Joint Programme Committee of the Onchocerciasis Control Programme in West Africa: twenty-third session, Ouagadougou, Burkina Faso, 4-6 December 2002

,l woRf,) n r..[,r, oRG{\ IZATI.)'. ORGANISATION MONDIALE DE L^{ SANTE REGION DE L'AFRIQUEAFRICAN REGIO\ ONCHOCITRCIASIS CONTI(OL PROGRAMME IN WEST AFRICA PIiOC.{--\MME D[ LUTTIl CO\TRE L'OI-CHOCERCOSE EN AFRIQUI] DE L'OUEST B P 519 OUAGADOUGOU lil, Burkrna Faso T6169r ONCHO OUAGADOUGOU Tel (226) l+2953-3-1 le5e-l-1 lq60 -Fax(226) 342875'31 3641 JOINT PROGRAMME COMMITTEE OF THE ONCHOCERCIASIS CONTROL PROGRAMME IN WEST AFRICA Twenty-third session, Ouagadougou, Burkina Faso 4-6 December 2002 REPORT J P C 23 I 2002 lOuagadougou @ 12 3 4 5 6 7 8 JOINT PROGRAMME COMMITTEE ONCHOCERCIASIS CONTROL PROGRAMME IN WEST AFRICA Twenty-third session, Ouagadougou, Burkina Faso 4-6 December 2002 REPORT CONTENTS OPENING OF THE SESSION. ELECTION OF OFFICERS ..... ADOPTION OF THE AGENDA REFLECTIONS OF THE COMMITTEE OF SPONSORING AGENCIES PROGRESS REPORT OF THE WORLD HEALTH ORGANIZATION REPORT OF THE EXPERT ADVISORY COMMITTEE............ EXTERNAL EVALUATION........ POST-OCP ONCHOCERCIASIS ACTIVITIES IN THE ..SPECIAL INTERVENTION ZONES'' FINANCING OF OCP - REPORT BY THE WORLD BANK REPORTS OF PARTICIPATING COUNTRIES ON THE IMPLEMENTATION OF TRANSFERRED ACTIVITIES ............ REPORT ON NGDO ACTIVITIES IN OCP COUNTRIES...... ARRANGEMENTS FOR THE CLOSURE OF THE PROGRAMME ........... SUPPORT TO SUSTAINABLE DEVELOPMENT IN ONCHOCERCIASIS-FREED ZONES AUDIT REPORT MATTERS DISCUSSED AT THE JOINT JAF-JPC SESSION ON 4 DECEMBER}OO2 OTHE,R MATTERS READING AND APPROVAL OF THE FINAL COMMUNIQUE CLOSURE OF THE TWENTY-THIRD AND LAST SESSION OF JPC..... Page ..... 1 .....2 ..,..2 .....2 .....2 .....8 ..... 9 ... l1 ... l19 10. 11. 12. 13. t2 13 l4 14. 15. 16. 17. 18. l4 15 l5 t5 16 16 Page ANNEX I LIST OF PARTICIPANTS t7 ANNEX 2 REFLECTIONS OF THE COMMITTEE OF SPONSORING AGENCIES ANNEX 3 CONCLUSIONS OF THE JOINT SESSION OF JAF8 AND JPC23 .. 30 ANNEX 4 FINAL COMMUNIQUE OF JPC23 INCLUDING CONCLUSIONS AND DECTSTONS ............... 32 ANNEX 5 AGENDA 35 ANNEX 6 EXECUTIVE SUMMARY - PROGRESS REPORT OF THE WORLD HEALTH ORGANIZATION FOR 2OO2 36 ANNEX 7 ADDRESS BY THE MINISTER OF HEALTH AT THE OPENING OF IPC23 .......,40 ANNEX 8 .41 .45 .48 28 CLOSURE OF OCP - ADDRESS BY HIS EXCELLENCY THE PRESIDENT OF BURKINA FASO - ADDRESS BY THE DIRECTOR-GENERAL OF WHO - ADDRESS BY THE NETHERLANDS ON BEHALF OF DONORS TPC23 Page 1 1. OPENING OF THE SESSION: Agenda item I 1.1 The twenty-third and last session of the Joint Programme Committee (JPC), the governing body of the Onchocerciasis Control Programme in West Africa (OCP), was held at the Ouaga 2000 Conference Hall at the invitation of the Government of Burkina Faso. The session opened in the afternoon of Wednesday 4 December 2002, following the OCP-APOC Joint Session held in the morning of that day, and closed at noon on Friday 6 December while the Closure Ceremony of OCP took place during the afternoon of that day. 1.2 The session was attended by representatives of the Participating Countries, the Donors, and the Committee of Sponsoring Agencies, private industry and Non-governmental Development Organizations collaborating with OCP as well as the Chairs of the Expert Advisory Commiffee and the Technical Consultative Committee. The list of participants is attached as Annex 1. 1.3 Before the opening of the session, Dr Dennis Carroll, the outgoing Chair, paid tribute to those who 29 years ago had the vision to enter into collaboration with the then seven Participating Countries for the purpose of controlling the serious health hazard of riverblindness in West Africa. Today the objective of the Programme - to eliminate onchocerciasis as a problem of public health and socioeconomic importance - had been reached and OCP would go down in the annals as a remarkable success. Children could now grow up without fear of contracting this debilitating disease. 1.4 He stressed the importance of the partnership as a cornerstone of the Programme since its very beginning and suggested, finally, that the OCP experience might show the way for other health development programmes. 1.5 The Director of the Programme, Dr Boakye Boatin, then referred to OCP as an evidence- based operations continuously solving problems by means of operational research. He rvas confident that the Participating Countries were now in a position to set up guards against possible circumscribed instances of recurrence of the disease. 1.6 He referred to the preparations for the closure of the Programme and mentioned the publication of a book on the history of OCP as well as the preparation of manuals for epidemiological and entomological surveillance. 1.7 Dr Boatin finally expressed the gratitude of the OCP staff for having been given the unique experience of serving this unique Programme. He stressed the collaboration the Programme had enjoyed in partnerships with the Participating Countries, the Donor Community and institutions, academic institutions, highly skilled scientists, NGDOs and the private industry. i.8 Dr Ebrahim M. Samba, WHO Regional Director for Africa, referred to his 14 years as Director of OCP and expressed his pleasure with its undeniable success. He paid a special tribute to Burkina Faso for hosting the OCP headquarters and for its continued logistic and administrative support. 1.9 The Minister of Health for Burkina Faso, Mr Bedouma Alain Yoda, in rvelcoming JPC participants to his country reminded them of the riverblindness situation in Burkina Faso at the time of launching OCP and the impressive results obtained by the Programme. He underlined the importance of the West African countries remaining vigilant to ensure that the OCP achievements rvere safeguarded. 4. JPC23 Page2 1.10 The Minister finally paid homage to all who had made the Programme a success and thanked the various partners for their never failing support to OCP. 2. ELECTION OF OFFICERS: Agenda item 2 2.1 Burkina Faso was elected to the Chair in the person of Mr B6douma Alain Yoda and Belgium to the Vice-Chair held by Dr Jacques Laruelle. 3. ADOPTION OF THE AGENDA: Agenda item 3 (document JPC23.1) 3.1 The provisional agenda, as reflected in the present report, was approved . REFLECTIONS OF THE COMMITTEE OF SPONSORING AGENCIES: Agenda item 4 4.1 The Chair of the Committee of Sponsoring Agencies (CSA), Mr Bruce Benton, underlined the importance of the constructive collaboration among the four UN Agencies having served as a secretariat cum oversight body in support of the Programme since its inception. He stressed that the Committee would continue its support to APOC after OCP came to a close and expressed his satisfaction that CSA had now widened its membership to include also representatives of the NGDO Group and Merck & Co., Ltd. 4.2 Mr Benton singled out the organization of the External Evaluation and the preparation of the documentation for post-2002 control in the "special Intervention Zones" as the more important tasks of the Committee during the preceding year and reported with satisfaction that a recent Donors' Conference had agreed to allocate the Reserve in the OCP Trust Fund to finance the post- 2002 activities. 4.3 Other activities of CSA during 2002 included providing recommendations regarding the composition and timeframe of the "winding down" team to handle outstanding OCP matter after 2002 andkeeping abreast of the development of the AFRO Multidisease Surveillance Centre' 4.4 Mr Benton concluded by expressing on behalf of CSA the Committee's gratitude to all the partners in OCp for having been allowed to work with them to make OCP a success story. (Full text is found in annex 2). 5. PROGRESS REPORT OF THE WORLD HEALTH ORGANIZATION: Agenda item 5 (document IPC23.2) 5.1 This agenda item was introduced by the Directorof the Programme, Dr Boakye A. Boatin, who referred to the conclusion of the External Evaluation Team that OCP had indeed eliminated onchocerciasis as a problem of public health importance and as an impediment to socioeconomic development although there remained a few zones where control activities would need to continue after cl,osure of the Programme. He was confident that the Participating Countries were capable of effectively detecting and controlling any re-appearance of onchocercal transmission, should it er er occur. The return of ttacknies and the nuisance of their bites would in some cases also need specific control measures. JPC23 Page 3 5.2 OCP manuals for the implementation of epidemiological, entomological and other onchocerciasis control activities were now available and publications of the OCP experience in different fields had been made. 5.3 Dr Boatin was satisfied that the transfer of OCP facilities and equipment to the Participating Countries, APOC and the AFRO Multidisease Surveillance Centre had been accomplished in a fair and equitable manner and he stressed in connection with the closure of the Programme that all possible efforts had been made to minimize its adverse impact on the staff . 5.4 He concluded by expressing his own gratitude and that of his staff for having had the opportunity to serve OCP and thanked all the partners in the Programme for their support to enable it to bring it to a successful conclusion. Reference is made in the following to the Executive Summary attached as Annex 6 - and the relevant pages - of document JPC23.5 (Progress report of the World Health Organization for 2002). Wen a subject was not introduced by a staff member (e.g. "Biostatistics and Information Systems Support") the summary is based on the relevant text in the Progress Report. Note: summaries of the discussion in JPC on the different sections under agenda item 5, 6 and 7 below have been combined after the discussions on the Report of the Expert Advisory Committee (Agenda item 6) and that of the External Evaluation (Agenda item 7). VECTOR CONTROL See paragraphs a to k in the Summary of, and pages 5 to 16 in, the Progress report (JPC23.2), updated taking into account the data of September and the identifications of the parasites made b1 the DNA laboratory. Summary of presentation 5.5 The vector control activities which were aimed at intemrpting the transmission of the savannah form (the most blinding form) of the parasite Onchocerca volvulus for a period longer than the longevity of the adult worm in its human host (about 14 years), covered more than 50 000 Km of rivers when the original Programme area as well as the southern extension in C6te d'Ivoire were fully operational. 5.6 In the original Programme area, these activities allowed for a virtual elimination of onchocerciasis after 14 to 15 years of control, except in rare foci such as the Lower Black Volta and the Kulpawn/mole areas in Ghana, and the Bougouriba area in Burkina Faso. These excellent results are maintained more than l0 years after the cessation of the larviciding operations and fit quite well with the Onchosim predicted trends. The infectivity rates of the blackflies are still nil or close to zero. 5.7 In most parts of the extensions areas, transmission has also been intemrpted by combined vector control and ivermectin distribution. Annual Transmission Potentials (ATP) are less than i00 and close to zero. Even in the few foci considered as "Special Intervention Zones". there is an improvement of the entomological results for the last 2-3 years. Control measures are being rnaintained and reinforced in these Special Intervention Zones to minimise risk of expansion of the TPC23 Page 4 parasite from there into the oncho-freed zones. However, transmission by forest flies (Simulium soubrense Beffa form) is still going on at the border between Nigeria and Benin. 5.8 The excellent results were obtained in the OCP area thanks to well oriented operational research conducted in collaboration with external institutions and consultants. Thus, re -invasion sources have been identified and control measures put in place to solve the problem. Alternative insecticides have been screened and a rotational scheme of the operational larvicides put in place to minimise the risk of resistance. 5.9 The plan put in place for the cessation of the activities of the vector control unit is being implemented even with the present situation in COte d'Ivoire. It is expected that only a few technical and administrative issues related with the closure of OCP (dismantling of satellite beacons, writing of some technical reports, data management of the last data collected by the team) and all vector control activities in the Oti tributaries area continue after the end of December 2002. 5.10 To ensure that the Participating Countries are in a position to maintain the achievements of the Programme, nationals have been trained in different fields (entomology, hydrology, molecular biology, environmental sciences) and are being intimately involved in the planning and implementation of research activities. Also, the national entomologists were assuming full responsibility for the early detection of recrudescence as well as for studies on the impact of ivermectin on transmission. 5. 1 1 Monitoring of the aquatic environment in river basins where larviciding rvas ongoing and in those where vector control had ceased continued to be carried out by national hydrobiologist teams. Their findings confirmed that no disappearance of various families of fish had occurred and that their abundance remain stable. Also, the taxonomic richness of the aquatic entomofauna had not been affected by larvicide treatment. As an example of collaboration betrveen public health programmes could be cited the invitation to OCP hydrobiologists to undertake for the Roll Back Malaria programme an assessment of the impact of washing impregnated bed nets on the non-target aquatic fauna. 5.12 Field studies carried out to determine the vectorial capacity of the Simulium sirbanunt migrant populations in Sierra Leone, Guinea and Mali showed a low-level compatibility between this vector and Onchocerca volvulus strains in the north of Sierra Leone but a somewhat higher capacity in the savanna areas of Guinea and Mali. IVERMECTIN TREATMENT AND EPIDEMIOLOGICAL ACTIVITIES See paragraphs I to q in the Summary and pages l6 to 24 in the Progress report S um mary of presentations Ivermectin treatment 5.13 Ivermectin treatment was introduced as from 1987, first in Ghana before being extended to the other OCP countries between 1988 and 1990. It was implemented initially b1'mobile teams with a relatively low therapeutic coverage, later - from 1996 - replaced by the Community-directed Treatment with Ivermectin (CDTI) approach resulting in improved coverage. TPC23 Page 5 5.14 During 2002 more thanJ,320,000 people in 21 100 villages within the OCP countries were under ivermectin treatment with an average geographical coverage of 92% (62 to 100%) and an average therapeutic coverage of 17 .7'h ranging from 64 to 82o/o; the less satisfactory results were due to civil unrest in C6te d'Ivoire and Sierra Leone where, however, the CDTI programmes were gradually catching up. 5.15 Particular attention was given to the ivermectin coverage in the "Special Intervention Zones" where re-enforced CDTI programmes would be carried out after the closure of OCP. Field studies showed that these unsatisfactory results in some areas were mostly due to poor accessibility and a high degree of migration in these zones and special measures were taken to improve the situation. 5.16 Since the inception of the CDTI strategy, more than 65 000 Community-directed Distributors, 3 500 rural health staff and 500 district medical officers had been trained or retrained in the OCP countries. The CDTI implementation continued to be supervised by the peripheral health staff who reported on the results of each treatment cycle to the district health authorities for forwarding on to the central level. As was the case since the inception of large-scale ivermectin treatment, several Non-governmental Development Organizatrons participated actively in, and supported, national CDTI programmes. EpidemiologicaVophthalmological surveillance/treatment 5.ll The onchocercal prevalence rates in most of the river basins ranged between nil and 10% with CMFLs practically at the zero level. This was a clear demonstration of the impact of OCP operations carried out in areas where prevalence rates reached up to the 90o/o level at the start of control operations. Also, no new infections had been detected. However, the prevalence in the "Special Intervention Zones" remained well above the zero level with an upward trend in Sierra Leone from35o/o (CMFL: 2.13) in 1996 to 73% (CMFL:9.4) in2002 (Kaba basin). 5.18 An ophthalmological evaluation carried out in Benin and C6te d'Ivoire confirmed the findings in several other parts of the OCP areas that the control had resulted in an impressive regression of onchocercal lesions in the anterior chamber of the eye with stabilization of the lesions in the posterior chamber with no new cases of blindness caused by the infection. BIOSTATISTICS AND INFORMATION SYSTEMS SUPPORT See paragraphs s to u of the Summary and pages 24 to 26 in the Progress Report Sumnrury of presentation 5.19 The Programme nearing its end, special attention was given to updating and validating entomological and epidemiological data for computerization as well as data on CDTI activities since 1987. Data-processing tools like equipment, programmes, data bases and user guides. were transferred to the Participating Countries and a workshop was organized to identify the application problems. A new bank covering ophthalmological data collected from the sLart of OCP operations was under preparation as was a data bank on socio-demographic studies. 5.20 The operational and scientific information collected since 1974 ri ere brought together in comprehensive data banks specifying their goals, history, mode of collection, definition and IPC23 Page 6 formulas of calculation. Also, a data register of people who had worked for OCP was being completed. 5.21 Training modules were being published and would soon be made available to the national authorities and technicians concerned. 5.22 The OCP web site was being improved to be fully functional before 31 December 2002 and the bibliographic references in the library and the technical OCP/APOC documents were available for in-house use. MACROFIL/FILARIASIS R&D See paragraph r of the Summary and pages 33 to 37 in the Progress Report. Also refer to paragraphs I to 3 of the Conclusiorts of the JPC23/JAF9 Joint Session. S u mmary of pres entatiort Product R&D for Filariases (Macrofil) 5.23 Moxidectin clinical development as macrofilaricidal drug This project is a not yet formalised partnership between Wyeth Inc. (the manufacturer) and the Onchocerciasis Chemotherapy Research Centre (OCRC) / TDR responding to control progralnme needs and conducted according to requirements defined by the regulatory authorities of developing and developed countries. Considerable progress was reported and challenges were highlighted: funding after clinical phase 2; identification of clinical research experts and centres in endemic countries to conduct phase 3 studies; capacity building to conduct clinical studies (GCP) for phase 3;finalization of the Memorandum of Understanding. 5.24 Optimization of DEC "Patch test" for oncho surveillance This project will aim at developing a "ready to use" test using the drug transdermal delivery technology; produced under GMP quality (always same); long shelf life; no need for special storage and low cost. Prototypes have been produced and will be tested for safety (ensuring that DEC does not get in the blood and cause systemic Mazzotti reaction) and efficacy (should match the DEC patch test). 5.25 Development of tools to detect ivermectin resistance A molecular biology team has shown that the genetic profiles of Onchocerca volvtlus from parients repeatedly treated with ivermectin differ significantly from parasites from non-treated patients. supporting the probability that ivermectin is selecting on the O. volvulus genome. The implications from this selection on parasite response to ivermectin are not known. Studies to validate these changes as markers for ivermectin resistance are ongoing. Clinical studies in Ghana identified patients who after repeated (10) treatntents still had skin microfilariae (m0. They came from "sentinel" villages where vector control had been conducted for 22 years until stopped in 1996 and ivermectin treatnient since 1987. Twelve individuals rvere documented as skin mf positive (and some with ocular nrf). They had no underlvtng disease and nt'r history of exposure in high transmission zoncs. They received ivermectin under clinical super-.istort and absorption was dernonstrated. JPC23 PageT After 8 days significant reduction of mf in the skin was found (normal ivermectin effect). However, after 90 days the adult female worms had highly active embryogenesis and after 360 days the skin mf had returned to levels equal or higher than before treatment (not to be expected.from someone who has received multiple ivermectin treatments). Possible explanations could be treatment failure during ivermectin distribution, patient reinfection (active transmission still ongoing) or aberrant parasite response to ivermectin. The Expert Advisory Committee recommended that fuither sfudies addressing these issues be conducted. 5.26 Drug discovery is targeted at Wolbachia and inhibitors for Aminoacyl-tRNA synthetase are being researched. 5.27 Proposals considered by MACROFIL Drug efficacy and safety studies towards supporting "integrated" disease control programmes. For integration of onchocerciasis and lymphatic filariasis elimination (LFE) control programmes, macrofil concucted clinical studies demonstrating safety of coadministration of albendazole + ivermectin or DEC. To support the possibility to integrate the control of onchocerciasis, schistosomiasis and Limphatic Filariasis Elimination (LFE) a study of the safety of coadministration of albendazole * ivermectin (or DEC) * praziquantel is proposed. Studies on albendazole efficacy in Loa loa to reduce the risk of ivermectin induced serious adverse events (SAE) during ivermectin distribution in areas with high prevalence of Loo loa are proposed. 5.28 MACROFIL issues MACROFIL will operate with20Yo less funding after closure of OCP. The focus will be on Moxidectin, DEC patch test and molecular biology of ivermectin response and drug discovery restricted to one Wolbachia project. Additional funding will be solicited for: clinical studies on ivermectin response; safety and efficacy of drug co administration; albendazole and Loa loa; capacity building for Moxidectin phase 3 study and DEC patch test evaluation in the "field". ADMINISTRATION AND SUPPORT SERVICES See paragraphs v to x of the Summary and pages 37 to 41 in the Progress Report Summary of presentation 5.29 During the past year the Administration and Finance Unit continued its support to the operational, technical and scientific units of the Programme, managing the human, financial and material resources of OCP as well as providing some administrative and managerial support to APOC. A considerable part of the Unit's time was spent on preparations for the closure of the Programme. 5.30 The re-orientation of the staff aiming at improving thcrr acccptance in private emplol,ment and efforts to find employment within the UN system were being rcinforced as OCP dreu' to a c1ose. JPC23 Page 8 5.31 Details concerning the arrangements made forthe closure of the Programme can be found in document JPC23.6. 6. REPORT OF THE EXPERT ADVISORY COMMITTEE: Agenda item 6 (document IPC23.3) 6.1 The report of the twenty-third session of the Expert Advisory Committee was introduced by its Chair, Professor Adenike Abiose. During the past year Members of EAC visited Mali, Togo, Senegal, Guinea, C6te d'Ivoire and Sierra Leone to discuss with national authorities integrated onchocerciasis surveillance activities and post-2002 control in the "Special Intervention Zones". 6.2 EAC reported that following their advocacy trip to countries, they have been satisfied with country preparedness to take over and maintain OCP achievements, though some countries have requested for additional support. They endorse plans that have been made for SIZ and recommend annual monitoring of activities as well as particularly intercountry collaboration to share experiences. 6.3 The Committee considered the overall entomological situatiozr as being satisfactory with declining transmission trends throughout the Programme area and recommended the continuation of entomological surveillance as an "alarm signal" rather than having served the purpose of "guiding" vector control as was the case during OCP operations. The Committee recommended in this connection that entomological surveillance be continued in OCP countries beyond the closure of the Programme. 6.4 The epidemiological situation within the Programme area was also considered on the whole favourable except in those zones where "special interventions" would be undertaken beyond 2002 although recent findings indicated a downward trend (see section 8 below which also reflects the EAC consideration of posG2002 onchocerciasis activities). 6.5 Professor Davide Calamari, Member of the Ecologtcal Group, summarized the findings and recommendations of the twenfy-third session of his Group. He referred to the need to preserve the specimens of fish and invertebrates collected by OCP and suggested that the collection be housed in a museum or research institute. 6.6 The Group having been informed that financing by the Global Environmental Fund of the WAFEM project had been rejected and that the project was being broadened to incorporate a strong public health component, recommended that CSA continue its support to the project to link environmental health with public health. 6.7 The Group finally recommended that a small advisory group be established to oversee environmental monitoring in the Oti-Ou6m6 basins where aerial larviciding will continue post- 2002. 6.8 The report of the Ecological Group and its recommendations were endorsed by the Expert Advisory Committee. 6.9 EAC reviewed the progress and operational plans of MacroJil, u'hich are summarized rn paragraphs 5.23 ro 5.28 above. The Committee noted that the n.ricrofilaricidal effect of ivermectrn was as expected but there was apparent lack of effect on adult \\/onns in thc Lorver Black Volta basin that made the following recommendations for the futurc rvork of thc project: that the JPC23 Page 9 phenotype responsible for non-response to ivermectin be included among the ONCHOSIM parameters; that non-responder phenotype validation be carried out in collaboration with other public health and research institutions; that collaboration with, and financial support to, the Hohoe Centre be continued; and that research and development of new anti-filarial drugs continue. 6.10 The Committee was informed by Dr Hans Remme about the operational research of relevance to onchocerciasis control carried out or planned by TDR. These projects included a study on advocacy; a study on the involvement of community-directed drug distributors in the control of other diseases; epidemiological/entomological studies on the conditions, and with what strategies, local elimination of transmission would be feasible. EAC reiterated its recommendation that all possible efforts be made to secure the funding of these studies 6.11 EAC was informed in detail by reports prepared by the OCP Management and by oral presentations by the Onchocerciasis Coordinators about the preparations and readiness of the Participating Countries to carry out surveillance and control of onchocerciasis. The Committee prepared a list, common to all Governments, of requests and recommendations concerning furure surveillance and control activities, as well as country-specific recommendations. 6.12 An update on ONCHOSIM research was presented by Prof. Habbema under the headings of the structure of the model; its applications; and documentation, training and transfer aspects. He further summarized the conclusions of a scientific article on the progress of elimination of onchocerciasis. 6.13 The Committee recommended that the future application of ONCHOSIM be taken up by APOC with the necessary resources made available. 6.14 A list of suggested indicators and criteria for monitoring onchocerciasis control rvas considered by EAC with the recommendation that it be finalized by the National Onchocerciasis Coordinators. 6.15 The Committee was informed about the progress in the establishment and development of the AFRO Multidisease Surveillance Centre. 7. EXTERNAL EVALUATION: Agenda item 7 (document JPC23.9) Summary of presentatton 7.1 The Independent External Evaluation Team (EET) concluded its review by the statement that "OCP objectives have largely been met" and that "the winding down of the Programme activities (was) progressing satisfactorily but that some residual activities (needed) to be undertaken urgently." The Evaluation Team believed that the Participating Countries \ rere capable of undertaking oncho-control activities, after 2002, endorsed the proposed activities in the "Special Intervention Zones" and supported continued strengthening of the AFRO Multidisease Surveillance Centre. 7.2 The EET enumerated the various OCP achievements, including the secondary impact on national health systems. Particular emphasis was given to the need for continued inter-country collaboration rvithin the former OCP area supported by WHO AFRO at the regional level and thc WHO Country Offices. The Tcam further expected the Non-governmental Development JPC23 Page l0 Organizations, active in support to national CDTI programmes to continue their collaboration with the countries concerned. 7 .3 The Evaluation Team drew up a list of the onchocerciasis-related activities to be adhered to in order to maintain the achievements of OCP and made specific recommendations conceming the institutional, financial and operational aspects of post-2002 onchocerciasis activities (see section 8 below which also reflects the views of the Evaluation Team). The EET also prepared a list of issues pending for consideration after December 2002. The report finally included a consolidated list of the Team's recommendations. Discussion on the reports and presentations under items 5, 6 and 7 above (discussion on the "Special Intervention Zones" deferred until after the presentation of item 9) 7.4 The Committee congratulated the Expert Advisory Committee and the External Evaluation Team on their respective contributions to the accomplishments of the Programme and for the recommendations for maintaining these achievements during the post-2002 era. 7.5 To a question on the plans for the posc2002 entomological surveillance it was explained that the national entomologists would survey during the highest transmission period the highest risk zones every three years. The list of the selected catching points as well as the surveillance plans elaborated by VCU in collaboration with the national entomologists would be submitted to the Multidisease Surveillance Centre. This would allow for the follow up of the impact of ivermectin on transmission and also to detect any recrudescence of transmission. Epidemiological surveillance would be carried out every five years in areas without ivermectin treatment using the DEC patch test. It was mentioned in this connection that the five zones identified for post-2002 special intervention activities had been identified but it could not be excluded that additional problem zones could develop in the future as a result of migration and civil unrest which would be identified by the national surveillance systems. 7.6 The question regarding when the community-directed treatment with ivermectin (CDTI) might end was raised. It was explained that this important issue was one of the studies undertaken by TDR in connection with the effect of ivermectin on transmission. Also, reference was made to the twice yearly ivermectin treatment in the Americas aiming at eradication of onchocerciasis and for which guidelines for indicators had been developed. 7.7 It was suggested that APOC might consider applying vector control in localized areas and it was explained that that Programme, although it had no mandate for vector control in general, was mandated to attempt eradication of local vectors wherever feasible in isolated foci not exposed to reinvasion. 7.8 The Committee stressed the importance of the coordination of post-2002 onchocerciasis activities among former OCP countries by APOC and the AFRO Multidisease Surveillance Centre with the involvement of the Committee of Sponsoring Agencies and the t'est African Health Organization. JPC also stressed in this connection the support to be provided by the Multidisease Surveillance Centre to onchocerciasis activities to be conducted during the post-OCP era. 7.9 The irnpression was gained during country visits by Members of the Extemal Evaluatiort Team that the concept and move towards integration of health programmes were more developed at the field lcvel than at the centre. Another impression by the Team was that there rvas some concern that the mandates of the AFRO Multidisease Surveillance Centre and the \\'est Afrrcan Health JPC23 Page 1 1 Organization (WAHO) might overlap but the Committee was reassured that the activities of the two institutions would be complementary. The Representative of WAHO provided JPC with a sulrunary of the objectives and the programme of his organization. 7.10 The Committee approved the recommendations of the External Evaluation Team 8. POST-OCP ONCHOCERCIASIS ACTIVITIES IN INTERVENTION ZONES": Agenda item 8 (document JPC23.4) THE "SPECIAL Summary of presentation 8.1 The proposed Plan of Action and Budget for the post-2002 onchocerciasis activities in the "special Intervention Zones" was introduced by the Director of OCP who summaized the less than satisfactory epidemiological situation in the five zones: the river basins of Pru in Ghana, the basins of Oti in Togo and Upper Ou6m6 in Benin, the river basins of Mafou and Tinkisso in Guinea and the river basins of Sierra Leone. He briefly explained the background for the EAC recommendation which had been made in the light of the ONCHOSIM predictions and field experience for continued control in these zones to which Sierra Leone had been added due to the intemrption of larviciding and ivermectin treatment since 1994 and the need, therefore, for resumption of control as the local conditions now so permitted. 8.2 The principal means of control would be reinforced CDTI aiming at 85Yo therapeutic coverage in all the river basins concemed, including those in Sierra Leone, with aerial larviciding added in the Oti and Upper Ou6m6 tributaries. A Special Intervention Team would be responsible, together with nationally recruited staff, for carrying out the control activities in the designated Zones, including Sierra Leone. The Team and its field operations would be financed from the remainder of the OCP Trust Fund available after closure of the Programme and would continue its activities during five years until 2007 while reinforced CDTI would continue to be carried out until 2012. The Director of APOC as WHO staff would oversee and support the activities of the Special Intervention Team which would in turn report to him. 9. FINANCING OF OCP - REPORT BY THE WORLD BAIIK: Agenda item 9 Summary of presentation 9.1 Mr Bruce Benton of the World Bank informed the Committee that at the closure of OCP the estimated Reserve remaining in the OCP Trust Found would amount to US$ l1 million to which should be added US$ 1,3 million as forecasted investment income from the Reserve during the 2003-2007 period and estimated donor contributions during that period in the amount of US$ 2,5 million thus bringing the total amount available to US$ 14,8 million. 9.2 The total expenditures would come to US$ 14,2 million (control activities in the "Spectal Intervention Zones": US$ 12,1 million and closing costs: US$ 2,1 million) thus leaving a remaining balance of US$ 600 000. JPC23 Page 12 10. REPORTS OF PARTICIPATING COUNTRIES ON THE IMPLEMENTATION OF TRANSFERRED ACTIVITIES: Agenda item 10 (documents JPC23.8 a-k, JPC23 .3 paragraphs 106 - 193 and JPCZ3IINFO/DOC.l) See paragraphs a to k in the Summary of, and pages 5 to 16 in, the Progress report (JPC23.2), taking into account the data of September and the identifications oJ'the porasites made by the DNA laboratory. Summary of presentations 10.1 The countries showed through their excellent presentations, their mastery of the control methods and their capacity to effectively continue the control of onchocerciasis. The results of the activities undertaken were on the whole satisfactory with respect to CDTI implementation, epidemiological and entomological evaluation, as well as the other control activities. However. some disparities can be noted from one country to the other and within countries. 10.2 With regard to CDTI, there is a need for improvement of the geographic and therapeutic coverages. It is important to reinforce ivermectin distribution activities, particularly in the "Special Intervention Zones" and the countries expressed the need for supervision and monitoring. 10.3 Some constraints were observed such as illiteracy among community distributors: the resistance of the populations to skin snipping; the delay in transmission or the non-transmission of the data collected in the field; the frequent movements of the health personnel from the endemic areas; the demand for motivation incentives from community distributors (CDDs); and the dropping out of some of them. 10.4 The countries stressed the importance of IEC and the support provided to them in this field as in others by the NGDOs and other partners. The ordering and supply of ivermectin is carried out by the countries through their national purchase and drug distribution systems. WHO and LINICEF are assisting them in the reception of the drug supplies ordered from the MDP. 10.5 The importance of reinforcing epidemiolgical and entomological evaluation/sun'eillance after 2002 was stressed. Integration and decentralization are well under way in the various countries. 10.6 In the face of the persisting problems and challenges of incentir-es / motivation of CDDs. each country is developing or planning solutions. The countries expressed their commitment to continue and reinforce ivermectin distribution and surveillance of onchocerciasis. Five-year strategic plans of action have been worked out for the period 2003-2007 tbr the continuation of the residual activities after the closure of OCP. Similarly, operational plans of action are being prepared by each country for 2003. 10.7 They have included the financing of these activities in their nationai health budgets. er.en if tlie funds reserved might fall short of what is necded in some countries. In others, hou'ever. substantial efforts have been made and the funds arc already available for 1003. The countries u,ere cncouraged to continue or develop new partnerships for the maintenan,-'e and improvenrent oi current achievcrnents. JPC23 Page 13 Discussiort ott the reports and their presentatiort 10.8 JPC participants expressed their satisfaction with the country reports which confirmed that considerable efforts had gone into the preparations for the countries to put in place the surveillance systems necessary to detect and control any localized recurrence of onchocercal transmission should it ever occur. 10.9 Several participants brought up the need to ensure that ivermectin be imported in their countries free of any taxation and the Committee suggested that a regional approach under the leadership of WHO be set in motion to obtain tax-free importation in countries where this was not the case. Using economist argumentation the case could be made that the financial benefits of ivermectin treatment largely exceeded the taxation benefits on the importation of the drug. Dr Samba suggested in this connection that a meeting with Jeffry Sachs might be arranged. 10.10 Noting the declining motivation of Community-directed Distributors in some CDTI programmes, the Committee suggested that although financial encouragement might be of importance in some cases, training might be re-enforced, possibly leading to improved motivation. l0.l I Satisfaction was expressed that onchocerciasis and its surveillance and control were given priority in the 2002 Programme. 10.12 Onchocerciasis being a disease approaching elimination its control could attract less and less attention by health authorities and the suggestion was made that a system of peer competition among countries in terms of maintaining the OCP achievements could help to maintain the necessary vigilance. 11. REPORT ON NGDO ACTMTIES IN OCP COUNTRIES: Agenda item 11 (document JPC23.10) S u mmary of p res entatio rt I 1.1 The input of the NGDO Coordination Group for Onchocerciasis Control was presented by its Coordinator, Ms Pamela Drameh, who informed the Committee of the activities of the three NGDOs - OPC, SSI & HKI - who support oncho controlactivities in OCP countries. ll.2 NGDO-supported projects continue to demonstrate significant coverage. The number of persons treated in 2001 reached 30 million, with 5.6 million people treated in OCP countries. 11.3 The Committee was informed that NGDOs contributed a total of US$ 7.4 million torvards oncho control, with over US$ 1.8 million for OCP countries. I i.4 The Comrnittee was also informed that NGDOs looked forward to consultation u,ith N.{DSC and APOC concerning their support to the SIZ and Sierra Leone. The Group congratulated OCP on its achievements and pledged its continuing commitment to the challenge of eliminating oncho as a public health problem. JPC23 Page 14 Discussion on the report and its presentatiort I 1.5 The Committee welcomed the report on the important contribution of the Non-govemmental Organizations to CDTI programmes in OCP countries and acknowledged with satisfaction their intention to continue this support during the post-OCP period within their financial limitation. t2 ARRANGEMENTS FOR THE CLOSURE OF THE PROGRAMME: Agenda item 12 (document JPC23.6) Summary of presentatiort l2.l The Committee was reminded that a tripartite Working Group with AFRO, OCP and APOC membership, and with AFRO in the Chair, had since 2001 planned the process of winding down OCP. The recommendations of the Group concemed buildings and real estate, capital and other equipment, human resources and other administrative and financial issues and had all been approved by Dr Ebrahim M. Samba, WHO Regional Director for Africa. 12.2 Regarding the OCP budget, the phasing-out measures were reflected in the 1998-2002 budget as was the need to the wrapping-up exercise foreseen during the first quarter of 2003 to deal with remaining payments; the closure of accounting; outstanding measures on personnel contracts; and finalization of data input operations. 12.3 During the past few years OCP staff had been prepared for the end of their assignment u,ith the Programme through counselling, training for employment elsewhere and presentation of curriculum vitae to organizations within and outside the UN system. Candidatures at APOC and the AFRO Multidisease Surveillance Centre had been posted. 12.4 Also, arrangements had been made for OCP infrastructures and key units to be transferred to other organizations : the DNA laboratory, the OCP/APOC Documentation Centre and the telecommunication network would be taken over by the AFRO Multidisease Surveillance Centre (MDSC). Arrangements were under way for APOC to continue support to and collaboration with the Onchocerciasis Chemotherapy Research Centre in Hohoe. The OCP garage and workshop would serve APOC, the MDSC and the WHO Country Office in Ouagadougou while OCP vehicles would be allocated to these offices, the SIZ team and Participating Countries. OCP HQs premises would be shared between APOC and MDSC while OCP premises in the field were to be handed over to Governments. 13. SUPPORT TO SUSTAINABLE DEVELOPMENT IN ONCHOCERCIASIS-FREED ZONES: Agenda item 13 (document JPC23.7) S umm ary of p res entoti orr 13.1 The report was presented by Mr Moise Sonou of FAO on behalf of the Comminee oi Sponsoring Agencies who had becn concerned about the negative inrpact of spontaneous rc- population in onchocerciasis-freed zones. His Organization had taken the initiative to launch investment pilot projects in ten countries in West Africa at tlie cost of USS 65 million and the pnnciple of national ownership of these projects had facilitated tlieir intcgration rvithrn national devcIopment programr-ncs. JPC23 Page 15 13.2 Given the importance of inter-countryproblems FAO had under the aegis of the Economic Commission of the West African States (ECOWAS) and with expected financing by Belgium, undertaken to formulate a pilot programme in the Red and White Volta basin area shared by Burkina Faso and Ghana with the expectation to start implementation early in 2003. 13.3 The principal objectives were sustainable management of natural resources in this inter- country zone; development of infrastrucfures of production, transport, trade, education and the health infrastructure; strengthening of human, institutional and organizational capacity both at the regional and national level; and create a favourable environment for political and managerial planning for development. 13.4 On a longer term basis it was proposed to integrate the pilot projects in the NEPAD programme with coordination being secured by ECOWAS. 13.5 With the closure of OCP it was hoped that a new partnership on the lines of that which so successfully brought that Programme to meeting its objectives would emerge to support socio- economic development in the onchocerciasis-freed zones. Discussion on the report and its presentation 13.6 JPC noted with interest presentation of the report and encouraged FAO to bring the plans for socio-economic development in onchocerciasis-freed zones to the attention of the donor community. 14. AUDIT REPORT: Agenda item l4 (document JpC23.5) 14.l The Committee took note of the report of the External Auditor, presented by the Director of the Programme, which confirmed the correctness of the accounts, receipts and expenditures as submitted for his scrutiny. 15. MATTERS DISCUSSED AT THE JOINT JAF-JPC SESSION ON 4 DECEMBER 20022 Agenda item l5 15.1 JPC endorsed the conclusions arrived at during the Joint Session in the morning of 4 December 2002 in respect to Macrofil, the AFRO Multidisease Surveillance Centre, the use of the comDT approach and operational research (see Annex 3). 16. OTHER MATTERS 16.1 Dr Samba emphasized the efforts made to secure employment of OCP staff after closure of the Programme. He intended to inform the Governments concerned about the ar.ailability of those staff members not yet employed after 3l December, stressing that they constituted a highly qualified group for employment within the health and other sectors. 16.2 The Committee learned rvith regret the death of Suzanne Vervalckc u'ho for many' years had beerl a strong suppoftcr of OCP as the representative of Belgium at v.arious mcetings of thc Progranrme. JPC23 Page 16 16.3 The Committee paid a special tribute to Dr Boakye Boatin who had demonstrated his firm grasp on leadership as Director of the Programme and during the last years of OCP made a singular contribution to bringing the Programme to a close with the least harmful impact on its staff. 17. READING AND APPROVAL OF THE FINAL COMMUNIQUE: Agenda item 17 17.1 A draft of the Final Communique was approved with modifications proposed and agreed upon during its consideration. (attached as Annex 4 ). 18. CLOSURE OF THE TWENTY-THIRD AND LAST SESSION OF JPC 18.1 Following statements by Members of the Committee and the Director of the Programme, the Chair declared the twenty-third and final session of the Joint Programme Committee closed. JPC23 Page 17 ANNEX I LIST OF PARTICIPANTS JPC MEMBERS Belgium Dr Jacques Walter LARUELLE Charg6 de Programmes,6, Rue Brederode, B-1000 Bruxelles, Belgique Tel:00 32251907 52 - Fax: 00322519 05 70 - E-mail:jacques.laruelle@diplobel.f-ed.bc Benin Dr Yvette C6line SEIGNON KANDISSOUNON Ministre de la Sant6 publique,0l B.P. 882, Cotonou, B6nin T61./Fax: (229) 33 04 64 Dr Doroth6e YEVIDE Directrice nationale de la Protection sanitaire, B.P. 882, Cotonou, Benin Tel./Fax: (229) 33 66 79 - Email: dnps.sess(i)intnet.bj Dr Eku6 Julius GABA Coordonnateurnational du Programme de lutte contre l'onchocercose,0l B.P. 882, Cotonou T6l./Fax: (229) 33 66 79 Burkina Faso Mr B6douma Alain YODA Ministre de la Sant6, Ministere de la Sant6, 03 BP 1009, Ouagadougou 03, Burkina Faso TdI: (226) 32 4t 59 I 60 -Fax: (226) 33 49 38 Dr D. Sosthdne ZOMBRE Directeur g6n6ral de la Sante, Ministdre de la Sant6, 03 BP 7009, ouagadougou 03 Tel: (226) 31 54 40 I 32 41 75 - Fax : (226) 31 54 40 - Email : dgsp@ccnatrin.bf Mr Jean Bernard ZONGO Directeur de Cornmunication du Ministerc de Ia Sant6, Ministdre de la Sante. 03 B.P. 7009. Ouagadougou 03, Burkina Faso Tel. : (226) 32 61 86 - Email : Jeanbernard-]0(g)hotmail.conr Dr Souleymane SANOU Coordonnateur du Programme nationai de D6volution, 03 B.P. 7009, Oua-eadougou 03 Tel: (226) 30 87 90 - Fax: (226)33 49 38 - Email : Pevg(.rirccnarnn.conr Dennrark Dr Erling Mollcr PEDERSEN C/o Danish Bilharziasis Laboratory, Jae-rlcrsborg Allc 1D. DK 2920,Char1otrcnlrncl, Dcnnrark Tc1: + 451732 7163 Fax: + 15 77321133 E.mail : cnrp(4rbrlarziasis.clk JPC23 Page 18 Annex 1 France Dr Christian BAILLY Chef de Bureau Sant6, Ministdre des Affaires etrangdres,20 rue Monsieur, 75700 Paris, France Tel : (33) 1 5369408214162 - Fax : (33) 1 53693119 - E-mail : christian.bailly@rdiplomatic.gouv.fr Germany Professor (Dr) Rolf KORTE Director, International Cooperation and Progranrmes, GTZ,65126 Eschborn, Germany Tel:(+49) 6196790 -Fax: (+49) 619619 -E-mail: ROLF.KORTE@gtz.de Mr Milan SIMANDL First Secretary, German Embassy Tel: (226) 30 67 31 6 Fax: (226) 31 39 9l Ghana Mr Moses DANI-BAAH Hon. Deputy Minister of Health, P.O. Box M.44, Accra, Ghana Tel:233 21 66615 I - Fax: 233 21 660176 Dr Kofi AHMED Ag. Chief Medical Officer, Ministry of Health, P.O. Box M.44, Accra, Ghana Tel. (233) 21 684275 - Fax: (233) 21 660176- E.mail :ghoncho@)africaonline.com.gh Mr Ahmed MOHAMMED Assistant Director, Ministry of Health, P.O. Box M.44, Accra, Ghana Tel. (233) 21 68 4218 - Fax: (233) 21 760067 I 660176 Mr Asare BEDIAKO Assistant Programme Coordinator, Ghana Health Service, Ministry of Health, P.O. Box M.44, Accra, Ghana Tel. (233)21 68 4241 - Fax: (233) 21 66 0ll6 - Email : bediako2004@yahoo.co.uk Mr Emmanuel TAGOE Ag. Executive Director, National Onchocerciasis Secretariat, Ministry of Finance, P.O. Box M.76 Accra, Ghana Tel. (233) 021 666 49314 - Fax: (233) 021 66 88 7l - Email : oncho@afrtcaonline.con.r.gl.r Guinea Dr Gbanace POGBA Chef de Cabinet, Ministerc de ia Sante, B.P.585, Conakry, Guinea Tel : (224) 41 20 32 Fax : (224) 45 20 50 - Email : canraranronto(4 ),uhoo.1l' Dr Mahi M. BARRY Dirccteur national de la Sante publique, U.P. 585, Cortakry, Guin6c 'l1l. . (221) 45 20 10 Fax: (224) 45 20 50 - E.marl : rtrrlrahlbt4')'ahtro.ll JPC23 Page 19 Annex I Dr Nouhou Konkour6 DIALLO Coordonnateur national du Programme de lutte contre l'onchocercose, B.p. 585, Conakry, GuineeTEl; (224) 40 89 67 -Fax: Q2g 45 20 50 - Emait : dnouhoufr@yhoo.fr Guinea-Bissau Dr Antonio Serifo EMBALO Ministre de la Sant6 publique, C.P. 50, Avenida Unidade Africana, Bissau, Guin6e-Bissau TEI- : Qal 20 44 38 - Fax : Qa\ 20 22 37 - Email : antonioserifoembalo@yahoo.fr Dr Antonio TAMBA NHAeUE Coordonnateur national du Programme de lutte contre I'onchocercose, s/c Ministdre de la Santepublique, B.P. 50 Bissau, Guin6e-Bissau - Tel : eafl 25 23 33 / zo 2g 3g Kuwait Dr Majeed Abdul-Ridha BAHMAN Agricultural Advisor, Kuwait Fund for Arab Economic Development, p.O. Box 29Zl Safat, 13030Kuwait Tel: 965 2468109 - Fax: 965 241909l/965 2439271 -E-mail: bahman@kuwait-fund.org Mali Mme Rokiatou N'Diaye KEITA Ministre de la Sant6, Koulouba, Bamako, Mali T61 : (223) 222 53 01 - Fax : (223) 223 02 03 - Email : Dr Mamadou Adama KANE Conseiller technique du Ministre de la Sant6, Ministdre de la Sant6 , Bp z3zKoulouba,/BamakoTdl : (223) 222 53 01 - Fax : (ZZ3) 223 OZ 03 - Email : Dr Mamadou Oumar TRAORE Coordonnateur national du Programme de lutte contre I'onchocercose, Direction nationale de la Sante, BP 228, Bamako, Mali Tel' (223) 220 3697 / 671 1766 - Fax: (223) 223 02 03 - E.mail : rraoremot@vahoo.fr Netherlands (The) DT Jan VISSCHEDIJK Public Health Specialist, Royal Tropical Institute, P.O. Box 95001 . I 090 HA, Amsterdam Tel: (+31) 20 693 9297 - Fax: (+l l) 20 66g 0923 - E_mail: j.r,isschedijk(gJkit.nl Niger N{. Abdraniane SALIFOU Directeur gdndral des Etudes ct de la Programntatron. N4inistcrc ri.-: la Santc publiquc ct dc la luttc contre les end6mies, B.P. 623, Niamcy, Niger Tel : (227) 12 25 3l I Z0 31 74 Fax (227) 73 3,s t0 JPCz3 Page 20 Annex I Dr Salamatou DIALLO Coordonnatrice du Programme national de D6volution Oncho, B.P. 851, Niamey, Niger TeL Q27)75 2219 - Fax: (227)75 20 62 -Email: oncho@intnet.ne Saudi Arabia Mr Abdullah ALLAHIM Economic Advisor, Ministry of Finance and National Economy, Riyadh 11662, P.O. Box 90829, Saudi Arabia Tel : 009661-405-0000 Ext. I 150 - Fax : 009661-405-7304 Dr Saad AL-JOHANI Consultant Ophtalmology, Chief of Ophtalmology Dept., R.M.C., Ministry of Health, P.O. Box 90829, Riyadh 11623, Saudi Arabia T6l. : 00966 554 80155 - Fax : 00966 127 70006 - Email : dr-ss-johan@hotmail.com Sen6sal Dr Mandiaye LOUME Directeur de la Sant6, Direction de la Sant6, B.P. 383-Dakar-Fann, Dakar, S6n6gal Tel : (221) 865 2525 - Fax : (221) 860 3287 - Email : dirsante@isentoo.sn Dr Ousseynou NOBA Chef de la Division de la lutte contre les maladies transmissibles, Direction de la Sante, Ministere de la Sant6 de I'Hygidne et de la Pr6vention, Dakar, Sen6gal T6l. : (221) 821 8845 - Fax : (221) 860 3287 - Email : dirsante@sentoo.sn Dr Lamine DIAWARA Coordonnateur du Programme national de lutte contre l'onchocercose, B.P. 59, Tambacounda, Sen6gal - T6l: (221)981 rL64 - Fax: (221)981 1077 Email : elddiawara@vahoo.fr / copie i resmedtba@sentoo.sn Sierra Leone Dr Ibrahim SESAY Deputy Minister of Health and Sanitation, Ministry of Health, Youyi Building, Freetown Tel. : 232 22 076 64817 6 - Fax : 232 22 242170 Dr Abdulai JALLOH Oncho National Coordinator, Ministry of Health and Sanitation, Sierra Leone, Tel:232 22 220469 - Fax : 232 22 22 7313 Email : iabdulai(a,hotnrail.conr fogo Dr Potougnrnia TCHAM DJA Directeur gcneral dc la Santc, B.P. 336. Lonrc. Togo Iel. (22E) Tl0921- I'ax (228) 221 89+E JPC23 Page Zl Annex I Dr Aboudou DARE Coordonnateur national du Programme de lutte contre I'onchocercose, Directeur regional de la Sant6, B.P. 487, Kara T6l. (228) 66 01710 I 66 000 47 - Fax: (228) 6600414 - Enrail : drskarar€D.yahoo.fi U.S.A Dr Dennis CARROLL Senior Health Advisor, USAID, 1300 Pennsylvania Avenue, Washington, D.C. , USA Tel: 202 712 5009 - E-mail: Dcarroll@USAID.Gov SPONSORING AGENCIES Food and Agriculture Organization of the United Nations (FAO) Mr Moise SONOU Senior Water Development Officer, Regional Office for Africa, Focal Point for Onchocerciasis Control Programme, FAO, P.O. Box 1628, Accra, Ghana Tel : (233) 21 7010930 - Fax : (233) 21 7010943 or 668427 - Email : moise.sonou(4rfao.or=q World Bank Mr Bruce BENTON Manager, Onchocerciasis Coordination Unit, Africa Region, World Bank, 1818 H. Street. N.W Washington D.C.20433 Tel.202 473 5031 - Fax: 202 522 3157 - E-mail: bbenron@worldbank.orc Dr Bernhard H. LIESE Consultant, Onchocerciasis Coordination Unit, World Bank, 1818 H. Street. N.W., Washington D.C.20433 Tel.202 458 4491 - Fax: 202 522 1616 - Email : Bliese(g)worldbank.org Mr Jesse B. BUMP Tropical Health Specialist, Onchocerciasis Coordination Unit, World Bank 1818 H. Street. N.W Washington D.C. 20433 - Tel. : 202 417 1234 - Fax: 202 522 3157 Invited guests Professor Alexander Sanruel MULLER Etneritus Prolessor Tropical Health, clo 42 Zandpad 3621 NE, Breukclen, The Netherlands Tel./Fax : 3 1 -(0)346-263193 Enrail : nrimLrller((r,worlclonlinc..nl Dr Maria-Gloria BASANEZ Lccturer. Dcpartntcnt of Eprdenriology of Inf-cctious Discases, Intpenal Collegc. Facultr of Medicinc (St Marv's Carnpus). Norfolk Placc, Lonclon W2 lPG, United Kingdorl Tcl.: 00-14 120) l5L)43295 Fax : 00-14 (20) 74022150 Enrail : rl.basunczr.rr rc,ac.uk JPC23 Page 22 Annex I Dr Kofi Yankum DADZIE Former Director, OCP, P.O. Box 01905, Osu-Accra, Ghana Tel./Fax : (233) 21 401353 - YankumDadzie@iname.con-r Dr Kwablah AWADZI Director, Onchocerciasis Chemotherapy Research Centre, OCRC/Hohoe, P.O. Box 144, Hohoe, Ghana - T el: 233 93 5 22 132 - F ax: 233 935 22 | | I - Email: aw adzi@ ghana.com Professor Davide CALAMARI Environmental Research Group, Department of Structural and Functional Biology, University of Insubria, Via J.H. Dunant 3, 21100 Varese VA, Italy, Tel: 00 390-332-421546 - Fax: 00 390-332-421554, E-Mail: davide.calamari@uninsubria.it Dr Amadou Moctar MBAYE Directeur de la Sante au D6partement du Developpement social, UEMOA, B.P. 543, Ouagadougou, Burkina Faso Tel.: (226) 3l 88 73 d76 - Fax : (226) 31 88 72-Emall: moctar.mbaye@uemoa.int World Health Organization Dr Gro Harlem BRUNDTLAND WHO Director General, Geneva, Switzerland Mr John LIDEN Charg6 de Communication, Cabinet de la Directrice g6n6rale, OMS/Sidge, Gendve Dr Ebrahim M. SAMBA Regional Director, Cit6 du Djou6, B.P. 6, Brazzavrlle, R6p.du Congo Tel. : 1321953 9124 - Fax : 1321953 9505 - E.mail : san-rbae@afro.who.int Dr Antoine KABORE DDC/AFRO Mr Alvaro Jose DA SILVA DURAO Chief of Personnel, OMS, B.P.6, Brazzavllle, Congo Tel.: 1321 953 9124 - Cell: (242) 67 39 10 - Fax: 1321 953 9505 - Email : duraoalv@afro.u'ho.int Dr Sam BUGRI Medical Officer, IDS programme Manager, c/o WHO Ouagadougou, Burkina Faso Dr Alhousscini MAIGA RegionalAdvisor for GWE/AFRO, c/o WHO Ouagadougou, Burkina Faso Mr Brendan DALY Chief Accountant. WHO/HQ, Geneva, Srvitzcrland Mr C'laudc Herrri \/IGNES Legal Ofllcer, c/o WHO/HQ, Avenuc Appia, Genci'a, Su'itzcrlarld 'fe l. -1122191 2638 1122191 4158 JPC23 Page 23 Annex 1 Dr Hans REMME Coordinator, Onchocerciasis & Filariasis Intervention Research, UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), 1211 Geneva 27, Switzerland - Tel: +41 2279123561 -Fax :+4122791 4174 Dr Marc KARAM Member of CSA, World Health Organization, 20 Avenue APPIA, 121 I Genev a 27 , Switzerland Tel.: 00 4122791 4389 - Fax: 00 4122791 4777 - Email :karamm@who.int Mrs Hilary WILD Comptroller, WHO/HQ, Geneva Tel: 00 4122 791 4855 - Fax : 00 4122 791 2825 - Email : Wildh@who.int WHO Secretariat M. A.F. AGBOTON Administrateur du Budget et des Finances, Programme africain de lutte contre l'onchocercose, Ouagadougou M. A. AKE Vector Control Unit, Onchocerciasis Control Programme, Odienn6 Dr L.K.B. AKPOBOUA Vector Control Unit, Onchocerciasis Control Programme, Ouagadougou Dr Uche V. AMAZIGO Social Scientist, African Programme for onchocerciasis Control, ouagadougou Ms A. BAFFOE Programme Officer, Onchocerciasis Control Programme, Ouagadougou DT Y. BISSAN Vector Control Unit, Onchocerciasis Control Programme, Odienn6 Dr Boakye A. BOATIN Director, Onchocerciasis Control Programme, Ouagadougou DT O.W CHRISTENSEN OCP Liarson Office. Geneva, Tel: 4122 791 2l I 1 - Fax: 4122 791 0746 Mr A. DARIBI OCP Liarson Office, Geneva. Tel: 4122 791 21 I 1 - Fax: 4122 791 0146 Prof-. Michel KABORE Translator. Onchoccrciasis Control Prograrunte, Ouagadougou M. S V KEI{IJ \/e'ctor c'ontrol Unit. onchoccrciasrs contrcl Prograurrne. oua_eadougclu JPC23 Page 24 Annex 1 DT J. LAZDINS Manager Filariases R & D (Macrofil), WHO/TDR, Geneva, CH-lzl l, Switzerland Tel:4122791 3818 - Fax: 4122791 4854 Mrs V. MATOVU African Programme for Onchocerciasis Control, Ouagadougou M. S. N'GADJAGA Planning, Evaluation and Transfer Unit, Onchocerciasis Control Programme, Ouagadougou Dr Mounkaila NOMA Epidemiologist Biostatistician, African Programme for Onchocerciasis Control, Ouagadougou Dr A. PANA Planning, Evaluation and Transfer Unit, Onchocerciasis Control Programme, Ouagadougou M. Mamadou SARR Vector Control Unit, Onchocerciasis Control Programme, Odienn6 Dr Azodoga SEKETELI Director. African Programme for Onchocerciasis Control, Ouagadougou Dr Konrlan SiAMEVI Chief a.i., Planning, Evaluation and Transfer Unit, Onchocerciasis Control Programnte Ouagadougou Dr Laurent TOE Vector Control Unit, Onchocerciasis Control Programme, Ouagadougou Dr Laurent YAMEOGO Chiel Vector Control Unit, Onchocerciasis Control Programme, Ouagadougou M. H. ZOURE African Programme for Onchocerciasis Control, Ouagadougou EX OFFICIO PARTICIPANTS Exncrl Advisorv Commiltee Prof. (Mrs) Adenike ABIOSE Chairpcrson EAC, Medical Director, Sightcare International, P.O. Box 10392. Kaduna. Nrgena Tel:234-62 4ll313 - Fax 234-62 410813 - E-Mail: abiose(r.'rnforvcb.abs.nct Mectizan Donatiou Pt'ogrant Dr Bjorn TIIYLEFORS Dircctor a.i.. Mectrzan Dor-rzrtion I'rogran-r,750 Conmcrcc. Drive Surtc -100. Decalur. GA. l()0-10 USA Tc.l: l-404-687--5616 - Fax: 1-404-311-1138 - Enrail: bthyletbrs(r tasklirre e .org JPC73 Page 25 Annex l Dr Mary ALLEMAN Associate Director Onchocerciasis, Mectizan Donation Program, 750 Commerce Drive, Suite 400. Decatur. GA 30030, USA - Tel: 1-404-3ll-1460 - Fax: 1-404-311-1138 - Email: nrallerr.ranf@taskfbrcc.org Dr Nana A.Y. TWUM-DANSO Associate Director of Lymphatic Filariasis, Mectizan Donation Program, 750 Commerce Drive, Suite 400, Decatur, GA 30030, USA Tel: 1-404-371-1460 - Fax: l-404-371-l138 - Email: ntwumdanso@)taskforcc.org Merck & Co. Inc. Dr Philippe GAXOTTE Former Medical Director. Mectizan Program, 27 Rue Vaneau - 75007 - Paris Tel.: 3314705 1164- Fax:331 3082 1094- Email :phgaxotte(lyahooi OBSERVERS The Carter Center Dr Frank O. RICHARDS Technical Director, River Blindness Program, The Carler Center, I Copenhill. Atlanta GA 30307, USA - Tel:770 488 451 I - Fax: 770 488 4521 - E-mail: FRichards(rrrcdc.gor Canada Ms Sylvia BARROW Health Specialist, Africa and Middle East Branch, Canadian International Development Agencv (CIDA),200 Promenade du Portage, Gatweau, Hull Quebec, Canada KIA OG4 Tel: (+l) 819 953 0732 - Fax: (+1) 819 991 5453 - E-mail: Slzlvia:barrou,(g acdr-crda.gc.ca The Institute of Scientific Research for Development - IRD Dr Bernard Michel SURUGUE Directeur de l'lRD-Audiovisuel, Institut de Recherche pour le D6veloppement. Centre d'lle de France, 32 Avenue Henri Varagnat, 93140, Bondy, France Tel.: 01 4802 5912 - Fax : 0l 4803 7806 - Email : bsuruguc(r.pans.rrd.fi' Dr Bernard PHILIPPON Charg6 de Mission Sante, D6parten-rent Soci6t6s & Sante, Instrtut dc Rechcrche pour Ie Dcveloppement, 213, rue La Fayette, 75010 - Paris, France Tdl. 33 1 48 03 1109 - Fax: 33 1 48 03 7806 - E-mail: philipt)oi(r pans.rld.ll Christoffei-Blindenrlission (CBM ) Dr Adrian Dcnnis HOPKINS Medical Advisor. Office of thc Coordination, C'hrrstoff-cl Blindcrrnlssron. U.}']. -+ob. Krnshasa J Democratrc Rcpublic of Congo Tc-l: (243) 880 3940 or (243)993 135.+ - Fax: (243) 880 3940 E-rnari Illsi l11 JPC23 Page 26 Annex I Sight Savers lnternational (SSI) Ms Catherine CROSS Director Overseas Programmes, Sight Savers International, Grosvenor Hall, Haywards Health RH16 4BX, U.K. 7s1; +44 1444 44 6600 - pav' +44 1444 44 6617 - E.mail: ccross@sightsavers.org Mr Aboubacar Philippe OUATTARA Sight Savers International, P.O. Box 18190, Airport, Accra, Ghana Tel. :233 21,171 4210 _Fax:233 21 777 4209 - E.mail : apouattara@ssirva.africaonline.corl.gh Dr Dennis WILLIAMS Sight Savers International, Department of Ophthalmology, Connaught Hospital, Freetown, Sierra Leone - Tel.: + 232 22 220 112 -Fax: +232 22 22 10 49 - Email : ssisl(isierratel.sl West African Health Organisation (WAHO) Mr Albert DIAO Chef Comptable, Economiste, West African Health Organisation (WAHO),01 B.P. I53. Bobo- Dioulasso Tel.: (226) 97 57 7 5 Fax : (226) 97 57 12 - Email : wahooasr? fasonet.bf NGDO Dr Paul DERSTINE NGDO Chair, Interchurch Medical Assistance Inc., P.O. Box 429, Blue Ridge & College Ave., New Windsor, MD 21776 - Tel : 410-635-8720 - Fax :410-635-8126 Ms Pamela DRAMEH NGDO Coordinator, WHO/HQ, Geneva Tel: +4122191 3211 - Fax: +4122 791 4772 - Email: Dramehp(=4rwho.ch Helen Keller International (HKI) Dr Danny HADDAD Senior Technical Advisor Onchocerciasis, P.O. Box34424 Dar es Salam. Tauzania Tel : + 255 744 566 057 - Fax + 255 22 264 7831 - E.rnail : dhaddad((i)hkr.org Dr Seydou MARIKO Coordonnateur OPC en Afrique de l'Ouest, OPC/Waro. B.P. 248, IOTA-Bamako. R6pubirque du Mali Tel: (223) 211 53 lll229 20 19 lax (223) 229 20 19 - E-rnail rr u1l'r Organisation pour la Pr6vention de la C6cit6 (OPC) JPC23 Page 27 Annex I EXTERNAL EVALUATION TEAM M. Georges KOULISCHER Consultant, Av. de l'Aquilon 7,1200 Bruxelles, Belgium - Tel./fax : 32 2 772 01 07 - E-rnail : georgcs.koulischer@belgacorn.nct Prof. Achille Ahlin MASSOUGBODJI Professeur de Parasitologie-Mycologie, Chef de service de Microbiologie, Faculte de Sciences de la Sant6, 08 BP 296, Cotonou, B6nin - Tel. : (229) 95 44 19 I 04 20 12 - Fax : (229) 30 40 96 - E-mail : Achillemri'r avu.org JPC23 Page 28 ANNEX 2 REFLECTIONS OF THE COMMITTEE OF SPONSORING AGENCIES (CSA) FOR THE TWENTY-THIRD SESSION OF THE JOINT PROGRAMME COMMITTEE Ouasadousou. 4 December 2002 Excellencies, Ladies and Gentlemen, As Chair of the Committee of Sponsoring Agencies it is my pleasure to present to the Joint Programme Committee the Reflections of CSA. Since 1982, the agenda for JPC has included an opening item giving the Reflections of CSA. As this is the final JPC, I would like to start off by sharing the experience \\'e have enjoyed in working with and supporting OCP over the past two decades. I believe it is fair to say that since the UNDP, FAO, the World Bank, and WHO joined hands to help launch OCP, the efforts by the CSA have been an outstanding example of sustained, constructive collaboration among four UN Agencies, each concentrating on its sphere of expertise, towards the attainment of the common objective of OCP - quote, elimination of onchocerciasis as a disease of public-health importance and obstacle to socio-economic development. and for the Participating Governments to nraintain this achievement, unquote. CSA has essentially served as a secretariat cum oversight body. following ciosely the progress of OCP, discussing and recommending solutions to ongoing operational and management issues, and serving as a suppoft and decision-taking mechanism upon which Program Management could rely when faced with important questions. The Committee has been instrumental in preparing long- and medium-term strategies and has organized a number of timely and invaluable independent external evaluations. I give this brief summary to underline the importance played by the CSA in OCP's governance. Having by and large fulfilled its mandate, OCP is coming to a conclusion in a few weeks' time. However, the CSA will have a continuing oversight role with respect to those residual activities, which must be completed to fully achieve the objectives of OCP. Moreot'er, APOC u'ill continue for another eight years and CSA will remain very active in providing the same suppoft to APOC that it gave to OCP. In doing so, we intend to ensure that coordination between APOC and the post-2002 activities witliin the OCP area endurcs so as to benefit all endemic countries across the continent. And now, Mr. Chair, a feu, words regarding thc work of CSA during the past r ear. It u'as the first year that the CSA widened its membersliip to includc representatives of the NGDO Group and Merck & Co. Unquestionably, the addition of these trvo important stakeholders to thc n.rembership has enriched its delibcrations by lactoring in the drug donation and field operation perspectives. One of the rnain activities of the CSA u,as the organizatiott and support to the OCP External Evaluation Team rvhich met in Ouagadougou and Gcttet,a attd uhosc report is nou bcforc JPC. Sufficc it to say that CSA lully endorses thc findings and reconltlL'Itdatroits prescnlcd rn the repoft. JPC23 Page 29 Annex 2 The CSA also prepared recommendations regarding the strategic approach to post-2002 control activities in the five "special Intervention Zones". After considering the EAC's findings on this subject and OCP Management's detailed analysis of the operational and expenditure implications, the CSA assisted in the preparation of the Plan of Action and Budget for the Special Intervention Zones, which is available for your consideration during this current session of the JPC. I am particularly pleased to inform you that the donors to OCP, who convened in Luxembourg, unanimously agreed to allocate the reserve remaining in the OCP Phase V Trust Fund to the financing of the activities identified in the special intervention zones and hence to complete the objectives of OCP. The CSA also gave a great deal of attention to the administrative and managerial aspects of closing down OCP and made specific recommendations regarding the composition and timeframe of the "winding down" team which will handle outstanding OCP matters after 2002. The CSA kept abreast of preparations to establish the Multidisease Surveillance Centre, which will inherit OCP headquarters and facilities. It is the sense of the CSA that there is widespread interest in the OCP community in the important role this Center can play in helping to ensure the sustainability of the achievements of OCP and in providing continuous surveillance of the most severe communicable diseases in the West Africa sub-region. There appears to be a ready and willing partnership to provide ongoing support for this Center, now that the bulk of OCp control operations have been completed. Finally, we are pleased to note that headway was made in preparing and undertaking regional initiatives to support socio-economic development in the Oncho-freed zones of the OCF countries. The representative of FAO will have more to report later in the meeting. Mr. Chair, this summarizes the main activities of CSA during its last year of dealing with OCP matters. Before closing, I would like to thank the Government of Burkina Faso for hosting this, the last session of JPC, and for the excellent arrangements made to ensure its success. Also, Mr. Chair, may I take this opportunity to express on behalf of CSA our sincere gratitude to all the partners in OCP who together have made it possible to achieve a unique success in the field of public-health development: freeing much of West Africa from a disease with devastating heatth and socio- economic consequences and ensuring that the capactty is there to deal with any posstble recurrence of this scourge. Our thanks go to all with whom CSA has had the good fortune to work, including Participating Countries, the Donors, the scientific community, Merck & Co., the NGDOs, and the highly dedicated Programme staff. It has been a most rewarding collaboration, which, I am confident, will continue as we proceed with the special interventiot-zone activities and ApOC operations. Thank you, Mr. Chair JPC23 Page 30 ANNEX 3 CONCLUSIONS OF THE JOINT JAFS-JPC23 SESSION Ouagadougou, 4 December 2002 Macrofil 1. A progress report on the Macrofil project was presented to the Joint Session. Macrofil had focused effectively on key products and established the necessary partnerships to bring these products as soon as possible into development. Moxidectin was entering phase 2 trials and a research agenda for ivermectin resistance has been developed and implemented. The DEC patch test was under development. 2. The Joint Session noted with interest the progress with Moxidectin. With respect to the studies on possible non-responders to ivermectin, it was recognized that these had not demonstrated any impairment of the microfilaricidal effect of the drugs. Further research on this issue rvas encouraged, as was research on safety of different drug combinations of relevance to integrated drug delivery strategies. 3. The Joint Session was pleased to note the support offered by the Mectizan Donation Programme for studies on albendazole pretreatment on Loa loa patients and the constructive collaboration with TDR. 4. The Session noted the need for increased financial support for Macrofil to allow it to undertake the required research. The AFRO Multidisease Surveillance Centre 5. The Joint Session took note that the Centre would be established in phases. It would initially focus on surveillance of onchocerciasis, malaria, HIV/AIDS and epidemic meningitis. The Centre would work in close collaboration with regional and national surveillance organizations to accomplish its task. 6. The Session recorlmended that a light governance be established, appropriate for the Centre, which would allow interested donors to financially assist the MDSC. This would be undertaken drarving on the support of some members of the Committee of Sponsoring Agencies. 7. The Joint Session welcomed the offer of the World Bank to establish a Trust Fund for the Centre and to assist in mobilizing funds from the donor community in addition to exploring the possibility of a direct grant to the Centre. The use of ComDT approach in Health Development Programmes 8. A report was presented on the first experience in Nigeria with integrating lymphatic filariasis and schistosomiasis treatment and Vitamin A supplementation with the CDTI approach for onchocerciasis. The Joint Session noted ivith satisfaction that the integrated activities reduced logistics required for carrying out the intervention of each disease separatelv, did not reduce the coverage of Mectizan treatment and might even increase the popularity of the ComDT approach. Hou,ever, similar challenges, such as demands for incentives and the associated s-eak PHC in communities still needed to be addressed. JPC73 Page 3 I Annex 3 Implementation research 9. The Joint Session was provided with an update on implementation research undertaken by TDR. A multi-centre study had shown that most CDDs were involved in other health and development activities but that there was no evidence that this had a negative effect on ivermectin treatment coverage. CDDs, communities and health workers were strongly in favour of greater involvement of CDDs in other health activities. 10. As recommended by JAF, a multicountry study had been launched on the use of the ComDT approach for interventions against other diseases. Following a consultative preparatory process, the study had been advertised in Africa and nine multi-disciplinary research teams selected. The study would assess the effectiveness and efficiency of the ComDT process for the delivery of health interventions with different degrees of complexity, and compare its cost-effectiveness with that for current delivery approaches. I l. Studies were planned to determine under which conditions it would be feasible to intemtpt locally onchocerciasis transmission with ivermectin treatment in Africa, and to develop criteria and guidelines for cessation of ivermectin treatment. 12. The Joint Session was pleased to note the high quality and relevance of the research activities and requested that extra efforts are made to identiSz the additional funds required to fully implement the important research agenda. The study of the use of ComDT for other and more complicated interventions, such as malaria and home management, would be a major challenge that addressed priorities of the Ministries of Health concerned. JPC23 Page 32 ANNEX 4 FINAL COMMUNIQUE Twenty-third session of the Joint Programme Committee Ouagadougou, Burkina Faso, from 4 to 6 December 2002 The Joint Programme Committee (JPC) of the Onchocerciasis Control Programme in West Africa (OCP) held its twenty-third session at the Ouaga 2000 Conference Hall at the invitation of the Government of Burkina Faso, from the afternoon of Wednesday 4 December, following the Joint JPC/JAF Session in the morning of the same day, until noon of Friday 6 December before the Closure Ceremony of OCP in the aftemoon. The session was attended by representatives of the Participating Countries; of the Contributing Parties; of the Committee of Sponsoring Agencies; of the Non-Governmental Development Organizations supporting Community-directed Treatment with Ivermectin (CDTI) in OCP countries; and of private industry as well as by the Chairs of the Expert Advisory Committee and the Ecological Group. Former OCP Directors also attended. The list of participants is attached as Annex 1. The Chair of the preceding session of the Committee held in Washington, Dr Dennis Carroll, made a statement followed by Dr Boakye Boatin, Director of OCP. After a statement by the Director of the WHO Regional Office for Africa, Dr Ebrahim M. Samba, participants in the session were welcomed to Burkina Faso by the Minister for Health, Mr B6douma Alain Yoda, who after a statement declared the twenty-third and last session of the Joint Programme Committee open. During the session participants expressed their gratitude to the Burkina Faso authorities for the excellent meeting arrangements, which had greatly facilitated the work of the Committee, as well as for the hospitality afforded to them. For each of the items for which conclusions or decisions were arrived at, a brief summary is provided in the following pages. The agenda is attached as Annex 5. CONCLUSIONS AND DECISIONS PROGRESS REPORT OF THE WORLD HEALTH ORGANIZATION (AgCNdA itCM 5) REPORT OF THE EXPERT ADVISORY COMMITTEE (Agenda item 6) REPORT OF THE EXTERNAL EVALUATION TEAM (2002) (Agenda item 7) The Committee after the presentations of the WHO Progress Report and the reports of the Expert Advisory Committee and the External Evaluation Team: l. congratulated OCP, the Expert Advisory Committee and the External Evaluation Team on their respective contributions to the accomplishments of the Programme and for the recomnrendations for maintaining these achievements during the post-OCP era; 2. stressed the importance of the support to be provided by the AFRO Multidisease Surveillance Centre to onchocerciasis activities after the closure of OCP operations; JPC23 Page 33 Annex 4 3. confirmed the responsibility of the AFRO Multidisease Surveillance Centre and APOC with the Committee of Sponsoring Agencies and the West African Health Organization in relation to the the coordination of post-2002 activities in the former OCP countries. 4. approved the recommendations contained in the report of the External Evaluation Team POST-2002 ONCHOCERCIASIS ACTIVITIES IN THE "SPECIAL INTERVENTION ZONES" (Agenda item 8) and FINANCING OF OCP (POST-2002 ACTIVITIES) (Agenda item 9) Following the presentations by the Programme Director and Mr Bruce Benton the Committee 5. approved the Plan of Operation and Budget for the onchocerciasis activities in the "special Intervention Zones", as set out in documents JPCB.a@) and JPC23.4(b), and financial support from the remainder in the Reserve of the World Bank Trust Fund. REPORT OF PARTICIPATING COLINTzuES ON THE IMPLEMENTATION OF TRANSFERRED ACTIVITIES (Agenda item 10) 6. The Committee expressed its entire satisfaction with the presentations of the country reports which clearly demonstrated the considerable efforts made for the countries to ensure that the achievements of OCP be maintained. 7 . In connection with reports on difficulties in ensuring that ivermectin be imported free of any taxation, the Committee suggested that an attempt be made on a regional basis with the support of WHO to approach all the countries concerned with the argument that the economic benefit of the elimination of onchocerciasis as a public health problem largely exceeds the taxation benefit on ivermectin. REPORT ON NGDO ACTIVITIES IN OCP COLTNTRIES (Agenda item l1) 8. The Committee welcomed the report on the support of Non-governmental Development Organizations (NGDOs) to CDTI activities in OCP countries and acknowledged with satisfaction that NGDOs would continue this support as required during the post-OCP era within their financial limitations. SUPPORT TO SUSTAINABLE DEVELOPMENT IN ONCHOCERCIASIS FREED ZO\ES (Agenda item 13) 9. JPC noted with interest the report on the FAO support to nationalpilot projects aiming at tiie development of onchocerciasis-freed zones and to the planned regional programme in support thereof. The Committee encouraged FAO to bring these plans to the anention of the donor community. IPC23 Page 34 Annex 4 AUDIT REPORT (Agenda item 14) i0. The Joint Programme Committee took note of the report of the External Auditor confirming the correctness of the accounts, receipts and expenditures for the year 2001 which had been submitted for his scrutiny. MATTERS DISCUSSED AT THE JOINT JPC/JAF SESSION (Agenda item 15) (document "Conclusions and decisions of the Joint JPC23-JAF8 Session", attached as Annex 3) I 1. The Joint Programme Committee endorsed the conclusions arrived at during the Joint Session in the morning of 4 December 2002 in respect to Macrofil, the AFRO Multidisease Surveillance Centre, the use of the comDT approach and operational research. OTHER MATTERS (Agenda item 16) 12. The WHO Regional Director for Africa, Dr Ebrahim M. Samba, emphasized the efforts made to secure employment of OCP staff after closure of the Programme. He intended to inform the Governments concerned about the availability of those staff members not yet employed after 3l December, stressing that they constituted a highly qualified group for employment within the health and other sectors. 13. The Committee learned with regret the death of Suzanne Vervalcke who for many years had been a strong supported of OCP as the representative of Belgium at various sessions of the Programme. 14. The Committee paid a special tribute to Dr Boakye A. Boatin who had demonstrated his leadership capabitity as Director of OCP and during the last few years of the existence of the Programme made a singular contribution to bringing OCP to a close in keeping with the least harmful impact on its staff. JPC23 Page 35 ANNEX 5 AGENDA I . Opening of the session 2. Election of officers 3. Adoption of the agenda 4. Reflections of the Committee of Sponsoring Agencies 5. Progress Report of the World Health Organization 6. Report of the Expert Advisory Committee 7. External evaluation (2002) 8. Posr2002 onchocerciasis activities in the "special Intervention Zones" 9. Financing of the OCP - report by the World Bank 10. Report of Participating Countries on the implementation of transferred activities 11. Report on NGDO activities in OCP countries 12. Arrangements for the closure of the Programme 13. Support to sustainable development in onchocerciasis-freed zones 14. Audit report 15. Matters discussed at the Joint Session 16. Other matters 17. Reading and approval of the final communique 18. Closure of the twenty-third and last session of JPC JPC23 Page 36 ANNEX 6 EXECUTIVE SUMMARY PROGRESS REPORT OF THE WORLD HEALTH ORGANIZATION FOR 2OO2 The principal activities undertaken during 2002 and the progress made are sununarised as follows a) Unlike the heavy rains recorded in 2001 which caused floods unequalled since nearly 20 years on the Milo, rainfall in2002 was poor during the first eight months in all the Programme area. b) The overall length of rivers likely to be treatedin2002 by aerial larviciding is estimated at 8 054 km as against 13 760 km for 2001. c) The number of helicopters under contract in 2002 is three with 1999.2 guaranteed hours to the company at a rate of 58.8 hours per month and helicopter. In 2001, OCP had five helicopters under contract with 3001.6 flight hours at a rate of 53.6 hours per month for each helicopter under contract. d) No aerial treatment was undertaken in the Eastem zone from week 9 (February 25 to March 3) to week 17 (22 to 28 April) either due to good results, or hydrological conditions unfavourable to the development of pre-development stages of Simulium damnosun. As for the Western zone, unlike 2001 where at the same period no total suspension of aerial larviciding was recorded, the treatments were entirely suspended from week 19 (from 6 to 12 May) to week 21 (from 20 to 26 May) due to good entomological results. e) The strategy of insecticide rotation continues in2002 with the use of the five main larvicides: B.t. H-14, the temephos, the pyraclofos, the permethrin and the etofenprox. No new cases of resistance have been recorded. 0 At the beginning of the Programme in 1974, 370 limnimetric stations were used weekly according to needs. Currently, following the progressive cessation of larviciding, the Prograrnme uses only 81 water gauges 34 of which are equipped with tele-beacons. g) In 2002 the entomological evaluation network counts only 52 catching points as against 107 retained in 2001, and 670 during the pre-operational period. Currently the network only covers the extension zones where larviciding is carried out in combination with ivermectin distribution. h) The results of the entomological evaluation are satisfactory in all the basins. In the specific intervention zone on the K6ran Kara and M6, the specific actions carried out since 1998 made it possible to maintain the annual potential of transmission below the tolerance level since 2000 on the K6ran. Transmission is well controlled on the Kara since 1994. During the first six months of 2002, these good results were maintained in particular in Titira (ATP: 14) and in Tapounde (ATP : 19) on the K6ran, and on the Kara at Landa Pozanda (ATP : 21). On the MO at Bagan. the partial ATP of 79 is mainly due to the forest flies coming from the rivers untreated since 2001 on the East of the Volta lake. In the Western zone, the specific actions carried out since 1998 made it possible to bring back the O.r,olvulus transmission to an acceptable level since 1999 (ATP of 71 at Fifa in 200i and 66 for the first six months of 2002, ATP of zero in Yalawa in 2001 and 35 for the first six months of 2002). JPC23 Page 37 Annex 6 i) During three last years (2000, 2001 and2002) the maintenance of the effectiveness of the vector control activities was based on the rotation of insecticides and the strict monitoring of the sensitivity of flies to the three organo-phosphorous used by the Programme. The risks of appearance or intensification of resistance to organo-phosphorous have minimised considerably. Investigations are on course to take stock of the sensitivity in all the river basins, including those where vector control activities were stopped after several years of intensive larviciding. j) The results of the ichtyofauna monitoring indicates that the specific richness of the settlements of the rivers in Guinea has remained stable. In COte d'Ivoire, the specific richness of the catches has been on the increase for the last five years. In Ghana the slight increase observed in 2000 in Asubende continued to 2001. On all the ichtyologic monitoring stations, no disappearance of species was recorded and the coefficients of condition of the different species are stable. The aquatic entomofauna indicates that on certain stations, Ephemeroptres, Neoperla sp and Caridina sp were identified as the taxon most affected by the larvicide treatments. On the water courses no longer under treatment, signs of re-colonisation by some taxon, especially Neoperla sp and Tricorythidae were observed. On the other hand, Oligoneuride are still missing in the samplings. k) Research activities are related to the knowledge of the genetic variability of the S. sirbantut migrant populations as well as the vectorial role of this species in the various foci of seasonal migration, particularly that covering the south-west towards the North-East, the areas north of Sierra Leone of the upper Niger basin in Guinea, and the middle Niger in Mali. Blackfly migration studies were also initiated in May 2002 on the catching points located in Ghana. Togo and Benin. Besides, following the cessation of larviciding in December 2001 post-treatment studies were initiated on the catching points most representative of these basins. Also, feasibility studies of ground treatments continued in the specific interventions zones. l) Treatment under Community Directives (CDTI) is effective in all the eligible basins of the Programme. Socio-political disturbances somehow disrupted its installation in the south of Cdte d'Ivoire, Guinea-Bissau and Sierra Leone. However a progressive resumption of activities in Sierra Leone is noted. Coverages have improved in the last few years due to the monitoring, and intensification of the follow-ups / supervisions and the socio-demographic studies undertaken in the less satisfactory zones. Partial results recorded in 2002 show an averaqe geographic coverage of88% and an average therapeutic coverage of75 o/o. m) Surveillance/epidemiological evaluation activities are now entirely carried out by the national teams (regional or districts) trained for the circumstance with the financial and sometimes technical support of OCP, as it is the case this year of Sierra Leone in the resumption of activities by the national team. These evaluations were carried out in zones of the original area in areas of combined larviciding and ivermectin treatment. A retrospectir-e analysis shou's a drastic regression of the epidemiological indicators compared to those at the beginnin_e of the Programme in most of the basins. Prevalence rates from the evaluations carried out in 2002 in 5 1 1 r'illages in 9 countries range between 0 and less than l0 o/o and the CMFL almost nil. n) In the original area where 160 villages were evaluated in Benin, Burkina Faso. Cote d'lvorre. Ghana, Mali, Niger and Togo the situation is very satisfactory. Prevalence dropped fronr 59 to 1.1 % on the Niger and its tributaries in Benin. On the Bougouriba /Black Volta in Burkrna Faso. where a resumption of transmission had been noted in 1995 thc highest prevalences in 2002 were observed in Mouvielo (6.6%) and Salibor (7.9 %) with zero CMFL. In Nlah and Niger the prevalences observed in the evaluated villages are practically nil. JPC23 Page 38 Annex 6 o) Prevalence dropped from 82.7 o/o to 02.3 oh at Landa Pozenda, from 65.7 to 2.6 o/o in Bagan with a CMFL lower than I on the Oti and its tributaries in Togo. The situation on the Kara K6ran M6 in Togo is becoming increasingly satisfactory, os for example in Titira where the prevalence dropped from 88.5 % in 1916 to 21.1 % in200l. However pressure will have to be maintained on these basins. p) In the extension areas prevalences which exceeded 70 oh are today between 0 and 10% in most of the communities. In Guinea the prevalences in 2002 range between 0 and 87o on the basins of the Niandan, the Tinkisso, the Niger and the Sankarani. A prevalence of 29.2 o/o was observed in the Badala village on the Milo. Vigilance will have to be observed on the basins of the Milo, the Koulountou and. the Niger/Mafou where the situation still remains very unsatisfactory. In Senegal the situation is excellent on the Falem6 and the Gambia rvhere prevalences in 2002 vary between 0 and 6.9 %. No new infection has been noted in these basins. q) An evaluation carried out in 60 villages in July 2002 in Sierra Leone shows general upward trend of the prevalences; from 34.7 % (CMFL of 2.13) in 1996 to 73.3 % (CMFL of 9.4) in Kotor in the Kaba basin. r) Research continues for the development of a macrofilaricide and that of the Di-Ethi l- Carbamazine (DEC) patch test preferred to the skin-snip test to which the populations are becoming increasingly reticent. s) The Programme continued and intensified the process of transfer of data and tools (equipment. programmes, databanks and user-guides) to the Participating Countries. To this end a revision of the various software was carried out to make them more handy for the national teams. An update of the various databanks including those of the ophthalmological evaluations and the socio-demographic studies was carried out. As in the past, OCP has this year, provided to the national teams additional high performing computer equipment to enable them undertake a better analysis of data. To reinforce the skills of the nationals in the use of the usual OCP software a training of trainers was once again organised this year for the participants of the 1 I Participating Countries (three people per country). t) The training modules already existing on the various activities undertaken by the national teams are being published and will be made available to the countries shortly. u) The web site of the Programme is now functional. The bibliographical references and the various technical documents of OCP and APOC have been constituted into a bank for in- house consultation. \,) The Administration and Finance Unit continues its function of support to the operational. technical and scientific units. Within the framework of the approved budgets and guided br a constant preoccupation of cost-effectiveness, it manages human. financial and material resources of the Programme. \\, In addition to its regular functions the Personnel section is involred in the actrvities of the group in charge of the sensitisation and supporl to personncl in thls delicate phase of the end of the Programme. JPC23.2 Page 39 Annex 6 x) The sections of Supply and Services, and Transport and Telecommunication are actively involved in the process of transfer of the assets and equipment and the WHO vehicles to the Participating Countries, in line with the Agreements established between OCP and the various partners since the beginning of the Programme. JPC23 Page 40 ANNEX 7 ADDRESS BY THE MINISTER OF HEALTH AT THE OPENING OF JPC23 Mr. Chairman of the 23'd Session of the Joint Programme Committee Honourable Ministers of Health The Honourable Representative of WHO in Burkina Faso The Honourable Representatives of the Donor Countries The Honourable Representatives of the Non Governmental Dcvelopnrent Organizations The Honourable Director of the OCP Programme Members of the WHO Secretariat Honourable Delegates First of all, I would like to wish you all a warm welcome to Burkina Faso. This 23'd session of the Joint Programme Committee of the Onchocerciasis Control Programme in West Africa, is an occasion to review 28 years of fight against this disease in our eleven States. You will have to review the control actions taken against onchocerciasis during the year 2002 and to especially take stock of the situation in each beneficiary country on the eve of the closure of this Programme, as well as consider the future. Onchocerciasis used to be a plague in our sub-region and more particularly in Burkina Faso wherc 50 000 people were blind from the consequences of the disease and I million inhabitants lived in areas where a person out three ran the risk of becoming blind. Today we can consider that the battle has been won because transmission of the disease has been stopped in all our river basins. But surveillance is essential to ensure that any tbcus of resurgence of transmission is quickly detected and controlled. The agenda which is proposed to you exceptionally does not comprise any plan of action for2003, let alone a date for the next session; however, it remains quite tight with the decisions that will have to be taken on the actions under consideration on the tributarics of the Oti in Togo and the Upper Ou6m6 in Benin. The External Evaluation of the Programme carried out during the l't six-monfh period of the year 2002 contains some recommendations which I invite you to carefully ctlnsider. The progress report of the installation of the Multidisease Surveillance Centre which occupies the buildings of the Programme, remains one of the important items of this agenda. On the eve of the end of this Programme, I would like to pay particular tribute to all those who fought to make it a success. I would like to also thank all the partners as a whole who mobilized for the elimination of onchocerciasis. Finally, I wish you fruitful deliberations in this nice setting of the Ouaga 2000 Conference Centre and I declare open the 23'd session of the Joint Progranlme Committee. Thank you. JPC23 Page 41 ANNEX 8 CLOSURE OF OCP Friday 6 December 2002 ADDRESS BY HIS EXCELLENCY THE PRESIDENT OF BURKINA FASO Madam and Honourable Presidents of State Institutions, Honourable guests, Honourable Ministers of Health of the beneficiary countries of the Programme, Honourable Members of the Cabinet, Madam the General Director of WHO, Honourable Regional Director of WHO, Dear partners in development, Distinguished delegates, First of all, I would like to wish a happy end of the Ramadan to those of you who had been fasting during this blessed month. Honourable Guests, Ladies and Gentlemen, It is both with pleasure and emotion that we welcome the present ceremony which terminates three decades of dedication to public health in Burkina Faso and in West Africa. I would like to particularly welcome the presence of Dr Gro-Harlem Brundtland, and congratulate her for the outstanding results she has achieved at the head of the World Health Organization. The harmattan winds which are blowing in this month of December surely make the temperature cooler but they also foster the blossoming of diseases. Hence the relevance of the messages of comfort delivered a moment ago by several distinguished personalities to this continent which is still a victim of many endemic diseases with their medical and socio-economic serious consequences. Honourable guests, Ladies and Gentlemen, In 1974, one could count in the river basins of Burkina Faso, some 50 000 people gone blind from the consequences of onchocerciasis, and I million people living in areas where one person out of three ran the risk of becoming blind before they die. At the same period, our countries, with the support of the international Community, embarked in a bold adventure of eliminating this river blindness. It was an original public health programme based on a novel strategy of disease control: larvicide spraying. Today, onchocerciasis is virtually eliminated as a problem of public health imporlance in Burkina Faso. thanks in particular to the operations of your Programme. The foliowing technical rndicators cont-rrm my claim: JPC23 Page 42 Annex 8 an annual transmission potential below 100; an almost zero community microfilarial load; a prevalence rate of infected people below 5oh in the sentinel villages and an incidence rate of the disease below l%. Honourable guests, Ladies and Gentlemen, The Onchocerciasis Control Programme in West Africa which, since its inception, was to benefit from efficient management was implemented with scientific and administrative rigour by women and men imbued with a spirit of innovation. The mode of financing of this programme was also quite original with a strong commitment from the World Bank which mobilized behind itself, a community of twenty-fwo Donors. The implementation of this large scale programme was entrusted to WHO, the World Health Organization which admirably fulfilled its mission. Honourable guests, Ladies and Gentlemen, Thus, twenty-eight years later, the immediate objective of public health was achieved u,ith the near total elimination of onchocerciasis in the l1 beneficiary countries. Complementarl' action is currently being taken to consolidate this significant achievement in order to make it irreversible. We are happy to note that the beneficiary countries have today the capacity to maintain the achievements of the programme, because of the presence of a critical mass of competencies in each country. To this effect, the programme contributed in the training of more than 500 staff in our countries in fields as varied as epidemiology, entomology, public health, health economy and hydrobiology. The supply of technical material and the advocacy directed by the programme these last years at the countries for the financing of the residual activities continue to reinforce these capacities. As a consequence, 50 000 kms of rivers were regularly treated with insecticides and ivermectin distributed to more than 7 million people in our communities at risk. In Burkina Faso, the fertile freed lands were very quickly recolonized by the populations and the Government has supporled this resettlement movement by initiating a vast programme of development, implemented by various organizations: the Volta fur,er Valleys Development Scheme, the Sourou Valley Development Authority, the Bagre Valley Authority'. etc. In support of these resettlement schemes, some social and economic infrastructures (schools. heaith centres, small dams, agricultural mechanization, roads, rural tracks) uere constructed in the freed areas which, today, are the best equipped and most modem from the agro-pastorai point of rieu. TPC23 Page 43 Annex 8 Honourable guests, Ladies and Gentlemen, On the whole, there are unquestionably real reasons for satisfaction and we can be proud of this on more than one account: firstly: this programme was implemented from beginning to end by largely African staff; secondly: it is the only programme of this scale that was successfully implemented in Africa; thirdly: the financial and accounting management was performed with great transparency. Allorv me therefore to congratulate the implementers of this programme, which have achieved an immense task, by travelling thousands of kilometers along the rivers to detect the breeding sites of the vector and to destroy them effectively. I u'ould like to also congratulate the various Directors who succeeded one another at the head of the programme for having kept a constant line of good governance. I cannot prevent myself in these moments of stock taking from thinking particularly of Doctor f prahim Samba, the first Director who, after so many years spent at the head of this programme. imprinted an indelible mark on it. You understand, therefore, that together, you really did a wonderful job, and Africa is proud of it I u'ould like on this same occasion to congratulate the various bodies rvhich accompanied and directed the Management of the programme. These are in particular: the Joint Programme Committee, whose session which ends today, is the last of the kind, for having been good at making the proper strategic decisions; the Expert Advisory Committee, represented here by Professor Abiose. for the relevant recommendations of the Committee, which were true guides for action: the Ecological Group, led by Professor Resh. It is quite simply a brilliant idea to have thought of this Group entrusted with the role of monitoring the impact of the programme's activities on the environment. That is so much commendable, especially in today's u'orld where environmental problems are becoming increasingly alarming. Mi thanks go to all the Donors, thc initial ones, as well as those who joined in later It is gratifying to note that no Donor withdrew from the coalitron, because the relevance of the action was so evident, and thc management of the allocated funds rvas so satisfactory. I reiterate my deep and sincere tlianks to all, convinced as I am that they ri ill accompany' the beneficiary countries in the maintenance of the achievements that they helped acconiplish. It riould be regrettable, evcn inadmissible, that aftcr so many joint cfforts. after so man) sacnfices bl thc international conrnrunlty, we had to lacc any resurgcnce of tliis plaguc and its consequcnt disastcrs again. Thr'refore, it is logical that together, we undertake to contirluc the surveillance of this disease so that this iniage of the child guiding a blind rnan in the areas formerll, haunted by thrs terrible disease. remains an inrage definitely of the past and of documentary films. IPC23 Page 44 Annex 8 Honourable guests, Ladies and Gentlemen, It is important to remember that the river blindness eradication programme in itself was only a first step, the finality of the combat against the disease being, actually, the agro-pastoral development of the freed lands. That is the reason why at this stage, the United Nations Development Programme, the United Nations Food and Agriculture Organization, the World Bank and the European Union are parti cularly challenged. If we can without fear affirm that we have won the battle against the disease, we still have to take up the more formidable challenge of development. Ladies and Gentlemen, Dear partners in development, The constancy of your commitment over nearly 30 years now reassures me that you will still be at our sides for the noble cause of sustainable development. Before finishing my remarks, I would like to renew, on behalf of the I I beneficiary countries and of Burkina Faso, my country, our gratitude and infinite gratefulness to the international Communrty for the sacrifices consented to and the exceptional mobilization which have allowed the eradication of river blindness, a disease that caused so much havoc in West Africa. Wishing all and every one a safe journey back to your respective countries, I declare closed the Onchocerciasis Control Programme in West Africa. Thank you JPC23 Page 45 Annex 8 ADDRESS BY THE DIRECTOR-GENERAL OF WHO Excellencies, ladies and gentlemen, dear colleagues, It gives me real pleasure to be with you to mark the completion of this unique programme. It is a rare occasion when we can celebrate such a long-term success in global public health. I am here today to recognize the achievement of thousands of people working together for a greater good. Together, they have prevented 600,000 cases of blindness. Their efforts meant that 18 million have grown up free of the threat of river blindness. Because of the people of the Onchocerciasis Control Programme, thousands of farmers are now moving to reclaim 25 million hectares of fertile river land, enough land to feed l7 million people. To fully understand OCP's accomplishment, let us recall the devastation river blindness has inflictcd on West Africa For centuries, black flies had been injecting parasites into people living near rivers. When the campaign began in West Africa in 1974, l0% of the population in high impact regions were completely blind and 30%had severe visual handicaps. More than 250,000 square kilometres of once-productive river valley had been abandoned. We can all take pride in OCP. Its objective has been fully met. River-blindness is eliminated as a public health problem in this part of Africa. The eleven West African countries are alert to, and capable of detectinE, any re-appearance of transmission of the disease, should it occur. This is a guarantee that the achievements of the Programme will be sustained. In reaching its ambitious goal of eliminating river blindness, this Programme has been a forerunner in building partnerships and showing the way forward for health development. This is one of the earliest examples of this fruitful partnership with private industry. Also. the OCP partnership with Non-governmental Organizations has set an example for mutual support in promoting health development. OCP, together with its partner the African Onchocerciasis Control Programme, have pioneered the decisive role of communities in taking responsibility for improving their oun health. This progranlme has also helped to train hundreds of Africans in vector control. epidemiology. entomology, environmental sciences and public health management and has become a source of much-nceded manpower for national health structures. JPC23 Page 46 Annex 8 OCP started very much as a vertical programme based on aerial larviciding, with only limited involvement of the countries themselves. However, after the introduction of large-scale ivermectin treatment, which requires full country participation, the Programme was increasingly integrated within national health services and became a health system-wide activity. This approach has gone a step further by transforming the know-how and facilities of OCP into a sub-regional multidisease surveillance centre. I would like to congratulate those who have had the foresight and imagination to further develop a single-disease control programme into an inter- country support centre for overall health development. I would like on behalf of WHO to thank all the partners whose contributions have enabled the Programme to move forward so that today we can call a close to its activities with the assurance that it has succeeded in removing a disabling health problem in West Africa. Without the unfailing and generous financial and other support from the donors, OCP would never have come off the ground. It is indeed an exceptional achievement for a WHO programme to retain a donor community practically unchanged for close to 30 years. I would like to express my sincere gratitude to all the donors for remaining with us for such a long period. And here, I wish to pay a special tribute to Merck and Company for making ivermectin available to OCP at no cost. Also, I would like to thank the World Bank for having so effectively assumed the role of the fiscal agent for OCP and so successfully secured the funding of the Programme throughout its lifetime. But again, without the close collaboration and support of the Participating Countries, OCP could not have succeeded. I therefore wish to express my gratitude to all those in the OCP countries rvho have contributed to the work of the Programme, ranging from high-level govemment officials to those who have sat patiently at riversides collecting black flies and those appointed by the communities to carry out ivermectin distribution. My thanks go to the Expert Advisory Committee, representing the scientific community, for its readiness to work with the Programme to give it sound technical and operational advice. To the Members of the Committee of Sponsoring Agencies my sincere thanks for overseeing the operations of OCP, organizing its meetings, assuming responsibility for medium and long-term planning and organizing external evaluation exercises. Also, I recognize the important role played by FAO to support Participating Countries in socio-economic development in the areas freed fronr onchocerciasis. The collaboration with Non-governmental Development Organizations in large-scale distribution of ivermectin has to a large extent contributed to the success of the Programme. I ri ish to express my gratitude to the NGOs for their efforts, together with OCP, to alleviate the burden of river blindness in West Africa. My thanks also go to the staff of the Programme, for their hard work and for their dedication to achieving the aims and objective of OCP. We know' they have all given the best of themselves, working long hours often under trying conditions. I rvish one and all of thenr the best of luck in thc future. So tar, I have not mentioned any names, because there are too many who should get credit. But I cannot talk about OCP without pointing to one man who stands out. Without Dr Ebrahim Saniba. aJPC23.2 Page 47 Annex 8 OCP would not have been what it is today. On behalf of everyone in this hall and millions of people in the region, I would like to thank you, Ebrahim, for your dedication and service to this cause. And finally, let me thank the Government of Burkina Faso for having hosted the headquarters of OCP, a programme to which the country has been fully attached and to which it has contributed in several ways since its inception. The accomplishments of this programme inspire all of us in public health to dream big dreams. It shows we can reach "impossible" goals and lighten the burden of millions of the world's poorest people. When critics say that the next proposal is too ambitious, that it will be too expensive, it will take too long, that funds will be wasted, that the job will be too complicated or dangerous - tell these critics to remember this day. Thank you JPC23 Page 48 Annex 8 ADDRESS BY THE NETHERLANDS ON BEHALF OF DONORS Excellency, Mr. President of the Faso Honourable Members of the Cabinet Excellencies the Former Presidents of the Faso Excellency the Heads of Diplomatic Missions Honourable Civil, Military and Traditional Authorities Dear Friends, Partners and Participants in OCP Ladies and Gentlemen It is on behalf of the Donors of the Onchocerciasis Control Programme in West Africa that I am taking the floor this evening in the closing ceremony of this vast Programme which was launched in 197 4. Not only the Netherlands have been one of the major financial contributors to the Programme throughout its lifetime, but I am all the more happy to deliver this address to you as it is a subject which I know personally very well. Indeed, I represented my country in the various Donors meetings and annual evaluation meetings of the OCP Programme from 1994 to 1997. Therefore, I also took part during that time in the first discussions on the APOC Programme. It is then a subject which has always been dear to my heart. I am pleased to be able to inform you that the bronze statue of the little boy guiding his father blind from onchocerciasis through the streets, of which we all passed a specimen on our way to thrs meeting place (and which Mr. Wohlfenson has just referred to as we were being shov'n a specimen ot the l|torld Bank Headquarters in Washington), will also soon be erected in a square in Amsterdam in front of the Institute of the Tropics, a favourite place for North-South contacts in the Netherlands. The Programme has been funded by countries and Donor organizations, intemational development banks, multilateral and bilateral institutions, and organizations of the United Nations System. The total cost for the 28 years of the OCP Programme amounts to 600 million EUROs. Today, the OCP Programme is ending and we can be delighted rvith its success since most of its objectives have largely been met. The OCP also had a secondary impact on national health systems. It facilitated the development of huntan resources through tlie training of versatile staff rvhich norv work on onchocerciasis control as u'ell as on the control of other diseases. The monitoring tools developped by OCP, as u'ell as the detailed handbooks prepared, are used as models for the surveillance of communicable diseases in an integrated health system. In more general terms. the OCP has facilitated the current health system reflorms. It has been used as a nrodel for the deccntralization of health systems. Excellencies, Ladies and Centlenren, Thrs success is due to a multi-parlnership on all levcls: - loint commitmcnt of the Donors, - dctermination of tlie go\/errrments of the countries conccmcd to overcortle thc oroblem. - rnter-countrycoordination and collaboration, a JPC23.2 Page 49 Annex 8 motivation of the populations, executive programmes which included WHO, various NGDOs and national technicians Here I would like to particularly pay tribute to the World Bank and its staff for having succeeded in managing in an exemplary manner this Trust Fund during all these years, and WHO for the continuous, assiduous and successful implementation of such a large scale programme. After 28 years of successful arduous work, the OCP has now come to its end. It is now up to the participating Countries to take over the task in order to maintain the disease at its lowest possible level. From the evaluation of the Programme made by the Joint Programme Committee, it emerges that the countries concerned are able, with a few exceptions, to suciessfully ensure this take over. The partners are now counting on the participating Countries to maintain the achievements of the investment made by all and to continue to make every effort to ensure that onchocerciasis is never again a problem of public health importance. Thank you very much.