Progress report: January - September 1975

JOINT COORDINATING COMMITTEE Onchocerciasis Control Programme in the Volta River Basin Area Ofice ol the Independent Chairman c/o World Health Organization 1211 Geneva 27, Switzerland Tel. 346061 TetcxI[!§ 27A21 JOINT COORDINATING COMMITTEE Second session Paris, 2-4 December 1975 COMITÉ CONJOINT DE COORDINATION Programme de Lutte Contre I'Onchocercose dans la Région du Bassin de la Volta Bureau du Président Inüpendant c/o Organisation Mondiale de la Santé l21l Genève 27, Suisse Tél 346061 Télc{iEtar( 2782I JCC2.2 24 October 1975 J.C.C.-C.C.C. Provisional agenda item 5 The Independent Chai.rman transmits for the consideration of the Joint coordinating committee, at its second session, the worrd Health Organization's report on the activities of the Onchocerciasis Control Programme. This document covers the period January-september r97b; the activities carried out during october-November will be reported at the session. q@ r::ï,iï:ï;îïï:ï:ïîA sANrÉ ONCHOCERCIASIS CONTROL PROGRAI',IME IN THE VOLTA RTVER BASIN AREA October 1975 PROGRESS PEPORT January - September 1975 presented by the ÿlorld llealth Organization as Executing Agency A. INTRODUCTION 1. At the first session of the Joint Coordinating Comittee which took place in Abidjan i.n February L975, a reportl riras presented by IüI0, as executing agency, covering the first year of activities of the Onchocerciasis Control Programe. The establishment of the Programne Headquarters in Ouagadougou, including recruitment of staff, procurement of supplies and equipment and conmencement of training activities, Idas described. The steps taken to build up an infrastructure of sÈores and offices throughout the Phase I area and to provide logistic support to the aerial operations were outlined. The JCC was informed that the aerial spraying operations had successfully coumenced on 10 December 1974, but had been temporarily suspended due t.o the crash of both the helicopter and the fixed wing ai.rcraft. Following the arrival of two additional helicopters in late January these operations were resumed on 10 February. 2. The assistance provided to the Programme by I{IIO Headquarters, and the activities undertaken by the OCP support unit were reviewed including the research already in progress, under con- tracts negotiated with institutions in the Progranrme area and elsewhere, in the fields of epldeoiology and chemotherapy, insecticide evaluation, vector cytoÈaxonomy, @!!gg population sampling and aquatic monitoring. 3. lleobers were informed of the action taken to set up the advisory bodj.es and the JCC approved the Memorandum of Understanding which sets out the principal features of the manage- foenÈ structures not covered by the 1973 Operational Agreement. 4. rt was clear that the objectives of the flrst year of the Progran'me had been met: the Ileadquarters of the Progranrme and infrastructure for Phase I were established and control operations.had begun. 5. The present report covers the period from January L975 to the end of September 1975; more detailed informati'on is provided in the quarterly progress reporEs.2 B. MANAGE}TENT STRUCTURES 6. Following Ehe assurances recei-ved from ConEributing Parties at the first session of the JCC, the onchocerciasis Fund Agreement was signed by representatives of nine donor counËries, the African Development Bank, IBRD, IDA, IINDP and IJIIO on 9l{ay L975, at the trIorld Bank Ileadquarters t{ashington, in the presence of Dr M. G. Candau, Independent Chairman of the JCC. 7. ths Steering Cotrmittee for Onchocerciasis Control in the Volta River Basin area met three times during the period under review. Discussi.ons at these sessions centred particularly on economic develop,ment and Ehe progress of operational activities. 'Oa, Progress Report, January-December 1974.2 ocplpglls,!, 2 and 3. I't -2- 8. Seven members of the Scientific and Technical Advisory Connnittee visited the progran@e areaduringMay-June..,a'Satthe"e"o.,dmeetingofthisCorr4ittee which took place in Geneva in June. The proposals for data storage and analysis, prepareld by I'rIHo iin accordance with the reconuoendations made by t.he STAC at its first meeting were reviproed, and oonsiderable attention was devoted by the Cormnittee to research into the fields of chefiro-ther4Py and epidemiology. A number of reconrnendations were made in this regard. l sfeC members now receive quarterly reports on all ongoing research activities. 9. Meurbers of the Scientific Advisory Panel participated in working groups to draw up prpto- co1sforinsecticid"mq,,aticmànitoring(June).In1inewitha recorrlnendation made by STAC at its first meeti.ng, and following investigations by OCp into work currently being undertaken in this field, arrangements rüere made for a working group sf sAP dembers to meet in Geneva in late october to §tudy the question of the establishment of,self-perpetuating colonies of S. damnosum. 10. A meeting took place in May between representatives of the sponsoring agencies and theChairtran of the Economic Deyelopment Advisory panel (fpap), to review the economic developgenE aspeclts of the Prograrme and the role of the Pane1. The chairman of the panel subsequenily visited the Prograrrne area to gain first hand information of the situation. It has been agreed that the membership of the Panel will be defined over the coming year as more databecomP available on the economic activities to be undertaken in the area. 11. The Ecological Panel had its third meeting during the month of August to study the revisêd aquatic monitoring programme. The report of this meeting2 refiects the panelrs concern at the duplicaEion of effort between EP and STAC and stresses the need to clarifythe roles of these two advisory bodies. This matter is under consideration and will be revieired with representatives of both groups, at the third meeting of STAC in March 1976. C. IMPLEI'{ENTATION OF TIIE PROGRAI'{ME L2. vector control operations and entomological surveillance activiEies continued in thePhase I area. Preparation§ r^/ere made for the start of control operations in Ghana and Uppervolta (Phase rr) including the development of the infrastructure, the purchase of equipment and sgpplies, and the recruitment and training of personnel. Epidemiological evaluation seganin upper volta and was extended to rvory coast. Plans have been drawn up for epidemiologilcal evaluAtion in MaIi and Ghana. 13" Although the possibility of invasion of the control zone by S. damnosum fromforescen in the PAG Mission report3 a greater number of adult flies was observed inphery of the Phase r control zone from May to August than anticipated. outside frras the perh.- L4. After a review of the development of control operati-ons, adjust the composition of the air fleet to give greater flexibi over the coming year. arrangements have been made to lity to spraying and surveil[ance 15' The first part of a management survey of the administrative and logistic support to theProgr4mme has taken place and action is already being taken to implement some of the missiofirs recorulendations. 16. office of the Programrne Director: The Programrne Director met with officials of thePartioipating Governments on a number of occasions t.o inform them of the progress of activiÈtes and of any problems which had arisen. rn particular, r^7ays of overcoming delays in customs clearance of supplies at the main centres and at frontier crossing points were discussed anflproblems encountered in carrying out aerial larviciding operations in certain areas reviewed. 1 2 JCC 2.3 Report of JCC 2.4 Report of OCP/73.1 Reporr of Ivory Coast, Ma1i, the scientific and Technical Advisory cormnittee, Annex. the Ecological Panel the Preparatory Assistance Mission Niger, Togo and Upper Volta. to the Governments of: Dahomeÿ, 3 Ghana, ,l,l -3- L7. Numerous visitors were received by the Program'ne Director, including naÈional officials from Ghana and Niger who came to the area to gain first hand information on the Prograrnme; STAC and Ep members who were evaluating appropriate asPects of the Prograrmers activitiesl the Chairman of EDAP; and representatlves of bilateral aid organLzations, with whom discussions took place on matters of mutual interest such as volunteers and economic developtttent activities. Other visitors included representatives from the sponsoring agencies, and from the inter- nati.onal press and information media. 18. Ihe Director participated in several meetings, including the River Niger Cornnission meettng in Niamey, the second meeting of STAC and the fourteenth session of the Steering Comittee. 19. The post of administrative officer in the Directorrs office was filled, as anticipated, in the first half of 1975. 20. The preparation of a monthly news bulletin entitled I'Oncho Flashr', which receives wide dis- tribution in.the Programre area, \r7as undertaken by the Inforoation Comrunications Officer, who, in addition to providing articles and other material for use by the information Eedia boÈh in the Prograûme area and elsewhere, received, and arranged Progra[mes for, all rePresentatives in this fie1d, including several television teams. 2L. The InformaEion Officer visited the seven participating countries to establish contact r^rith representatives of national television, press and radio, and to di.scuss the diffusion of information regarding Programe activities. The possibility of holding'an 'rlnfortation I{eekfi on onchocerciasis in the various countries vlas considered with national officials. Visits were also made to the lleadquarters of the I{orld Bank, in Washington, and the United Natlons Developurent Progranrme, in New York, for briefing on the economic development aspecÈ8. 22. Other information act,ivities included the preparation of a radio progrrnrme and the organization in Upper Volta of an evening symposium on the Programe. 23, Vector Control Unit: Aerial spraying operations have been carried out since February by three Bell 206 B helicopters equipped with a rapid release system specially developed for Èhe Programe. A Turbo-Porter fixed wing plane, similarly equipped, joined the fleet in March L975. A fourth stand-by helicopter was positi.oned by the subcontractor to ensure continuity of operations in the event of a temporary grounding of another aireraft, and was avail-able to the Programe on a charter basis. Lnitially, 4 pilots and 2 engineers were provided by the subcontractorl later this number increased to 6 pilots and 3 engineers. 24. Ihe Programe radioconmunications network linking the Progrrme Headguarters, Ouagadougou, and the main aerial base, Bobo-Dioulasso, with Temaler Bole (Ghana), Korhogo, Bondoukou, Dabakala (Ivory Coast) and Sikasso (Uati.), sectors and subsectors rùas set up during the first quarter of 1975. It was later extended to include Leo (Upper Volta) and Yendi (Ctrana). Meteorological data was received regularly from the mai.n ai.rports of the zone of operations and the assistance received from the civil aviation authorities of the Progr:nrme area r.ras satisfactory. 25, The infrastructure of airports, airstrips and helipads used for maintenance purposes as rdell as for refuelling and refilling with insecticide was extended with the establishment of additlonal facilities in Ghana, l'Iali, Upper Volta and Togo. 26. To ensure that, the aircraft fuel supplied to all refuelli.ng points scattered over the Phase I zone \,ÿas of a reliable quality the main suppliers would use only new drums, with distribution from Abidjan; however, this resulted in an i.ncrease in the cost of fue1. 27. For reasons beyond the Organizationrs control, supplies of the special formulation of Abate insecticide used for larviciding \,ÿere not always received sufficiently in advance to ensure smooth running of the operations and on several occasions the insecticide had to be airfreighted to, and within, the Prograûme area. Despite these difficulties all spraying operations were carried out as scheduled and the flight figures for the first year of the contract \irere as follows: -4- IIe licopters Fixed wing aircraft Total Flight hours 2 074.5 426,7 2 50L.2 Fuel used ( litres ) 19r 538 6L 594 253 L32 Insecticide applied ( lirres ) 49 378 19 660 69 038 28. Insecticide applications are adjusted according to the r.rater flow of the rivers whi4h variçs considerably aE the start of the rainy season according to local weather conditiong.the Çxisting net$rork of hydrological stations in the participating countries is being grafually exte4ded to meet Progrnrnme requirements. so far, additional stations have been insLalle{ river coding system for insecticide tüeat- established and progressively improved.l 29. During the period under review, the aerial spraying operations proved exËremely eff{ctivein cQntrolling the breeding of S. damnostrm in the rivers and streams of the phase I zone.I{owerfer, in spite of the satisfacËory control achieved throughout the phase I zone, S. dauinosumfema1eswerefound,sometimesinlargenumbers,inpar!softhetreatedarea.rni"# phen{menon, which was particularly noticeable along the hlhite Bandama, the Nzi, and at cedcainpoin(s on the Black Volta and Leraba rivers, began in May and continued through June, July and dugust; in September the numbers of flies declined rapidly and by the third week theüehad §een a marked reduction which could not be related to the control acElviti-es. AÈhorQugh survey was undertaken from the ground as well as by helicopÈer, which showed con-i clusilvely that so many blackflies could not have originat.ed from the successfully treated area§ of the Phase I zone. 30. The determination of the physiological age, and the infection and infective loads, of theinva(ing flies suggest that t,hey may have originated from the south and south-west of the Progdarune area, where special surveys confirmed the existence of profuse S. damnosum breed]lng. The deteorological studies carried out in the Progrannre area by a team rriiEG,ire forOver§eas Pest Research (IJK) could assist in determining whether unusual meteorological condiltions r^rere aÈ the origin of this exceptionally long-range flight of the vector. 31. Cytotaxonomical studies will also help in identifying these flies and a special operational research plan is being prepared for a ful1 investigation of the situation in 1976, should a similar phenomenon recur, and to develop appropriate countermeasures. 32. During the period under consideration, the hydrobiological teams, contracted to moni3orthe possible impact of the insecticide applications on freshwater non-target organisms, difl not detect any harmful side-effects from the treatments. For recording purposes, and alss to or, r1.r"." in Ivory Coast, Upper Volta and Mali. A ment and for the recording of larviciding data was plan nnd evaluate the control operations, all data originating from the entomological hydrobiological surveillance networks are being recorded on forms, specially designed PurPo§e, for subsequent computer storage and analysis. an ophthalmologi-st, parasitologist, a sociologist, operations officer and support Following a period of Eraining, the team began detailed and basic surveys in Upper Februêry. Sociological studies are made of villages under survey. and for Lhis 33. In addition to carrying out the vector control operations and monitoring results, thê Vectotr ConErol Unit has devoted a considerable proportion of its time and resources toprepafation for the extension of control operations to the Phase II and III zones. For Phase II, geographical reconnaissance has been completed, the required infrastructures estab[-ished, staff recruit.ed and trained. The entomological surveillance network was operafional in time to collect pre-spraying base-line data in the Phase II zone during the rainy season of I975. The final geographical reconnaissance and aircraft crew training if schedtrled for November and December 1975, and actual operations will begin in January 1976i 34. Epidemiological Evaluation and Public Health Unit: I^Iith the filling of a number of keyposts in this Unit, the first, mobile epidemiological evaluation teérm vras formed, consistin$ of s taff " volra id -5- 35. After several weeks of operaÈions, the methodology for the epidemiological evaluation was redefined in collaboration with staff members frour I,rIHO/HQ, and the forms used for the differenÈ types of evaluation were modified. In view of the necessity of re-examining at regular intervals Èhe population of villages selected for longitudinal epidemiological study, a special form was devised for the population census. 36. I{ith the exception of the second ophthalmologist, the remaining personnel in Ehe Unit, including the Chief, assumed their dut.ies during the second and third quarters of the year and the second evaluation team became operational in September. 37. So far simple and detailed surveys have been carried out in about 55 villages with a population of about 12 O0O, in Ivory Coast and Upper Volta, and plans for evaluation in ùIali and Ghana have been developed; the plan for Ghana was discussed with the national authorities during September. 38. Cooperation from the national medical services and participation of the population has been generally very good. 39. In the field of public health, the inventory of health resources in the Progranune area is being reviewed in collaboration with the national authoriEies and the I^IHO rePresentatives in the countries concerned. This will be used to assist, when necessaryr in the establishment of a health infrasEructure. 40, At Èhe request of the Government of Dahomey, a special study is being made concerning the developent of health services in the Provinces of Bourgou and Atakora. 4L, Adoinistrative Servlces Unit: In addition to the general administrative support provided Ëo Ehe Programne in terms of installations, budgeE and finance, personnel and supplies, the Aùninistrative Services devoted much time to the preparation of the infrastrucEure for the Phase II control operations. Additional support personnel were recruited and trained, supplies and vehicles were obtained and allocated as aPProPriate. 42. Arrangements rüere made for the construction of subsector offices at Bole and Yendi and garages at Bobo-Dioulasso and Korhogo Sectors. lùork on the Tamale Sector/subsector offices began in September and bids for construction of Èhe hangar Trere called for. 43. Steps rüere taken to\,ÿards the construction of the Prograrrme Headquarters: in preparation, existing structures on the site were modified or demolished; plans for the new building \,ÿere approved; a contract concluded for supervision of the construction and a call for bids sent out. For.budgetary reasons, however, this Project has been postponed. 44. The Unit is responsible for the management and maintenance of the Programme vehicles, and workshops for vehicle repair and maintenance are being set uP throughout the Progranrne area. Five of the six volunteers who assist the Programre are engaged in this work. 45, At present administrative matters related to 32 senior sEaff and 391 suPPort staff are handled. Training courses for drivers and typisEs were initiated; English language classes are also being held for staff in Ouagadougou and Bobo-Dioulasso. Arrangements vÿere made for staff members exposed to the dangers of parasitic diseases to undergo special periodical medical examinations. 46. During the period under consideration WHO internal auditors and staff from the I^IHO/IfQ Division of BudgeE and Finance visited the Progranrre to revie\^7 financial controls and procedures. D. VTHO IIEADQUARTERS SUPPORT UNIT 47. In addition to handling all research activities (paras 54 to 69) and relations with the advisory and management bodies and other sponsoring agencies, the OCP Unit in trüHO HeadquarEers has continued to provide backstopping to the Programre i.n connexion with the recruitment of personnel and consultants, procurement of supplies, including insecticide, and establishment of J'I -6- the fadiocourmunicaÈions network. The Unit also handledfor the aerial spraying operations. Members of the unitduring the absence of field personnel on vacation. negotiations concerning the subcôntract were detached to assist the pro$farmre 48. In view of the urgent need, as stressed by t.he Scientific and Technical AdvisoryConrnlttee, to develop epidemiological and chemotherapeutical research, a medical officer(epidemiologist) was recruited to handle these activities and assumed his functions in Ap(it.Simifarly, to meet the reconmendation made by STAC at. its first meeting regarding the sto(qge and 4nalysis of data, Ehe suPPort personnel was further strengthened by the addition of astatlstlcian and a sÈatisticaL clerk. 49. Recognizing the i-mportance of the research activiti.es toto set up an ocP Research coordinating connnittee to revi.ew alldecide priorities for the allocation of funds. rhis cournitÈee considered about 30 propositions for research covering subjects the Programrne, it was deci{ed proposals submitted to I{HO end has met five times so far lapd ranging from aquatic monitpringto the study of antigenic extracts from onchocerca volvulus. 50. Visits were made by support personnel to research institutions and workers in the unfl.tedstatg§ of America, canada, the Federal Republic of Germany and Belgium, to discuss ongoing, reseârch of direct interest to oCP and to consider possible collaboration. visits ,"." "paomade to institutions in Ghana and rvory coast to review the research already being conductpd under agreements with WIIO. 51. Following the aircraft accidents early in the year, discussions took place with reprp-sentatives from Evergreen HelicoPters rnc. to review the possible reasons for the accidentp and to agree measures which might be tâken to safeguard against future incidents and ensurpthe oontinuity of spraying. Às a result of this, a standby helicopter was positioned i, theProgramme area. Further discussions took place in August to negoÈiate the price for theadditional helicopters required by the prograrmne. 52. rn addition to PreParati-on of the thirteenth and fourteenth sessions of the steering,Corunittee and the second meeting of the scientific and Technical Advisory corEnittee meeEinÊ.the lfrtit organized working grouPs of scientific Advisory Panel members ro revj-ew ins.ctici[ievaluiation and aquatic monitoring Protocols, and took steps to arrange a further working gtoupon ttrc development of self-Perpetuating colonies of S. damnosum. Members of the Unit alsQparticipated in the inter-agency meeting on economi" d;""l"pr;t, the third meeting of theEcological Panel and an rnformation Day on onchocerciasis organized by the Government ofBelgium. 53. Preparation of Èhe quarterly progress reports for distribution to members of theCoordllnating Connnittee, National Onchocerciasis Corrnittees, the advisory bodies and thesoring agencies is also undertaken by OCp Geneva. E" APPLIED RESEARCH AND TMINING Joidt spqn- 54. The research element of the progranrne r^ras strengthened during the year and embraced q varieEy of studies on the ecology and biology of Simulium damnosum, o., ,,", and establishedinsecÈicides, and on the effects of insecti"id"r iilt"rget and non-target organisms. Thesestudies are being conducted under reseatrch agreements negotiated by i^IIIo with the instituti(ns concerned. 55. The center for Disease control, Atlanta, GA, united states of America, and the rnstiquteof Tropical Medicine, Tübingen, Federal Republic of Germany, worked on the development of qelf-perpeÈuating laboratory colonies of S. .damnosum. Research on the s. dry comprex was ,conducted by the Organization for coordination and cooperatio.r in tEffintror of Major Endelri.cDisease (occcE) at iEs onchocerciasis Entomological centre at Bouaké, rvory coast, and a cÿto-taxonomist was included among the staff of the Progranune. other - particurarry biochemic4l -methods for identifying cytotyPes hrere studied at Legon university, Ghana, in association wllththe Llverpool school of Tropical luledicine, united Kingdom. systlms for sampring adult andllarval populations I^rere under development by the office de la Recherche scientifique etTechnlque outre-Mer (oRSToM) in conjunction with the Bouaké onchocerci-asis Entomological -7- Centre and the Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium, while the Centre for Overseas Pest Research, London, has been investigatlng Ehe effecÈ of meteorological factors on the dispersal of S. danrnosuo. 56. Among the organizaEi.ons or institutes collaborating on insecEicide and associated envi- rormental studies hrere Ëhe Onchocerciasis Entomological Centre and the Hydrobiological Section of ORSTOM, both at Bouaké, the Instit.ute of Aquatic Biology at Accra, AlberEa University in Canada, the Center for Disease Control at Atlanta, Reading and Salford Universities in the United Kingdom, and the Institute of Medical Research at Zagreb, Yugoslavia. In order to suit insecticide formulations Eo the vecEor, the size of particles ingested by S. darnnosum larvae was under investigaEion. Research on the physico-chemical ProPerties of emulsion concentrate larvicides rÿas focused not only upon Abate - the compound at Present in operational use - but also upon possible alternatives. This included studies of the effects of various compounds on larval detachment and reattachment and attempts to improve the presenE methods for testing the susceptibility of the larvae to insecticides. New and strict protocols for insecticide trials and for aquatic monitori.ng were drawn up with the assistance of members of the Scientific Advisory Pane1, and the evaluation of insecticide formulations are made on both target and non-target organisms. Several new larvicides and a micro-encapsulat.ed formulation of chlorpyrifosmethyl - already shown to be effective as an eoulsifiable concentrate - are being evaluated under field conditions in I{est Africa. A larvicidal formulation of chlor- phoxj-m, also known to be effective, will be applied weekly (as in oPerati.onal use) to a Sinulium-infested river in lvory Coast to êvaluate its possible long term side-effects on non-target species. New chemical methods of monitoring of Abate in the environment ldere developed, and similar methods are being devised for other larvicides under trial. Ttre methods developed lnclude special field saopling and extractlon techniques, and accurate determination of residues by gas-liquid chromatography. For AbaÈe it is possible to measure quantities as low as 2 ng in mud, water and fish samples. Ttre effect of metrifonate upon the manrnalian organi.sm that has been exposed to Abate is also being studied. 57. Epideroiologv and chemotherapy: Under the UNDP-financed applied research progrâme, trials have been carried out with suramin and diethylcarbamazi-ne (DEC) in villages in Upper Volta by the National Mobile Ophthalmological Unit, and research into Èhe feasibility of mass treatment of onchocerciasis with DEC over a long period was conducted by the Royal Connnon ".lanSociety for the Blind team in Northern Ghana. The RCSB teem also carried out detailed epideuriological studles in a number of villages in Northern Ghana. 58. A compleEe search of medical, pharmaceutical, biochernical and biological Iiterature on suramin and DEC has been initiated in IÿHO Ileadquarters. 59. CollaboraEion with the Centre for Disease Control, Atlanta and OCP has been established for the standardization of a specific indirect fluorescent antibody test. 60. Tralning: Under the agreement concluded with OCCGE for the training in entomology at the Centre Entomologique de I r0nchocercose at Bouaké, I assistant enÈomologist and 8 technicians(5 Ghanaians and 4 Voltaics) attended courses. Two candidates from Togo began basic ento- mological training in September, and a candidate from Niger will conrqence training in October 1975. 6L. The participating countries were advised of the availability of fellowships for studies in public health, and onchocerciasis epidemiology and chemotherapy. So far one fellowship has been awarded to a candidate from Mali to attend a public health course in France comenci.ng October 1975. This course will be followed by studies on onchocerciasis. 62. Conclusions The first year of actual control operations has been constructive and informative: from the experience gained, the Organization has been able to adjust the control strategy before extending acÈivi-ties into the Phase II zone. t'I tE -8- Larviciding activities r^Iere highly successful throughout the phase r zone, despitediffficultie§ encountered initially at certaln sites where intensive breeding occurs. I^Iiiththe heans available, every effort was made to find the reason for, and the origins of, thBhigh density of flies which were recorded from May to August in the southern part of thecontrolred area and an operational research prograuure is planned to investigate in detailthis phenomenon should its recurrence in 1976 be of a similar type and magnitude. The logistic and administrative support provided to the prograuune is being evaluatedl :[nthe light of experience gained to achieve the best possible utilization of manpower and resources. -9- ONCHOCERCIASIS FUND Financial situation as at 3O September L975 ANNEX Advances received Disbursements: t97 4 L975 (to 30 September) Total Unliquidated ob ligations Total obligations Cash balance 2 638 846 3 670 6t7 6 309 463 42 335 1 334 311 L 376 646 2 681 181 5 004 928 7 686 to9 361 154 (r70 617) 190 537 L97 4 Budget 3 000 000 1 878 998 759 848 L97 5 Budget 3 500 000 3 670 6t7 TOTAL 6 500 000 878 998 430 465 1 4