WHO/AFRO support to OCP devolution activities: report of the Regional Director

JOINT PROGRAMME COMMITTEE Office of the Chairman JOINT PROGRAMME COMMITTEE Thirteenth session Geneva. 8-l I December 1992 Provisional aeenda item 8 Onchocerciasis Control Programme Programme de Lutte contre I'Onchocercose in West Africa en Afrique de I'Ouest COMITE CONJOINT DU PROGRAMME Bureau du President JPCl3.r0 ORIGINAL: ENGLISH September 1992 JPC - CCP WHo/AFRO SUPPORT TO OCp DEVOLUTTON ACTTVTTIES Report of the Regional Director CONTENTS L Progress made in support of PHC 2. Coordination of OCP devolution activities3. Training'in public health 4. Future WHO/AFRO support to OCP Devolution l. Progress made in support to PHC l.l. A high priority has continued to be given to the strengthening of national health system in WHO/AFRO's collaborative support to national devolution activities. Significant collaboration in this important area during the reporting period has been the further strengthening of WHO country teams in disease prevention and control within the national Primary Health Care (PHC) system. The various members of the country teams have been assisting the national authorities in making and updating epidemiological situation of important endemic diseases. Some of the country teams hive managed to draw up feasible action plans for the control of specific endemic diseases as part of national health services. Where such action plan have been developed, the country teams have been collaborating with the authorities in developing guidelines for training of health services personnel in surveillanCe and control activities related to important endemic diseases. The WHO/AFRO Devolution Coordinator has supported the activities of these country teams. A new initiative between OCP, WHO/AFRO and WHO/HQ has just been launched aimed at establishing an Intercountry Agency for Multidisease Surveillance and Control including onchocerciasis based in the West African Subregion. WHO/AFRO contributions in this initiative wiil consist of the strengthening of the technical input of the WHO country teams and in increasing the technical support of the intercountry team. 1.2. At the level of the Regional Office, the monitoring of activities with regard to the strengthening of health infrastructure has continued. The self-assessment of national treatttr systems using the criteria of operationality of district health systems developed jointly with the countries has continued to be used to describe and group various countries into various PHd developmental stages. JPCl3.l0 page 2 The criteria thnt hnve been used to incricate revels of opcration are: - Level of development of implementing structures - Management cycle - Health infrastructure with referral system - Community participation - Priority hearth activities based on row cost technorogies - Availability of locally managed funds I '3' Furthermore, the Regional off ice has continued to develop and refine the 2l set of conrmunityhealth indicators for the measurement of the impact of the heatth development programme:; on thehealth status, health coverage and the health related social needs of irre population. with thisframework, it is anticipated that collaboration with countries can strengthen multidisease surveillanceand control including onchocerciasis. 2. Coordination of OCp devolution activities The mechanisms for coordination of activities involving monitoring and evaluation t,etweenthe country teams, the oCP teams, the wHo/AFRo Devolution coordinatJr and the various staff ofthe Regional office were strengthened over the past year. The joint country visits between the ocpDevolution Unit and the wHo/AFRo Devolution ioordinator have reinforced the wHo support.Following the Regional Committee Resolution AFR/RC /40/R10, the Regionat Director has informedall concerned Ministers of Health about the actions ,equired to implement the resolution. In additionthe Regional Director in collaboration with the WHo Representatives and the national authorities hasmade provision in the national wHo country budgei (AFRopoc) for the support of r;pecificdevolution activities. The Devolution Unit trai supported individuui .ountry .rr*t in n,ouiriringexternal resources for implementing their national programmes. During the reporting period theWHO/AFRO Devolution Coordinator carried out the foliowing specific a'ctivities : - strengthening the organization and functioning of national onchocerciasis controlcommittees in Burkina Faso, Mali and Cote d,lvoire; - participate in training workshops for district health staff in Burkina Faso and Niger; - planning with WRs and national authorities ro utilize funds from AFRopoC to c,onductcountry. activities in Niger, Cote d'lvoire, Mali, Togo, Benin and Burkina Faso.Altogether US$ 50 000 was allocated; - revision and updating national plan of action for devolution in Burkina Faso, Coted'Ivoire and Mali; - in collaboration with OCCGEI elaborated training guidelines for district and peripheralhealth staff. 3. Training The Regional office has made considerabte effort in training the nationals of onchocr:rciasisendemic countries in various public health disciplines. A senior level course for four months ingeneral epidemiology has been conducted in Engliih in Nairobi since l9g2 and in Bamako in Frenchsince 1984' This course is aimed at providing eidemic disease programme managers with principles and methods of epidemiology. I I organisation de Coordination et de Cooperation pour la lutte contre les grandes Enderrries(organization for coordination and cooperation in the conrrol of major endemic diseases) t\ JPCr 3.l0 page 3 For the 1992 course,30 participants were enrolled in the Bamako course while l6 were enrolled in the Nairobi one. In order to strengthen the skills of the peripheral health staff in surveillance and disease control techniques, the Regional Office has developed various modules for training at the intermediate and district levels. These modules have been used so far in intercountry workshops of training trainers. However recently the need to accelerate the training of staff at the district level has necessitated the shifting of our training activities to the individual country level. 4. The future \YHO/AFRO support to Devolution Even when the appropriate OCP technical and management support to the countries has been successfully taken over by countries, there will still remain a need for some intercountry coordination of devolution activities. It has been felt that such a need would even become more necessary if countries develop multidisease surveillance and control programme in the process of onchocerciasis devolution. It has been envisaged that WHO/AFRO will be the most appropriate organization to take on this role. 4.1. Accordingly, the first informal discussion on the increased WHO/OCP support was organized by Dr R.H. Henderson, Assistant Director-General(ADG), in May 1992. Present at that meeting were heads of various programmes under the ADG and the OCP Director. The principles of such increased support to countries were outlined. Again in July 1992,Dr Henderson brought together the Programme Heads, OCP Director, the Liaison Officer, the Devolution Chief and WHO/AFRO Representative. At that meeting a programme outline was developed for the nature of WHO/OCP support to devolution. In September a further discussion of the programme outline by representatives of WHO/AFRO, OCP and WHO/HQ is planned. The proposals in the programme outline indicate a need for combining the Devolution units currently being separately managed by wHo/AFRo and ocp inro one Devolution unit. On I September 1992 a follow-up meeting consisting of OCP, WHO/AFRO and WHO/He representatives was organized in the WHO Regional Office in Brazzavtlle. The draft programme outline that was developed in July I992 was studied and revised (see doc. JPCl3.l2). It is expected that the revised programme outline when approved could be developed into a final proposal for submission for funding. 4.2. In order to achieve the objectives of such a revitalized Devolution Unit, it has been proposed that extrabudgetary funds mobilization would be crucial. The proposed mechanism for such a vital activity was for the present mechanisms of OCP to be utilized to assist individual countries in reaching bilateral agreements on funding support for their devolution plans or multidisease surveillance and control plans as most of them are turning out to be. It has been proposed that within such externally procured budgets specific operating support costs could be provided to enable WHO/AFRO to provide the necessary coordination and technical support. It is hoped that the realization of the proposal outlined above will very much facilitate the realization of the increased role of WHO/AFRO in the support to OCP Devolution in the OCP Participating Countries.