First meeting of OCP commission

JWORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE ONCHOCEROIASTS cot\TROI PROGB.AM'IE rN THE voltA RrvER BAsrN AREA FIRST I\.EETING OF OCP COI,{MISSION IRAINING J.D. MaIr Ouagadougou May 1979 TfuIIII]}IG ArSrone acquainted nrith lYest Africa is awa^re of the relative scarcityof professional personnel in certaln speclalized disciplines. lhis wasful1y recogn-ized when the Onchoeerclasis Control programrne was l-a*nchedso that, from the begiru:ingr a substantial training element wa.s ea:cmarkedin the budget. ^ . &ltonologists, who represent the key factor in the over.al1 operationsof the Progrsmme, were especlally few 1n- number. In SirnuLir.u control or1.ese3rchprojectspriortol9741herewereon1yrourffi="duatesfromthe l{est African_corintriesr two from Ghana arrcl two from upper Vo1ta, whowere both suitable and available. There was no question of selection.They all had to be recruj-ted but, before being install-ed in their responsi-ble positions as sector ehi-efs, charged with developing a11 evaluationnetwork in a specific area while urr"irber"d w'ith tnl everyttay adninistrativeduties, they had first to undergo artcrasrr,tiratn:.rrg oor""" in simullido1ory. rn this respect the programme was very fortunate to have immsdisf,sfyadjacent to lts area the OCCGE ilInstitut aL Recherches su:. lronchocercoserat 3ouak6 wl:-1ch r.mdertook to train entomological staff on a contractualbasis. The courses fo1Iowed. were developed in consultation w:ith theProgranme to ensure that they were pcrtinm.t to ocp requirements. Thesefirst- entomologists, and othlrs who have been recmited since, beneflttcd.greatly fron this approprlate ancl applled instruction. In the Vector Control Unit the next line of responsibility is at thelevel of entomological techniclafs who generally have completed. onlybaccalar:reate or secondary school education. Their biological lorowledge when recnrlterl 1s generaliJr minimal so they also have had to be given speci-fic techn:ical- tralnlng suiled to their subiequent appointment as sub-sectorchiefs 1n charge of several mobile teems coliecting vector distribution anddensity d.ata in the area. Again, in lr9l4t only a few with Si-mu1ir:m experiencewere avalIable and they and otirers subsequentiy recnr-ited l "tt"rra"aspecial four to six month coLlrses at the occcE onchocerciasis Researchfnstitute at Bouak6. rn this way, and. with a certaln a.melioration of recmitment pressureassociated with the phased annual brrild-up of the operations until the wholearea was covered,, the Progremme gras able to fill the seven sector chiefposts-and twenty-six sub-seetor technician posts on time. Ihroqghout thisperiod the problem of lack of selectj-vity cintinued and, in retrospect, the?rograrnme has been very fortr.urate indeed in the general standard of personreelit has obtained. Ihe number of far:ilures has been negligible, and that onlyon the technj-cian level on other than technical grounds, so that the invest-ment to date i-n entomological training to meet the needs of the progravnmehas hatl a very sound retun:. As the countries currently involved in the ?rogramme and those neigh-bgrllte_ 1tl e.g. s9nega1, Guinla, Nigeria, are calr-jlg out for an extensionof [i4uliuq operations because oi ti:e "r""""""" so far achleved in oCp, theneed for additional entomologi-sts continues r-lr:abated. w-ithin wlio. This need.of cor:rse, can be multiplled several ti-mes on a country by country basisfor the development of national- structures but that is a separate 1ssue.fhe tlearth of suitably qualified personnel in this field ls in fact as bad ., ./... aas 1t was in a974t but, this is harclly surprising. Ghana is the only cor:ntrywith a steady trickl-e of biologists grart,rolirrg fron j-ts Universities, nearlyall of whom are readily absorbed into estaUlisnea posts available in agricr,[-ture, foresty or teaching. lhe educationa-l systen in the franeophone countrles,for'rnded' on a different bisis, leads obly a srrf1 percentage on to universj-tyoducation, much of whi-ch, lmtil recently-, was ava_tIabl_e to tirem only inEurope. so much for entomologists but the situation is no better in most otherd'isciplj-nes. I'[edicine has always attracted top-grade stuclents from a-11courttries but the desire to enter tirat field has not arways been for hunar:.-itarian reasons. clinical medicine and private practice have lured themajority because of t]:eir financial retGn and so, compouncled by the desireof many to remai-n in the country of their under or post-graduate training,the developing colurtrj-es are leit with very few, if ar1y, with arqy motivationtolvards involvement in fiel-d operatlons. Accordingly, in launching thePrograErre the epidemiologist, parasitologist anci ophthalmologist had to berec:rrited from outside the participating coirntries. subsequently, one medicaroffi-cer from the ocP area lvas sent-to tie Prograrune for training. He wasthen recruited by the Progrannnre because, follfvuing.hj-s specialiied. tralning,his Goverzim.ent co,"rId not offer hlm a po"t. - Again hydrobiologlsts, though not recrutted directly by the ocp tod'ater have, with the exception ci Gl-rana, not ueen avair_able from flreparticipating eountrj-es to carry out the aquatic monitoring activities.Expatriates have had to <1o the ;oh ana ,ro* w'ith the planned remova] of theoRsroli \ydrobiological teen from the area a large gap renains to be firledln this discipline as a natter of urgency. T/hat then of the futr.rre? For the Conrnrlssion there are three areas tobe reri-evred: (") the Prograr,rme itseffr (l) the need for additional staff for extenslon operations, and(c) the needs in relation to the development of national structures. Ihe Programme The Dircctorate, Vector Control Unit, Epiden:iological Evaluation Uni-t,Econonic Development unit and Adininistration unit have a fixed complementof personnel to direct2 p1an, coordinate and execute the programme. Almostall posts are flIled at the present tlme, and predom:inantly by professionalsfrom other than participating countries.' nlalniy for budgei*ry ,"r"ons therange af posts carries no reserve so that v,,hen L vacancy occu-rs a replace-ment has generally to be sought outside the progrommeo It is evident thatthe present corps of staff wi1l not remain untii the entl of the programmeatld alternatives wilr have to be found in al-l- disciprines repxesented astime progresseso t}rom where will- they come and whai upprou"ius shoul-d befollowed? fhe desire of course is for these posts to be filled more and.more by personnel from the Participatlng cor.rriries. only junior professionalposts are held by nationaLs from tne participating cowrtries the seniorlevel posts being fi11ed predornlnantly by exiatriates. .../... 3- fhe greatest rislt of cor.rse is at the most senior Ieve1. In many respects the Progra.mrae is quite r.rni-que and its success is in measure dueto the long association and evol-ving experiences of the Director and UnltChiefs sirlce the lawtehing of the Pro6roJr[1er At solie point new managers t,rust assure responsibility, rn tjris respect, the application of thePetcr Priirclple must be avolcled at all- costs. Se""use a person is a good entomologist or parasitologist tecjtricall}' does i:.ot automatically quoiity hira for the nanagerial post of Unit Cirief. [o prepare staff for more senior roles in future and to enabLe appropriate pronotional selectionin-servlce training of personnel together rvith a gradual extension of i;heir respective respol'lsibilities rcust be r-uedertaken routir:eIy. Accordingly somesector chiefs a^re now beiirg exposed. to nelv dutics aird. given responsibi-fityfor clifferent aspects of the operations. On a more jr.rnior entomologica-lleve1 a training officer has been appointed to acquaint those concerned vrith new methods and techniques developed and to ensu.r.e common standards are maintajrred tluoughout the progranrae. At present ti:e worl-d market is depleted of professional personnel- with experience in Sinul+um biology and. corrtrol or j-n Orrchocerciasis so, no ,natter who is recnriteo for ihe progranme in future, there is going to be need for some 1eve1 of trainlng. The r-rriclueness of OCP type olerations issuch that recrr:its are certalnly best trained. in the lrograrme in whateverdisciplines they are going to foll-ovr. Ilovrever, while this is currentlyideal for ocP in its present form, it nrns the risk of devel-opiqg a cadreof super specialists and. one may query wtrether this is sound preparationfor the future- The Cornrni ssion uril-I no d.oubt be add.ressinE; iiself to this matter j-n relation to whether or not OCP shoul-d d.evetop a mul-ti-diseasecontrol role. Extension ts Because the tirclng of OCP extension studies in lvory Coast, Ghane,Iogo and Benin and implementatlon of control operatiorrs in Ivory Coast coincided with the rationalizati-on of the use of staff already Lngagea, a n'mber of personael were redeployed fron the northern areas vrhere sectorsald sub-sectors rlrere bei-ng rearangecl to nel,{ areas south of the programrne area al:d. this reduced the number of fresh recruits needed on the eniomologi-cal side. For epidenlologica-l surweil-lance, nationaJ- teams from Governnent service a:rd institutj-ons undertook the vrork in sotre of the eolu:.tries,folloiving association r"rlth tire Epid.emi-o1ogical },\aluation Unit to learnthe techniques arrd to ensrrre that data vrai coll-ected in a standardized manner. For studies in other a-reas to the west (Senegafr Guinea, Guinea-Bissau) and east (tf:-geria) of the OCp area, the pro,;grarnme has provj-ded tra_lnir]g vrithin its Units (a) to wIIo personnel vrho r,vil1 assist the cou-rr.tries and(l) to a rar€e of personnef or entomological and medical disciplines fromthe countries themselves' Gui-nea has been especially responsive to the need for training ar:.d subrritted a lengthy lisi of suitable cand.idates.Again the OCCGE onchocerciasis Research lnstitute at Bouak6, assisted. asdid the Ophthatnrological Institute (fOfA) at Barnako. r['V]ren the tirne cofles for control operatj-ons to begin in these outsideareas, additional staff vrill- be requ-i.red and speci alj,zed training cou-l-d beprovided as appropriate by OCp. . . .r/ . a. 4liati onal Structures r''rorn' reports of meetings of the Joint coordinating Comn-ittee arrd earlyifational onchocerciasis Qqmmilf,sss, the Comr,ission must be aware of thecriticisn hr.lrl-ed at the Onchocerciasis Control- Programme lvith. regard totraining and especially to the non-util-izatj-on of fwrds eazroarked. by UliIDpfor this purpose. At the onset, for obvious reasons, ti:e whol-e emphasiswas placed on trainirt8 persomel for enpIo1r,rent directiy in t]:e progra-nuneitserf and this made consiclerable o"" oi tire firnds, but when this requ-lre- ment v'ias more or less satj-sfied it was no lorger necessary to spend noneyfor tiris specific purpose, The participeting cormtries were alertedconcerning tire availability of these funds i:ut tne response vias very poor. Accordingly a paper was drafted reviewing the situation and subrclttecleventually to the JCC. Holever, prior to its submission the prograrurieDirector vlsited each of the Partieipatiirg countries to explai:r that fi;-ndswere ava-L1ab]e to traj-n nationals in disciplines related to Onchocerciasis and' its control. The Progra.Inme was ready io amange traii:ing for ophthal-mologists, parasitologists, entomologist!, cytotaxonorrlsts, ,{yarobielogistsand cherrists, the l-atter two categorius oeing ilecessary for aquatic andchemical- nonitoring activities. ft soon became evident that the scarcity of trainees forthconfng fronthe countri-es wa_s due trot only to the lack oi suitable candldates in thedlfferent disciplines, but alio anc essentrally to the rack of any establ-ishedposts i:r the countries to wldch the personnel Loulcl be attached after trainingto nalre use of their speciality - there rvas no career structure. As inreIlas that there was no scarcity of trai-ning fellolvships available from othersources e'g' the Regional office for Africa and bilateral donor agencies,so there lvas no urgency on the part of the participating cogntries to tapOCP resources to the full-. Regarding the training of pcrson:reI for nationirl- structuresr twopoints have to be considered. First, there i-s a smal1 reserwe of certaincategori-es already and potentially available to the cou::tries. AlI thestaff in the Vector Control Unit frora the technician or assistant entomolo-gist 1evel d.ournrrards for exarnple are operatirry in their cou-ntry of origin;so each country already has a core of operat:-Jna1 persorurel fu1ly engaged il.9i'U1"+ surveill-ance wj-thin i-ts borders but as yet on tae fiJo payro1l.\Wrile not fi6uring in the natlonal structi.u,es ti:ey could transfer at theend of OcP to the countrj-est payroll for the inaintenamce of operations,bttt.-this rvoul-d just require action on tlre part of the Goverrunents to establishsirtjl-ar posts. There are arso ocP recruitco enio;i;d;i;-G;;;;""ci,i"i"i--"'^from these countries but generally serving irr-ottu, tha.n their own countrles,but because of thej-r potential lrse in other 1THO projects their avallabilityto the corrntries carrrrot be gua,reu:teed. At any rate, aoditional professiona-lsof this category vrill certainly have to be tr-airred. s_e_condry; training in onchocerciasis and,/or its vector arone may- notbe wholIy appropri-a,te to a coi-urtryts requiroou"t". rf and lvhen ocp activitiesare halded over to the SoYerYxnents they will have reached the maintenancephase when there will be no question oi reciucing vigilance, but rvhen therewill be the nced to use pers&:neI efficientry ii the presence of row densitlesof flies, a point alread.y raised. during this meeting, ectual- requirementsvrill vary greatly fron corrntry to country, and from area to area particularlyin those countries which are toastal. urr-idisease specialists such as ocpproduces may not be the ideal arrd the most efficient structure may haye tobe geared toward's a multidisease approach. fn tids case, the role of OCpin prov-iding the broad-based trainiig ,r""u""ary vd1I also have to be clearlyspecified. .../... u5 Ihere is no doubt that whatever approach is foll-owed 1n establishing national structr:res, sufficient furds are available for trajling from OCp and other sources and collaboratj-on can be sought with training institutions according to the disclpline, but the nain rlifficul-ty may be for the Goverl- nent to find the necessary personnel for training and atlocating funds forthe new posts which will have to be created. General Greatest consid.eration in this presentation has been given to the entonological requirement because for Onchocerciasis Cont. ot, in the absenceof suitable chemotherapy, it is this group that definitely holds the keyto success. In fact in arry multi-d.isease ipproach in parrlit"-"i6den VlestAfrica blologists and entonologists should prettoninate vrhere preventionhas priority over cu-r€o These are categorles rvhich figure at a very 1owIevelr if at all, in ]\[inistries of Health at present and represent the area where a major training effort 1s requirecl. However, to engender interestin potential staff, contact has first to be made at'Unlversity 1eve1 to ensu-re that undergraduate courses are geared towards the medical entomol-o-gical needs of the cowrtries and studerrts are motivated towards enteringthis field at an early stage. Cytota:conomists who are highly specialized in methods of identifyingthe different species of S.damrrosum are extremely scarce a1d pot to befor:nd in the participatin[ffiffis. hrtenslon work requires theirseruices to deterrine the d.istribution of diff erent "pe"ie". ophthe-lmelogists to detenninc patients at rj-sk of going blind and whoshouLd be treated are equally sc?.rceo Hydrobiologists are a,1so requi.red to raonitor the effeets of regular application of pestlcides to the rivers on the aquatj-c environnent. While not normally forurd in L[inistry of Health establiJhnents, they are necessarTrjl a Programme of thls nature and could have an increasing role as the need for sr:rveillance of the :rlvcr systems increases. Analytical chenlsts to check periodically on the presence and possible accumulatlon of insecticid.es in organic and inorganic material are also necessary but dlfficult to find,. The Progranrms [45 done lvhat lt can not only to stimu]-ate the countrieslnto putting up candidates in the different disciplines, but in agangingappropriate training,. The tables of candi-dates trained already circulatedprovide an inlpressive list of what has been achieved., but it ii only a start.So mueh sti11 has to be done and in this respect i-t must be emphasized that 9CP j-s willing to play a leading part. oCP is not a tralning institution butlt will provid.e what specialized training it can, preferably to seni-orpersonnel who, in turn, can carry out traj-ning programmes appropriate tothe needs in their oyrn countrles. J.D. Marr