Plan of operations for the third financial phase (1986 - 1991)

Onchocerciasis Control Programme in the Volta River Basin area Programme de Lutte contre l'Onchoc.ercose dans la R6gion du Bassin de la Volta JOINT PROGRA,MME COMMTTTEE Office of the Chairman JOINT PROGRAMME COMMITTEE Sixth session Geneva 10-13 December 1985 JPC.CCP PI-A,N OF OPERATIONS FOR THE THIRD FINANCIAL PIIASE (1e86 - 1991) COMITE CONJOINT DU PROGRAMME Bureau du Pr6sident JPC6 .6(ocP/8s.2) ORIGINAL: ENGLISH September 1985 t- ocPl85.2 ONCHOCERCIASIS CONTROL PROGRAMME PLAN OF OPERATIONS FOR THE THIRD FINANCIAL PHASE (1986 - 19el) ocP 03.9. 85 A1 TABLE OF CONTENTS EXECUIIVE SWMARY 1.1 - 1.15 PART I B BACKGROUND Onchocerciasis and its transmission Onchocerciasis in hlest Africa before the start of OCP operations Events leading to the establishment of the Onchocerciasis Control Programme C PROGRAI"ME AREA Geographical coverage C1 imate Populat ion Socioeconomic situation Health conditions D THE PROGRAMME TODAY 10. Operations and results - Vector Control - Ecological monitoring - Epidemiological evaluation - Socioeconomic information - Research and operational studies - Training 1t. ManagemenE of the Progrannre - Management structure - Budgetary and financial aspects - Agreements L2. Final observations on Ehe Programme today PART II THE PROGRAMME TOMORROW: THE LONG-TERM STRATEGY 13. The situation in 1985 and the background for thepreparation of a Long-Term Strategy 14. I'lain features of the Long-Term Strategy approach designed to reach the Programme objective Page 10 10 T2 l2 13 13 T4 L4 t4 15 15 15 L6 t7 1 3 4 4 2 3 4 5 6 6 7 8 5 6 8 9 E -11 - F TRANSI,ATION OF THE LONG-TERM STRATEGY INTO A PLAN OF OPERATIONS FOR THE THIRD FINANCIAL PHASE (1986 - 1991) Programme target for 1991 General considerations Vector control : operational approach Vector control : operations - Present OCP area - Southern Extension area - Western Extension area Vector control : staff requirements for total Programme area Epidemiological evaluation : operational approach Eplderniologlcal evaluatj,on : operations Socioeconomlc development : oPerational approach Socloeconomic development : operations Malntenance and devolution Train ing Research The Onchocerciasis Chemotherapy Project Management, Administration and Support Summary of total estlmated costs for the thlrd Financial Phase (1986-1991) G BEMFITS, RISKS AND SAFEGUARDS 30. Benefits 31. Rlsks and safeguards Annex 1: Annex 2 Annex 3: Annex 4 Annex 5: Annex 6 Annex 7: Annex 8: Annex 9: Annex 10: Annex 11: Annex 12: 15. 16. 17. 18. 19. 20. 2L. 2' ,'1. 24. 25. 26. 27. 28. 29. 26 27 28 28 29 29 30 30 31 32 18 18 19 2l 2L 23 24 33 36 37 The present (1985) Programme area and the areas of the Southern and Western Extensions Populat ion Definition of operatlonal Phases Annual Transmlsslon Potential Prevalence of Onchocerciasis: 0-4 years Prevalence of Onchocerciasisi 5-9 years Prevalence of Onchocerciasis: 10-14 years Entomologlcal surveillance network: present (1985) area Entomological surveillance network: inlestern Extension area Staff: summary of Posts Research priorities identified by EAC List of subJects for R & D studies -111- Annex 13: Annex 14: Annex 15: Annex 16: Annex 17: Annex 18: Annex 19: 1985 budget: breakdown by Prograrome activity Detalls of financial forecasts Distrlbution of total cost for vector control (1986 - 1991) List of donors to the Onchocerciasis Control Prograrnme Llst of references OCP Organigramme Projected operational developnent - the Strategy ocP /85 .2 Page 1 A EXECUTIVE SI.J}IMARY 1.1 The present document has been prepared at the request of the Joint progranrne CommitEee which, at its fifth session in December 1984, adopted the Progrannne Directorrs proposal for an OCP Long-Term Strategy with the understanding, inter alia, that a Plan of Operations for the third Financial Phase ( 1986-19 9L) be submitted to the Committee for consideration during its sixth session in 1985. L.2 The Plan of Operations has been developed on the basis of the Long-Term Sgrategy whose strategical approaches are all reflected and elaborated upon in the operational and managerial developments foreseen for the years 1986 to 1991. Although the Plan of Operations, which is built up around three two-year periods 0986/87, 1988/89 ar.d L99Ol91), provides more details than did the Long-Term Strategy, iE does not give the same amount of operational specifications that will appear in the corresponding biennial Plans of Action and Budget. It constitutes a framework which leaves a good deal of flexibility both for the preparation and implementation of future Plans of Action and Budget. 1.3 The main thrust of the Plan of Operations is the extension of Prograrmne operations towards the south and to the west. By thus carrying out larviciding throughout an area in I,Iest Africa whose southern and western boundaries come close Eo the Atlantic coast, the present and fuEure risk of recrudescence of the blinding form of onchocerciasis, due to reinvasion of infective blackflies from breeding sites outside the Programme area, will be e 1 iminated . L.4 The addition of the Southern and Western Extension areas to the present(1985) Prograrnme area will increase the laEter by 47L 000 km2 (111 000 km2 in the south and 360 000 km2 in the west) to a total of L 235 000 km2. The length of rivers under vector control will more than double from 18 500 km in the present OCP area to a total of 46 300 km (addition of 5 800 km in the Southern Extension area and 22 0OO km in the Western Extension area). In all about eight million people (two million in the south of Benin, Togo and Ghana and six million in the west) will be added to the 16.5 million nosr sheltered by OCP control operations. 1.5 In paraltel with the extension of the Programme to the south and to the west, there will be a marked reduction in vector control activities in the present (1985) OCP area, which will allow for a significant shift of resources from there to the Extension areas. In the present area it is expected thaE the leve1 of vector control activities during the second biennium (1988/89) will be half of what it was in the 1984/85 period (expressed in terms of cost esLimates) reducing further to a 1ittle more than one sixth for the l99Ol9L period. 1.6 A particularly important aspect of Programme operations in the Western Extension area will be Ehe use of OCP staff paid by the Participating Countries at national salary scales. Ihis will ensure direct and close collaboration with the national authorities concerned from the very start of operations, and a1low for a harmonious development of the devolution process. 1.7 Although control operations and their organization during the third Financial Phase (1986-1991) will fol1ow the pattern developed since the Progranrne began, a number of modifications will be introduced in order to achieve maximum cost-efficiency. This will include greater mobility within the entomological surveillance network and reduction of its staff complementl the use of locally recruited village blackfly catchers; the use of the Be1lec trap as a partial substitute for human bait; and the establishment of a ocP /85 .2 Page 2 network of beacons for teletransmission of hydror.retric data. A1so, larvicldlng in the Western Extension area will be conducted on a more selectlve basls wlth emphasis on breeding sites in larger streams. However, before such modiflcatlons become part of routine activities they must be tested for operatlonal feasibility through research and development (R & D) studies. 1.8 As recommended by the Expert Advisory Committee, larviciding will in future be conflned to the control of savanna species of the blackfly, unless the results of ongoing studies on the role and vector capacity of the forest specles necessitate a reconsideration of this strategy. 1.9 EpidemioJ-ogicat evaluation in the Extension areas will, to a great extent, be carrled out by natlonal teams with technical and material support from OCP. Conprehenslve pre-control baseline data are being assembled and it ls planned that future evaluatlon will be conducted on a rotational basis and on a less lntensive scale than that applled in the present (1985) Programmg area. A number of vlllages situated within the core area will be reserved for the continuatLon of special epidemiological studies carried out by OCP staff. 1.10 OCP wl11, in the fleld of socloeconomic development, concenErate lts efforts on the collectlon, analysis and dissemlnation of information concerning resettlements, wlth the understandlng that external support to overal,l socloeconomic development will come from other intergovernmental and btlateral organizatlons interested ln that field. 1.11 The issue of devolution has been glven considerable atterrtion during the past few years. It ls now becomLng increaslngly clear that at the time Prograrmre operatlons cease in a given Operational Zone, very 1ittle will remaLn for the natlonal authoritles concerned to do in terms of conducting malntenance/surve1llance actlvlties. On the other hand, OCP experience and lts infrastructure could very we11, together vrith WHO leadership and guidance, help the Partlcipating Countries ln developing their prinary health care systems which would also take care of such remaining onchocerciasis survelllance activities. l.LZ Research wll1 contlnue to focus on such matEers as larvicide development; chenotherapy; lnnunodLagnostic testing; the forest type of onchocerciasls and its transmlssion; decreasing risk of transmission fol-lowing control of onchocerclasls; and the length of the fecundity period of the female worm. 1.13 The estimated total cost of imolementing the Plan of Operations amounts to US $ f::.6 mll1ion. Under the assumptlons made it ls felt with a high degree of confidence that the total cost will remain withln that ceiling and hence match that specifted by the Joint Programme Commlttee (US $133.2 mi11lon). The cost of operatlons during the first bienniun (f986/87), when gCP w111 extend to the south and west, w111 be somewhat in excess of the costs for the 7984/85 perlod (US $ 51.4 million against US $40.2 rnillion). The flnanclal forecast for the second biennium (1988/89) remalns at the same level, while a substantial drop is anticlpated for the third biennium(L990197), namely to an amount of US b Zg.l mi11ion. The annual costs are summarlzed below (in IIS$ millton).' 1986 t987 1988 1989 1990 1991 ( 1986-1991 Base cost Price contlngency 23.56L 0.387 25.589 L.827 18.584 4.592 8.348 3.809 25.488 3.939 13.003 4.527 L14.573 19 .07 5 To tal 23.948 27.4t6 29.427 23.L76 77.524 L2.157 133.648 ocP /85.2 page 3 1.14 Throughout the implementation of the Plan of Operations a continuing monitoring wlli be made of all OCP operations, using the R & D approach, with a vlew to ensurlng that the deployment and utilization of manpower and other resources are ln conforrnity with what is actually required for the Programme to reach lts operational targets. These efforts at achlevlng the highestpossible degree of cost-efflciency might conceivably lead to savings in the estlmated costs which, however, could very well be absorbed by unforeseen expenditures and other financial vagarles. 1.15 No operatlon of the magnitude and complexity described in thls document is without lnherent rlsks. In the case of OCP the posslbility of larvlcide-resistance developing cannot be dlscarded. Problems of adhering to a set timetable and of staff deployment and communlcations within a greatly extended operatlonal area must be foreseen as should the speelal clrcumstancesprevalllng ln the I^Iestern Extenslon area. The Plan of Operatlons has taken such rlsks Lnto account and provides for remedial action. A special hazard is that of demanding of the Programme to add on to its principal activity other tasks not dlrectly relaEed to the attainment of its objectlve, a tendency whlch at thls cruclal stage of OCP must be reslsted. PART I BACKGROUND Onchocerclasls and its transmission 2.L Onchocerciasis which is found along rivers ln troplcal zones, partlcularly ln Africa, is a serLous and disabllng disease leading in its flnal stage to loss of slght, hence its common name: ri-ver bllndness. Other clinical manifestations include lntensely itching rashes; wrinkling, thickening and depigrnentation of the skin; and the characteristlc skln nodules ln whlch the adult worms (see following paragraph) are found.Heavily-infected patients often lose welght and suffer from debilitatlon. 2.2 The dlsease is caused by a parasitlc, fllarial (threadllke) worm, Onchocerca volvulus transmitted by the blte of a parasite-carrying female blackfly of the species Sfunulium damnosum sensu lato. The f1y ltself picks up theparasitebyb1tingaffiost.Bothmanandf1yaretherefore essentlal elements ln the 11fe cycle of the parasite. 2.3 The symptoms of onchocerciasis are all provoked by embryos(mlcrofllariae) produced ln millions by the adult female worm (macrofilaria) during lts more than ten yearsr reproductive 1ife. I^lhen a female blackfly bites an lnfected person, it may take up microfilarlae which develop intoinfective larvae within the f1y ln slx or seven days before being liberated on the skin of a human host, from whon the blackfly takes a blood meal, and from where the infective larvae penetrate to the subcutaneous tissues. There theydevelop into adult male and female hrorms and thus conplete the life cycle ofthe parasite. B 2 ocP / 85.2 Page 4 2.4 The females of the blackfly lay their eggs at water-level, or up to 50 mm below the surface on parEially submerged supports in fast-flowing rivers. The eggs hatch in 36-48 hours and the larvae feed by filtering organic and other particles carried by the current. After eight to ten days the larvae moult into pupae before developing, within three days, into adults who take flight as soon as they reach the water-surface. The females mate once in their life, a few hours after cheir emergence, and take their first blood meal the following day. Each blood meal is followed by the maturation of the eggs Eo be laid three to five days later and each laying is followed within 24 hours by the taking of a new blood meal. The lifespan of a blackfly is in the order of three to four weeks during which time it can cover a distance of several hundred kilometres aided by the prevailing winds. 3. Onchoce rciasis in West Africa before the start of OCP operations 3.1 The savanna zone of the Volta River basin area was, at the time when the Programme was prepared, one of the worst endemic onchocerciasis zones in the wor1d. It was estimated that over one million of the ten rnillion inhabitants of the area to be covered by the original Programme (654 0OO km2) were infected by the disease, and that more than 100 000 of them were blind or had serious impairment of sight. As long as onchocerciasis persisted in highly exposed, hyperendemic communities, it gave rise to blindness at an early age(mean: 39 years) when the victims would norrnally be at the peak of their productive lives. Also, the blind persons would suffer a 13 to 15 years reduction in life expectancy. 3.2 In addition to causing great human suffering, onchocerciasis has a marked deliterious economic effect. The productive capacity of those afflicted is reduced; the blin<t and near-blind become a charge on the conrnunityi and inhabitants of the fertile valleys flanking the rivers migrate to poorer lands which are then overcropped and fail to provide adequaEe means of subsistance. It vras thus estimated before the start of OCP operations that in all more than 65 000 km2 of tand in the river valleys had been abandoned by the former occupants due to the then prevailing high risk of the disease and that somewhere around one million people could eventually be settled in the onchocerciasis infested areas, once the transmission of the disease had been brought under conErol. 4. Events leading to Ehe establishement of the Onchocerciasis Control 4.L With the growing concern about the serious adverse effect of onchocerciasis on human health and on socioeconomic development in extensive parts of West Africa and the recognition that control of transmission of the di""."" was a distinct possibility, it was decided to convene a Joint USAID1/OCCGE2/WHO Technical Meeting on the Feasibility of Onchocerciasis Control which was held in Tunis, Tunisia in 1968. The meeting concluded thattta large-sca1e prevalence and savanna zorle o Simulium c intens ty f West Afri ontrol scheme for the PurPose of reducing the of onchocerciasis among the people living in the catt was feasible. The governmenEs of seven countries in that geographical area (Benin, Burkina Faso, Ghana, Ivory Coast, Mali, Niger, and fogo) then submitted requests to a number of inEergovernmenEal and bilateral agencies (including UNDP, FAO, I^IHO, IBRD, European Development Fund and USAID) for support in the preparation of a programme for the control of onchocerciasis in the Volta River Basin area and for eventual assistance to the implementation of this prograntrne. 1 Ag".r"y for International Development of the United States of America 2 Organization de Coordination et de Coopdration pour 1a lutte contre 1es Grandes End6mies. ocP 185.2 page 5 4.2 Subsequently, a "Preparatory Assistance Misslon to the Governrnents of the Participating Countries" (the PAG Mission) \^7as set up by WIIO in association wlth FAO and funded by UNDP to work out an overall strategy, identify the expected costs and benefits and analyse the potentially available financlal resources. The PAG report was submitted late 1973 to a meetlng of representatives of the Participating Countries in l^lest Afrlca, of potential donor countries and of the lntergovernmental organizations concerned. The proposed strategy covered twenty years as the PAG Mission felt that a period of that duration of a "very hlgh 1evel control" of S.damnosum in the OCP area would be necessary considering that "the cumulatlve lifespan of adult Onchocerca volvulus filarlae and of the last qlcrofilarlae produced by these @regionof16to18years'.1.Thestrategyitse1fandthe technlcal recommendations were approved and funds committed for the initial phase of operatlons of the Onchocerciasls Control Programme in the Volta River Basin area (OCP), for which WHO was appointed the Executing Agency. C. PROGRAI',IME AREA 5. Geographlcal coverage 5.1 Onchocerciasis ls found in Africa between the fifteenth north and seventeenth south parallels. Apart from countries in WesE Afrlca where the disease, as mentioned above, reached hyperendemic proportions, endemlc focl of river blindness occurs ln Nigerla, Cameroon, Equatorial Gulnea, Central Africa Republic, Congo, ZaIre, Angola, Rwanda, Burundi, Uganda, Sudan and Tanzania. 5.2 The area covered by the 0nchocerclasis Control Programme was orlginally sltuated between latltudes 80 and 15o north and longltudes 40 east and 80 west. The definltion by the PAG Misslon of the area in which OCP operatlons would be conducted was origlnally (1973) arrived at on the basls of a number of criteria lncludlng a high prevalence and pronounced severity of the disease; field control operatlons already underway in the area; and the availability of entomo1ogical and epldemlologlcal data. It was realized, however, that the priorlty glven to the Volta River Basin area should not preclude future extensions of control operations to neighbourlng onchocerciasls foci. 5.3 Another determlning factor was based on the assumption that the presumed "forest straLn" of Onchocerca volvulus which gave rlse to cllnica11y less serious dlsease manifestations in partlcular eye lesions) than the "savanna straln", could not establlsh ltself outslde forest areas and there act as an agent of the savanna-type of onchocerciasls. A1so, it was taken for granted that the "savanna straln" of the parasite could not survlve ln forest zones. The control would therefore be limited to the savanna species of the blackfly thereby essentlally excludlng forest areas. Savanna blackflles Slnullum damnosum sensu stricto and S.slrbanum) are the exclusive or predominant cytospecies ln the Programme area. The forest specles, S.soubrense and S.sanctipaull, are found in the western and southern zones 5.4 Furtherrnore, as lt was known Ehat the dlsease vector was able to travel long dlstances, i.e. 150 km or more (1ater data showed that this dlstance could be conslderably exceeded)r^it was expected that by conductlng operatlons in such a large area (654 000 kmz of Sudan and Gulnea savanna in Benin, Burkina Faso, Ghana, Ivory Coast, Mall,, Niger and Togo) the risk of serious adverse effects of reinvasion of the blackfly would be virtually obviated. 1PAG r.po.t, page 43. See consoltdated list of references, Annex 17. ocP /85.2 Page 6 5.5 However, as early as L976 it became apparent that the problem of reinvasion of infective blackflies from outside the Programme area might pose a threat to the successful outcome of the OCP operations. In order, therefore, to combat the reinvasion of blackflies, the Progranrners southern border was redefined $rith the result that operations were started in 1978/79 within an additional 110 000 km2 situated in the south of the lvory Coast. So far more than 18 000 km of river have been treated by larvicides within this exEended Programme area at one point of time or another. 5,6 The expansion of operations referred to in the preceding paragraph resulted in some limited control of blackflies in the area concerned, but reinvasion of infected blackflies from sources outside the OCP area has continued Eo be of concern to the Programme. The annually reinvaded areas are located in the western part of the Mali section of the present OCP area; in the north-r^restern Ivory Coast; and in Ehe northern Parts of Benin and Togo. The external sources of migration are found in Guinea in the west and in the SouEhern extension area in the east. The invading blackflies all belong to the g roup of savanna species (S.damnosum s.s. and S. sirbanum) . Plans have Eherefore been made for larviciding of breeding plE-Ei -uEGide the ocP area from where the reinvasion originates i.e. the Southern Extension area (a south-eastern section of Ghana and the southern parts of Togo and Benin) and the I^Iestern Ext.ension area (parcs of Guinea, Sierra Leone, Guinea Bissau, Senegal and Mali) (see map in Annex 1). These plans are now reflecEed in the Long-Term Strat.egy for the Programme. 6. Climate 6.1 The Programme area lies essentially within the sudanian climatic zone with a southern extension of the h,esEern part into the forest-savanna/rain forest mosaique. 6.2 In normal years the annual rainfall varies between 600 and 1 000 mm in the nort.h, and from 1 000 to 1 300 mm in the south. The vegetation varies from thorn bush and dry wooded savanna to guinean savanna with forest galleries along the streams and rivers in the southern-rnost parts of the OCP area. The wet season, during which blackfly breeding is at its peak, and consequently larviciding at its maximum, extends from May to October with the highest rainfall in August. 7. Population 1 7.1 The total population of Ehe present OCP area (including tt.e 1978179 extensions into the southern part of the Ivory Coast) is estimated at 16.5 million. The average annual growth of the population varies from 1.8 to 3.37"(see Annex 2). It is further estimated that Ehe extension of Programme operations to the south and to the west will increase the population covered by another eight million (two million in the south of Benin, Togo and Ghana ".rd "i*2 rnillion in the west) to around 24.5 million (see Annex 2). 1 Most of the figures in this section are quoted from t'World Health Statistics Annual" (wHo, 1983). 2 Revised upwards from estimate given in LTS document (three million). ocP / 85.2 Page 7 7.2 The life expectancy at birth in half of the countries in the Programme area is estimated at 43.5 years and in the other hatf at levels between 45 to 49 years, except for Ghana where the longevity reaches 51 years (see Annex 2). This compares with 70 plus years in most of Europe. 7.3 Another revealing indicator is the infant mortality rate (IMR) i.e. the number of infants who fail to survive the first year of life out of 1000 liveborn. The IMR in l,lest Africa, which in Sahelian countries is among the highest in t.he world, varies from around 100 (Ghana) to 200 (Burkina Faso and Sierra Leone) (see Annex 2) as compared with IMRs as 1ow as 7 or 8 in several European countries. 7.4 The proportion of children Eo adults is very high indeed l children less than fifteen years of age constitute around 452 of Africa's population. This is also reflected in the growth of the labour force which, on the average, is in the order of 3Z a year, a rate which is now accelerating. 7.5 The population is unevenly distributed, more for historical reasons than as a result of bioclimatic factors. Apart from the subdesert, desert and rainforest zones, most of West Africa offers potentially good opportunities for arable farming or animal husbandry or both. The extent of urbanization varies considerably within the Prograntrne area : the ratio between the urban and the total population ranges from 1:10 in Burkina Faso to 4:10 in the Ivory CoasE. Ihe annual growth raEe of urbanization lies between 5 and 77". 8. Socioeconomic situation 1 8.1 The economies of Ehe Participating Countries are essentially based on agriculture. For most of the countries between 707" atd 807" of the labour force is engaged in this field r+ith the exception of Benin and Ghana (462 and 53% respectively). This notwithstanding, imports of food constitutes from 2OZ to 302 of all imports in several of the Participating Countries. As a matter of fact, the food production per capita during the three years 1980-82 hasfallen quite considerably when compared with that of 1969-7t except for Benin and the Ivory Coast. This reduction, which is essentially due to the prolonged drought in the countries concerned, varies from 5Z to L7Z. 8.2 As a result of the heavy dependence on agriculture in the economies of most, if not all, of the West African countries and following the extended period of insufficient rainfa11, the per capita Gross National Product (GNP) remains at a rather low leve1 in practically all the Participating Countries. It ranges from US$ 200 Eo $:SO (low-income economies) with Senegal reaching a GNP per capita of $ 490 and the Ivory Coasr $ SSO (both middle-income economies) (see Annex 2). This compares with GNP per capita of US$ 10-15 000 in several industrialized countries in Europe and in North America. 8.3 Most of the OCP countries in West Africa receive substantial external suPPort to their economic and social development prograrnmes as welL as to Eheir efforts to cope with the irmnediate effects of the drought which has now afflicted the area for more than ten years. Using the net official development assistance (OECD and OPEC) as an indicator of the flow of aid, an average US$ 33 per capita has been dispersed annually in the receiving countries during recent years. However, this indicator varies considerably from one country to another : it is estimated at $ 11.5 for Ghana and Guinea and reaches US$ 85. I for Guinea-Bissau (see Annex 2). 1th" figrrres in this section are quotecl from the rviorld Bank publicationt'Toward Sustained Development in Sub-Saharan Africa" (1984). ocP / 85 .2 page 8 8.4 Although considerable progress has been made during the last two decades in the educational field as regards enrolment, great differences stiIl exist among the West African countries in this respect. Thus, the number of children attending primary school as a percentage of the total number belonging to the corresponding age-group, ranges from 20-30 (Burkina Faso, Guinea, Mali and Niger) to 70-100 (Ghana, Guinea-Bissau, Ivory Coast and Togo) (see Annex 2). In the majority of the countries the ratio between boys and girls attending primary school varies between 2tl and 3:2. 8.5 Over the last few years a number of fundamental principles for sound and realistic socioeconomic development planning seems to gain widespread acceptance among African countries. It is increasingly realised that p1ans, alrhough firm in determining priorities, must be flexible in their implementation. It is furthermore suggested that in many countries the respective roles of the central government, loca1 governments, conrnunity and cooperative groups, and Ehe private sector need to be reviewed. 8.6 Many governments are now concentrating on the improvement and maintenance of the existing infrasEructure (transportation, telecommunication, energy, water, health and educaEional services) rather than venturing into new, costly undertakings whose eventual contribution to the promotion of the countryts socioeconomic development is uncertain. It is also felt that there is a need to move away from the recent yearsr "crisis managementtttowards a realistic medium/1ong-term progrannning in such fields as educaEion, health, agricultural research and forestry and to apply low-cost and efficient. methodo log ie s. 9. Health conditions 9.1 The morbidity paLEern irr West Africa reflects the socioeconomic condiEions in tropical countries belonging to Ehe 1ow/middle-income economy group. Although there is room for improvement in the national health information sysLems, the data and information reported by the Participating Countries point clearly to a situation where infectious diseases are dominant both as regards sickness load and severity, and this to such an extent that chronic and noncommunicable diseases, although far from absent, tend to be submerged in the overall morbidity picture. Among the parasitic diseases, malaria is by far the most widespread with holo- and hyper-endemic zones throughout the Prograflrme area, while schistosomiasis is conrnon in several of the Participating Countries. Cases of trypanosomiasis occur frequently in parts of West Africa and in some areas, entire village populations are infested with guinea-worms. Of other infectious diseases tuberculosis, leprosy and f.rachoma are prevalent all over West Africa and ye11ow fever and cerebrospinal meningitis occur in localized epidemics. Diarrhoeal and helmintic diseases are other important public health problems in the Participating Countries. 9.2 As regards mortatity, again it is the infecEious diseases which contribute the most, i.e. between one third and one half of all deaths of hospitalized paEients. In one country malaria is the main-ki11er within this group, followed by childhood and pulmonary infections. A1so, the group of serious gastrointestinal infections accounts for a high proportion of total deaths, particularly among infanEs. The crude mortality rate in the Participating Countries is somewhere between 20 and 30 per 1000 compared r"rith 10 to 15 per 1000 in European countries. ocP / 85 .2 page 9 9.3 The shortage of water constitutes one of the major obstacles to a sound public health development within the Progranme area. As litt1e as L57" to 3OZ of the Sahelian populations have reasonably easy access to water sources and the differences between the urban and rural areas are strlking. In one country (Burkina Faso) che daily consumption per capita is 75 litres ln the cities, 15 litres in the smal1 tor^rns and 5 litres in the rural areas for communities located two to four km from the water points' 9.4 The persistent drought has, as mentioned in the preceding section, resul-ted in a drastic reductlon in agricultural production and in a shortage of 1oca1ly produced food, leading to short-term emergency solutions detrimental to the planning and implementatlon of longer-term develoPoent schemes. But, equally serious, are the effects of the reduced level of food-productlon on the health, resistance to lnfections, and Producing-Power of the populatlons in West African countries which to a large extent have been, and continue to be, dependent on a subsistence economy. According to a recent (1981) survey conducted by FAO, the daily calorie supply per capita' expressed as a percentage of requlrementsl, varies considerably frorn one country to another withln the OCP area. For about half of the countries it reaches 100% or more while the other half shows a shortfall of fron 10 to 302. 9.5 Faced with a multitude of serlous and debilitating health problems the ma3orlty of the West African countrles have avallable very llmited means indeed. Furthermore, as in most other underprivillged countries the distrlbutlon of health resources (manpower and health instltutions) tends to favour urban populations so that Ehe statistical data collected and rePorted countryr{lse do not reflect the true situatlon which is often Isorse in rural areas than would appear from the average ratlos presented. 9.6 The ratlo of physiclans per 10 000 population ranges from 0.2 (Burklna Faso and Nlger:) to 1.4 (Ghana and Gulnea Bissau) as comPared to 15-20 physicians/10 000 population In certaln European countrles. For nurslng personnel (mldwives, registered/certlfied and assistant/auxiliary nurses) the ratios vary between 3 (Burkina Faso and Niger) and, l5-2O/ 10 000 populatlon(Ghana, Gulnea and Guinea Bissau). The corresponding figures in some European and North American countries are in the order of 50-100 Per 10 000 population.(Source: "World Health Statistics Annua1", (1983)). 9.7 The number of population per hospital bed (a1l cateSorles included) ranges from 1 900-1 600 (Nlger, Burkina Faso) to 650-530 (Togo' GuLnea Blssau). This compares with a level of L7O to 70 In the European region. 9.8 The expenditures directly ascribable to the health field constitute between 5Z and IO7" of the natlonal budgets in the Participating Countries. 0f this, up to 90% ls earmarked for emoluments and other personnel costs. In :^g75/76 the natlonal health budget per lnhabitant varied between US $0.50 and US $1 per annum with the exception of the Ivory Coast ($7 per capita, per annum). 1 Requirements : the calories needed to sustain a person at normal levels of activity and health, taking into account body welghts and envlronmental tempera tures . ocP / 85.2 Page 10 D THE PROGRAMME TODAY 10. Operations and results 10.1 The principal OCP operations are those of vector control (including environmental monitoring) ; epidemiological evaluation; the collection, analysis and disseminaEion of socioeconomic information,' and research. In suppor! of these acEivities, a biostaCisfical service ensures Ehat operational/research data are properly analysed to help in operational decisionrnaking, and an ongoing training programme is directed towards the preparation of nationals of the Participating Countries in the field of onchocerciasis control. Vector control LO.2 The technical approach to onchocerciasis control in the Programme area is based on vector control and the consequential interruption of disease transmission. This control consists of aerial application of insecticides in order to kil1 the blackfly in its larval stages at breeding sites in fast flowing rivers and in large streams and is monitored by an entomological surveillance network wiEh an esEablishment of two zones, six sectors and 17 sub-sectors to which should be added one sect.or and five sub-sectors already operational in the Southern Extension area. 10.3 The problem of blackfly resistance to organophosphorous larvicides is geographically limited to the Atlantic basins in the Ivory Coast and has been confined to the forest species except for one circumscribed and time-limited instance. It has thus been possible to continue the use of the most cost-effective larvicide, temephos, in more than 752 of the OCP area where the savanna species are the sole vectors. The use of chlorphoxim as a replacement for temephos in the control of temephos-resistant forest species has led to cross-resistance as both compounds belong to the same group of organophosphorous larvicides. A formulation of Bacillus thuringiensis H-l4 is usedinriverswheretheb1ackfliesareresi"ta',@ larvic ides . 10.4 During the rainy season, approximate1.y 24 000 km of river (including 6000 km in the Southern Extension area) are under OCP entomological surveillance. Obviously the number of river kilometres actually treated with larvicides varies appreciably from the wet (14 000 km) to the dry(3 000 - 8 000 km) season. Eight Hughes 500D helicopters and two fixed-wing aircraft operate during Ehe wet season. 10.5 The control of the effect of aerial operations is carried out at- 624 capture points (human baits) wittrin the treated Prograrmne area to which should be added 46 points in the Southern Extension area. These points are visited regularly (Z:O + 46) or occasionally (394) by entomological surveitlance staff in order to check for the absence or presence of blackfly aquatic stages in rivers treated; to capture blackflies, when present, for identification and dissecEion to determine their infectivity,' and to read water gauges - all in order to provide the data necessary for directing aerial operations. 10.6 Ihe presence of blackflies and their potential infectivity is measured by the following two indices : Annual Biting Rate (ABR): The number of blackfly bites a person would receive if he or she were to sit at the river bank for eleven hours a day, 365 days a year. The level of tolerability has been set at an ABR of 1000. ocP / 85.2 page 11 Annual Transmission PoEenEial (ATP): The number of infective larvae which might have been Lransmitted to the person above by the biting flies. T'he level of tolerability has been set at an ATP of 100. 10.7 Vector control from the ground is carried out in the Bandiagara area near Ehe Niger river in Mali. Regular blackfly control and weekly searches for larvae are made by two OCP teams with rhe support of village health workers who have been trained for thaE purpose by the Programme. A11 breeding places found to be "positive'r are treated manually with larvicide. 10.8 For planning, programming and managerial purposes the Progrannne has distinguished the following four operational phases: preparation, attack, consolidation and maintenance (see Annex 3). The duration of the maintenance phase has been set at ten years. This would seem reasonable in the light of recenE findings which suggest that the reproductive lifespan of the female Onchocerca volvulus is on the average eleven years. Given that the combined attack/consolidation phase lasts five years, an additional ten yearst maintenance should prevent the risk of recrudescence of the diseasel. 10.9 Furthermore, the areas in which Programme operations are being, and wilI be, carried out are divided inEo OCP Operational Zones (OOZ). An OOZ is defined as a geographical area throughout which the present entomological and epidemiological conditions are relatively uniform, and the past and presenE OCP operations have followed a similar pattern and can be expected to do so in the future (see map in Annex 19). 10.10 Transmission has been virtually interrupted in the original Programme area for now several years, judging from the Annual Biting Rate (ABR), the Annual Transmission Potential (ATP) (see Annex 4) and from the epidemiological trends observed in the indicator vi11ages. However, in the reinvasion areas, and in the south of the Ivory Coast and of Ghana, where the forest speciesprevail, the blackflies are present in numbers which frequently give rise to ABR/ATP values exceeding the levels of tolerability, which have been set at1000 and 100 respectively as the limits below which the risk of eye complications is 1ow. 10.11 The entomological results are fu1ly substanEiated by the epidemiological evaluation data (see Annexes 5-7) according to which it can be safely stated that the initial onchocerciasis morbidity is disappearing fast, to the extentthat the disease is no longer of public health importance within the majorpart of the original Progranrme area. However, transmission continues within the reinvasion areas, although at a lower leve1 than before vector control. lObviously, the final operational decision that the maintenance phase is over must be taken on epidemiological grounds in every case. once an ocpOperational Zote is thus declared as having completed its maintenance phase,it would be safe Eo let non-infective blackflies re-enter the zone. ocP /85 .2 page 12 Ecological monitoring 10.12 The surveillance of the hydrobiological environment in terms of detecring any possible adverse effects of new or currently used larvicides employed in the conErol of onchocerciasis has for some years been the operational responsibility of Participating Countries. The role of OCP in this fietd is one of coordination and the initial detection of possible adverse effects of new larvicides being tested. The continuing monitoring of Ehe river fauna ensures that no damage is caused by the Programme to the environmenE and the intensive control of possible i1l-effects of new larvicides prevents future ecological damage. Epidemiological evaluation 10.13 Data pertaining to the incidence, prevalence and conununity load of infection concerning onchocerciasis are obtained by repeated examination of populations in preselected indicator/evaluation vi1lages. 10.14 The epidemiological evaluation has until recenEly been based on a comparison between the initial prevalence in a given area and that existing today. A more sensitive analysis is now based on a combination of the incidence of the disease among children born since OCP operations started, the community load of infecEion (mean microfilarial load of a cohorc of adults), and the number of microfilariae in the anEerior chamber of the eye (ufAC). 10.15 It has been calculated thaE around three million children born within the core of the Programme area since the sEart of OCP operations are now safe from onchocerciasis infection. Furthermore, of the children born after programme operations commenced, onty 8% of those expected to become infected in the absence of control have actually contracted the disease. These infections (a total of. 59) have practically all taken place in reinvasion areas. Also, it has been estimated that as a result of Programne operations, 27 OOO people have been saved from going blind in Burkina Faso a1one. 10.16 The findings of longitudinal ophthalmological investigations over eight years, and in parEicular the now very low-level of invasion of the eye by microfilaria, confirm the reduction in transmission of Ehe disease. Of those who initially showed ocular microfilariasis, 707" have now improved or recovered while there was no change it L5Z, and a deterioration in 10-30% of the cases (depending on the invasion load). 10.17 Using the mean microfilarial load index, regression lines have been dravm in respect Eo the leve1s of intensity of infection over defined periods of time. Practically all such regression lines converge at zero at a point of time situated around 11 years afLer the interruption of transmission, thus suggesting that the average reproductive lifespan of the adult female worm is in the neighbourhood-f tt years (and not 16 co 18 years as presumed in the pAG report (see paragraph 4.2 above)). This finding is now supported by the results of laboratory studies on the mortality of macrofilariae. ocP 185 .2 page 13 Socloeconomlc inf ormation 10.18 The monltorlng of any population movements whlch could be ascribed to the successful operatlons of OCP and the impact of such movements on the populatlons concerned has been an ongoing Preoccupatlon of the Programme. 10.19 The role and activities of the OCP Socioeconomic Unit are oriented towards the collection, analysis and dlsserninatlon of information on developments in this sphere withln the Programme area and the conduct of special studies for the benefit of OCP countries. 10.20 A recent OCP sponsored investigation in Burkina Faso has revealed that 1n the basins of the White Volta, Red Volta, Como6-L6raba and Bougouriba Rivers, 2 800 km2 out of a toral of 17 000 kn2 of arable land originally deserted (i.e. L6%) had been reoccupled. It i.s estimated that about lO7. of the land cultivated today ln Burkina Faso had prevlously been deserted due to the rlsk of contracting onchocerciasis. Research and operational studies 10.21 Continuing research is undertaken in respect to the identification, lifecycle, reproductlon and transmission of Onchocerca volvulus the pathology, dlagnosis, treatment and epldemiology o sease; and the identification, reproductive behaviour, flyLng/resting patterns, vector capaclty and control of the various Sftnullum cytospecies. Also the Programme conducts operational research concerned wlth such issues as treatment schedules, aerLal and ground transport, lmprovement of spraylng equlpment, blackfly trapping and organlzatlon of entomological survelllance. 1O.22 It is expected that the additlonal larvlcldes, conditional for commencing fu11 control operations in the Extenslon areas, will be available before the start of the third Flnancial Phase (1986-1991). One of them could very well be an operatlonally convenlent formulation of B.t. H-14 while the second might be a pyrethroid, permethrln. trlith these, aid--possibly other larvicides ln hand, the Prograntrne will have at its dlsposal a sufficiently large number of producEs, belonglng to dlfferent groups, to allow for a reslstance-avoidlng, rotation scheme. t e 70.23 The outlook for developing an lmmunological to distlnguish between o1d and recent infectlons, lntensified research is belng supported by OCP in antlbodles technlques, electrophoretlc studles of engineering. test, sufficlently sensitive is more dlstant, but thls field, using monoclonal enzyme systens and genetlc 10.24 Particular attention 1s glven to fleld and laboratory studies designed to separate a "forest type" of the paraslte (Onchocerca volvulus) fron that of a "savanna type" and to determine the respectlve roles of the forest and savanna specles of the blackfly in Ehe transmission of either of the two types. L0.25 As mentioned in paragraph 10.17 above, the Prograrmers laboratory analysls of the mortallty and fecundity of female r^rorms shows a remarkable consistency with the findings of the OCP Statistical Unit (based on epldemiological trend analysis) i.e. that the fecundity period of the parasite seems to be in the order of 11 years. ocP / 85.2 Page 14 L0.26 In the field of operational research, OCP has been inst.rumental in developing a blackfly trap (the Bellec trap) which is now ready for widespread use as anrrearly warning" system partially replacing human fly catchers. Also, as a result of field testing by the Progranrne is it now possible to rely on teletransmission of hydrometric data by satellite. other subjects for operational research have been the use of villagers within the entomological surveillance network (with so far encouraging results in the Western Extension area) and the gradual reduction and reorienEation of this network. Training 10.27 The OCP supported training programme has over the years had an appreciable impact on the availability of scientists and technicians in the Participating Countries. Around 80 candidates have received fellowships in the field of entomology, almost twenty in parasitology/epidemiology, 15 in hydrobioloBy, 10 in ophthalmology and 15 in economics and other subjects. A11 OCP fellows are selected on the recommendation of the Participating Countries. The candidates are thus, in practically all cases, government employees having the assurance of returning to their posts upon termination of their fellowships. Losses in terms of "braindrainrr and non-utilization of knowledge and skil1s acquired have, therefore, been negligible. 11. Management of the Progranrne Management structure 11.1 The overall direction of the operational rests with the Joint Progranrne Conrnittee (JPC) year and is composed of representatives of the Donor Countries and Donor Agencies, and of the FAO, the Inlorld Bank and WHO). and budgetary policies of OCP which normally meets once a Participating Countries, of four Sponsoring Agencies (UwoP, LL.2 A National Onchocerciasis ConrniEEee (NOC) has been established in each of the Participating Countries with a view to ensuring liaison between the Progrannne and the national authorities concerned. 11.3 An ExperE Advisory Cornmittee (feC) wittr a membership of 12 scientists, coming from disciplines of direct relevance to OCP operations, carries out technical audit of OCP and furnishes technical and scientific advice. The Ecological Group (five members), although having an independent status, is a sub-group of EAC. 11.4 RepresentaEives of the four Sponsoring Agencies meet whenever required as the Cormnittee of Sponsoring Agencies (csA). 11.5 The Progrannne is an autonomous entity managed according to WHO procedures and technically and administratively assisted by that organization. The Director of the Progranrne is responsible for all OCP operations. He is supported at the OCP Headquarters in Ouagadougou, Burkina Faso, by four technical uniEs (Vector Control, Epiderniological Evaluation, Socioeconomic Development and Administration and Support Services) each headed by a chief assisted by operational/scientific and general service staff (see organigrarnrne in Annex 18). In 1985 there are 62 professional and 759 general service posts within the Progranrne. ocP / 85.2 page 15 Budgetary and financial aspects 11.6 The financing of the Onchocerciasis Control Programme is borne by a number of governments of countries situated outside the OCP area, by certain inEernational development banks, and by orgatizations and specialized agencies belonging to the United Nations system. A11 contributions are paid into an Onchocerciasis Trust Fund ruhich is administered by the World Bank. An addirional source of financing is provided by the Participating Countries at the 1eve1 of lZ of the annual budgeE estimates. Financial forecasts are made for six-year periods for which donors make long-term pledges. The first Financial Phase covered the period L974-1979 and the second the years 1980 to 1985. LL.7 A Plan of Action and BudgeE is presented annually to the Joint Programme Conrnittee for approval on the basis of which funds are secured for the subsequent year. Every quarter the Programrne Director draws from the Fund the amounts required to support the operations. The OCP expenditure is subject to Ehe same internal and external audit as WHO while the OCP Fund itself is audited by the World Bankrs external auditors. 11.8 Ia 1974 the Programme was financed by only six Donor Countries, UNDP and the World Bank. Now, there are 19 Donors, including development banks, foundations and international organizations (Annex 16 lists the current(1985) donors). A11 in all, OCP has been, and continues Eo be, a good example of international solidarity and this in particular as regards the collaboration between the donor conmunity and the Participating Countries which has pursued only one aim; to rid the Prograflrme area of a serious health problem and this in a spiriE of mutual understanding and genuine desire to work togeEher. 11.9 The total budget approved for 1985 amounts to US$ 20 867 000. Annex 13 shows the distribution of the budget by Programme activities. Agreement s 11.10 Each Financial Phase is covered by an Onchocerciasis Fund Agreement signed by the ttContributing Partiestt, i.e. those governmenEs, funds and organizations which agree to make contributions to the Onchocerciasis Fund for the Financial Phase in question. The Agreement, which constitutes the 1egal basis for Ehe funding and operations of the Progranrme, defines the status and administration of the Fund and specifies the role of the World Bank and I^IHO in this respect. A Memorandum of Agreement, which describes the institutional and operational arrangements of the Programme and is signed by WHO and each of the Participating Countries individually, for:ms part of the Onchocerciasis Fund Agreement. 12. Final observations on the Programme today l2.I Most of the problems with which oCP is faced today have been briefly referred Eo in Ehe preceding sections. As regards resistance to larvicides a great deal of progress has, as mentioned above, been made in the search for new products and for improved operational formulations of atready known larvicides. Furthermore, the fact that vector control is being limited to the savanna species (see paragraph 14.4 below), which on the whole have remained sensitive Eo the most effective and operationally convenient larvicide(temephos), will to a great extent reduce the problem of resistance to an easily manageable leve1. ocP / 85 .2 paSe 16 L2.2 One issue of fundamental importance for OCP has been, and will continue to be, the complete freedom of movement within and among the Participating Countries. In this respect it is worth emphasising that the Programme has enjoyed a unique confidence by, and fu11 collaboration from, the seven countries concerned, and that OCP operations inside and betvreen countries have continued unhampered by any political upheavals that may have occurred. 12.3 A critical factor in any field operation is the availabiliry of a technically competent, managerially oriented and highly motivated staff. OCP has been fortunate in securing the services of such staff on both the professional and general services sides. There have been serious problems in filling a number of professional posts, but today the complement is fu11. With the expected extension of operations to the south and to the west, all efforts will be made to reduce administrative and other chores to an absolute minimum so that the professional staff can concentrate on their essential task; to manage field operations. 12.4 Another important issue is that because of the long-term nature of Ehe Programme an assurance of its rnedium- and long-term funding remains imperative. Again, OCP has been in a unique position insofar as agreements were reached at the start of operations for the donor community Eo support the Prograrmne for a period of. 20 years. Furthermore, even if the need to ensure cost-effectiveness of Progranrne operations has always been a preoccupation of the OCP management, increasing attention will have to be given to this issue in order to maintain future btrdgets within the ceiling set by the Joint Progranrne Committee for the third Financial Phase (1986-199f). L2.5 The problem and control of reinvasion will continue unabated unless larviciding is extended beyond the present OCP borders. Until Ehat time the Programme can be considered as being in a stalemate with control in reinvaded areas being carried out at. great cosE. to the donor community. To retain the ful1 supporL of donors it will then become necessary to programme and implement operations in a manner which clearly demonstrates a shift in the use of resources towards the Extension Zones from the core of the present OCP area, where Eransmission has been interrupted for extended periods. L2.6 An issue which will require increasing attention is that of devoluEion. Much has already been said and wriEten about this process and its implications for the parties involved. For further details see section 24 below. PART II E THE PROGRAMME TOMORROW : THE LONG-TERM STRATEGY The situation in 1985 and the background for the preparation of aI3. !e!C-Ie-!q !!ratesy_ 13.1 The transmission of onchocerciasis has been virtually interrupted within 90:l of the original OCP area and the r:esettlement in riverine zones, previously abandoned due to the devastating effects of the disease, is now becoming an important contributing factor to overall socioeconomic development in the Participating Countries. L3.2 One problem, however, has been of constant concenn to the Programme almost since its start, namely reinvasion of blackflies into the western and south-eastern border zones from sources located outside the OCP area. Although, therefore, it has been possible to drastically reduce larviciding operations ruithin most of the Programme area, it has been necessary to use an increasing proportion of OCPts resources to control reinvasion in the border zones, and this without hope of ever being able to get at the root of the problem. ocP / 85.2 Page 17 13.3 In order to determine clearly the future course of the Onchocerciasis ConErol Programme, the Joint Prograrmne Committee decided at its third session (December 1982) that a Long-Term Strategy (LTS) should be worked out before the completion of the ProgranEne's second Financial Phase (1980-1985) and that Ehis Strategy should be accompanied by a long-Eerm financial forecast for OCP as a whole, taking into account devolut.ion in protected areas and extensions into new "...".1 13.4 Consequently, the Director of the Progranrne presented a proposal for the Long-Term Strategy to JPC at its fifth session in Decernber 1984 (Document JPC 5.7, ocP/84.4). The Committee approved the proposal with the understanding inter alia, that the Strategy be Eranslated into a Plan of Operations for the third Financial Phase (1986-1991), that the costs of this Phase were not to exceed US$ 133 million and that the Plan of OperaEions would be approved by the Joint Prograrmne Committee during its sixth session in 1985. t4. 14.1 The Expert Advisory Committee has defined the Programmers overall objective as follows : I'to eliminate onchocerciasis as a disease of public health and socioeconomic importance throughout the OCP area and to ensure that there is no recrudescence of the disease thereafter" (within that area). L4.2 The end point with the attainment involves operations national basis. In the end of OCP. of the OCP Long-Term Strategy wi11, therefore, coincide of the Prograrmnets overall objective, even if this carried out under the Stategy but exclusively on a other words, the Strategy will remain in operation after 14.3 The Joint Programme Cormnittee concluded that the only strategy which would allow the Prograrnme to reach its objective within an acceptable period of time and at a reasonable cost hras one that would effectively preclude the risk of infective blackflies reinvading the present (1985) Programme area from outside. The Long-Term Strategy therefore cal1s for ful1 cont.rol operations in the Southern and Western Extension areas. An equally important consideration is the need to protect the populations in these two areas against onchocerciasis and thereby remove a barrier to socioeconomic deve lopment . L4.4 The Strategy also foresees that control of the forest species of blackfly be temporarily discontinued within the present OCP area and that operations in the Extension areas be aimed at controlling only the savanna species as recommended by Ehe Expert Advisory Committee. However, this aspect of the Strategy will be reviewed later, if it should be found that the forest species are significant as vectors of the savanna type of onchocerciasis. 1 Document JPC/3, paragraph 12.1 (see also paragraph 11.17 of the same document ) . Main features of Eh. Lo"g-T"r. Stt.t.@. FocP / 85.2 page 18 L4.5 Implementation of the approved Long-Term Strategy will bring the entire Programme area, including the Southern and Western Extension areas, into the maintenance phase by 1991, i.e. well within the tlrenty-year period initially allotted to the Onchocerciasis Control Programme, and this in spite of the addition of control operations in the southern part of the Ivory Coast and in the Southern and the Western Extension areas. Furthermore, by L993/1994, ttte whole of the original Progranrme area will have been in the maintenance phase for five years or more. It is worth stressing that during the major part of that phase in the Extension areas, OCP will sti1l be available to deal with unexpected events. L4.6 Another important aspect of the StraCegy, which will contribute to the Programme meeting its objective on schedule, is the emphasis on an orderly and reliable arrangement for the Participating Countries to assume responsibility for the few remaining maintenance operations. This process of devolution will start in the core area of the Progranrne in the comparatively near future. TRANSLATION OF THE LONG-TERM STRATEGY INTO A PLAN OF OPERATIONS FOR THE THIRD FINANCIAL PI{ASE (1986-1991) 15. Progranune target for 1991 15.1 As mentioned above, the only strategy that will bring the Prograrnrne to its objective must allow for operations to eventually cover all sources of reinvasion, i.e. to control blackfly breeding in the Extension areas, more or less reaching the Atlantic coast. On a more limited scale the Plan of Operations has been develop ed with the following OCP target for 1991 in mindttEo reach the maintenance phase throughout the Prografitrne area, to complete devolution of maintenance acEivities in Burkina Faso and to undertake preparations for devolution elsewherett. 15.2 This target would seem to be operationally feasible as implied in the Long-Term Strategy adopted by the fifth session of the Joint Progranrne Committee and according to which the last OCP Operational Zone (OOZ fO.3) to enter the maintenance phase will do so by l-991. The attainment of the target witl be facilitated by the introduction, in particular in the western Extension area, of a number of modifications of the current control methods(see Section 17), the extensive use of national staff (see para.28.6) and the increasing reliance on trresearch and developmenttr as a means to ensure a high cost-ef fectiveness ratio. 16. General consideraEions 16.1 By translating the Long-Term Strategy into a Plan of Operations, limited to a six-year period, more complete operational, managerial and financial details will be presented for that period than did the Strategy documentation. In essence, it amounts to the definition of a managerial framework within which OCP operations will be conducted. The Onchocerciasis Control Programme, which for its implementation depends on a series of essentially biological and climatic variables, mostly unforeseeable in nature, has in the past been allowed a great deal of flexibility as regards the direction of operations and use of resources, a t'freedom of acEionttwhich has been indispensable for the successes so far achieved. It is important that this principle continue Eo apply and that Ehe Plan of Operations, even if it ocP I 85 .2 page 19 provides fairly detailed operational and financial forecasts for the 1986-1991 period, be seen as embodying a contingent authority to rnodify the planned activities in order to respond to trnforeseen circumstances. More specifically,; the OCP Plan of Operations ouElines the planned tacEical dqve lopmen ts in programmaEic terms leaving it to the OCP management to translate such developments into Operations should be seen as a tt erational decisions. ro rng P n The Plan of 1 be reviewed and adjusted (within its total financial ceiling) as and when required. L6.2 The t.extual part of the Plan of Operations describes and quantifies Programme activities, resource requirements and the expected results on the basis of three Ewo-year periods in order Eo avoid encumbering the description of planned operations with an excess of deEails and to allow for more "freedom of action'r on the lines referred to in the preceding paragraph. However, the biennial quantifications in the text are based on annual forecasts presenEed in the corresponding annexes (in particular Annex 14) by calendar year. The bienniall Plans of Action and Budgets (peS) will provide more specific details for the periods 1986187, 1988/89 aod 1990/91, and therefore an updating of the Plan of Operations conforming to the actual advancement of Programme activities. PABs will retain the same degree of flexibility in implementation as heretofore. Obviously, that part of the Plan of Operations concerned with the 1986-1987 period must correspond closely to the L9861L987 PAB, even if the former does not provide the same amount of details. 16.3 Whenever applicable, the description of an activity is structured as follows : the overall operational approach emphasizing possible modifications of that currently applied (wittr parEicular imporrance being given to the Extension areas) r' the nature and extent of operations within the present(1985) Progranrne area and in the Extension areas, including a sumnary statement of the resources required; and the financial implications. L7. Vector control : operational approach 17.L The control of onchocerciasis within the present OCP area and in the Extension areas will continue to be based on aerial larviciding and the consequential interruption of transmission of the disease until the human reservoir of the parasite (Onchocerca volvulus) has died out (at least 11 years ) . In the Extension areas, and particularly in the west, there wilI, however, be some noticeable modifications of the technical and operational approach followed hitherto by the Programme. L7.2 The attack phase in the Extension areas will last for two years only, followed by a one year consolidation^phase after which the area in question will move into the maintenance phasez. Ihis will have important cost implications insofar as the aerial operations and quantities of larvicides used for consolidat.ion operations are around 502 to 60% of. those required during the attack phase, reducing to 2OZ for the first year of maintenance and to about LOZ for the second year of maintenance. A1so, it should be stressed Ehat OCP-conducted maintenance operaEions in the Extension areas will cease after the first seven years of the maintenance phase leaving the responsibility for such operations during the last five years of that phase with the Participating Country concernedz. 1 F,rtrr" Plans of Action and Budgets will be prepared on a two-year basis as from 1986. 2cf. Annex 3: insofar as Extension area control operations will exclude reinvasion, reductions in the duration of the atEack and consolidation phases(from respectively three and two years to two and one year) should be operationally feasible. The extension of the maintenance phase to tr^relveyears will maintain OCP support for ten years. ocP /85.2 Page 20 L7.3 Aerial operations in the west will to a large extent concentrate on the control of breeding siEes in the main rivers and in their principal tributaries. This "selective larviciding" approach has been applied during the 1984/85 exploratory vector control operations in the Sankarani/Fie-Sassandra river systems in eastern Guinea. Although, obviouely, the results for 1985 can only be provisional it can be concluded from this experience that vector control in that area is possible; that transmission can be interrupted; that there is 1itt1e, if any, reinvasion from untreaEed zones; and thaE this control results in a significant reduction of the reinvasion within the present (1985) boundaries of the Programme area. 17.4 The decision to confine larviciding to the control of the savanna species of the blackf1y, referred to in paragraph 14.4 above, will also have important operational and possibly financial implications for the Programme, both in the present and in the Extension areas. It should be emphasized in this connection that larviciding of savanna species of the vector breeding in the forest areas will continue throughout the Progranrme area. L7.5 Another important, cost-saving measure will be the use throughout the Western Extension area of national staff rather than OCP staff employed under WHO conditions. For further details see paragraph 28.6 below. L7.6 EnEomological larval prospection and surveillance in the Western Extension area will initially airn at achieving a high "coveraget'in terms of inspection at larval breeding places as well as capture, identification and dissection of blackflies. In order for this to be possible a fairly elaborate system of sectors and sub-sectors will be established, similar but more flexible as regards personnel than that developed in the PresenE Prograrmne area. It is, however, planned to reduce Ehe entomological surveillance network at a much faster pace than has been the case within the currenE OCP area. Once consistent data concerning breeding sites and capture points, as well as their trproductivitytt, have been assembled during the preParatory and attack phases, enEomological surveillance will focus predominantly on those areas where experience has shown the risk of recrudescence to be the highest. The surveillance neEwork can thus be considerably reduced at an early date, in particular by introducing a more mobile approach geared Eowards "spot checkingtt so that larger areas can be covered by a sub-sector than has hitherto been the case. L7.7 Furthermore, the employment of village-based vector collectors in situations where this is possible will reduce the size of the mobile teams and enable lighter and more economical makes of vehicles to be used to a great extent. Also, more use will be made of helicopters for the surveillance of breeding sites (aerial prospection), in particular in difficult areas of ground-access, so thaf a limited staff canttcoverttmore sites than would otherwise be possible. These approaches should result in considerable cost reductions compared with those employed to date in the Programme and also provide greaEer f lexibility. 17.8 In conjunction with the use of village vector collectors a more mobile approach to the identification and dissection of captured blackflies is envisaged. Sub-sector technicians will undertake a schedule of visits to the villages and traps concerned, during which the blackflies will be identified and dissected and the results recorded for subsequent reporting. This will require careful progranrning and control of such circuits if savings are to be obiained. In this manner the sector/sub-sector esEablishment will be lessened and the entomological network reduced to the absolute minimum comPatible with the operational requirements of the Programme. rl ocP / 85 .2 Page 2t L7.g Also, the systematic use of Be1lec traps and hydrometric transmission via satellite will help to reduce the need for manpower in OCP sub-sectors. The Bellec trap is nord operational. Negative findings are conclusive but "positivettresults need to be validated or invalidated by human bait catches. The trap attracts a wide range of insects, in addition to S.damnosum s.1., and, amongst the latter, it is noE selective betweerr..rthr6iip--hilic atd zoophilic species. Its main use will be during the maintenance phase as ant'alert mechanism". The trap, cheap Eo purchase, must be controlled every four days (possibly by villagers), its use being limited to accessible areas and non-f1ood periods. 17.10 The experimental teletransmission of automatized readings of hydrometric data by satellite has shown promising results. Its eventual use, in particular in the Extension areas, will relieve Ehe Programne staff of visual reading of the river gauges; al1ow readings in otherwise inaccessible areas; and, due to the closer proximity in time of readings to the larviciding itself and to a high degree of accuracy, enable a SreaEer precision of larvicide application, avoiding both under- and over-dosage, as well as improving progranrming of suspension and frequency of treatment. The installation of one beacon costs US$ 10 000, guaranteed for five years at least, with a subsequent US$ I 500 annually for maintenance but these costs must be balanced against savings in manpower and in larvicides. Sharing the facility u?ith other organirzations (such as Ehe Hydro Niger network) could result in a similar sharing in costs. 17.11 OCP will conEinue the operational research and development Process geared towards ensuring that the technical approaches, applied within the Programne, are the most cost-effective, and that adjustments are made as and when required (for further details, see section 26 below). Future adjustments resulting from this process could lead to a reduction of the estimated costs without impeding the operational effectiveness of the Prograrrne. 18. Vector control ; o rat ions Present OCP area 18.1 A11 of the present (1985) Progranrne area will be in the maintenance phase at the conclusion of the first biennium (L986/87 ) while at the end of the third Financial Phase (1986-1991) the core area (002 0I) will have completed ten years of maintenance, 002 08 seven years and the remaining zones(O0Z O2-O7), excluding the Extension areas, the first four years of that phase(see map in Annex 19). 18.2 A gradual reduction of the entomological surveillance network was initiated some years ago. The network wiI1, by the end of 1985, consist of seven sectors (one, Ouagadougou, classified as a ttgrouptt) and 22 sub-sectors, of which one sector and five sub-sectors are located in the Southern Extension area. Each sector has a complement of 16-25 posts : one chief ent.omologist, one assisEant entomologist, one technician/entomologist, one or two clerks, one laboratory assistant, one radio operator, a storekeeper, two mechanics, 4-6 drivers, 2-7 vector-collectors, and one or turo guards/labourers. The number of staff of a sub-sector ranges from 10 to 21 : one technician/enEomotogist, one laboratory assistant, one radio-operator, one mechanic, 3-6 drivers,2-9 vector collectors and one or two guards. q+ ocP / 85 .2 Page 22 18.3 A substantial reduction in the number of blackfly catching points will have taken place by the end of 1985. Of 230 points, visited either weekly orfortnightly, 432 will be eliminated afEer which a 4OZ reduction will be exercised within each biennium. Ttrus at the end of 1987, 150 capture points will need to be visited regularly, diminishing ro 90 during the 1988/89 biennium and to 50 in l99ol9l, as a reflection of reduced reinvasion of the rivers in the present OCP area due to control operations in the Extension areas. 18.4 A corresponding reduction will take place in the sector/sub-sector network. By the end of 1985 there will be around 60 field teams in operation, each of which is made up of tldo vector collectors and one driver. These teams investigate the presence or absence of blackflies; act as human bait; transport captured fties to the sector/sub-sector laboratory for identification and dissection,'check for the absence or presence of blackfly larvae in treated rivers; and read water gauges. At the end of the 1986/87 biennium Ehe number of teams will have dropped to 35 and by the 1990/91 biennium to twelve. 18.5 The reduction in the number of catching points and of vector collectors will also be reflected in the entomological surveillance establishment. At the end of 1985 the number of sectors and sub-sectors will be six and 17 respectively (excluding the Southern Extension area). This will decrease to one sector and 14 sub-sectors in 1987, to nil sectors and 9 sub-sectors by the end of the 1988/89 bienniun and to seven sub-sectors in 1991 (see Annex 8). There will therefore no longer be one sector for each of the Participating Countries so that one of the sub-sectors in the countries concerned must assume the reduced sector functions. Special efforts will be made to adjust the staffing and running-costs (including transport) of the sectors and sub-sectors to the actual, st.eadily diminishing, operational exigencies of enEomological surveillance within the area. The nature and extent of such adaptation will to a large extent depend on the R & D referred to in paragraph 17.11 above. One modification could be the use of village vector collectors supported by Imobileil entomotogists, as suggested in paragraph 17.8 above. The application of rhis approach already in the present Programme area would allow for it to be tried out before its adaptation to operations in the Western Extension area. 18.6 With the expected interruption of reinvasion, as a result of larviciding in the Extension areas, there will be an appreciable reduction in the number of flying-hours and in the amounts of larvicides required within the present Programme area. This will be particularly significant as from the end of the 1988/89 biennium. The total number of hours planned for 1985 is in the order of 6 100 (helicopter : 5 300, fixed wing aircraft : 800). For the second year of the first biennium (L986187) the estimate will have dropped to 4 500(4 000 + 500), in 1989 to 2 150 (2 000 + 150), and ar rhe end of the third Financial Phase (in 1991), the flying hours required will be at the 1evel of 600 only (500 + 100). 18.7 The reduction in the amount of larvicides required during the period 1986 to 1991 is even more drastic. It is estimated that 135 000 litres of temephos and 350 000 litres of B.t. H-14 will be dispersed during the 1986/87 biennium. The corresponding esffiates for 1988/89 come to 85 000 and 220 000 litres respectively, while tor L99O/91 the amount will be reduced to 40 000 litres of Eemephos and 125 000 litres B.t. H-14. 18.8 The number given above are presented in tabular form in the following figure: zi'{ ocP I 85.2 PaBe 23 Figure 1 Resource requirements for vector control in Ehe present (1985) area, by biennium t984/85L W86 /87 1988/89 L990/91 Number of sectors Number of sub-sectors Number of flying hours - helicopter - fixed-wing Larvicides ( litres) - Temephos - B.r. H-14 4 500 450 2 000 200 6 t7 200 000 750 000 t4 135 000 350 000 85 000 220 000 40 000 125 000 1 0 7 0 9 000 200 9 1 00 00 11 1 J 9 Southern Extension area 18.9 As mentioned above, the Progranrme will extend its operations to the south and to the west. Already for some years, an entomological surveillance network has been established in the Southern Extension area while a similar network is only now being set up in the Western Extension area. 18.10 By the beginning of the second biennium (1988/89), the Southern Extension area will have completed the first year of the attack phase and at the conclusion of thaE two-year period, the area will reach the end of the consolidation phase. The second year of maintenance will be completed by the end of the third biennium (L99019L) (see map in Annex 19). 18.11 The entomological surveillance activities in the Southern Extension area will diminish fairly rapidly and at a faster rate than has applied in the Present Prograrrne area. At the present tirne (1985) there are 30 field teams(see paragraph 18.4 above) which by the end of the biennium 1986/87 will be reduced to 18, by 1989 to six and at the end of the period of the plan of Operations (1991) Eo four. Ihe number of capture points will gradually diminish from 50, to 30, and to L5/20 during the corresponding periods. l8.LZ During the years 1986 to 1991 there will be little change as regards the sector/sub-sector network. The only sector of the area existing in 1985 will disappear the following year, and the five sub-sectors will reduce to four by 1988. However, the manning component may be lessened. 18.13 The number of flying hours in 1991 will decrease to one fifth of those used at the beginning of full control operations i.e. from I 400 hours (1 200 helicoprers, 200 fixed-wing) ro 250 (2OO + 561. 18.14 The larvicide consumption will diminish substantially during the period of the third Financial Phase: from 95 000 litres of temephos during the first biennium (1986/87 ) to t5 000 litres in 1991. 1 Th. lg84/85 figures are provided for the purpose of comparison. ocP /85 .2 Page 24 18.15 A recapitulative table is presented below: Figure 2 Resource requirements for vector control in the Southern Extension area, by biennium 1984 1985 L986/87 1988/89 r990l9L Number of sectors Number of sub-sectors Number of flying hours - helicopter - fixed-wing Larvicides (litres) - Temephos 1 5 0 5 0 4 00 00 20 3 0 4 1 200 200 600 150 95 000 60 000 Western Extension area 18.16 Operations in the Western Extension area will gradually proceed westward from-the present. Prograrmne boundaries. The total area, now estimated at 360 000 km2 witl Zt 900 km of river, will be divided into three oCP operarional Zones; 002 10.1 to the east (195 000 kmz - 10 600 km of river), obz ro.2 03 000 km2 - 6 600 km of river) in the middle, and 002 10.3 to the west (72 000 km2 - 4 7OO km of river). During the first biennium (1985/87) preparatory activities will be concluded and attack operations commenced in 002 10.1, while 00Zs 10.2 and 10.3 will remain in the preparatory phase. In rhe second biennium (1988/89) 002 10.1 will complete Ehe attack and consolidation phases. A1so, attack operations will be completed in 00Zs 10.2 and 10.3 in so far as 002 10.3 will require only one yearts attack phase as it will not be exposed to reinvasion. Fina11y, at the end of the third biennium(L990/9L), 002 10.1 will have been in the maintenance phase for two years while 00Zs 10.2 ar.d 10.3 will have completed one yearts consolidation and the first year of maintenance (see map in Annex 19). 18.17 The entomological surveillance network wi11, as menEioned above, be developed so as to ensure a high degree ofrrcoverage", at least initially. The network will be built up along the lines of the present Programme area with the exception that zone offices will assume the functions of the sectors. It is expected that there will be two zone offices and 19 sub-sectors by the end of the first biennium (L986/87) and three zone offices and 21 sub-sectors throughout Ehe second (1988/89) and third (L990/9L) biennia(see Annex 9). Although at this stage no reduction is foreseen in the zone/sub-sector network during the period in question, the operaEional requirements in the Western Extension area will be kept under continuing scrutiny and modifications of Ehe planned establishrnent in terms of a reduction of Ehe network might eventually be justified, in particular as the Operational Zones will already have been in the maintenance phase for one or two years by the end of the third Financial Phase (1991). 160 000 ocP /85 .2 Page 25 18.18 As already polnted out the zone and sub-sector staff will be paid by the Participating Countries concerned wlth supplements and per diem provided by the Programme. 18.19 As regards the use of aircraft, it is estimated that 5 315 flying hours(4 015 helicopter and 1 300 ftxed-wing aircraft) w111 be needed during the first biennium (L986/87), 8 390 hours (6 400 + 1 990) in the second (1988/89), and 4 600 (3 300 + 1 300) for the thlrd (1990/91). Ihese flgures include hellcopter hours for prospectlon of larval breeding sites throughout the Programme area, Lncludtng that of the Extensions. An addltlonal 300 hours per year are also ldentified for the use of a llaison aircraft to facilitate movement of commoditles and staff wlthln the Programme area. This will enable the Programme to avoid the use of a more expensive and less effective ground transport network. 18.20 The consumptlon steep rlse and fa1l in Phase.' 193 000 litres litres for the L99O/9L preceding delivery. of larvlcldes (temephos only) will also reflect the vector control operatlons during the thlrd Flnanclal In 1986/87, 542 OOO lltres during 1988/89 and 178 000 blennlum. The payments are made during the year 18.21 The above numbers are presented in tabular forn in the followlng figure: Figure 3 Resource requirements for vector control ln the Western Extenslon area, by blennlum 1984 I 85 L986 / 87 1988/89 2 3 19 2L L990 I 9t 3 2L Number of zone offices Number of sub-sectors Number of flytng hours - helicopter - flxed-wing Larvicldes (litres) - Temephos 4 015 1 300 6 400 1 990 3 300 1 300 193 000 542 000 178 000 ocP /85.2 page 26 L8.22 The table below provides a summary of the estlmates glven in this sectlon by rnain components: Flgure 4 Total resource r uirements for vector contro ma .n component and by blennlun 1984 85 ]-986 I 87 L988/89 L990/9t Number of sectors (zone offlces) Present (1985) OCP area Southern Extenslon area Western Extenslon area Number of sub-sectors I 0 2 6 1 0 0 3 0 0 3 Present (1985) OCP area Southern Extension area Western Extenslon area 5 Number of flytng hours@ Present (1985) OCP area Southern Extension area Western Extenslon area 11 300 Number of lllng ttegl! Flxed-wing Present (1985) OCP area Southern Extenslon area Western Extension area 1 900 Temephos (lltres) - Present-1985) ocP area 200 0oo Southern Extenslon area Western Extenslon area 9 000 1 200 4 015 4 500 2 000 6 400 2 000 600 3 300 200 150 1 300 17 L4 5 9 4 2l 7 4 2l{ 20 20 30 0 0 0 000 000 000 1 1 1 45 30 99 0 0 0 135 95 193 85 000 160 000 542 000 40 000 60 000 178 000 B.r. H-l Pres OCP area 750 000 350 000 220 000 125 000 19. Vector control staff requirements for total Programme area 19.1 It 1s expected that the present (1985) number of posEs (entomological surveillance and aerlal operations) (23 professlonals and 550 general service staff) wlll lncrease to 24 ar.d 680 (for the total Programne area including Sourhern and Western Extenslons) by the end of the first biennlum (L986187), to 25 and 755 during the 1988/89 perlod thereafter decreasing to 12 and 613 posts by the end of the third Financial Phase (L986-1991)' B.t. H-14 could very well be employed also in the two Extension areas ,rnaer the "rotatlon of insectlcldes" scheme (see para 31.1 below). In such Lnstances the temephos requlrements would be reduced correspond inglY. 1 NP /85.2 page 27 Lg.2 The overall management and direction of vector control operations is the responsibility of a unit at the OCP Headquarters and of the zone offices. As mentioned below an operaEional sub-headquarEers will be established in Bamako nearer to the Western Extension area. There are at Present (1985) nine professional posts in Ouagadougou which will be reduced to three by 1987 and to thro posts in 1991 (included in the above estimates). 20 idemio ical evaluation rational a 20.L A close collaboration between entomological surveillance and epidemiological evaluation is being developed and will be further strengthened during the third Financial Phase (1986-1991). ftis is particularly significant in the Western Extension area where the selection of indicator villages is made in close contact with the staff responsible for vecEor control so as to ensure Ehat future epidemiological findings can be correlated with those reported by the entomological surveillance network. It is also expected that the ongoing analysis of epidemiological data from the present OCP area will enhance the current understanding of the dynamics of onchocerciasis and increase the role of epidemiological evaluation in respect to decision-rnaking regarding the continuation and degree of intensity of vector control. This will apply particularly during the maintenance phase. 20.2 Epidemiological evaluation as regards onchocerciasis has until recently been the exclusive domain of the Prograrnrne with 1itt1e or no involvment by the Participating Countries. In preparation for devolution in Burkina Faso and elsewhere, this activity wi1t, in the third Financial Phase, (1986-1991) become the responsibility of the national authorities concerned, both in the present OCP area and within the Extension areas. Thus national staff have already received training in the methodology employed by the Prograrmne in some of the Participating Countries which in turn have established onchocerciasis-evaluation teams or included this function among those of the countriesi general epidemiological services. In the Western Extension area practically all epidemiological mapping has been done by national staff and current epidemiological evaluations are being conducted by nationals with the support of OCP. Ihis collaboration will continue as a permanent feature of Programme operaEions. 20.3 In order to ensure comparability between, and consistency of, the resulEs obtained by the various teams, the Prograrmne staff concerned will provide the necessary field training (including guidance for how to analyse the data collected), undertake supervisory functions, and ensure conformiEy with OCP sEandards through rrblind'r readings and comparative surveys of separate villages. OCP staff will also continue Eo have free access to all data for quality control. 20.4 Some evaluation villages in the central part of the present Prograrmne area will be retained for fo1low-up examinations carried out exclusively by the OCP teams. This will allow for the continuation of a series of studies of global (ttcorett) interest to the Programme, €.g. deEermination of values of epidemiological criteria, trend analysis, the longevity and fecundity period of the female worm and the characteristics of the forest type of onchocerciasis, as well as biochemical and oEher tests of onchocercal nodules. The OCP functions and the respective responsibilities of the Programme and of the governments concerned will be covered by legal agreement s. OC Page 5.2 28 Pls 20.5 The technical approach in the Western Extension area differs from that employed in the present OCP area in that initially a broad based data bank will be accumulated (by national teams in collaboration with Progranrne staff), after which a follow-up will be carried out by simple evaluation in a rotating sample of villages. The epidemiological trend of the disease in an area under eight yearsr effective vector cont.rol is now well known and there is no reason why a similar trend should not reproduce itself in the Extension areas. Hence the need for a reduced "confirmative" evaluation in the savanna zone of the Western Extension area with more emphasis, including detailed examinations, on the preforest zone. 21. Epidemiological evaluaqlcqj operat ions 2L.L As can be inferred from the preceding paragraphs, the functions of the OCP staff concerned with epidemiological evaluation will change from being essentially operational and executive to those of training, supervision, support and control in addiLion to carrying out ttcoret' studies. FurEhermore, it will be incumbent on the Programne Eo advise the Participating Countries on the nature and magnitude of the epidemiological evaluation that is real1y needed and suggest ways and means whereby this can be carried out by national staff in the most economical manner. OCP will also be concerned with the monitoring of the health situation of resettled populations with particular emphasis on onchocerciasis. 21.2 For the purpose of performing the functions enumeraEed above, it is planned to retain four professionnal and 30 general service posts into the second biennium (1988/89) after which one or two professional Posts will be suppressed and the number of general service staff gradually reduced to ten. Close to three-quarters of the activities will be carried out in the Western Exrension area. Although costing of Ehe third Financial Phase (1986-1991) will be based on the above estimates, it is not unlikely that the actual requirements, once subjected to R & D studies based on field experience during the initial period, will turn out to be less than those now anticipated. ZL.3 In conformity with the approach followed in vector control regarding national staff, the Programme will provide government-paid epidemiological staff with a supplement and per diem corresponding to the amount of time sPent on onchocerciasis surveys. 22. Socioeconomic development : oPe rational approach 22.L The functions of the Programme in the field of socioeconomic development in geographical areas, previously deserted due to onchocerciasis, will be essentially to collect baseline data and informaEion concerning their subsequent development; to carry out the analyses necessary to establish meaningful trends and to draw valid conclusions therefromr' and Eo ensure the distribution of the maEerial thus produced to the Participating Countries, for Ehem to learn from each oEherst experience and to the donor community for it to identify, together with the Participating Countries, oPPortunities for collaboration in the field of socioeconomic development. ocP / 85 .2 Page 29 22.2 In fulfilling the above tasks, the OCP uniE concerned will collaborate closely with, and receive substantive suPPort from, other multilateral agencies within the framework of the Conrnittee of Sponsoring Agencies (CSA). 23. Socioeconomic development : operations 23.1 Within the present Programne area, OCP, together with other sponsoring agencies, will continue conducting surveys at different leve1s (district, village and household) concerning changes that have occurred between the start of Prograrmne operations and the current period in such fields as demography, arable farming, animal husbandry and ecology. 23.2 In the Extension areas, governments of the Participating Countries will be encouraged to undertake socioeconomic surveys so as to establish a pre-OCP operations baseline which will a11ow for a continuing evaluation of the situation in this fie1d, using simple, standardized socioeconomic indicators. The Progranrne will provide technical backstopping whenever required. the countries concerned will thus be able to identify more clearly the activities required for supporting planned and spontaneous community development in zones freed from the risk of onchocerciasis. 23.3 Three professional and tr^,o general service posts are foreseen for the first biennium (L986187), gradually reducing to one post in each category by the end of the third Financial Phase (1986-1991). 24. Maintenance and devolution 24.L The Long-Term Strategy foresees the assumption of responsibility by the Participating Countries of residual maintenance activities once the Programme ceases operations in a given Operational Zone. However, it has now become quite clear that there will be very 1ittle left for the Participating Countries t.o do once an OOZ reaches the second half of the maintenance phase. 24.2 The first country Eo be involved is Burkina Faso and the Prograrrne has recently entered into close collaboration with the government in respect to the planning for post-OCP enEomological surveillance and utilization of the OCP sector/sub-sector staff in the national prirnary health care system. Given the need Eo provide all possible safeguards against recrudescence of the disease, OCP wi11, in collaboration with the authorities of Burkina Faso carrv out studies in these fields during 1986/87. 24.3 There will however be a difference beEween maintenance (and post OCP surveillance) in the present Programme area and in the Extension areas. In the former most of the OCP Operational Zones have already, for all practical purposes, been in the maintenance phase for 5-6 years and will benefit from OCP support, whenever required, during another, say Een years. In that area more than 15 years of OCP conducted maintenance and nationally-directed and OCP-supervised and supported maintenance operations will take the OOZs concerned very close to Ehe dying out of the human parasite reservoir. In the Extension areas, on the other hand, the Programme will cease operations 5 years before the end of the maintenance phase, a situation which as mentioned above calls for a study on how best to ensure that post-OCP surveillance is conducted in a manner whereby all necessary safety precautions are taken. Such a study will give due consideration to the potentiat contribution of the hlorld Health Organization as E.he organizer and coordinator of a facility ready to take any remedial action which is best carried out on an intercountry basis, in case local insEances of recrudescence occur. a ocP / 85 .2 Page 30 24.4 A connected issue is that of how best to make use in the public health field of the Programmers technical and managerial experience and of its infrastructure as and when OCP operations commence to reduce in intensity and in magnitude. Although OCP has a legitimate role to play in ensuring that optimum use is made of its unique experience to support endemic disease control in the Participating Count.ries, it will be incumbent on the World Health Organization, through its Regional Office for Africa, to take the lead and to support the countries concerned in regard to the utilization of opportunities offered by the Progranrne for the sErengthening of their health systems. A particular aspect, to which great attention must be given in this context, is the need to ensure that the countries themselves will be able to carry out the necessary post-OCP surveillance activities and to undertake the very limited control measures whenever indicated. 24.5 As stressed above the devolution process will be centered on the integration within national prinary health care (pHC) systems of a few residual onchocerciasis surveillance activities, rather than building-up a comprehensive conErol system capable of undertaking all the various operations currently carried out by OCP. Any plans or timetables for devolution must, therefore, be inEimately tied up with the Participating Countriestown plans for the strengthening of their PHC systems. A first sEep in the direction of preparing such plans is the collaboration established between Burkina Faso and the Programtre in this respect, and the intenEion to conduct related studies. Obviously, Ehe estimated costs of devolution will depend on the Participating CounEriest approach to PHC development. Again, it can be expected that the Burkina paso/0Cp collaboraEive studies will provide some indications as to the resource requirements and that WHO/AI'ROrs close participation throughout the devolution process will help to attract bilateral and multilateral funds to support the counEries concerned in their effort to strengthen their health care systems. 25. Training 25.1 OCP will continue to support the Participating Countries in their efforts to train national staff in disciplines relevant to maintenance/surveillance activities. Ihe Prograrune will follow closely the process of health systems development within the countries concerned and collaborate with the national authorities in this field in order to ensure that onchocerciasis maintenance/surveillance activities be firmly anchored into the country health care systems. OCP will in this respect collaborate closely with the Regional Office of the World Health Organization whose foremost role is to promote and support health care development in its Member States. The emphasis of health manporder development will be in the field of epidemiology. 26. Research 26.1 The prioriries of OCP-conducted and Programme-supported research have been laid down by the Expert Advisory Conmrittee at its session in 1985 (see Annex 11). 26.2 Research carried out, or supported, by the Progrannne will continue to be confined to issues of direct relevance to OCP operations, the criterion being thaE findings can be expecEed to influence the decision-naking in respect to the technical, operational and managerial direcEion of the Programme. In this respect, the EAC priorities meet the exigencies of OCP and will continue to do so during the third Financial Phase taking into consideration the comments made in the second column ('rPresent (1985) situation") of Annex 11. ocP / 85.2 page 31 26.3 Another dimension of the research programme which will be of prime importance during the third Financial Phase is "researclr and clevelopmenttt. R & D is the ongoing detailed investigation of any activity, or group of activities, designed to deEermine what changes will be appropriate or what improvements can be made to enhance the effectiveness and cost/efficiency of such activities and to amend Ehe operations accordingly. In other contexts this could be referred to as t'operational research". However, for the sake of uniformity of expression t'research and developmentrt has been used throughout this document. Subjects for R & D studies are listed in Annex 12. 26.4 R & D will play an important managemenE role within the Programme. As already stressed in the preceding sections, several of the principal activities in the Extension areas do initially aim at t'full coverage" with a resulting high concentration of manpower and other resources along the pattern originally established by the Programme. However, these activities will undergo a critical analysis each year and be adjusted to match actual needs.This witt, no doubt, in most cases result in an accelerated downward trend of acEivities. 26.5 The Programme Director will involve all staff concerned in such critical reviews of Programme operations during annual seminars of which the first washeld at the beginning of 1985. The list of subjects presented in Annex 12gives an idea of the agenda for future staff seminars. For each item the seminar will solicit the consolidated technical and managerial views of the staff which will serve as a basis for the elaboration of a detailed R & D sEudy protocol to be applied within the prograntrne area as appropriate. Thefindings and results of the study will be discussed aE a subsequent seminar and firm decisions taken as to how the R & D findings may be integrated within Progranrne operations. Their implementation then becomes a managerial concern. 26.6 The intensity of OCP-conducted or supported research can be expected tolessen as results accumulate during the first part of the third FinancialPhase (1986-1991) and OcP operatiois diminish iowards the conclusion of thatPhase. 26.7 Much of the research and operaEional studies undertaken by the programmeitself are carried out by OCP staff as part of their day-to-day activities. rn addition, ten professional and 33 general service posts, assigned to research programmes and studies in the fields of entomology, larviciding, epidemiology and hydrobiology, are planned for the first iwo years (L986i87) with a reduction to three professional and ten general service posts during the third biennium (L99019L). Special efforts will be made to ensure thatinformation on the progress and achievements of the programme, as well as scientific papers emanating from OCP, are produced and published in a timely manner. 27. The Onchocerciasis Chemothe rapy Project 27.1 The Onchocerciasis Chemotherapy Project (oCT), which is being carried out in close collaboration with the Filariasis component of the wHo/uNDp/world Bank Special Progrannne for Research and Training in Tropical Diseases (TDR) and with the pharmaceutical industry, has so far 1ed to the identification of one compound (Ivermectin) which is showing promising results both in terms ofkilling Lhe microfilariae, and of preventing their release from the adultfernale worm. Furthermore, the compound is given orally in a single dose, is effective in supressing microfilariae in the skin and eye for more than six months, and does not seem to give rise to serious side-effects such as thel{azzotti reaction. If, therefore, field trials confirm that these qualities of the drug apply also on an operational scale, and no toxicologicai problems arise, Ivermectin could become an important means of control, as a complementto larviciding. However, irrespective of the outcome of these trials, ocr wiIl continue its search for a macrofilaricide, as only by killing the adult worm will chemotherapy achieve definitive elimination of the parasite and thushave the maximum, and operationally optimum, effect within the Programme area. ocP I 85 .2 page 32 27.2 The actual method of employment of a drug as a complement to larviciding(and under certain circumstances possibly substituting for it) remains to be determined. Much would depend on whether the final producE will be a macrofilaricide or a microfilaricide. The main use of the drug would in all likelihood be in t-he maintenance phase, although it could play a role already in the attack/consolidation phase within the Extension areas should the drug become available for mass use by, say, 1988. 27.3 The extent to which the drug would be used to deal with Iocal reinfestations, should they ever occur, or to provide a prophylactic cover intthigh-risktt areas, or both, would have to be considered carefully through research and development studies. Such studies would also need to focus on the possibility of development of resistance, a concern which should continue to be kept in mind once the drugs are released for operational use. 27.4 A particular consideration relaEed to chemotherapy would be the eventual impact of a specific inrnunodiagnostic test for detecEion of early infection with O.volvulus. Should such a Eest become available in time for use during theaEffio1idationphaseintheExtensionareas(1988/89)itwou1d greatly enhance the role of chemoEherapy as a means of control comPlementary to larviciding. During the maintenance phase the combination of an inrnunological test, capable of detecEing recent infections, and an effective drug would have important repercussions on, and greatly facilitate, surveillance operations. 27.5 According to a decision of the Joint Programme Coumittee, the overall progress of the Onchocerciasis Chemotherapy Project will be reviewed in 1987 at which time the future course of the project will be determined. 28. Management, Administration and Supportl 28.L The DirecEorrs Office will continue to be responsible for the implementation of the OCP policy and the overall management of the Programme; public health activities related to OCP activities; the devolution process; informationl statistics; fellowships and training; research coordination; and the liaison office in Geneva. 28.2 The Office has (in 1985) 12 professional and eight general service posts which during the third Financial Phase will be gradually reduced to six and seven Posts resPectivety. 28.3 In order to provide OCP operations in the Western Extension area with the necessary managerial and technical direction and support, a subheadquarters of the Progranrne is being established in Bamako. This centre will have fu11 responsibility for directing and supervising vector control operations in the hlestern Extension area and in the neighbouring reinvasion zones within tl're present Programme area. Also, Ehe Bobo-Dioulasso aerial base will be transferred to Odienn6 (Ivory Coast) while Kara (Togo) will remain the main aerial base in the east. The OCP headquarters in Ouagadougou will retain the overall responsibiliEy for operations throughout the toEaliry of the Programme area. It is expected that a number of the professional and general service posts for vector control aE the Bamako centre, all of which in the OCP/WHO category, wiIl be transferred from OCP headquarters in Ouagadougou. The above arrangments witl be concluded before the beginning of the third Financial Phase. l il ri lsee also Annex 18 a trP /85.2 page 33 28.4 The Administration and Support Services comprise budget and finance, personnel, supplies and transport. With the establishment of an operational subheadquarters in Bamako there will be a need for a few additional posts, even if the requirements of the Bamako centre will be partly met by transfer of administrative sEaff from Ouagadougou. (For summary of posts see Annex 10 and Annex 14). 28.5 The number of professional and general service posts will be reduced from 11 and 146 respectively during the first biennium (1986/87) to six and 75 at the end of the third biennium. 28.6 In the Western Extension area ful1 use will be made of national staff rather than OCP staff employed under WHO conditions. This use of national staff will apply only to those who work exclusively within their or^m national boundaries. Ihey will be selected in collaboration with, and seconded to, the Progranrne with the understanding that any changes of such staff will be arranged in consulEation and with the approval of OCP. For this category, the government concerned will pay according Eo the national salary scales, while the Programme will provide a fixed subsidy plus per diem at an ad hoc rate when on travel. Special arrangements will have to be made for the recruitment and payment of village-based vector collectors. This approach has already been followed on a limited scale during the past one or two years. The arrangements in the Southern Extension area, where OCP recruited sector and sub-sector staff have been in place for some years, will fo1low those pertaining to the present Programme area. These arrangements will be firmly embodied in lega1 agreements with each of the governments concerned. 29. Sunnna of total estimated costs for the third Financial Phase 29.L Programme costs are expressed in June 1985 prices and do not include taxes and duties because of the tax-exempt status of OCP. Cost estimates for aerial operations are based on the number of estimated flying hours per year for each operational zone. The number of flying hours required is based on the kilometres of river to be treated (assuming a year with an average rainfall) and related to experience over the past 10 years in the present OCP area. The costs per flying hour are calculated on the basis of the present aerial contract: for helicopter US $486 and for fixed-wing US $444, excluding fuet. Ihe cost of each larvicide is estimated at US $11 per litre for temephos and US $4 per litre for B.t. H-14. Equipment requirements are estimated according to lists prepared for the different OCP units which would seem reasonable both in scale and costs. Personnel expenditures which, as in the past, are a major Progranrne expense, are calculated in accordance with the OCP/WHO scales on the following basis: internationally recruited professional staff, US $65 000 per annum; international general services staff, US $4 000per annum; OCP supplements/per diem for staff paid by the national government seconded to OCP, US $700 per annum. In estimating personnel costs a fill ratio of 93 is used. The contingency allowance of US $tg mittion includesprice contingencies assuming the following annual inflation rates. Year Foreign Component Local Component 3 7 8 OZ 57" 07" 5 7 8 07" 57" 07" 1 986 L987 1988-9 1 ocP 185.2. page 34 The forelgn component of 3Z for 1986 reflects the fact that the cost of the aerial contracts will remain constant ln L986 and that pesticides are bought at 1985 prices. 29.2 By applying such standard costs to each Programme component, the followlng tabulatlon can be constructed. Figure 5 Es tl mated costs of operations by Prog ramme component and by calendar year 1 Detailed cost tables by Programne activity (component) and by category of expendlture are provided ln Annex 14. No provlslons made for L989, 1990 and 1991 as actlviEies during that perlod to be determined during OCT revlew ln 1987 only. 1 2 a A. UECT()R Ctl}{IRt}L ()PERATIONS AERIAL OPERATI(}IIS EilT(}Hq.OGICAL SURVEILLANCE Sub-Totat UECT0R C0NTROL 0FERATI(}NS B. EPII]EIIIOL(}GICAL EVALUATIt)I{ C, 0FERAII0I{AL RESEARCH r O, CHE}IOTHERAPY RESEARCH E, IRAININE 9D EilVIRONI{ENTAL I,IONITORIilG F, SOCI()ECONOIIIC ITEUELOPIIENI 6, PROGRAI1 }tAilAGEItEilI OFFICE OF IHE I|IRECIOR AIII{I}IISTRATI(}il AND SUFPORT SERUICES IIEEIIN6S GENEVA LIAISON OFFICE Sub-Tot.I PR0GRAII HAilAGEIIENT Iotal BASELINE C0STS Prrce Conttngenctes Total PR0JECT C0STS Bese Costs (uS$) 19 86 1987 1983 1989 1990 1991 Base Costs 7r438r550'0 10r008r000.0 10r516r800,0 9r007r000,0 5r454r000,0 6r469r600.0 6r287r000,0 6r279r000,0 5r203r000.0 4r139r000,0 2 r 711 r500,0 3rl8lr800'0 13r908r 150,0 16r295r000.0 16r795r800'0 llt2l0r000'0 763,000,0 692r200,0 581r800,0 126r000,0 1r813r800,0 1r773r800,0 1r623r800'0 1r191r200,0 3r200r000,0 3r190r000,0 3r150r000'0 100r000,0 100r000'0 , 1001000,0. 50r000'0 282,200,0 2821200,0 1901200.0 179r200,0 9r591r000,0 326r000,0 859r000'0 50r 000,0 165r200,0 5 r 896r 300,0 80r000'0 576,000,0 82,600,0 911,000,0 780r000'0 2r118r200,0 2r0{0r600.0 300,000'0 300r000'0 135r000,0 135,000,0 697,800,0 1r911r000,0 300r000'0 135r000'0 593,600,0 155r000,0 1r196r000.0 1r120r000'0 300r000'0 100r000,0 135r000,0 135,000,0 122r000'0 856r000,0 300r000.0 135 r000,0 3r16{r200'0 3t255r600'0 3r0{6r800,0 2r521r600,0 2t010r000.0 1r713r000,0 23r561r350'0 25r588r000,0 25r{88r100,0 18r581r000,0 l3r003r?00,0 8r347r900,0 386r820,2 1r827r048,3 3r9J9r385,8 1r591t579,2 1r521r110'9 3r808r732,3 23r918r170'3 27r115r848'3 29t427t785,8 2]l!75t379,2 17r521r310.9 12r156r632,3 15 r 138r 850,0 3l r559 r 100.0 76r 698 r 250,0 2 r 869r 000 '0 7r 870 r 600,0 9r 510 r 000,0 100r 000 ' 0 1r181r600,0 3r 859 r 100,0 9r511r800.0 1r800r000.0 810 r000,0 16,01{ r 200,0 It1r57}650,0 19r07fi676,8 133 r 618r326,8 39 28 67 3 7 I I Total 3 I 2 __-__1 l1 100 .__::. 117 ocP / 85.2 Page 35 29.3 The figure below shows a breakdown of the costs of vector control by geographical area (present, SouEhern and I^/estern Extension areas). It shows the shift of resources from the presenE OCP area to Ehe Extension areas (see also the graph in Annex 15). Figure 6 Estimated costs of vector control entomological surveillance, aerial operations and larvicides) by OCP area and by biennium(cont ingEnc ieE noE inc luded) ( $ooo ) (t984/85) (L986187) 22 969 t3 795 ( 1e90/e1 ) ( Present (1985) Prograrune area Southern Extension area Western Extension area 1 500 4 958 11 450 5 565 t6 770 ( 1988/89) I 67L 4 347 2 522 8 620 Total 24 469 30 203 31 006 15 489 From this figure it can be seen that the gradual reduction of vector control operations in the present Progranrne area results in the saving of US $ 42.1 million which will be directed to operations in the Extension areas. This demonstration of the shift in the use of resources has been limited to vector control operations, accounting for 67% of. Ehe total Programme costs. Other OCP component activities enumerated in Figure 5 above are common to Programme operations and do not, therefore, lend themselves to a breakdown by OCP area. ocP 185.2 page 36 G BENEFITS, RISKS AND SAFEGUARDS 30. Benefits 30. t The Programme will provide continued protection to the present OCP area. By extending control operations to the south and to the west towards the Atlantic coast, the risk of reinvasion of infective blackflies, giving rise to the debilitating form of river blindness, will eventually be eliminated. 30.2 The dynamic, gradually expanding apProach foreseen by the Programme will enable it to reach its objective. Thus, the populations in the OCP area, present and future, will reap the fu11 benefit of control operations: those already protected will no more be exposed to reinvasion and those not yeE included will see the threat of infection disappear. Eight million people will be added to those currently under protection in the present Programme area (16.5 million). 30.3 Another important beneficial aspect is the strong active participation of the beneficiary countries in all OCP activities, as foreseen in Ehe l{estern Extension area, from the very beginning of Prograrune activities. This will also resulE in reduced operating costs to the Programme for a shortened period. 30.4 In the field of socioeconomic development, the role of OCP is clearly defined Eo avoid the Progranme venturing into activities for which it lacks competence and resources. At the same Eime, the scene is set for a closer collaboration between the sponsoring agencies and with other international organizations, each of them contributing according to their expertise and means. 30.5 By freeing large areas in fertile river valleys from the threat of river blindness, the Progrartrne will make an important contribution to agricultural development to the benefit not only of the residing populations but also to those moving from poorer overcropped land to settle nearer the rivers. Furthermore, several mineral-rich zones in the Western Extension area hitherto inaccessible due to onchocerciasis in hyperendemic proporEions, will be open for prospection and exploitation without the risk of contracting the disease. 30.6 Through the emphasis on making full use of the devolution process in support of overall health care developmenE within the Participating CounEries, OCP will conEribut.e substantially to WHOrs collaborative efforts with its Member States in West Africa to strengthen national primary health care systems. The training of staff within the Progrannne and of national fellows will aid PHC development in these countries. It is worth stressing, in this context, that 962 of the present (1985) OCP staff (in all more than 800) comes from African countries. 30.7 The continuous research and developmenE process being strengthened in the Progranrne will ensure that it is carried out in the most cost-efficient manner possible. 30.8 The resource requirements of the Programme during the third Financial Phase and the costs attached thereto, will be at the level approved by the Joint Progranrme CommiEtee. This will to a large extent be achieved by a shift in the use of resources from the present OCP area towards oPerations in the Extension areas. i ocP I 85.2 page 37 30.9 Onchocerciasis control on the lines developed by OCP is noE within the means of countries acting individually and on their own. The Participating Countries have therefore established an unusually successful collaboration in this particular aspect of the public health field, a collaboration which will continue to the benefit of all and gradually spread inEo other health related areas. And, perhaps equally significant, the smooth and effective collaboration between the Participating Countries and the donor conununity has set an example for international cooperation in socioeconomic development. 30.10 The benefiEs of the Onchocerciasis Control Prograrmne wiIl accrue not only Eo the West African populations, but also to the peoples exposed to the disease in other parts of the world. The OCP experience and the results of its scientific and research endeavours (including the possible finding of an effective drug) will be at their disposal for whatever control prograrrnes they intend to undertake. The close collaboration with industry in research has been, and will conEinue to be, an important aspect of the Prograrmne. 31. Risks and safeguards 31.1 With Ehe beginning of the implementation of larviciding operations in the Extension areas, the risk that resistance to temephos might develop in the savanna species will be enhanced within the present (1985) OCP area insofar as the prevention of reinvasion of blackflies into the border zones could give rise to an increased possibility of selection leading to resistance. It is hoped to counteracE this development by a control strategy which includes rotation of insecticides when required, as well as refined treatment tactics. This task will be facilitated by the expected availability of several larvicides belonging to different groups. 31.2 The possibility of reinvasion of infective blackflies from the east(ttigeria) has been advanced as a potential danger to the eventual success of the Programme. Several surveys at the eastern border of the OCP area have established that this risk is practically non-existent. The prevailing wind direction being south-west/north-east, blackflies are not carried from east to west, a fact which has been confirmed t.hrough field observations in the areas in question. Furthermore, it is hoped to establish close collaboration in terms of information exchange between Prograrune staff and the Nigerian authorities who have now instituted an onchocerciasis control programme with support of the World HealEh Organization. 31.3 A "calculaEed" risk in a programrne as complex as OCP will always be that the implementation timetable cannot be adhered to so that operations fal1 behind schedule. Ihis could apply to the availability and recruitment of international/national staff, training, the establishment of new operational centres, provision of supplies and equipment, etc. Such delays are probably inevitable, but it is felt that E.he Plan of Operations is sufficienEly flexible and with adequate safeguards to alIow for coping with any possible rnanagerial and logistics problems Ehat may occur. 31.4 Another managerial concern, connected with the expansion of the Prograrmne area to the south and to the west, will be the need to ensure adequate cornmunications within, and sufficient administrative support to, a greatly enlarged operational area. Several steps are being taken to cope with this problem, including Ehe move of managerial and administrative staff closer to the Extension areas, expansion of the radio net\^rork and more use of fixed-wing aircraft for liaison purposes. ocP 185 .2 Page 38 31.5 With the introduction of government.-paid staff seconded to the Prograrrne, the Participating Countries concerned will be more involved in OCP operations, both in financial terms and as regards the organization of the payment to a very dispersed staff, often working in remote parts of the country. The Progranune, which has accumulated considerably experience in logistics will be prepared to help countries in this respect whenever requested to do so. A1so, the fact that OCP is providing salary supplements and per diem to the national staff in question will make it possible for the staff to subsist even if the government salaries suffer delay in their payment. It is worth stressing in this connection that, although the staff is paid by national authorities, it is seconded to OCP and therefore under ful1 operational and disciplinary control of the Prograrmne. 31.6 Operations in certain parts of the Western Extension area will be conducted under conditions different from, and more difficult than, those prevailing in the present OCP area. Doubt has been expressed as to the practicabilit.y of carrying out vector control and other Programme activities in these zones. However, the exploratory and preparatory operations of the last few years (including collection of baseline data and larviciding of the Sassandra river system) have proved that full cont.rol can be instituted in the west, even in the most inaccessible areas, and in many cases due Eo Ehe wholehearted support provided by the governments in terms of facilitating conununications, opening up new roads, making available national staff, etc. To overcome the geographical and logistical obstacles ful1 use will be made of helicopters, for instance for larva1 prospection. Also, the use of villagers for vector capture, of t.he Be1lec trap, and of teletransmission of hydrometric data will help in this respect. And, furthermore, the application oft'selective larvicidingt' will facilitate vector control operations to a great extent. 3L.7 A cormron hazard of success is the temptation to add new tasks Eo an already overstretched programe structure with the confidence that, having dealt successfully with its essential concern, that same prograrmne witl ensure equally satisfacEory results in other fields. The Onchocerciasis Control Prograrme has, in the past, been exposed to such temptations. At this stage of expanding operations it is, however, important for ensuring a continuing success of the Prograrmne that it be left to deal exclusively with those tasks originally assigned to it, i.e. to control the blinding form of onchocerciasis and to ensure that there be no recrudescence of the disease. Additional Prograrune-related, but ancillary, issues must be handled by bodies other than OCP or be considered only at a time when the Progranrne has attained its primary objective. If not, there is a real risk that the manpower and other resources of OCP become stretched to a point where the principal operations of the Progranrne will suffer. ocP /85 .2 Anncxl-Annexel fh"_P:SrS.t (l9tl) Programme area and the areas of the Southern and I.Jestern Extensions L'aire actuelle d'OCP et les extensions du Pro r anu'ne I I 4 a .) + +}1^LI -.-.-.J-J NIGER ( ,l irIceR ,))+ Conakry Free toun , I N TGERIA + Y \) )t) ')t ,l -r 't- Ban lol CAME ,) I i ocP 185 .2 Annex2-Annexe2 page 1 Country Pays Benin Burkina Faso Ghana Guin6e Guin6e Bissau Ivory Coast - C6te d'Ivoire Mali Niger Senega I Sierra Leone Togo Popu la tion Pro arnme area l'aire du Pro s tima te s estimations Iotal population PsP!1e!1!" lple (ooo) 1 600 6 000 3 000 3 500 zoo 5 000 3 000 100 400 800 I 200 Population at risk Population sous rr- sque (ooo) rarnme 1 700 3 000 I 500 2 000 100 2 500 1 500 50 200 400 600 Total 24 8OO L2 55O Note: The esti.mates in the first column (total population of area covered by OCP o-iZiations) are based on updated PAG and SENEGAMBIA figures. The "population at risk" has been estimated according to the average proportion given in the SENEGAMBIA report. Note: Les estimations de 1a premibre colonne (population totale de 1a zone couverte par 1E!-op6rations drOCP) reposent sur des chiffres PAG et SENEGAMBIA. La "population sous risque" a 6t6 estim<ie en fonction du pourcentage moyen fourni dans le raPport SENEGA-I'{BIA 1 At time of start of OCP operations. A 1'6poque de debut du Programme. ocP 185 .2 Annex2-Annexe2 page 2 Populatlon and socloeconoolc lndlcators Indlces des populatlons et de leur condltlons soclo6conoclcues - Natural Lnc rea se - Accrolsse=ent naturel(per 10C0) po pula t 1 on) I 3L.2 26.8 (nalssance)I (1C00 nEs(years/ans) vlvants) I - Ltfe expect - Infant ltort - GllP peE rncy(Elrth) alltY (1000 caPlta ' llveborn) - Esp6rance - Hortallr6 1nfant1lede vle . (ner) - Prodult - AlCe offl- - Inscrlptlons na!.bruc 1el pour en 6coles prle par pcrson- le d6veloppe- Z de BrouPe ne etren! ' d'age(us S)2 (uSS per cgr- (d + g )2 1tr)(1962)z 3r0 2r0 2t.7 1l o 65 20 950 15. 5 76 340 27 ,6 lr t3 - Offlclal dcve Iopoen E asslstance - Enroluenc Lu prla. schools I of age group Benl n BurLlna Fa so Cha na Cutn6e Gu I n6e Blssau Ivory Corst Lole d'Ivolre Ha l1 lll6er Sencgal Slerra Lcone Togo 3 4 48 43 148 204 5 5 30. o 32.6 26.8 18.1 28.2 30.4 26.8 28.O 18. 5 121. 6 103.2 50.8 46.0 43.5 oa 1 159. I 142.8 360 310 170 11.5 11.5 85. r 69 33 r0l3 43.4 43.4 43.4 4 8.3 118.5 140.0 11L-4 200.0 180 310 490 390 27.t, 47.7 46.8 22.2 27 23 48 39 30.7 48.5 1 2 5 'Source: uorld }iealth Starlstlcs Annual - Annualre de Statlstlques sanltalrcs oondlalcs (L933)lsorrce: -Touards sustalned Developccnc 1n Sub-Saharan Africa" (A Jolnt ProBrame of Actlon) Itorld Bank,1984) 'Sone puplls belou or above offlclal prtnary school age' Y cocprts €leves au dcssous ou au dessus I'age scolatre (prlo.) offlclel. ocP /85.2 Annex 3 DEFINITION OT' OPERATIONAL PHASIIS Preparatory phase: this covers the period during which information and data necessary for the planning and Prograuning of an OCP operat ion (including epidemiological and socioecononic baseline data) are being collecEed and norrnally leads direct to the launching of the aEtack phase in accordance with a set schedule. Attack phase: are carri.ed out this covers the perlod during which vecE.or control operations regularly and without interruPtion; according Eo OCP experience, it will normally last three years unless the eotoDrological surveillance system finds blackflies st.ilI present in epiderniologically dangerous nunbLrs, in whlch case a longer period will be necessary; during the attack phase intensive entomological surveillance is conducted. Consolidatlon phase: Ehis covers t.he period during which vector control operations are no longer carried out control rleasures are determined entir regularly and without interruPtion; eIy by the findings of Ehe surveillance systems, vhich remain unchanged from the attack ptrase; it w111 last for two yuars unless the findings of the overall surveillance systeros indicate that disease transmission is continuing; reseEtlement and socioecononric development may be encouraged as from the beginning of Ehis phase. Maintenance phase: this covers the perlod during which vector control ceases to be a constant component o f OCP operations, but is confined to any foci of blackfly reinfestation that may occur; the entomological surveillance system is gradually reduced and concent.rated in the areas known Eo be PotenElal sites of ieinvasion and 1ocal breeding. The area will remain in the maintenance phase untll epideniological evaluation indicates that the prevalence of human infection is sufficlently lor{ to prevent. recrudescence of Ehe disease in case of rei.nfestation of the area by blackflies and that there are sufficient safeguards againsE the risk of the disease being imported from outside the area, ln whlch case vector control and chemotherapy, when available, would be resumed in the event of local reapPearance of infective blackflies. Annual Transmission potential l. Before Proe ramme OperaEions ocP/85.2 Annex 4 O o-. Q ro-rrO p--O o-nOo' , \ o ,- ----J ),()rr ) I r _r_ -'\.1t- n', i--tl.- .{iI 1982 - 1983 a t O 'rooO loo- tee Q zoo- rsr Q roo-rer O.aoo o_o o- o ) 2 e o )t o /, ocP 185.2 Annex 5 Pr6valence of Onchocerciasls: O-4 Years a Pr.rcl"r. r O O Prcvolcnce e 0 tO O Prcvolcncc rn<,aosrD, O Prcvqlcrcc. 0 o o :tAo/l 4 '("\I9- a I I A a q 1 { I \ I .l I r- o -rt?\ ' --'ao-/ / to o .-..1 o L_ t- I I I I tY al \ I I t-.: ,! ! ! I I 1. Before Prograume OperaEions 2. 1983 .t t. o I ocP /8s .2 Annex 6 Pr6valence o t Oncho cerciasis: 5-9 Years 1. Before Programme Operations a Pr.vol.nc. > O O Prrolcncc = O Ia o OPrtvolcncc i^cr.osr^g @ Preolcncc dacrGo5rag U Prrvolcncc r 0 o ---_9 lr I(.- t- ,! ! I II l l 1I r ,OI t a o. /' .-ati,t-:2.- a O\( t a 2. t983 t .\ _t l- 't I I I L- b I o. o -"j' ')lr) .l\ $ .o - ,.u _---.. )Ja ::. I ocP / 85.2 Annex 7 Pr6valence of clasls: l0-14 Years 1. Before Programre Operations a Prwolft.>O O Prcvol6c" = 0 6 I I I 5.t ..? / ( o { ( 1, 2. L983 tPrdol.dcc rncraotrng OP..vql.E. d.Gr.orr^g OPtovolcncr r 0 I : o ( ..) o.. tl il o ) 1 It-1 i '-o o I II I \ I I o o o o r I l' r l\ o, o a { 'r! l- 't I I I Il- i I I I t I I ( I @ t oo oI 1 ocP /85.2 Annexe 8 Annex 8Reiseau de 1a surveillance enEomologique: 1'aire actuelle OCP 1 Errtomological surveillance neEvrork: present (198, area Zote drexEension sud y comprjseSouEhern Ext. area includeri 0 <2 5 ,80 24 4 250 1q o 150 11 o' 160 1 Zone Ouest - Zone West (Bouakd ) Secte:rs - S/sectaurc Bobo Bobo Diibou3ou Banako Pcoako BouSc'.uri S ikas so Zcutl- l.,r Nombre dt6quipes - Teams hofessionnels Prof. staffServices Gir6raux General servrce staff 1984 t9B5 1985 Lg87 1gB8 LgAg r x x x x x x - Sectors - sub- o 2) ?2 r7 t4 tI 1r sectors 0 x o 0 o 0 o o 0 x x 0 o 0 0 x x o x 0 0 0 o 0 0 0 x x o 0 0 o x x o x 0 x 0 0 c :i x (J o c x x o x o 0 x. x C c x x \ (') x o x o x 0 0 x 0 x o 0 x x x x x I x x 0 )< :l x v. o 0 )a Y 7a x x x :a x 7 x x x x x 7 :a I x Z x x x x *. x x 0 x x x x o )a :l x x x Bouakd Groupenent - fuaF tsouakd Od iennE Si5uela Korogho Bondoukou Group Ouaga liiemey Zone 9st (fa=a) - Zone East z Sectau:s - S/secteurs Tan--1e fa';:Ie BoIt:ta-:: -- Honoe H in:'ra-:o Kara K:.ra Dapao:: Atakpane hrakou Parakou Kandi Natitintou Sohicon Total nnit6s /terzatn 31 94 Uni ts 0oxxxxx 0 x 0 x 0 0 I o x o x 0 0 x 0 x o x ; x 0 x o x 0 0 x .J 0 -\: x o x 0 x 0 o x o 7 0 I 0 0 :.: 0 0 x 0 x x 0 x o x x o x 0 x 0 x x x x o r 't o x x 0 x x x x x t x x x x x I x x x x L :( x x x :t x x x x x x x I t450 5 l1 90 6 , 540 ,t, 440 lro r LValu.ltion cooroon::de -:ur un i'rofess:.onneI de t* )i:,,ct.tc;^.. Surveillance coordinaEed by professional staff rember aC OCp HQ ocP /85 .2 Annexe9-Annex9 E6seau de 1a surveillance entomoloeigue: 1'aire d'extension ouest Entomoloqical surveillance network: Western Extension area ?one I Zone II Zone III Sou s- s ec teu rsub-secEor Kankan Siguiri Beyla Kouroussa Dabola Dingr:iraye Faranah Kissidougou Lab6 Kindia G oual Bana-ko Kita HanantaLi Di6ma Kayes K6ni6ba TaEbacounda K6dougou Kabala Gabu 1 985 x o o x x x x x x x x o o o x x x x o o o o o o 198? x x o x x x x x x x x x x x x x x x x x x x o o 1 9BB x x x x x x x x x x x x x x x x x x x x x x x x 1989 x x x x x x x x x x x x x x x x x x x x x x x x 19n x x x x x x x x x x x x x x x x x x x x x x x x 1991 x x x x x x x x x x x x x x x x x x x x x x x x 13 21 2\ l.+ 2\ 24 ocP/85.2 Annexe 10 - Ann ex 10 Personnel: F6ca pitul ation g6n6rale Staff: Summary of posts I $: professionnels 3G: serv-ices g6n6raux general service 1986 1987 1988 1989 1990 1991 qigrrlb-ur1on par pays/by country Guin6e Mali Senegal Sierra Leor-e Guin6e Bissau 165 75 205 110 50 25 230 110 50 25 35 230 110 50 25 35 230 110 50 25 35 230 110 50 25 35 1985 ,'Ts 1986 '-G 1987 -l * 1e8Q PFI -l SG 19S9 I;[-l 1990r"l * lee IPF SG Bureau Directeur (y compr. bur. Liaison) Director's office (Liaison off. incl. )i L2 8 lo L2 9 L2 9 lo 8 6 7 6 2 LuEte anti-vectorielle Vector control (0cP) (nationaux) 1 23 550 23 456240 24 290 390 26 315 450 23 255 450 16 165 450 1 2 163 450 Evaluation epid6miologique Epidemiological evaluation 5 46 4 30 4 27 4 18 J 1o 3 Renseignements socio-economique Socioeconomic inf orma tion 4 1 3 2 -) 2 2 2 2 2 2 2 1 1 Recherche et surveillance de 1'environ. Research and environmental monitoring Projet chimioth6rapie Chemotherapy project 7 37 10 33 10 33 10 33 7 22 7 10 J 10 1 1 1 1 1 1 1 1 Administration et services de support Administrative services & support 10 116 1I L37 11 r46 11 r40 to 110 8 95 6 75 Total 0cP nationaux 62 759 62 67L 240 62 511 390 63 519 450 53 407 450 42 279 450 z 8 z5t 150 Total- 240 390 450 450 450 450 ocP / 85 .2Annex 11 Resea rch priorit.ies identi Larvicide development . new B.t.H-14 formulation . other larvicides (e.g. carbamates and growth inhibitors) Chemotherapy . Ivermectin . Ciba-Geigy 6L4O . basic research - Devo lution immunodiagnostic test for early detection of oncho-infection fly trapping and monitoring techniques for community participaEion drug delivery - Strategy and operations savanna/forl"t parasites and vect.ors(identification, relationships, dynamics and impacE) strategy for use of pesticides(efficacy and avoidance of resistance) larviciding schedules teletransmission of hydrological data transmission of onchocerciasis . dynamics of human migration relevant to OCP area . modelling Present (1985) situation well in hand trials underway promising in initial stage of research supported by OCT sofar: progress ineviEably s low; research being intensified field studies continuing to be undertaken when more is known about. the drug Ehat will eventually be used under study in the field and in laborat.oriesl conclusions expected by ts86fLs87 ongoing field studies R&D studies t,o be undertaken in Extension areas experiment.al stage completed data analysis to be intensified studies underway studies initiated ed by EAC I List of Sub ectsforR&DStudies extent of operatlonal survelllance and staffing of sectors and of sub-sectors(see para. 17.6 above); relatlve lmportance of surveillance network flndings accordlng to operatlonal phases - methodology of ldentlfying and orientlng surveillance to "hlgh rlsk points" (see para. L7.6 above) trainlng, organizatlon and management of a systen of flxed vlllage vector collectors (see para. 17.7 above) - dlscrimlnatory power of Bellec trapsln the ldentification of blackflies(see para. 17.9 above) - use of "moblle" sub-sector technicians and potential repercussions on structure of surveillance network (see para. 17.8 above) requlrements ln terms of transport 1f above modifications became operational (see para. 17.7 above) - early "clean-up" operations and their effect on subsequent "routine" larvlclding - extended larvlciding lntervals and increased suspension of treatments (see para. 17.10 above) - "selectlve larviciding" (concentration on breedlng sltes 1n naln rivers and thelr principal trlbutaries) (see para. 17.3 above) - criteria for and extent (lf any) of ground treatment, its organlzation and its management - extent of epidernlologlcal evaluation (see para. 20.5 above) - identiflcation of the lntenslty of epldemlologlcal evaluation to be carried out by national teams in present and Extension areas (see para. 21.1 above) - devolution (for details : see section 24 above) ocP / 85.2 Annex 12 Cornments posslbile modtfi- cations will be influenced by flndlngs of other vector control-related R&Dstudies(see below). - could be tried out ln 0OZ 01 before appllcatlon to Extenslon areas thls could be tes ted in ooz 10.1 - possibly first ln present OCP area to carry out and control in Western Extension area - to be considered ln the context of maintenance ac tlvi t ies - could have implications for OCP staffing - OCP collaboratlon with Burkina Faso ocP / 85 .2 Annex 13 - Annexe 13 Lutte - Vector conlrol. anri- S 10 656 (52.1 9i) vec tori e1 1 e 1985 BUDGET _ BREAKDOWN BY PROGRAMME ACTIVITY ($OOO) REPARTITION PAR ACTIVITE DE PROGRAMME Epidemiological evaluation - Evaluation $ sas ls.grr) 5pid6miologique Socioeconornic development - D6veloppement socio- $ 303 (1.5 90 6conomique 0rfice of the director - Bureau directer-rr $ t303 (6.3e0 l''leetings - R6unions $ 3co (1.1 9'.) Apptied research and - Recherche environmentel monitoring app l iqu6e $ l5l0 (7.29:) eE surv. de 1'env. Chemotherapy - Chimioth6rapie s 34s0 (r6.5 9:) Western exlension $ 1030 (4.990 ExEenslon ouest Ad minist ratio n $ I4 I 7 (6.8 9'.) ocP I 85 .2 Annex 14 page 1 coico o.O\ O\ c, \o f. I !(dl (, o,i I o, >l > F\O@o\O\ O\ \.o O\@6O\ O\ i$ l.l r.(!l G o.r I n) >l > :; ll t{(!l (d ol oJ >l > X qJ .rt ]J ! o h0 5 otl Er @ U o uc o un u(nG= 'o =a rc oF oF € t/" to c{ I Iltil ilIIIIIrilI ltIIIIltltIII ilI ll ltIIIIlt ltIltIll IIilIIIltltIIIlt IltIIIIIIIIII IIillttlIilIIIII ltilltIIltltltIIllI @ €e{?n @ € m It e{ € € n e{ 6 o lq ctn e{ GN u1 n loe{ @ tr,oN cl GN m @ @ !a Nct n o o G mct tq € €m 6 €@ @ rr! 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ExEension PresenE OCP Area Aire actuelle OCP I { a .. ocP /85.2 Annex 16 Annexe 16 Llst of Donors to the Onchocerclasls Control Programroe Llste des donaEeurs au Programme Belg 1um,/Belglque Canada France Germany, Federal Republlc of/Allemagne, R6publique f6d6ra1e d' Italy/Ita11e Japan/Japon Kuwalt/Ktiwei r Net herlands/Pays-Bas Norway/NorvEge Saudl Arabia/Arabie Saoudite Swl tzerland/Sulsse unlted Klngdom of Great Briraln and NorEhern rreland,/Royaume-uni de Grande-Bretagne et drlrlande du llord Unlted States of America/Etats-Unis drAn6rlque Afrlcan Development Bank/Banque afrlcaine de D6veloppement A1 Sabah Foundarion/Fondation AI Sabah organlzation of PeEroleum Exporting countrles/organisatlon des pays Exportateurs du P6trole Unlted Natlons Developnent Programme/Programme des NaElons Unies pour le D6velopperoent The World Bank/La Banque llondiale l{or1d Health organizatlon/Organisation Mondiale de la sant6 1 985 t- ! , Title Ti tre List of References Liste de R6f6rences Proposal for a Long-Term Strategy and its Supplement 1 Proposition d'une Strat6gie i long terme eE le Suppl6ment 1 Long-Term Strategy: Information Document Strat6gie d long terme: Document d'information OCP: Report of the Preparatory Assistance Mission to: (the Participating Countries) OCP: Rapport de la Mission d'assistance pr6paratoire aux gouvernements de: (1es pays participants) OCP: Evaluation Reporr (I974-1979) OCP: Rapport d'evaluation (L974-L979) WHO Independent Commission on the Long-Term prospects of the Onchocerciasj_s Control programme La Commission ind6pendante sur 1es perspectives a long terme du Programme de Lutte contre 1'Onchocercose OCP: Plan of Action and Budget, ocP 185 .2 Annex - Annexe 17 Reference Date a a 1 ,_ 3. - 4. - 5. - ry Par ocP WHO oMs I^lor1d Bank wHo oL.lS OCP OCP T.INDP,FAO OCPf 73.L IBRD,WHO PNUD,FAO I^IHO ocPf 78.2 JPC 2.6 ocPf 84 .4a 29 .06.84 ocP/ 84.4 ocPf 84 .4 SuppI. l ocPf ,$.L ocP/ 84.t vBC/8t .2 *n/ rcp/ nPo/oot' 29 .06.84 20.o8.73 08 .81 6. - 7. - 8. - 9. 10. - 11. t984 198 5 OCP OCP OCP: Plan d'Action et Budget, L984 1985 Ten Years of Onchocerciasis ConErol in West Africa Dix ans de Lutte contre I'onchocercose en Afrique de I'Ouest World Health Sratistics Annual Annuaire des Statistiques sanitaires mondiales Toward Sustained Development in Sub-Saharan Africa A Joint Program of Action Epidemiology of Onchocerciasis. Report of a WHO Expert Committee Epidemiologie de l'onchocercose. Rapport d'un Comit6 d'experts de 1 'OMS Senegambia Proj ect 1983 t984 ocPf 84 .3 1984 1983 1984 TRS 597 L97 6\ : 1 Proj et S6n6gambie wHo 1981 ocP / 85 .2 Annex 18 OCP Organigramne P ROCR.A}C{E DI9ICTOR ECONOHI C DEVELOP)&IiT TE.A.II ENTOYOLOCICAL EVALUATION a t. a AD!{I N ISTRATION A,\D f{^ f,"4 G Ell EN T EPID9I.{IOLOC ICAL EVALUAT ION VECTOR CONTROL APPLIEO RE SEARCH PEP SONNEL TEfY AER IAL OPIRAT IO:iS BUDCET aND F I I:ANCE OPHTHALYO TEA,YSERVI CES S UPPL I ES TRA}ISPORT H IIACfYENT ZONE ITEST 3 SECTORS l1 suBSEcroRs ZONE EAST 3 SECTORS } CROUP ] ] SUBSECTCDS I : I EroiecteC__g pgre! ele!__d9y9!9 pgga!_:_!be_S!re!qsy_ ocP /85 .2 Annex 19 page 1 SITUATION IN 1986 l ') u):- "1 ' i .' [r Ma r ntena nce(1-5 years) Marntenance(6-10 years) t a ffi Prepa,atory phase ! Artack phase VWh consot,d.t,on |} SITUATION IN 1988 SITUATION IN 1990 Th9 boundares of the three subdrvrsrons rn the Western Extensron area have been drawn for rllustratrve purposes only ..: L< lt/ I t 1 '7 o I IE IE Irl ( ( I I I i rorl |./ ( ( I I 10 1 ,i-sI ocP /85 .2 Annex 19 page 2 Eloie cted o pgtg! o!el1!9yg!9 p n94_:!9_Stle!9sy_ t a a ./l t ? I ? I SITUATION IN 1992 ,r:,i h. @can*tdatron fi=il Marnrenancetijj,iJ (1-5 years) Ma r ntena nce(6-10 years) 1O years marntenance completed I I -f, SITUATION IN 1994 7. t The boundarres of the three subdrvrsrons rn the Western E xtensron area have been drawn for r llustratrve purposes only I---_ SITUATION IN 1996 ta t -.\ oOZs 10.2 & 1O 3 wrll enter second half ol marntenance perrod rn 1997 and ]998 respectrvrly, when remarntng area I has already had 1 0 years or more ma r nte na nce lExcepr OOZs 09 and 10.1 01 01 r 03 F1 o2 I r , x ,io8l x r r tH rxJtxr .@1.*. 1 r l03l o7 ,,'r,@ , , xt04tr . rrtxrr t l, t l I I tl ( ( I I\a { rx!x+ , x ' x 108| xxrx- rxfrxI it,kx {6E1"" @ * ozl. , ft*il I