII Secretary of Committee Spain Mr Ranon Gomez de SalazarChief, Health Cooperation Progrnmme, rnstitute for Cooperation for Deveropnent,Spanish Agency for International Cooperation, Ministry of Foreign Affairs Dr Jorge Mas onchocerciasis Control Progranme, Spanish Agency for International Cooperation,Embassy of Spain, Malabo, Equatorial Guinea JPC/LL page 54 Annex III Guinea Dr S6kou Yalani Canara M6decin, Chef Unit6 Epid6miologie, Projet Oncho' Kankan Mr Tokpa Roger Lana Chef Unit6 Entomologie, Entomologiste Chef, Secteur oncho, Kankan Mr Moussa Elimane Diop Hydrobiologiste, Chef de 1'Unit6 Hydrobiologie, Projet Onchocercose, Kankan Mr Djiba Camara Chef Brigade Hydrologie Mr Ounar Kouyat6 Directeur Division, Ministdre du Plan et de la Coop6ration Mr Aliou K. Diallo Directeur Hydraulique, Division de 1'Hydraulique, S.E. Energies M1Ie Assiatou Cossa Charg6e d'Etudes d la Division Am6nagement Hydro-Agricole, Direction nationale G6nie rural, Ministdre de 1'Agriculture et des Ressources aninales Professor E.H. Baba Kourouma M6decin Inspecteur Sant6, Gouvernorat Conakry Dr Babin6 Kaba Coordonnateur national adjoint, Kankan French Insti te of Scientific Re for Development through Cooperation ORSTOM Dr Bernard Philippon Directeur du D6partement Sant6, Paris Orsanization for Coordination and tion in the Control of ior Endemic Diseases OCCGE Professor Hilaire Tiendrebeogo Secr6taire g6n6ra1 adjoint, OCCGE, Bobo-Dioulasso External Review Tean Professor Gerald Webbe Tea.m Leader, External Review, London School of Hygiene and Tropical Medicine' St Albans, UK Dr Paul Lechuga Directeur du Centre d'Epid6niologie, de Statistiques et d'Information OCCGE' Bobo-Dioulasso, Burkina Faso Subject to Audit ITfTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT AS ADMINISIBATOR FOR TI{E SPECIAL ACCOT'NT FOR THE oNCHoCERCTASIS CoNrRoL PRoGRAMME (PHASE rrr) STATEMENT OF CASH RECEIPTS, DISBURSEMENTS AND ACCOTJNT BALANCE (Expressed in United States dollars) Year ended Decenber 31, 1990 2 134 188 L 513 579 268 60L L L2g 742 2 500 000 2 000 000 50 000 244 481 3 447 502 163 693 150 000 4 ooo ooo L 397 olgL 665 72O 1 520 000 4 9Bo ooo 27 77 2 042 575502 29 217 O77 JPC/7r page 55 ANNEX IV January 1, f986 Inception to Decenber 31. 1990 $ 12 000 4 460 9 300 L20 ( Receipts: Contributions African Development Bank S Belglun Canada European Economic Comnunity Finland France Germany, Federal Republic of Gulbenklan Foundation International Bank for Reconstruction and Developnent Italy Japan Korea Kuwait Luxembourg Netherlands Norway OPEC Fund for International Developnent Saudi Arabia Switzerland United Kingdom . United Nations Development prograxme United States World HeaIth Organization Incone from investments Balance from Phase II Total Receipts 7 492 431 4 z6o 75t 7 o3O 523 6 772 972L 431 497 5 225 976 5 855 083 75 000 2 5OO 462 000 000 000 000 000 905 139 950 L5 750 3 038 300 10 000 t2 869 6 458 B 27O 18 480 1 500 000 000 513 893 000 000 000 138 574 644 8 863 774 22 594 373 17O 732 7gL
Всемирная организация здравоохранения (ВОЗ / WHO) · Technical Documents
Joint Programme Committee eleventh session, Conakry, Guinea 3-6 December 1990: report
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