75th Session of the Committee of Sponsoring Agencies (CSA): Ouagadougou, 25 - 26 September 1997

fdll+t AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL APOC ) .J'i 75th Session of the Committee of Sponsoring Agencies (CSA) Ouagadougotr,Z5 - 26 September 1997 I ,.'-t*jC ( CONSIDERATION OF NATIONAL PLANS, COMMUNITY DIRECTED TREATMENT WITH IVERMECTIN PROJECT PROJECT PROPOSALS, AND ONE VECTOR ELIMINATION PROPOSAL BY: . CAMEROON - CAR - CHAD - NIGERIA - UGANDA - TANZANIA {\i ] C. { ' ,"-. I | \\ ) I . ,t, ,l CAMEROON NATIONAL PLAN 1. Background Information Sixty-five per cent of the population of Cameroon (13 millions) live in areas that are endemic for onchocerciasis. Both blinding and skin diseases exist in the country and in many parts co-infection with loa loa exists. Cross-border infection exists with Chad and CAR in the East and with Nigeria in the West. The National Plan, main objective is to establish nationwide annual distribution of ivermectin to all eligible persons within the framework of the "Reoriented Primary Health Care System", the hallmarks of which are cost recovery and community participation. The program will be developed in 4 phases, with the last Project proposals to be submitted to APOC by the year 2000. Mass treatment with ivermectin distribution was initiated in 1991 and to date nearly 600.000 cases have been heated. The following NGDO are members of the NOTF: IEF, HKI' ssl, BArrAr, GLOBAL 2000. 2. TCC Comments and Suggestion to APOC The document gives a good background of the Country in relation to the Onchocerciasis Problem. It gives a good account of the Personnel Health Care strategy within the Ministry of Health. However, TCC noted that the main mode of delivery of ivermectin envisaged in Cameroon is a pseudo-mobile system, that has a poor record, as against the Community Directed (ComDT) mode that APOC has adopted as being more cost effective. The committee expressed reservation that (ComDT) for ivermectin was to be tried out in only a few remote communities in the target arca. All Cameroon Proposals need to be closely, and specially monitored. Furthermore, the Cameroon NOTF should be put on notice that the concession on the mode of delivery would be closely linked to and assessed on the basis of adequate and e.tfigi9U.t coverage of distribution of ivermectin to the eligible population The following aspects need to be elaborated further: a) b) d) The procurement procedures. The document advocates for multiple entry points. This needs to be agreed upon by the Mectizan Donation Program. The proposed cost sharing should clearly state how exemptions for the poor assessing ivermectin. Strategies for dealing with Cross-border Problems should be outlined. The budget should be rationalized for as it is now on the high side.)e 3. TCC Recommendation This Plan is recommended for funding after the above concerns are worked out between the APOC Management and NOTF Cameroon. ADAMAOUA PROVINCE PROJECT PROPOSAL 1. Background information This Project seeks to establish CDTI in the health districts of Meiganga, Banyo and Tignere of the Adamaoua province and is a partnership between MOH and International Eye Foundation (IEF). The proposed Project an extension of the current Sight First/IEF program which is a 5 year program (1996-2001). The original Sight First /IEF Project area was divided tnto 2 after the first year due to the large area, poor or non-existent roads and difficulties in reaching the affected communities. Each include the following districts: I 2 Sight First: APOC: Ngaoundere, Djohan, Tibati Banyo, Tignere, Meiganga - Remo data is almost complete although refinements are still needed in some areas. AII tree districts consist of meso and hyperendemic communities. The total target population is around 190,000. Despite the policy of the MOH in Cameroon, this Project will attempt to carry out a form of CDTI in which the method and place of distribution will be decided on by the community health committees, the cost recovery and its use will be decided on by the community. Health workers will work with the communities in areas where reorientation is complete; community health committees will be set up in the areas where there is not yet re-orientation. That way CDTI will actually help initiate PHC. The proposed Operational Research plans to look at socio-cultural factors affecting participation, compliance, coverage etc. 2. Budget summary Year CosVtreat APOC cost 1 2 3 4 5 9300c 1 8000c 26800C 26800C 27100C 24100C 14700C 143000 1 1 8000 1 0500c 2.e 0.8 0.s 0.4 0.4 189000 89000 83000 31 000 8000 TOTALS 271004 754000 2.8 400000 3. TCC comments and recommendation TCC considers that this is a good proposal that seeks to implement CDTI in a difficult area and recommends its approval with the following amendments: 1. The discrepancies noted in the figures in all the various tables need to be clarified J Ireated Total (US $) 23 o o a a a a a Annual targets for coverage may need to be set and some evaluation of coverage after the first year of the Project may be required. The budget should be reviewed in keeping with APOC guidelines and to the satisfaction of APOC Management. In particular, it should reflect a cumulative cost per person treated over 5 years to APOC of not more than $2. CENTRE 3 PROJECT PROPOSAL 1 BACKGROUND 2 ENDEMIC AREA 3 PROPOSAL 4 BUDGET a a Population: 500,000 in central province of Cameroon PHC: 8 health districts, 96 health areas, 1024 communities a o 306 hyper and 449 meso endemic communities Population at risk: 380,000 Target 755 communities in 8 health district. Treat 37,000 (yr. 1) up to 274,000 ( yr. 5 ) Strategy through nurses at PHC clinics; if no PHC then CDTI as appropriate Year freated Total (US $) SosUtreat APOC cost 1 2 3 4 5 3700c 251 00C 25900C 26600C 27400C 683000 357000 356000 325000 362000 18.5 1.4 1.4 1.2 1.3 483000 214000 1 97000 1 53000 1 38000 TOTALS 274004 2083000 7.6 1 185000 Year 1 $ 683,000, TlohFrom APOC: $483,000 Total 5 Yr. Budget $ 2,086,000: $1,186,000 APOC. CosUr Yr. 1 Through 5 : $18 ;1.4 ;1.4 ;1.2 ;1.3 Total APOC 5 Yr. Cost Is $4.3 Per Treatment Year 1 Requests To APOC Include: Capital Training Operating Expenses $ $ s 238,000 110,000 93,000 4 5 COMMENTS good operational research ideas working within PHC structure where it exists system ofcost recovery present 6 Is the strategy feasible? Is it CDTI? Loaisis Motivation / Incentives Expensive :- Technical Assistance: $ 16,900 HKI/ Staff Technical Assistance: $ 16,900 (Yr.1) - 18,600 (Yr. 5) Capital Eq.:2 Vehicles * 48 M'cycles ($ 204,000) Training :- $ 110,000 a Lot Of Per Diems Supervision :- $ 30,000 In Per Diems 7 RECOMMENDATIONS It is recommended that this Project be accepted for APOC trust fund support, when APOC management are satisfied that the following outstanding issues have been satisfactorily addressed. BUDGET a a a PROBLEMS a a a a a) b) c) d) Need For 2 New Vehicles From APOC Need For 48 Motorcycles In Year No. Of Workshops/per Diems Per Diem Level of Supervision NORTH PROVINCE PROJECT PROPOSAL 1. Background Information The Northem province is part of a larger "onchocerciasis belt" that runs from the Nigerian states of Adamawa and Taraba to the South Westem and North Westem parts of Chad and CAR respectively. According to current estimate based on a partially completed REMO, there are 215 000 persons at risk with 172 000 infected, out of a total population of about 1 million persons. 431 communities are targeted for treatment. Mass treatment with ivermectin was initiated in 1992 through funding from the River Blindness Foundation. To date 68 333 persons have been treated at a total cost of $ 98,000. This proposal in which the MOH is in partnership with the Global 2000 River Blindness Foundation seeks to expand ivermectin treatment to a total population of 172 000. 5 'reated cost 1 1 1 1 1 2 1 1 1 1 341 1 72 72 1 1 1510 1 000 I-OTALS 1720 13 2. Budget summary 3. TCC comments and suggestions to APOC Management. TCC considered that the North Province proposal is well written, and the expansion of ivermectin in this severely affected area should be supported. However, TCC consider that further clarification should be sought by APOC Management on the following concems (issues): a) the organisation of the Project is too top down b) there needs to be real evidence of CDTI in a situation where pseudo mobile treatment exists c) the specific roles of the nurses and the village health committee members in the context of the "Reoriented PHC system" and how this relates and /or affect ivermectin distribution should be clarified the mechanisms put in place to ensure sustainability of this Project once APOC funding has ceased perhaps through utilisation of revolving Fund generated the role of funding to NGDO 4. Recommendation TCC recommends the approval of the North Province Project Proposal with the above amendments. LITTORAL II PROJECT PROPOSAL 1. Background information The Cameroon Littoral II CDTI proposal covers 4 health districts consisting of a total of 34 Health areas in which hitherto there has been limited ivermectin mass treatment. The Littoral province is among 5 of the ten provinces in Cameroon that is still going through the reorientation pro."r, of its PHC system (43% of PHC reoriented to date). Since ivermectin treatment is integrated in the PHC system of Cameroon, this will have a direct bearing in the way CDTI is going to be implemented in the proposed target area. The target population is 320.000 persons living in 520 communities (152 hyper and 368 meso endemic). The NGDO partner supporting the current proposed CDTI Project is the Bahai Agency for Social Economic Development (BASED). d) e) 6 (ear Iotal (US $) Cost/treat 8.d 84300( 2. Budget Summary 3. TCC comments and suggestions to APOC Overall this is a well written proposal which seeks to initiate mass treatment in an area that has received little consideration so far. The particular strengths of the proposal include the following: close post-treatment supervision and observation for serious adverse reaction being planned operational research on incidence ofadverse reactions a real attempt and commitment on the part of the goverrlment to implement PHC and integrate all health related activities; MOH share of the budget increasing over years, includes cash consideration given to the possibility of linking with another more experienced NGDO partner? However TCC requests APOC Management to review or seek further clarification on the following issues/queries : the rationale for starting in Year 1 with mesoendemic instead of hyperendemic communities the mechanisms to be put in place to ensure that adherence to cost recovery principle will not adversely affect coverage the description of the proposed monitoring of the Project is weak and needs to be further elaborated, particularly in view of the somewhat limited experience of the NGDO partner health education materials must be comprehensive and should not be limited only to the use of leaflets more detailed information must be provided on the NGDO partner personnel that will help implement the Project; health education materials should not be limited only to the use of leaflets, but must be comprehensive and budgeted accordingly it is not clear which customs charges are being claimed by Government for importing Mectizan 4. TCC recommendation TCC recommends the approval of this proposal provided that the above issues are resolved to the rates faction of APOC Management. (ear Treated Total S APOC cost 1 39000 217000 292000 31 3000 334000 20200c 8900c 1 0800c 1 0400c 9400c 1 E 0,4 0,4 0,3 0,3 1 2500 3900 4400 41 00 2200 TOTALS 334000 597000 1,8 27100 CosUtreat CAMEROON SOUTH WEST PROVINCE CDTI PROPOSAL 1. Background information Eight health districts are targeted in this proposed Project, made up of 294 onchocerciasis hyper endemic and 56 meso-endemic communities, with an aggregate population of 505,314. Most areas have been subjected to REMO survey, some refinement is needed in a few areas. About 3500 are currently under treatment with ivermectin from onchocerciasis by the Medical Research Station in Kumba in the past five years, in association with CBM, the Presbyterian Church, a Special Fund for Health and the WHO/TDR. 2. Budget Summary Year Treated rotal (US $) cost 1 2 3 4 5 305000 375000 385000 397000 408000 678000 270000 275000 280000 290000 2,2 0,7 0,7 0,7 0,7 383000 1 38000 96000 83000 52000 TOTALS 408000 1793000 414 752000 3. TCC comments and suggestions to APOC As mentioned earlier TCC noted that the main mode of delivery of ivermectin envisaged is a pseudo-mobile system, that has a poor record, as against the Community Directed (ComDT) mode that APOC has adopted as being more cost effective. The committee expressed reservation that (ComDT) for ivermectin was to be tried out in only a few remote communities in the target area. Along with other Cameroon Proposals the South West Province I Project Area Proposal was to be closely, and specially monitored. The Committee noted with approval the intention to carry out operational research on: a) alternative cost recovery mechanism; identification of communities where loaiasis infection is endemic using a rapid assessment method, and; evaluation ofdifferent ivermectin distribution strategies and assessment of sustain ability indicators: b) c) The proposed budget totalling $1,793,000, over a five year period was considerably too high, particularly the first year budget of $678,000. Personnel cost need to be trimmed substantially. Lunch allowances and per deems as presented are not sustainable and should be pruned. The four tier level of training earmarked for every year is superfluous and excessive. 8 3osUtreat It should be reduced by at least 50o/o in the first year and though kept to the barest minimum necessary. Four 4-WD vehicles and 31 motorcycles cannot be justified, given the current status of the programme. APOC Management is authorizedto carry out appropriate adjustment of the budget. 4. Conclusions and recommendation TCC considers the proposal was well prepared with clear objectives and adequate background information provided on the Project area. TCC recommends that the proposal should be funded on the basis of its observation and the budgetary adjustments indicated. NOTF SECRETARIAT SUPPORT PROPOSAL 2. Background Information This is a proposal submitted alongside the first specific Project proposals of Phase I of the National Plan of Cameroon. It seeks support for the NOTF Secretariat which will oversee and coordinate mechanism distribution activities throughout the country for at least the next 12 years. 3. TCC comments and suggestions to APOC Management The NOTF though well established does not seem to be fully operational and many of its members are yet to be identified or recruited. The budget is too high with double funding being requested under various headings for some line item. Personnel cost represent 60%o of the total budget and consist essentially of salaries and allowances, many ofwhich are not justified. Similarly the request of US$ 20,000 for "contingencies" seems abnormally high. Sustainability of this secretariat beyond the 5 years of APOC is of special concern. The contribution of both the most and the partner NGDOs is negligible and APOC Trust Fund support remains the same throughout the 5 years. No mention is made to the possible role cost recovery could play in support ofthe secretariat. 3. Recommendation Notwithstanding the above, TCC reckons that there is a strong case for the support of a functional NOTF secretariat in Cameroon, given the crucial role it will play in ensuring effective distribution of all eligible persons in the country within the framework of the "Reoriented PHC system". The following recommendation are therefore made to APOC Management. The budget must be reduced significantly in particular all activities related to specific projects should not be included into the secretariat budget. Any personnel related cost should be proportional to the time that is actually spent on onchocerciasis control activities. a) b) c) Capital equipment must be in keeping with the actual needs of the secretariat 9 CENTRAL AFRICAN REPUBLIC NATIONAL PLAN AND PROJECT PROPOSAL 1. Background Information 1.5 million people out of a total population of 2.68 million (1988 census) live in areas that are hyper- and meso-endemic for onchocerciasis. This corresponds to 10 (out of 16) prefectures in the country. Cross border infection exist with Chad and Cameroon in the North West, the Democratic Republic of Congo in the south and the Sudan in the East. The National Plan and the Project Proposal seek to establish nation-wide CDTI integrated into PHC for a target population of 1,000,000., and reach at leastT5o/o of the at risk population. Mass treatment with ivermectin was initiated in 1991 and expanded from 1993 through funding from cBM and RBF. About 400,000 people received treatment in 1996. 2. Budget Summary Year otal cost 1 2 3 4 5 1 0 0 0 0 0 192000 172000 1 57000 1 37000 64000 TOTALS 1 1 1 722000 3. TCC comments and Recommendation The National Plan has relevant data on demography, endemicity (mainly from REA data), health policy and structure. The proposed implementation of CDTI is well described, as well as ,o*. of thrmajor constraints needing to be addressed along the way. Cross borders issues are adequately addressed. The budget is in keeping with APOC guidelines and reflects the lowering costs to APOC and treatment costs. TCC therefore recommends the approval of the cAR National Plan. 10 I-reated 70000c 80000c 90000c 1 00000c 100000c 1NIGERIA ADAMAWA STATE PROJECT PROPOSAL The TCC would like to commend Adamawa State proposers for effectively addressing the issues raised by TCC3. The document is greatly improved in all major areas. Despite this, a number of issues must be addressed. They are as follows: Given the importance of sustainability, and its relation to the utilization and strengthening of the Primary Health Care System, the discussions of this link must be improved. First, it is mentioned that only 10%-20% of communities have access to Primary Health Care (PHC). Later when asked how CDTI will initiate or expand the PHC system, the response was that the question was not applicable. The applicability is obvious and must be understood and adequately explained. The discussion of the previous program is improved, however, it still requires strengthening. The Total Costs which include Global 2000's input must be completed. Explain in further detail the nature of the Project that treated 332,850 people in 1996. Explain who were the major contributors to this success and their strategies. The operations research that will compare the GRASP health education methods to others seems interesting. It is necessary to further describe the other methods that you plan to compare with the GRASP methodology. 4. NGDO Letter of Endorsement must be provided to APOC Management. 5. Budget Summary 2 J Year Treated Total (US $) CosUtreat APOC cost 1 2 3 4 5 72100C 74300C 76500C 78800C 81 1 000 62600C 26400C 25400C 24700C 23400C 0,8 0,4 0,3 0,3 0,3 251 000 1 08000 59000 58000 42000 TOTALS 81 1000 1 625000 2r0 518000 a b) ) ) The budget structure was clear and well presented. The l0%o annual increase in personnel salary must be justified. Personnel cost calculations which include the l0%o increase are faulty in places. These must be corrected. c 11 The $2,000/yr. cost to APOC for the storage and transport of Mectizan must be justified. The fuel cost of $217,000 over the life of the Project seems high and should be reduced. Although a KAP survey is intended to be carried out, a budget for this is not included. Please explain where KAP budget is located. Please justify the $2,500/yr. cost for Sub-Committee Special Assignments under other Expenses. There are 12 vehicles included in the budget. Only 3 receive maintenance - Please explain. Recommendation The TCC recognises that the Adamawa State Proposal has greatly improved and recommends that it be approved in the condition that the above issues are resolved to the satisfaction of APOC Management. The TCC would also suggest that APOC Management consider adopting the budget Format utilized in this proposal and the summary table on page 34 as standard formats for Future APOC Proposals. BORNO PROJECT PROPOSAL 1. Background Information The proposal covers 8 of the 21 LGAs in the State consisting of 25 districts. PHC exists in the proposed aria but is only partly functional. The target population is 827.862 persons living in902 communities (709 hyper and meso-endemic). Mass treatment with ivermectin were initiated in 1993 by AFRICARE. To date 224.309 persons have been treated at a total cost of 5205.979, of which 45o/owere contributed by the state. This proposal, which is actually a resubmission seeks to establish and expand CDTI to a total population of 827.862. 2. Budget Summary (ear 7360 6 0 0 0 2 17 2 6 b 82 0, 0, TOTALS d) e) 0 s) h) t2 hotal 828OOd 1681000 2.0 56400( 3. TCC Comments and suggestions to APOC Management TCC considers that this second version of the Borno proposal has adequately addressed the critical issues raised at TCC3. The particular strengths of the proposal include the following: past experience of the partners in working in this highly endemic area; the relative low cost of treatment per person treated if adequate coverage is achieved; the proposed intention to introduce cost recovery, that will be decided by the community, as a means to sustain the Project; the strong commitment of the State to support ivermectin treatment, as is reflected in the existing IDP; There are however some issues still needing clarification. These are the need for the Project to develop a clear cross border strategy; the list of personnel, provided for only 4 LGA and the State, must be completed; explanation is required on the non inclusion of 5 meso-endemic LGAs in Project area; more information is needed on how the sharp rise in the number of persons treated will be achieved; 4. Recommendation TCC recommends the approval of the Borno State Project Proposal, provided the above queries addressed to the satisfaction of APOC Management. THE FCT PROJECT PROPOSAL 1. Background Information The Federal Capital Territory of Nigeria was established in 1976 to provide a new capital for Nigeria. It comprises Abuja, the capital city and the surrounding rural areas of some 500-600 settlements. The Federal Capital Territory of Nigeria is divided into six administrative areas (Local Govemment Councils), comprising 28 districts. The population is 300,000. Mass treatment with ivermectin in the FCT has been in existence since 1995. To date, 95.653 have been treated at a total cost of $33,000. The proposed Project in the State is an extensior/continuation of the current treatment progrzmrme and will include all the 6 Local Govemment Councils. The targetpopulation is280.704(200.250 hyper, 80.454 meso-endemic). However, CDTI will be confined primarily in the areas outside the Capital city itself. 13 2. Budget Summary 3. TCC Comments and Recommendation This is a good and well written proposal that should be recommended for funding with the following amendments : a) REMO for the LGC be completed within the first year of Project implementation; b) The budget be reviewed (minor adjustments) in consultation with the NOTF and to the satisfaction of APOC Management. OSUN PROJECT PROPOSAL BACKGROUND1 a Population 2.2 mlllion 30 LGAs 2 EXISTING PROGRAM MOH partner: [II\IICEF' since 1992 17 LGAs treating 90,000 (22,000 in Project area ) Total cost in 1996 $ 40,000 (50% LINICEF ) 3 PROPOSAL A resubmission Target area: 10 LGAs No of Treatments: 226,000 (yr. 1) up to 623,000 ( yr. 5 ) Strategy : CDTI intended but not clearly explained a a a a a a a a a Year freated Iotal (US $) CosUtreat APOC cost 1 2 3 4 5 202000 21 8000 233000 255000 281000 431 000 200000 1 53000 1 88000 1 54000 2,1 0,9 0,7 0,7 0,5 239000 48000 33000 28000 24000 TOTALS 281000 1 126000 4,0 372000 I4 4 BUDGET Year 1 requests to APOC include Capital Salaries Education/training Travel $123,000 $ 59,000 $ 76,000 $ 55,000 5 PROBLEMS/ISSUES Endemicity of LGAs / Communities Not Clear Strategy stereotyped - No innovation - No Operations Research. Budget - Many Simple Adding Errors Expensive Salaries / Incentives New Vehicle + 25 Motorcycles 6 RECOMMENDATIONS It is recommended that this Project be accepted for APOC trust fund support, when APOC management are satisfied that the following outstanding issues have been satisfactorily addressed. That sufficient technical assistance for training and supervision is available for implementation of the Project. That clarification is obtained regarding the endemicity and justification for why some communities are being treated and others not, in light of the existing treatment programme area. That the budget undergo major revision, particularly in regard to the requested first year expenditure on capital ($123,000), training ($76,000), travel ($55,000) and personnel (S59,000). a a a 1 2 J Year Treated Total (US $) CosUtreal APOC cost 1 226000 574000 2,5 339000 2 347000 543000 1,6 323000 3 520000 682000 1,3 278000 4 589000 552000 0,9 1 97000 5 623000 586000 0,9 1 07000 TOTALS 623000 2937000 4,7 '1244004 15 a a a a PLATEAU PROJECT PROPOSAL 1. Background information This proposal concerns two states, the new Plateau state and Nassarawa state (both formerly one state, Plateau State. The new Plateau state has 17 LGAs, 5 of which are hyper or meso endemic, while Nassarawa has 13 LGAs, of which seven are hyper and meso endemic. The two states have a combined population of 3,843,814. Mass treatment with ivermectin in the two states in 1992, through funding from the River Blindness Foundation, which mission was handed over to the Carter Global 2000 program in 1996. 564,731 persons were treated in 1996, and 107 4 treated. The proposed Project is an expansion and a reorientation of the current program, to reach and provide treatment to a target population of 800,000 persons 2. Budget summary Year Treated Total (US $) APOC cost 1 2 3 4 5 679000 708000 723000 746000 770000 676000 31 700C 28800C 24400C 1 5500C 1 0 0 0 0 357 223 196 148 101 ALS 1680000 3. TCC comments and recommendation TCC considers that this is a good proposal that will be greatly helped by solid experience already on the ground. TCC recommends that this proposal be accepted for APOC Trust Fund support, when APOC management are satisfied that the following outstanding issues have been satisfactorily addressed: a) b) c) Technical Assistance for NGDO staff Need for new vehicles Operational research 16 CosUtreatl 77000c UGANDA UGANDA PHASE 2 PROJECT PROPOSAL 1. Background information This phase 2 of APOC supported Project in Uganda will be carried out in the districts of Kabale (assisted by Global 2000 river Blindness Program), Busheny (assisted by Christoffel Blinden Mission), Kabarole (GTZ), and Mbale (Global 2000 River Blindness Program). It is an expansion and reorientation of existing ivermectin distribution programmes in these districts. The total population targeted for CDTI in the Project area is close to 2 million. 2. Budget Summary Year Treated Total (US $) CosUtre at APOC cost 1 2 3 4 5 28 30 31 2 1 800C 1 5700C 1 4500C 9900c 7300c 0, 0, 0, 15 11 1 0, 31 TOTALS 322000 692000 2,1 46000c 3. TCC comments and suggestions to APOC Management The TCC recommends with conditions the approval of this well written and presented proposal. The issues that need to be addressed before it can gain final approval include: a) b) c) d) The TCC recommends that the APOC Management not release Fund to this Project until all appropriate Letters of Endorsement from the NOTF & partner NGDO's are submitted. The existing budget that was received and reviewed by the TCC from the NOTF will be considered as the official budget. If the NOTF wishes to submit another budget, it must accompany the NOTF Letter of Endorsement. In this case, the TCC must review and approve the amended budget before it's officially adopted by the APOC management. The calculation of the target population to include 9lo/o of the Total population must be further justified. The Letter of Endorsement from the partner NGDO's must be in order. The cost of treatment pre-APOC is $038. This level of efficiency is not achieved again until the 4th year of this grant. This needs further explanation and justification. The operation research in regard to transmission may duplicate studies undertaken by TDR. This must be further discussed with APOC Management. Once, these issues are resolved, the TCC 4 recommends the approval of the Project. e) t7 TANZANIA TUKUYU PROPOSAL FOR VECTOR ELIMINATION TCC reviewed this proposal and an accompanying report provided following a feasibility study on vector elimination for the TDR Task Force on Tanzania foci. This proposal was reviewed in the context of the criteria which were required for a vector elimination Project. The focus must be isolated, there should be a local defined vector , the activity should be cost-effective and manageable, and provide a rapid return on investment by enhancing productivity and reducing the requirement for long term CDTI. The Tukuyu focus was an area of 3000 km2 on the TanzanialMalawi border. Endemic Onchocerciasis in Tukuyu was centred around 4 river systems draining south into Lake Malawi. The focus was believed to be isolated and transmission of O. volvulus by the S. damnosum Kiwiro form was at its peak in dry season June-November months. Maps of the river system provided dosing points and spraylng of insecticide (Temephos) to be used has provided in this report and accompanying document. Earlier studies of the area were referred to which provided information on biting rates, transmission potentials and distribution of the Kiwiro form together into hydrology. The TCC considered that whilst it was in favour of embarking on Vector elimination in Tukuyu and required clarification of certain key questions raised in the report, some of which may have been addressed in the interim. 4) Confirmation of the absence of the Kiwiro from the Songwe river 5) Susceptibility tests should be completed to confirm the susceptibility to Temephos of the Kiwiro form of S. damnosum 6) Confirmation of the minimum duration of egg to pupae as more than or approximately 2 weeks The committee recommended that the Project should receive support to obtain information relevant to the control programme which were critical to the successful implementation of the programme. TCC recommended that provided the issues above were satisfactorily resolved, control should commence in 1999. Detailed planning should commence in 1998 to anticipate commencement of field operations a year later than envisaged in the proposal. TCC requested APOC Management to ascertain if, as indicated in the report, any information on the cytogenetics of the S. damnosum, populations was available following the 1996 and 1997 dry seasons. TCC considered it appropriate to involve an appropriale consultant to assist further susceptibility tests and preimaginal development duration. The proposal and the feasibility report were well prepared and the proposal was recommended for support at a budget level for 1997 and 1998 activities as determined by APOC Management. The scheduling of activities according to the time lines in the proposal had been retarded and management flexibility was necessary to respond to managerial and technical information required by TCC and accepted by the proposers as necessary prerequites for the commencement of operations. 18