Report of the Special Advisory Committee (SAC): session from 07 to 11 June 2005

I WORLD IIEALTH ORGANIZATION AFRICAN REGION @ ORGANISATION MONDIALE DE LA SANTEREGION DE L'AFRIQIIE Special Interven-tion Zones (SIZ) Zones d'Interventions Sp6ciales a SPECIAL ADVISORY COMMITTEE Third session Ouagadougou. 07-11 June 2005 -u/ REPORT OF THE SPECIAL ADVTSORY COMMITTEE (SAC) SESSION FROM 07 TO 11 IUNE 200s 201062005 APOC/SIZ, 20106t2005 I CONTENT A. OPENING OF THE SESSION B A TV\TYTT/1]\T /1E 'IALIE AT-EI\TI'\ AAIJ\-,'I IIL./I\ \JI' IIIL NULI\VI \. COMMITTEE MEETING.......... C. REVIEW OF RECOMMENDATIONS OF THE SECOND SPECIAL ADVISORY ......2 ,..,..',,.2 I D. HIGHLIGHTS OF THE REVIEW AND PLANNING MEETING OF NOVEMBER 2OO4 ON SIZ ACTIVITIES ... E. ISSUES FROM THE 1OTH JAF SESSION AND FROM THE 1O9TH SESSION OF THE CSA OF APOC IN RELATION WITH ACTIVITIES IN THE 512............. ........."......' 5 F. INFORMATION ON THE PREPARATION OF THE MID-TERM EVALUATION SIZ G. INFORMATION ON THE PREPARATION OF THE SECOND AND LAST AERIAL CONTRACT FOR VECTOR CONTROL IN THE 512...,.,...... ..................,7 H. PRESENTATION OF PROGRESS REPORTS ON 2OO5 ACTIVITIES IN THE SIZ AND PROVISIONAL PLANNING OF ONCHO CONTROL ACTIVITIES IN THE SIZ IN 2006 ,.....7 I. UPDATE ON THE SITUATION IN SIERRA LEONE .....................20 I POST-OCP ONCHO SURVEILLANCE ACTIVITIES IN NON-SIZ AREAS. ....................23 K. FINANCIAL AND ADMINISTRATIVE MANAGEMENT OF THE 5T2...,............,.,,.......23 L. RECOMMENDATIONS OF THE SPECIAL ADVISORY COMMITTEE (SAC) TO THE APOC/SV MANAGEMENT AND TO THE NATIONAL HEALTH AUTHORITIES CONCERNING ONCHOCERCIASIS CONTROL ACTIVITIES IN THE SIZ COUNTRIES...24 M. OTHERS... ...---...-..-32 -Dates and place of the fourth session of SAC -Operational research -Revision of the reporting format of the annual technical report N. ADOPTION OF THE SALiENT POINTS AND RECOMMENDATIONS OF THE THIRD SESSION OF THE SAC...... .... .... ,.33 o. cLosING CEREMONY................ ..-..... ....33 ANNEXES .'............."'.35 20106t200s 1 I 4 Ij A. OPENING OF THE SESSION 1,. Professor Adenike Abiose, chairperson of the Experts Advisory Committee' openeci the session and weicomed participants' She th'en highlighted the major activities under CDTI, epidemiologicai evaluation and entomological activities in the sIZ on which deliberations were to be centred. she went on to say that the director of APOC, Dr Seketeli, would retire in september 2005, and so was taking part in the SAC meeting for the last time' 2. Dr Seketeli in turn welcomed participants, and stated that due to ill health' Dr John Gyapong, National Oncho Coordinatoi of Ghana, will not be attending this very important session of SAC meeting. Because of the short notice Management was not able to arrange for another member of Dr Gyapong's team to attend the meeting' 3.DrSeketelithenindicatedthatthekeyissuesthathewouldlikediscussedand be advised upon by the sAC members during this session were the following: - The special situation of Sierra Leone, and the actions to be undertaken prior to the end of SIZ activities in December 2007 ' - The need for the committee to guide us towards the best way of conducting SlZactivitiesuntil20oT,bearinginmindthefollowing: a)Thecontinuationofvectorcontrolactivitiesonthetributariesoftheoti (Keran,Kata,Mo)inTogoandBenin'andontheUpperOuemeinBenin' b) The approach to adopt "*itn a view to improving results on the Pru basin' in Ghana, where the situation seems to be stagnating' c) The ongoing neid-term evaluation of activities in the sJZ,.whose terms of reference *Jr" amended by the CSA to include the activities in other countries of the ex-OCP. -: 4. The Director then continued by welcoming on board Dr Bernard Philippon, entomologist, who was participating ftr the first time as a full member of the Special Advisory Committee of the sz. Th"e Director also welcomed and congratulated the newly appointed National Coordinator of Benin and Deputy, Dr Fagla Medegan and Dr Frank Sintondji resPectivelY' 5. The representative of the WHO Country Representative in Burkina also welcomed puiti.ipu.rts, and wished them success in their deliberations' 6. professor Koumare, Director a.i. of the MDSC, in his speech recalled the mission and objectives of the Centre, and wished the sAC meeting success' 7. Dr Laurent Yameogo, Team Leader, sIZ introduced the make-up of the meeting's secretariat as follows: -Dr LKB Akpoboua, DTL I SIZ, principal rapporteur - Dr Grace Fobi, CDDT/SIZ, rapporteur - Dr Nouhou K. Dia1lo, National Coordinator for Guinea, Rapporteur 20t0612005 I B. ADOPTION OF THE AGENDA 8. The agenda was adopted with the following amendments(see arurex): - The sifuation in Sierra Leone was to constitute a separate presentation. Item "I" was earmarked for this. - A separate presentation was to be made on financial and administrative management of the SIZ. Item "K" was earrnarked for this. - A proposal was made that a session be organised exclusively for SAC members to deliberate on salient issues of the meeting, and the schedule of country visits under mid-term evaluation activities of SIZ. This was to be done during the ieport-writing session on Friday 10h |une 2005. - Coordinators were to meet and review the progress report form that was agreed upon at the November 2003 SAC meeting. C. REVIEW OF RECOMMENDATIONS OF THE SECOND SPECIAL ADVISORY COMMITTEE MEETING 9. Most of the recorunendations made during the second SAC were implemented, with some specific indications as follows: All countries are now working with partners other thanSlZ/APOC. Benin recently signed a partnership memorandum with SSI. SSI is strengthening collaboration with Togo. SSI, HKI are active partners in Sierra Leone. In Guinea, SSI HKI, OPC are working with the national programme. LF and oncho are integrated in Benin, Ghana and efforts are being made to integrate the two in Sierra Leone. CDTI and blindness prevention programmes are integrated in Guinea. Togo is in the process of integrating CDTI, LF, Malaria and Nutrition 'ammes. I 2 Recommendation Follow up action 139: That in future progress reports should follow the reporting format earlier developed and finalized at the November 2003 SAC first session. The 2004 report of Benin is partly in this format. The other coordinators did not understand that they had to send the 2004 at this This will be corrected That teams should maximise the use of available resources in the country, as well as seek alternative sources of funding, collaboration with existing programmes and integration wherever possible in order to ensure sustainability of the progranune. That SIZ Management address the problem of delayed release of funds for activities. Timely transfer of resources to the countries is made after Letters of agreement have been signed. The committee encourages the countries to continue the im ortant activities of Entomological and epidemiological zed for SIZ inTogo,surveillance are being reali 20t06t2005 tBenin Beninrealized timel nothast beingILeone.Sierraand SIZonNlnGuineaandfor feedbacktimelvveha providedMDSCareas. SIZthelnofons samplesidentiJicatitheof to vmade providebeenareEffortsareas PooIwellASareasSIZnontheinfeedback 1nareasSIZnonthe1n1Ssamof plesscreenlng Benin and Guinea is in timel and toMDSC provideandsurveillance allowwouldwhichfeedbackv achon.taketo approPriatecountries October and November 2005 beenhavetteescornmlrealizedisThis being andvetratiadminissocial,1nt place(Pu hasMDSCofbodvThe goverrungscientific) address pendingtoint helpbeen placePu andtific steenngthe sclenofMeetingissues Tof'elv vrespectiarettees plannedcommi 143. -k.r"ur.d collaboration between SIZ' APOC and MDSC -PromPt feedback to countries iJtg* MDSC Director and WHO/ AFRO to u"r,ror" that adequate financial.means ,r"- *ua" available for the functions of MDSC ln"qr"tt" MDSC to give.higl ptttity to the identification of 6' aolaulus and black flies frorn SIZ lo enable improvement of andwearl Donefteatmentthe period44. Harmonizrng1 NBeninTbetween Freetown tegic theondocumentAon1s golng.The process Sierra1nCDTIofontistra reorganiza SIZAPOCbybeenhas preparedLeone andthw1discussed partnersandManagement or byganizedworkshoPtheatadopted SIZAPOCandLeoneaSierrMOHS st rn2005At|e.-21.1 priltheonManagement Sierra Leone on of CDTI in149: Strategic reor ganizatr Not yet imPlemen ted. authorities tional trolof Pre-conexistence goodthevenGi thealso Presenceandthisontada countrY withinentomologistsnaof qualified SACtheo 'amme/tional grna Prthe dissections,resumetorecommends to1ntakeshichwatoaccor protocol,ding 1Shichwandtinelsen villagesaccount thw1tamutual greemenestablished by allowwillThisMDSC.theandSIZWHO themalntairungtotion1n addfor ofthe theringthis staff, gaofa1technic ty actiThis itytaadal1oentomo gicbasic nationalandSIZthed:kebacbed byshoul ) 2010612005 HIGHLIGHTS OF THE REVIEW AND PLANNING MEETING OFNOVEMBER 2OO4 ON SIZ ACTIVMIES a) Activities and outcomes in the SIZ 10' CDTI results in 2004 in the sIZ were in general satisfactory. Geographic andtherapeutic coverage rates reported. theru ,"rpZ.irr"ly were as follows : 9g.6% and.80.9 in Benin; 100% and 79% in Guinea; 97,/o )nd, g2% in Togo; 1,oo% and r2.g% inGhana; and22.2o/o and2g% for Sierra Leone. 11' The peculiar situation of sierra Leone, where onchocerciasis is still a publichealth problem, was discussed. The session r"gg";*a the use of available resultsfrom disease surveillance studies to delinea-tJ the zones, u."o.dirrg to theirendemicity, while prioritising hyper-endemic areas for setting ;t SDTI. It wassuggested that this strategy wouldilso facilitate the interventiorioriartner NGos inSierra Leone. 12' The epidemiological evaluations indicate that, overall there is a downwardtrend in prevalence and CMFL on the tributaries of the oti, except in the Mo basin. 13' There is the need to conduct operational research to clear up certain issues thatare coming uP on the field. Given the importance of this issue, the session deemed itnecessary to set uP a technical committee that will review op".utiorral Researchproiects' Dr Grace Fobi, cDDT/sIZ is incharge of coordinating activities of the said.committee. !4' , Concerning the necessity to have a good data base for analysing CDTI resultsin the SIZ. The issue of GDTI d1a3_ management Trd analysis for decision_making wasdiscussed' The sPSS and Healthttiupp", software *"ru chosen as the most adaptedfor data analysis' The APoc/cEv iepartment was charged to design and test asoftware for managing epidemiological, entomological andtDTI data,'and to plan aseries of cascade training in the SIZ countries. 15.. The design of an advocacy handbook to demonstrate the link betr,and onchocercilsis will be done in collaboration with HKI and the w.r.tJ;""11:""tt' b) Activities carried out in non-slZ countries of the ex-oCp 76' surveillance activities are going on quite well in Burkina Faso and Mali. InGuinea Bissau, entomological andlpidemiol,ogical evaluation activities were carriedout with the assistance of APoc and the w6rld Bank, while in Ivory Coast onlyepidemiological activities were carried out with the assistance of ApoC, HKI andthe World Bank. D. I 4 20t06i2005 I 17. ssl assists in slzcountries like Guinea, sierra Leone and Togo and in non-slZ countries such as Mali and APOC countries' HKI assists in aPOC countries (Cameroon, Nigeria, iur,ru.riu) and in the ex-oCP countries ( Burkina Faso' Cote d,Ivoire, Mali, Niger, sierra Leone o.J Grir,"a.) The oPC assists in Guinea, Senegal c) Support from Partners: and Mali. d) Activities of the MDSC activities THE SIZ these countries to advance Oncho control ISSUES FROM THE 1OTH JAF SESSION AND FROM THE 1O9TH SESSIONoFTHECSAoFAPOCINRELATIONWITHACTIVITIESIN 18. MDSC provides technical assistance in the entomological and epidemiological surveillanceofonchocercicasis,andthesurveillanceofottterepidemicdiseaseslike HIV/AIDS, meningitis and malaria' it".",tt'e also has a training mandate' and is designated u, u r"f&"nce centre for the use of the wHo Healthmapper software' The centre is in charge of documentation, radio communication and carries out research E. ISSUES FROM THE 1OTH JAF SESSION lg.ThelOhJointActionForum0AF)ofAPoCwasheldinKinshasainDecember 2oo4,and,S|Zactivitieswerereportedthereforpurposesofin{ormation' 20.The}ointActionForumQnrlisthegoverningbodyoftheAPOCProgramme, just as thE joint rrog.u**" do*hittee g?c; *urlo, the oCP' since several donors of APOC were also oCP donors, it was necessary to take atlvantage of the holding of the )AF to inform ih"r" donors on the progress of activities in the sIZ' 21. Thus, report of partial results of the CDTI, vector control' as well as results of epidemiological evaluations was presented to participants' It must be noted that two countries of the ex-oCP, namely Mali and Guinea were at the forum as observers' and made presentations on the situation of oncho control in their countries' two years after the closure of the OCP' 22.Overall,presentationswereverymuch-appreciatedbytheForum'which congratulated SIZ Ma.rug"*".,t and countries of the ex-OCP for what they had been able to do. However, the situation in Sierra Leone and Ghana caught the attention of the Forum, which deemed it necessary for more stringent measures to be taken in 23.OtheritemsofimportanceforSIZ,butwhichwerediscussedunderAPOC activities were sustainability of the community-directed treatment with ivermectin' and other health interventions using CDTI as a vehicle. Taking into consideration the current outcomes of epidemiological evaiuations, prevalent" *t"t could be said to be still high in Sierra t-"one and Chana, but also in some villages in Togo and Benin' 5 2010612005 The sustainability of CDTI therefore remains a current issue in the SIZ. Theimportance of integration of other health interventions for purposes of sustainabilitf of CDTI and the improvernent of cost-effectiveness is equalty of importance for theSIZ. 24' It is worth noting that the current WHo Regional Director, Dr Sambo, gracedthe closing ceremony of the JAF10 session with"his presence, and reiterated the support of the wHo Regional office for oncho control in Africa. 25' Finally, a tribute was paid to Mr. Bruce Benton of the World Bank, who wasgoing on retirement, and to Dr Ole Christensen, OCP/APOC consultant, for theirdevoted services to onchocerciasis control in Africa. ISSUES FROM THE l09th SESSION OF THE CSA OF APOC IN RELATIONWTTH ACTIVITIES IN THE SIZ 26' The APoC Director informed the meeting about the holding at the WHOHeadquarters in Geneva, from 23'd to 24ft March z-oos of the 109h session of the CSA.Representatives of the World Bank, MDP, NGDO coordination group and WHO tookpart in the session. 27' Discussions_centred, among other issues, on the terms of reference of the mid-term evaluation of activities in the SIZ and on the need to continue vector control activities in the SIZ. 28' With regards to the necessity of maintaining vector control, the CSA recorunended that the issue be sfudied, taking into account the high cost of vector control -riel ated activities. 29' The SAC took note of the information given, and indicated that this issue would be carefully examined, and that recom-u-r-,dutiorrs of the Committee would bebased on the technical results obtained on the field. 30' The Director of APOC indicated that arrangements were ongoing for the continuation of activities until 2007 as decided by thelpc of Decemb er 2002. F. INFORMATION ON THE PREPARATION OF THE MID-TERM EVALUATION SIZ ACTIVITIES 31' Professor Abiose, chairperson of the SAC, confirmed that the meeting on theplanning and finalization of mid-term evaluation activities, scheduled to be heldfrom 13 to L4 June 2005, is maintained. The committee indicated that the amendment of the terms of reference, including the evaluation in the other ex-OCp countries would entail considerable modifications in the schedule of visits to the countries. a 6 20106t2005 IG. INFORMATION ON THE PREPARATION OF THE SECOND AND LAST AERIAL CONTRACT FOR VECTOR CONTROL IN THE SIZ 32. The Director of APOC informed the session about the holding of an informal meeting between APOC/SIZ and the representative of EHI in Ouagadougou on 3L't May 20b5. The objective of the meeting was to discuss issues of common interest and to examine the prospects of future collaboration in 2006 and 2007. 33. The meeting was informed of the impact of the socio-political events in Togo on SIZ activities. The said upheavals obliged the United Nations security system to relocate temporarily all the international staff in Togo including SIZ international personnel. The aircrafts used for aerial larviciding were grounded during that period of social unrest and larviciding activities were suspended for six weeks. The stock of insecticides were transferred from Kara base to Parakou (Benin) and Ouagadougou(Burkina Faso) 34. Concerning the prospects of collaboration between APOC/SIZ and the EHI, the renewal of the contract will depend on the advice of the WHO Committee in charge of managing contracts. The Director insisted on the fact that the recorunendation for maintaining EHI depended on the bid price of the comPany. The EHI Director has been inlormed that the SIZ can only maintain aerial larviciding, given the budget available, if the company maintained the same budget, i.e. the same cost/flight hour as per the 3-year contract that is running out. H. PRESENTATION OF PROGRESS REPORTS ON 2OO5 ACTIVITIES IN THE SIZ AND PROVISIONAL PLANNING OF ONCHO CONTROL ACTIVITIES IN THE SIZ IN 2OO5 O Summary of progress report onaector contral A-Entomological activities in the SIZ in Togo and Benin Entomological evaluation network 35. Entomological evaluation activities centred on the tributaries of the Oti and Mo in Togo, and the Upper Oueme in Benin. 36. Sixteen (16) catching points were followed up by 4 capture/dissection teams Hydrology 37. Since the beginning of SIZ, 19 water gauges have been utilised each year for larviciding. The national hydrology teams of Benin and Togo are in charge of the upkeep of the network. 38. The flow rates recorded in the Oti and Oueme basins were in excess in 2003 and2004, as compared to those of 2000 and2002 . 72010612005 For the January-April 2005 period, the flow rates recorded were lower, as against those recorded in 2004 for the same period. Larviciding 39. Aerial larviciding of the tributaries of the Oti was disrupted from January to May 2005. Treatments were suspended in the first and second weeks of January, following Poor weather conditions in the harmattan season. A month later, the outbreak of socio-political disturbances in Togo also brought about complete cessation of aerial larviciding for three weeks in February (week 6,7 and 8 ) and inApril-May (weeks 16, 17 and 18 ). All these suspensions occurred within an unfavourable entomological context in the Keran basin. It must be noted that 100% of treatment circuits were supervised by SIZ technicians. 40. Except the weeks in which there were social upheavals in Togo, larviciding of the Mo, Oti, main Oti River, and Upper Oueme was entirely carried out on the ground by the entomological evaluation teams from ]anuary to May. The teams also carried out ground larviciding in the Keran and Kara basins, as a supplement to the aerial larviciding, or during the time aerial larviciding was suspended. STOCK: A residual stock of insecticides at the end of 2005 larviciding activities is estimated to be as follows: 3 100litres of temephos, 25 500 litres of BTH14, 3 500litres of Permethrin,T 700litres of Pyraclofos and 2700litres of ethofenprox . This is estimated to be worth about 523 355 US $ Dollars and could be sufficient for larviciding activities for up till July 2006 Entomological results 47. Entomological data analysis from 1999 shows that, overall, there is a gradual reduction in black{ly densities on the tributaries of the Oti. This downwards trend went on to reach unprecedented densities on the Mo in 2001 and on the Keran and Kara in 2002 From 2001 and 2002, considerable changes in the larviciding coverage in Benin and Togo were done, following good entomological results. Thus, larviciding of the tributaries of the East Volta Lake, the Mono, the Sio and the Kouffol were definitely suspended in 2001. A year later, aerial larviciding stopped on the Lower Oueme and its tributaries upon closure of OCP in 2002. The cessation of treatment brought about the increase in captures, especially in the basins on the Mo and Upper Oueme, located in the southern border of the SIZ. These bordering basins are, actually, regularly colonised by migrant females with the upsurge of monsoon winds. The exceptional high rainfall recorded in 2003 and 2004 also favoured the high local breeding of blackflies, with the filling up of several secondary tributaries with water, which had been dry for several years, and so were not planned for treatment. Fortunately, the ongoing high coverage of larviciding with insecticide in the SIZ enabled the blackfly density in the Oti and Oueme basins to be generally kept under control. 82010612005 t r42,From}anuarytomid-May2005,availabledataindicatedabetter entomological situation, as .o*pu'."Jio'anu, of 2004 for the s me period' A downwards trend in weekly .upt ru, *as observed in all the basins' except for the Keran, where a high rlensity *ur-."to'<iec1' Thus' the compulsory cessation of aerial and ground larvic-iding during. the social disturbances in Togo' did not allow this basin"to be effectively controlled' 43. Concerning the id,entification of infective larvae' it is to be noted that' in 2003' some onchocerca sp larvae, which were badly preserved' could not be identified by the DNA lab in ouagadougou' These larvae were, therefore, considered to be savannah Onchocerca aibulus ir. tft" luftulation of the transmission rate' The Keran and Mo basins were the most .or,.""t"d' Also in 2004' tfuee infective larvae collected on the Keran at Titira, o., ,i" Xu'a at Sarakawa kpelou' and on the Upper Oueme at Beterou could not be identified' ( Keran Tapounde,o 44. where as the reduction in blackfly densities' which started in1999 continued to reach orrpr"."d".r,"d 1"*r"1, in 2002, ih"r" has, at the same time' been a gradual increase of corrected ATps up to zooi'tcorrected ATP of 109)' In 2004' these ATPs 45 Even if the local production of blackflies, due to the exceptional rainJall levels of 2003, and the inadequacy of high water larvicides (stocks meant for this having been storen in cote d,Ivoire in 2002 during the socio-poiiti.ul upheavals) could partly explain the entomological situation of 200-3, this upwards trend of ATPs at Tapounde raises a lot of questions (resumptlon-J utiit'ity o? residual parasite reservoirs in the area, migration of populations * ,irO, .r"* .rr"s of infesiation or low ivermectin coverage etc). Investigations ur" ,r.,J"r*ay in this basin for a better understanding of the phenomenon' Notransmissionwasobservedforthe}anuary-May2005period. came down from 109 to 14' @ Titira 46.Azigzagevolutionoftheblackflydensity.o:"dwasnoted,withageneral downward trend of captures up to iiOZ,'und'a peak in 2003' This is due to the s rne reason mentioned above. Similarly, ,h" tot'"tted ATPs dropped from 128 rn1999 to 65 in 2001, and then progressed ,n u-igrugfashion, with a p.ut of 97 in 2002 and 105 in 2004 Notransmissionwasobservedforthe}anuary-May2005period. @ KouPorgou 47. Excellent entomological situation' Corrected ATPs went down from L4 in 2003 to 0 in 2004. Notransmissionwasobservedforthe}anuary-May2005period. 9 2010612005 ( Kara basin 48' The entomological situation remained satisfactory overall until 2003 at LandaPozanda and Sarakawa Kpelou. From 2004, though the corrected and crude ATps onthese points are still lower than L00, the upwardsLend of these parameters calls for a reinforcement of larviciding and rarvae prospections in the basin. No transmission was observed for the ]anuary-Muy 2005 period. € Mo basin 19_ Following the treatment suspension of the basins located in the South of theSIZ in 200-1., the massive inIlux of females into the Mo basin, aided by the monsoon winds, increased the transmission risk in the area as from 2002. Thus, an increase inthe corrected ATPs from 104 in 2002 to 271 in2003 was observed at Bagan and from 0 in 2002 to 91 in 2003.at Mo, thougl b]!ng rates dropped from g1 femaie s/ rrran/ dayin 2002 to 57 females/man/ day in 2003 ui Brgur, urd ,"*uined the same in Mo (16females/man/ day). Corrected ATPs of zzt it Bagan and 91 at Mo were broughtdown to 29 and 42 respectively in 2004. At Alehlride, the situation has remained excellent since 7999. No transmission was observed for the January-May 2005 period.( Upper Oueme basin in Benin 50' The entomological situation remained excellent at Wewe and Barerou. ATps atWewe were nil in 2003 and 2004. At Barerou, the corrected ATps were 2g in ZO02,1gin 2003 and nil in 2004. No transmission was observed for the January-May 2005period at these two points. However, at Wari Maro and Beterou, corrected ATps hav-e been going up since 2004. At Wari Maro, these corrected ATps went from 44 in2003 to 137 in 2004. At Beterou, they went up from 3g in 2003 to 113 in 2004.Apparently, the reduction in biting rates at Wari Maro and at Beterou in 2004 was not enough to bring down transmission. This area has to be given some special attention in 2005. B- Aerial contract t 51' 2005 marks the end of the first three-year contract signed between \AIHO andthe Evergreen Helicopter Company. one irelicopter was under contract and 636guaranteed hours were provided to carry out larviciding of the tributaries of the Oti and Upper Oueme. arrangements have to get underway now to negotiate the second contract, since a relatively Iong time is needed to come to an agreement. A Summary of the aquatic enaironmental suraeillance of (Nooember 2004 - April200s) 52' Aquatic surveillance during the 2004-2005 campaign was more regular, as compared to the previous one. of the three stations seiectid, sampling was carried 20t06t2005 l0 out without a break, from November 2004 to April 2005. The aquatic habitat quality of the Beterou station on the Oueme did not allow for regular sampling. 53. The use at the sampling points of only one round of a larvicide, known to be non-selective, in relation to the non-target fauna, was noted during this surveillance campaign. The larvicide in question is Pyraclofos, used in November 2004 at Titira. The other insecticides used (Vectron, Temephos, Vectobac and Teknar) are known to be very selective and not harmful to the non-target fauna at operational doses. 54. Regular sampling, coupled with the use of very selective insecticides for non- target fauna made it possible to identify a varied fauna of aquatic invertebrates. 55. On the Oueme at Beterou, in comparison with the sampling carried out between L985 and 1995, the samples taken at the station in 2004 enabled the identification of 4 additional taxa (Zygoptera, Hydrophilidae, Sysiridae and Tipulida) through the combination of the two sampling methods. 56. At Landa pozanda on the Kara, the surveillance of aquatic invertebrates started during the previous campaign in January 2004. This last surveillance campaign from November 2004 to April 2005 made it possible to identify four other taxa (Euthyplociidae, Neoperla sp, Oligoneuriidae and Ecnomidae) at the station. 57. On the Titira point on the Keran, four new taxa (Euthyplociidae, Tricorythidae, Neoperla sp, and Tipulidae) were identified during the period between November 2004 and April 2005. 58. Fluctuations were observed in the total fauna numbers on the rocky slabs of the river bed, due to the variation in quality of the aquatic habitat. The months beginning the loilr water-level period (November, December)'had, on the whole, few organisms 59. Very selective anti-blacl.Jly insecticides, such as Vectobac, Temephos, Teknar and Vectron were used, as a matter of priority, and this made for the protection of non-target aquatic invertebrates during the surveillance period between November 2004 and April2005. 0 Summary of the presentation of Ghana 60. The goal of the program is to control Onchocerciasis as a public health problem in Ghana; to integrate the program into the Ghana Health Service delivery system. The Oncho program merged with the LF prograrn in 2003 and a national taskforce was created. The LF taskforce was expanded to include five new members with expertise in Oncho Control to form a Joint Taskforce for the two programs. The taskforce is co-chaired by the Deputy Minister of Health and the Director of Public Health. ll201061200s t The taskforce is working closely with the national program management in seeking closer collaboration with various stakeholders such as World Visions International, Sight Savers International and the Research Institutions in Ghana. Epidemioiogicai Surveiilance 6l The epidemiological evaluation was done in September in villages located along the Pru River Basin; one conununity was inaccessible. Out of a total of 4689 people registered 49.9y, were males and 50.1% were males Of a total of 2400 examined 213 were positive (8.9%) .The Community prevalence ranged from 0-21.9%. Males(119) were more affected than Females (94 ). Most of those with total blindness were below 20 years old. 62. All planned CDTI activities were completed in the SIZ and non-SIZ areas in BA for 2004 Reports available were received from the Central and Western RegionsReports from Eastern and Volta Regions endemic for Oncho are still being awaited(activities re-started with support from SSI) Therapeutic coverage in the Brong Ahafo Region was70.9% Entomological Surveillance Activities 63. The selection of blackfly catching sites was done in the second quarter of the year 2004. This was followed by( sensitization of health workers at the regional, district and sub-district levels and community members( Identification/ Selection and training of focal persons at each level( Selection and training of vector collectors and community health workers( Establishing a system of collecting and transporting preserved black flies through the national level to Ouagadougou. 64. In the Brong Ahafo Region the last entomological activities took place in 2003 in Wenchi district in Bui village(Black Volta Basin), Atebubu district in Asubende village (Pru Basin) and Nkoranza district in Tanfim village(Pru Basin) An 8-hourly catches was done at all the catching points for 6 days in Tanfim and 7- days in Bui and Asubende 65. The results of this survey showed that in Bui out of a total of 4382 flies caught, 2 were infected and 83% being nulliparous. In Asubende, 1951 flies were caught and out of these 14 were infected of which 8 had larvae of stage 3 in the head. About 52.5% were nulliparous. In Tanfim, 650 flies were caught, none was infected and76o/o were nulliparous. 66. Advocacy and Sensitization is done prior to the implementation activities. There is need to develop and implement a joint sensitization strategy with LF. There is an urgent need to train the new programme team to effectively take up activities Ivermectin is ordered through the WHO/Ghana country office. The National 1220t06t2005 t 69 70 secretariat then distributes it to Regional medical stores for all oncho regions. The Regional focal persons are responsible for distribution to the districts. /- rr-----^-^ n^^.-,=*noo fat nnnh.r control consist of 3 members at the national levelol , flullldrr I\EDULrILED riir vi.Lr'v ! , one entomologist, one Regional focal person for each endemic region and Community volunteers for treatment at community level. Financial Contribution of Partners is as follows: 68. SIZ provides funds for activities in the Pru River Basin (CDTI and Epidemiolo gical surveillance) Sit fo, supiort of activities in Volta, Eastern and Ashanti Regions and \AIVI for the Western Region. The Government of Ghana (GOG) provides funds for all other endemic areas. Challenges consist in( Improving ownership at all levels of the programme( Inadequate staff( Addressing issues of Transportation, Incentives compilation and rePorting and Delays in data Issues of concern Health staff and volunteer attrition & fatigue Incentives offered by "rich programmes" e.g. National Immunization Days (NrD) Community boundaries New communities (ProbablY hYPo) Drug Reaction Misinformation about. $DTI 7L. The Ghana presentation was done by SIZ management in the place of the national coordinator who was absent because of illness. After the presentatiory the Director of ApOC/ SIZ explained to the committee that because of the lateness in receiving the information about Dr Gyapong's illness it was not possible to make arrangement for his rePlacement. 72 The Director then inJormed the committee about his meeting with the national oncho team last February in Accra. During this mission he also met the Director General of Medical Services. What transpired from the meetings was that there was a general good disposition of the national progamme to continue collaboration with 6lz/ npoc and the coordinator promised to send pending technical and financial reports as soon as possible. As Dr Gyapong explained, delays in sending these reports is usually the consequence of decentralization and the integration of Oncho, LF and other diseases at the district level. The frequency of sending results and returns to the central level depends on the planning at the district level. xq : F t-c F.: zg Discussions 20t0612005 l3 0 Summary of Guinea presentation 73. The activities carried out in Guinea are under the implementation of the action plan of the National Oncho and Blindness control Programme (NOBCP) in 2004 and from January - Muy 2005. 74. They centred on: the supplying of Ivermectin to the DIrS , the training of health workers on the use of ONCHO picture boxes, ivermectin distribution, payment of fuel costs to heads of health centres involved in CDTI, epidemiological evaluation of (52 villages in 2004 and 35 villages in 2005) in the SIZ, and the supervision at health centres and at village level. 75. In 2004 for the first round of treatment wit ivermectiry 2411 villases were treated out of the2411, planned for in theSIZ, i.e. 100 % geographic coverage, and 687,1,46 people were treated with ivermectin out of 872 954 people registered in the villages under CDTI, i.e.79 %. Contrary to 2003, the second round could be organized but for lack of Ivermectin treatment could be carried out only in 20 health centres out of the 58 in the SIZ in Guinea. 76. Thus, 1003 villages out of the 2 411. planned were treated, i.e. a geographic coverage of 41,.6 %, and 767,598 people were treated out of the 872,021 persons registered in the SIZ, i.e.19.27% therapeutic coverage. 77.In the non-SIZ areas, treatment was carried out in 4 951 villages out of the 4 959 planned, i.e. a geographic coverage of 99.839o, and L 598 150 persons were treated out of the 2 011 806 registered (79%). 78. lt should be noted that as a whole, the majority of the eligible villages for treatment were treated in2004, with coverage rates varying from 64% to 92 %. 79. 1n2005, as from January, the coordination of the NOBCP has supplied the DIIS of all areas (SIZ and non-SIZ) with Mectizan for the first round. A total of.6,362,500 tablets of Mectizan of 3 *g were distributed. O.ty results for the SIZ area are available to date (1st round) and are as follows: 80. Two thousand four hundred and ten( 2 410 )villages out of the 2,41,2 planned were treated from January to May 2005, and 685 542 registered persons, out of 866,405 were treated. The geographical and therapeutic coverage rates are 99.5 7, and79% respectively. It must be specified that only two villages were not treated in the health centre of Kintinia (DPS Siguiri) because they were to be evaluated. Training of health workers on the use of picture boxes: 81. As part of the follow-up and enhancement of community-directed distribution of Ivermectin, the Ministry of Health, through the National Oncho/blindness control Programme, in partnership with Hellen Keler International (HKI) and Sight Savers International, organized in Faranah (1't - 2"d April 2005) and in Mamou (from 4tt' - 20106t2005 t4 5th April 2005), two training trainers' workshops on the use of ONCHO picture boxes. It should be specified that the picture boxes designed by the Programme' with the financial support of HKi, "o*prir", i8 boarcis reiati.g to the definition, clinical signs' Eansmission, treatment of onchocerciasis, the side effects of Mectzan, height measurement, nuisance, the incentives (motivation) of Community distributors (CDDs), census and the recording of treatment data' gZ. It was thus deemed relevant that before making this picture box available to Health centres covering the villages involved in CDTI, beneficiaries should be trained on its use. 83 The following participated in the training : 7 doctors in charge of disease control (Faranah, Dabola, Dinguiraye, Kissidougou, Mamou, For6cariah et Kindia; 47 health centre chiefs of Provincial Health Directorate (DPS) the officer in charge of LTO of the DIIS of Dinguiraye; 6 Oncho worke.s" transferred to the DI]S of Faranah, Dabola, Mamou and Forecariah. 84. During this training, one day of practice was organized in seven districts of Faranah and Mamou. To this end, 55 Community distributors of Ivermectin attended the hands-on training with enthusiasm. It should be noted that prior to producing the final version, a pre-test session of this picture box was carried out in ilIu*o, ilr., lunrury 2005 and i., fort villages under the prefectures of Soyah and 85. The training of the Cornmuniti Distributors using such picture boxes appeared to be of great importance because, the latter had hitherto been trained only through interpersonal communication, without visual aids. Payment of fuel allowance to health workers: 86. Payment of fuel for agents for the re-training of Community distributors, and for the distribution of Iverirectin by CDDs was effected. An amount of GF 52,222, 500 was thus paid to the 212 heads of health centres, to the 24 teams of the DPS and to 7 DRS. Supervision 87 The Supervision objectives were: To insure good progress of the first round treatment in 2005 To Determine the level of knowledge of CDDs on CDTI To Sensitise populations on onchocerciasis and its treatment 2010612005 l5 - To Determine the level of involvement of sub-District Officers and chairpersons of CRD in the implementation of CDTI. - To insure the existence of management tools. 88. Methodology consisted in making a random choice of the health centres to be visited and the control of management tools (stock cards, books and measuring stick). 89. The mission took place from l.'t to 22"d April 2005, and the supervision team visited 6 DI5 teams, 23 health centres in the SlZ, and2 DRS teams. It must also be underscored that during this supervision, 77 villages under CDTI were visited and everywhere the team met the authorities of the sub-District and of the members of the rural development committee. Results: 90. The team noted the following points : - Existence of Community distributors in the visited districts, i.e. two CDDs per village, often males and not re-trained in some areas on the new integraied approaches of CDTI, especially the screening of vision. - Existence of management tools (books, measuring sticks) in the visited villages. The distribution registers are badly filled out in some places (the child coluriru, FG, patient or refusal columns are badly traced or do not even exist), the column of Visual impairment and Trichiasis/Trachoma does not appear in the treatment register in 12 districts out of 77; - Insufficient'Mectizan quantities served in certain villages hence partial treatrnent (according to the distributors and contents of treatment registei); - Low supervision and re-training of CDDs by the head of centre according to CDDs themselves; - Involvement of the sub-district authorities in CDTI (sensitization and community mobilization for treatment with ivermectin); - Ivermectin distribution for the 1't round in 2005 was on-going in the visited districts; - Non-screening of visual impairment and Trachoma for lack of training of CDDs. - Ivermectin is well appreciated and requested by the population - The distribution of Mectizan by village is not recorded in the Stock card in the health centre of Nounkounkan (Siguiri DpS); - Health chart not posted, as well as list of villages under CDTI in the health centre; 20t06t2005 16 - Good knowledge about the oncho disease and its vector by the heads of village' where the --- bOU activitY is well conducted; 91. Planneci soiutions: - Feedback was given to administrative authorities (sub-prefects and chairpersons of theCRD)ineachsub-prefecture,aSwellastoDlrsandDRSteams; - For better enhancement of CDTI in all the areas under ffeatment' it was suggested that a closer r"flr"irr"n of CDDs by joint DPS and national Coordination teams beundertak".,utth"rateofonceperquarter. -Continuationofsensitisationoflocalauthoritiesinordertoreinlorcetheir involvementintheCDTIprocesswherethathasbeenlacking; - Considering that rural radios are very mucf patronized by the communities' it was recorunended to strongly .rr" ih"'" channels to diifuse messages calling on population, of an" vi[afes foriollow-up of treatment with ivermectin' Epidemiolo gical evaluation 92. In 2004, 52 villages were evaluated in the basins of the Upper Niger/Mafou and the Tinkisso, with results as follows: 2l villages out of 52 (40'38 %) had 0 % prevalence; 27 vlllagesor, of SZiSt'OZfinaa a prevalence rate lower than 5 % ; 4 villages orri of 52 d,'7%)h:9 u prevalence above 5 %' These were: @ Boroto on the Tinkisso (6'6%); @ Walia Dabourou on the Niger (8'7%); @ Mamouria on the Niger (12%) ; @ Herako on the Mafou (5'3 %)' gs.Thecommunitymicrofilarialload(CMFL)waseverywherelowerthan0.5 Hit#'; tTIn", v,lages were evaruated in the same basins, and the results obtained 6"1"rT,fliL""H" the Niger;5 villages on the M1:: and,\7 villages on the rinkisso; O 15 Villages out of ZS\+Z'AS'|) had a zero prevalence rate; O 19 villages ."i "f aS 1b+'ZA 7") had a prevalence below 5 % ; @ 1 village out of 35 had a prevalen." ubot'" 5 % ; this was Serekoroba (5'4 %) on the Mafou 94.ItshouldhoweverbenotedthatinthevillageofYalawaontheMafou, though the standardized preval".r." i, lower than2i, a9- year old girl who was negative tn20[2,was found to be .urrylr',g microfilar.iae in 2005' for reasons of non- treatment with Mec tizan. A 20- V"'rt [fa boy still remains positive during 3 successive evaluation s (1999 -2002IZOOS); and yet he takes Ivermectin every yeat' according to him. 2010612005 t'7 t 3T *"1o that greater vigilance must be accorded this area, and efforts continuedboth on the entomological and CDTI levels. 0 Summary of the presentation of Togo 95' From Lst JanuarY to 1st June 2005, the activities in the SIZ and non-S IZ arcas ofTogo could be summed up as follows: - Training/re-training of CDTI respondents in the field. - The supply of the regions with ivermectin - The annual review of activities of 2004 - Production and supply of regions with household registers - Procurement of computer equipment - Installation of a new application software for input and management of CDTI data - Prospection of villages for epidemiorogical evallation - simple epidemiological evaluation of sentinel villages in the sIZ. Thus 96' A total of 198 Persons were trained ancl/or re-trained, of which 1g3 were inthe SIZ and 15 in the non-SIZ area. In the SlZ, the funds used were fromv{lfo/sv, and in the non-slZ the funds were from ssl. I 97. iv All the five regions (SIZ and non-SIZ) involved in CDTI are supplied with ermectin 98' Six thousand(6000) household registers have been printed with the financial assistance of SSI, and a community contribution of CFe gOO per register for thewhole country; they are already arriiluble in almost all the regions. ( 99' The annual review of activities of 2004 took place from 23.d to 25h March Atotal of 50 participants from all levels of the health structure of the country attended the meeting. At the end of the exercise, the review made 1.2 recorrunendations for the various actors.. 100' The national coordination office bought a computer and installed a new application software for the input and maiagement of cort data, thanks to thefinancial assistance of the SSI. 101 Prospection oJ 30 villages and simple epidemiological evaluation of 26 villages was carried out. A total 4919 perso.,, *Lr" examined,306 of. which were P!1i!ive, giving a-standardized prevalence rates of between 0 and 23%, anda CMFL of 0'00 to 0.21. The lowest age of the positive persons is in the age bracket of 5-9,including two 6-year old girls. 702' As a precautionary measure, the first round of ivermectin treatment, whichnormally starts on 1't April, was postponed to May due to the elections. 20t06t2005 l8 L03 In the area of funding, the NOCP in 2004 and 2005 benefited from the financial assistance of WHO/SIZ, and NGOs like SSI, AFROPOC, as well as from the Ggyefnment Of TOo.t and thp cornmrlnitv. 104. Finally, the tentative plan of action for 2006 for WHO /SlZ amounts to CFA 9,245,921,, and will cover CDTI and epidemiological evaluation. 0 Summary of the presentation of Benin 105. In Benin Oncho control activities covers 5L cornmunes, of which lL are in the Special Intervention Zone. 106. With respect to CDTI, Benin has implemented six activities for 2004: - Departmental workshop on information and planning at Natitingou on 30ft March 2004 -Training of health workers at DJOUGOU on the 1't 2"d and 3'd April 2004 - Training of CDDs - Sensitisation of population and mass treatment with ivermectin - Supervision - Treatment Coverage survey 1.07. At the end of this series of activities conducted in April 2004, 1553 villages were treated, out of 1575 planned (i.e 98.60% of geographic coverage). In all the 11 cofirmunes,502,719 persons were treated, out of the 62L,680 persons registered (i.e. a therapeutic coverage of 80.86%). For this first treatment round, geographic coverage rates by cofiunune vary from 97.63% to100%, while therapeutic coverage rates go from 72.20% to 85.63%. A comparison'with the results of 2003 shows a marked increase in coverage rates. In spite of this good trend a lot more effort is needed to improve results in certain cofiununes. 108. Contrary to 2003, a second treatment round was able to be organised, and recorded a geographic coverage of 90.50% and a therapeutic coverage of 78.88%. These results denote a regression, as compared to results of the first round, and could be explained by the inadequacy of supervision. 109. It must be noted that the first round of treatment in 2005 has started and that partial results are available. For this campaign, particular attention was given to the gold-washers along the Keran River. 110 With regard to the epidemiological surveillance component, 20 villages were evaluated in2004, the results of which are as follows: ' l2villages out of 20 (60%) have a prevalence and a CMFL of zero. ' 5 villages out of 20 (25%) have a prevalence between 0 and 5% . 3 villages out of 20 (75o/o) have a prevalence higher than5%; the villages are: 20t0612005 t9 Kouporgou on the Koumorigou: L6.22%Koutayagou on the Koumongou : 6.74%Monnongou on the oueme: 7.6o/"The CMFL everywhere remained lower than 0.5 mf7'skin snip iii. it is worth noting that tor the village of Kouporgou, which has the highest prevalence rate, the downward trend is very clear, when a longitudinal analyrir is conducted. On the contrary, the stagnation observed in the other two villages, which have prevalence rates over 5% calls for greater vigilance and much more &ort, both in the area of entomology and that of CDTI. 112. As part of the implementation of activities, the prograrnme has difficulties, the topmost of which is the inadequacy of resources. In this connection, it is important to note that the prograrlme is also in charge of LF control, for which no additional resources have come in. Nevertheless the newly signed partnership agreement between the government of Benin and SSI will enable the availability of more financial resources. 113. A report on the finance situation for 2004 and on the implementation of reconunendations of the last session of the SAC has been presented. Action has been taken on all the recommendations. Summary of post-OCP activities in Benin 1'1,4. In the non-SIZ areas in Benin, epidemiological and entomological surveillance activities and community-directed treatment with ivermectin are on-going. 115 Epidemiological surveillance was organised in 2004 in 19 sentinel villages in Benin and the outcomes show in general good evolution of the indicators. 176 Concerning entomological surveillance, captures were made at three points in 2003, and at nine points in 2004. The results for 2004 are not yet available. For 2003, the catching point of Kaboua gave an infectivity rate of 0.042, which is lower than the threshold of 0. 5. The samples at the catching point of Atcherigbe were not analysed because of insufficient resources at MDSC. 117. With respect to CDTI, Benin organised treatment in 2003 and 2004, and outcomes were generally good. I. UPDATE ON THE SITUATION IN SIERRA LEONE 0 Progress Report of NOCP Actiaities in Siena Leone in 2005 118. During the first two years of SIZ in Sierra l.eone the attempt made to establish CDTI did not yield the anticipated results. The CDTI result for 2004 show that only about 28% of Total Population at Risk of getting Onchocerciasis was treated with Ivermectin. 20t06t2005 20 llg. Recent epidemiological and entomological studies show alarming indicators for the disease. Prevalenie of onchocerciasis can be as high as 66.8% and Crude Annual Transmission Potential as high as 3933 in some areas of Sierra Leone. l2O. In ]anuary 2005, the NOCP in collaboration with Helen Keller International (HKI), had conducted a Training of Trainers on the use of newly developed Information Education and Communication flEC) materials. These IEC materials will be used during sensitization to improve the knowledge of Onchocerciasis, its prevention and treatment within communities' 121,. Since then, the following activities were conducted by the NOCP in connection with these IEC materials: ( Training of Peripheral Health Unit (PHU) staff on use of these newly developed IEC materials;( Training of Community Drug Distributors on these IEC materials;( Joint supervision by NoCP and HKI during and after the trainings;( Launching of the newly developed IEC materials. 122. On the 28h March 2O05,The NOCP application for supply of Ivermectin by the Mectizan Donation Programme was approved. The tablets requested are expected in Sierra Leone in ]une 2005. 123. On the LLm March 2005, the APOC /SlZ oryanized a meeting in their office in Ouagadougou involving the World Bank, Sight Savers International (SSI) and HKI, wheie they made commitments to contribute to the funding of CDTI in Sierra Leone. 124. Between 28h March 2005 and 4h April 2005, the National Coordinator visited Ouagadougou with three District Medical Officers (DMOs) and discussed a Working Document prepared by Management of APOC/SIZ for the "Strategic Reorganization of CDTI in Sierra Leone". 125. On 19ft - 2-L't April 2005, the NOCP organized a WorkshoP on "Strategic Reorganization of CDTI in Sierra Leone" in Freetown in which officials of the Ministry of Health and Sanitation, WHO /SIZ, WHO Sierra Leone, WHO Geneva, the World Bank, Sight Savers International and Helen Keller International participated. 126. After 3 days of discussion of the Working Document on "Strategic Reorganization of CDTI in Sierra Leone", several recommendations were made including a suggestion that the document be accepted as CDTI Hand book for Sierra Leone. 127. After the Workshop on Reorganization of CDTI in Sierra Leone, the NOCP in collaboration with all its partners prepared a Chronology of CDTI Activities for 2005 - The NOCP is presently preparing letters of agreement for CDTI with the various Partners for signing and commencement of activities' 20t0612005 2l 1?8. Entomological surveillance in 2005 started in March with the monitoring of all the points monitored in 2003. 129. Results currentlv obtained show the following: 1. Most of the infective flies are forest flies. 2. All basins are showing crude cumulative transmission potentials above L00, except the Kaba basin which has zero transmission potential level; 3. Crude Transmission potential levels are higher in the Southern basins than in the Northern basins. 130. The NOCP in collaboration with the Management of APOC/SIZhas decided to conduct epidemiological evaluation in areas of Sierra Leone for which little or no data on endemicity exist. Epidemiological evaluation will be conducted in49 villages selected in these areas. The NOCP is currently on the process of signing a letter of agreement with APOC /SlZfor the evaluation to corunence. 131. The suggestion made by \AIHO Headquarter for the integration of Lymphatic Filariasis (LF) with CDTI was unanimously accepted by all participants at the Workshop in Freetown on Reorganization of CDTI in April 2005. Mapping for LF has already started on the 28ft May 2005 and treatment for LF will be integrated with CDTI in 2006. Discussions 132. Following the presentation of Dr Koroma, the overall remarks on the CDTI situation in Sierra L6one was made along the following points: c€ On CDTI: The following actions are to be undertaken: listing of the villages to be covered in the areas that are meso and hyper-endemic for Oncho; involving nationals especially at the district level as part of the decentralization process and for CDTI sustainability; studying the options selected for the installation of CDTI by phases, taking into account the priority areas, as defined in the working document of APOC/1Z, which was the basis for discussions during the workshop on CDTI, held in Freetown from 19 to2'L April 2004. ca On the entomological level: the committee deemed that it was necessary to maintain entomological activities, especially for following up the migration of savannah blackflies from the northern part of Sierra Leone to Guinea and Mali. The committee recommends the planning of periodic entomological studies on the impact of ivermectin on transmission, when CDTI is firmly established in the various priority areas in Sierra Leone. c€ On financial commitment: The meeting took note of the following: APOC/SV has a budget and funds available to cover the CDTI activities, epidemiological evaluation and entomological activities until 2007. The meeting took note that V'{HO/SlZ has already prepared letters of agreement to cover entornological activities, CDTI and epidemiological evaluation in 2005 20106/2005 22 I133 Concerning the financial contributions of the partners, Sfl has made commitments for a S-year period, while HKI has announced that it could make commitments for a S-year period, provicieci Oncht-r were iritegrateci iiito other ireaitii prograrnmes The World Bank announced a substantial contribution 134. Regarding sustainability, the meeting noted that the most critical concern was the continuous flow of financing of activities beyond 2007. It indicated that a lot of advocacy is to be made with partners, such as SSI, HKI, CBM and the World Bank to guarantee consistent financial assistance to ensure the conduct of post-SIZ activities. 135. The meeting took note of the on-going process of integration of LF into Oncho control activities, particularly through the mapping of LF, which was conducted with the contribution of SIZ ( by provided temporarily 3 vehicles for this exercise). l. PosT-ocP oNCHo SURVETLLANCE ACTTVTTTES rN NON-SrZ AREAS 136. Since the closure of OCP the MDSC has the mandate to insure the implementation of onchocerciasis surveillance activities with special emphasis on entomological surveillance in order to detect recrudescence of transmission. A network of capture has been suggested to the Countries. Samples of captured female flies were sent to MDSC in Ouagadougou. 137 The results of 2003 do not show any point reaching the warning threshold established for surveillance. It shogld be.noted t\at in 2004,.a11 the countries did not undertake entomological suweillance, and that the total numbers of flies collected did not meet the minimum required of 6000. This makes the interpretation of results difficult for decision-making. Actions are planned for addressing the situation, and preliminary results of 2004 have been presented. 138. The delay in identifying infective larvae has been made up. The results of infections of SIZ in 2003 and 2004 were presented. The missing identifications are due to bad operations on the field. The MDSC has also identified parasites from Equatorial Guinea under the elimination of Oncho on the Bioko Island. K. FINANCIAL AND ADMINISTRATIVE MANAGEMENT OF THE SIZ 139. The meeting took cognisance of the information pertaining to {inancial and administrative management in the SIZ. The Budget and Finance Officer of APOC (BFO/APOC) recalled that the budget covering activities in the SIZ comes from the balance of funds of the ex-OCP. Among the problems he raised was the delay in making funds available by some WHO country offices; also the issue of non- justification of funds made available to Ghana in 2004 to cover activities conducted was mentioned. As a whole, the meeting was informed that the rate of providing 20106t2005 :) returrls for the entire prograrnme was 92% n 2004 and 86% from January to June 2005. National coordinators were asked to take the necessary steps to submit returns within the required deadlines. After congratulating the SIZ Management on its financial management, the meeting expressed the wish that, for subsequent meetings, the presentation of the overall budget of SIZ be done with an indication of the major activities conducted. L. RECOMMENDATIONS OF THE SPECIAL ADVISORY COMMITTEE (SAC)TO THE APOC/SZ MANAGEMENT AND TO THE NATIONAL HEALTH AUTHORITIES CONCERNING ONCHOCERCIASIS CONTROL ACTIVITIES IN THE SIZ COUNTRIES. GUINEA SAC remarks on Guinea: 140. The national coordinator presented a detailed report on activities of 2004 and beginning 2005 in the area of training of top-level personnel of health centres, trainers, supervisors and CDDs. 1-41.. The problems encountered during implementation of activities in the field were noted, analysed and solutions proposed. The most worrisome was the case of the little girl in Yalawa village who was found negative in 2002 and has become positive in 2005 because she was not treated. And also the case of a Z}-year old boy who has been consistently positive in1999,2002 and 2005 in spite of regular annual treatment with ivermectin, according to him. 1,42. The Committee reiterates its recommendation of 2004 relating to the rehabilitation of. the entomological surveillance network in Guinea with the establishment of an inter-country surveillance network with Sierra Leone and Mali. IAtrhile expressing its satisfaction for the excellent work done, - The Committee recorunends that there is the need to analyse the possible causes underlying the difficulty in achieving the required coverage rate. - Following discussions and observations on the entomological and epidemiological situation of some "pockets", such as Yalawa, the Committee recommends that special and urgent attention (identification of sites, special follow- up actions) needs to be given to this area. GHANA SAC remarks on Ghana: 1,M. After reviewing the report of Ghana, the Committee is happy about the integration initiative of the onchocerciasis programme with that of LF eliminatiory as 20106t2005 24 well as the decentralization Process, and the take-over of activities by the regional and peripheral health facilities' 145. The Committee notes with concern that the definition of the area and the number of villages under slz isstill not precise; an$ that the prevalence of infection between 2003 and 2004 in most of the communities as weli as the prevalence of blindness especially in adolescu.,t'r,r, gone up' The Committee notes also that' the g""grrpni"aiand tirerapeutic coverage rates recorded are low' l,46.TheCommitteewasalsonotquiteh,pqywiththelapsesinthemanagement of the entomological component and^ the incoherence in the presentation of data in the texts and tables especially with r"spect to therapeutic coverage,rates and the prevalence of i.,f".ii# It particularly explessed its. dissatisfaction about the non- submission of returns for funds granted to the Ghana team by slz since 2004' L47. The Committee, however, appreciates the initiative taken by Ghana to mobilize resources from other purt.,"r, to ensure the sustainability of the prograrune' To the national team l4STheCommitteegreatlydeplorestheattitudeofProgllTTeofficerswhodo not respect commitmerits to r".rd finu.,cial reports to APO| /gZ' Such an attitude could have serious rePercussions o"in"-op"*tio"'.of the Programme' and cast a slur on the country's imuge' The committee recommends to: 1. Use criteria already in force to delineale slz' and select villages to be covered for the correct estimation of geographic and therapeutic coverage rates; 2.ImplementacoherententomolOgicalevaluationproglammeinlinewiththe network suggested bY MDSC 3. Intensify u??o.u.y with government and its partners for mobilising ."ror..", and for making human resources available; 4. Submit toslzManagement expenditure returns of funds granted in 2004' To SIZ Management 1'4gEnsureclosersupervisionoftheGhanateam,withrespecttoCDTI implementation. The Committee recommends that APoc/srz management approaches the concerned Ghanaian authorities to require regular financial reports,inconformitywithcommitmentsmadebythegovernmentofGhana. SIERRA LEONE 150. The Committee reaffirms, after the presentation of sierra Leone' that the situation in the country is worrisome and constitutes a major public health problem SAC remarks on Sierra Leone for the entire countrY 2010612005 25 I 151. The Committee notes with regret that CDTI has not been properly initiated for !!e past two years, since the therapeutic coverage rates for 2003^ and 2ti04 were only 34% and 28o/o rcspectively. 152. The Committee notes with satisfaction the CDTI reorganisation strategy that has been put in place by the country in collaboration with APOC/SIZ, up-on the recorunendation of the SAC and also the setting up of a new national management. This has permitted the start up of activities (training on information; education and communication, and also adoption of a schedule of activities for 2005). 153 To the National Team L.Draw up a detailed strategic plan for CDTI implementation, with the complete list of villages to be treated, population to be coverld and an implementation time- frame; 2' Implement CDTI gradually, phase by phase on the basis of feasibility criteria, while prioritising meso and hyper endemic villages, where the disease is a major public health and socio-economic problem; 3. Carry out epidemiological evaluation in the areas where endemicity-related data of the disease are insufficient or not known; 4. Set up an entomological evaluation network, in consultation with Guinea and Mali; 5. Collaborate with the national teams of Liberia and Guinea with a view to harmonizing the CDTI implementation time-tables in the villages along the corrurron borders; 6- Intensify advocacy for resource mobilisation so as to ensure prografiune sustainability. ToSIZ Management 154 The Committee calls on the APOC /SlZ Management to continue giving adequate technical assistance to the Sierra Leone team in the process of trlinin[ planning and the implementation of its strategic CDTI plan of action. 155 The committee appreciates the commitment of all the other partners especiallySSTHKI and World Bank in assisting the Government of Sierra Leone in the reorganisation process of CDTI. BENIN General comment 156 The Committee found the Benin report for 2004 highly satisfactory: a)Complete technical and financial reports using the recommended fo.mai, bi satisfactory geograPhic and therapeutic coverag", .; do*.,ward trend in prevalence rates. 20t06t2005 26 l- 157 SPecific Comments villages). term J 5 158 Recommendations 1 themselves l.Geographicalcoverage:Thecommrtteenotedthreen"crgingtrendof variationsinthereportednumberofvillagesanddrawsattentionto implicatio* for'oUiui.,i.,g ,"1irb1;;ograpf,iclt .coverage estimates a d for making .o-pu"'I" ;i ;"; gF"pttit t J'"iu g" o""' time' F or example : Marked variation were observed in the total number of planned villages earmarked fo, t."ut*"r,t to, round r iiSii"iUages) as comPared' to round 2 (1588 2. Tax imposed on Ivermectin: The committee notes the arrangement with Togo,formeetingivermecti"'"q'i'"1""t'fo'Benln'duetotaxleviedonthe importatior, of- -ir"rmectin by the Benin government' The committee is concerned that prevailing tax ,"g,tutiotts for"nenin wi||trav1 implications on access to lvermectin in the short i"'* and on therapeutic coverage in the long 4 Crossbordermeetings:Therewas.nocrossbordermeetingheldbetween Nrg".fr, iogo u,td-B"fiit i" 2OO4'to harmonize activities' IncentivestoCDD:IncentivesforCDDiscoveredundercommunityfunding managed'byperipheralhealthunits.Thecommitteealsolearnedofaplanby donors to maintain-u luurk"t funding' for meelllmonetary incentives for community,otrrrrt""r tealtt *ork"rr?rrcluding CD-DS. The intended practice .onni.,t wlth and threatens the CDTI policy' Budget -Attention was draw".lo-t-h" mentiongf WHO/ SlZasbearing the full implementation cost for core CDTI activities' This is an issue for concern with rejards to sustainability post SIZ' Incentives for CDD: Benin to continue with ComPensation strateSies'for comrnunity health workers, that are initiated and managed by community 2.Taximposedonivermectin:NationalonchoControlProgramme,National Committee for Oncho Control and APOC I Slzmanagem"I t-t fl::ate at the highest r",rJ-to outain tax free status for importation of ivermectrn' 3. Cross Border meetings: Programme Management for Benin' Togo and Nigeria ao orgu.,tr" f3, u *J",i.rg within tie next quarter to harmonize 2010612005 cross border activities 2'7 TOGO overall, available documentation shared by Togo, is suggestive of satisfactoryprogress towards meeting CDTI expectations foiz0o+. Hi-wever, inconsistenciesfound in the revised SIZCDTI report-concerning the validity of 'g"ogruphic andtherapeutic coverage rates. For example: a) nimber of villages (denominator) ghal8es significantly for each treat*".,t round; b) the number of persons treated ishigher than the number of ivermectin tabrets received. 1tr() t-. ^-- ^-- -1 ^iJY \renerai Uomments 160 Other Specific Comments 1' High Prevalence levels: The committee noted with concern the highprevalence levels for selected settlements in the Keran / Kara/ and Mo riverbasins despite high reported geographic and therap".rii" .orr"rrg". 74 of 22 villages surveyed showed prevalence rates above 5%. prevalence rates for thefour villages surveyed in the Keran, ranged from 7-1,% to 22"/o. 2' Actions taken post follow-up visits - The committee recognized the effortmade by the team to organize for field follow-up ,rists for obtaining stakeholder Perspectives and recorunenrlations to tackle the persisting highprevalence problem. The country report provides a detaited list of recorunendations suggested by stakeholdlrs to address the problem, but did not provide information about steps taken to act on the r".o.r*r,".dations. 1,61 Recommendations 1" High Prevalence level: More intense effort to achieve optimal CDTI coverage by ensuring: a) complete geographic coverage, b) treatment of all eligible population, c) field visit by tlie national team to find out the real causes for high prevalence in spite of high geographic and therapeutic coverage. 2' Actions taken post follow-up visits - The revised reporting format to allowfor an account of recommendations generated from field follow-up activities, as well as corrective actions taken. GENERAL RECOMMENDATIONS 1'62 Geographical coverage: Countries are to maintain a standard baseline listingof all planned villages {or treatment. Health workers are too to be oriented as part oftheir training, about the relevance of the baseline list and discouraged from personal 20t06t2005 28 adecisions to alter list. In the event field realities necessitates a change in the number of baseline villages due to disappearance of existing villages and/or emergence of new villages, the reason for the change in number of villages (that is new dpnnrninatnr\ rnrret he evnlainerl 1,63 Incentives for CDD: Countries to work out sustainable compensation strategies for community health workers, while taking into account compensation strategies that are initiated and managed by community themselves. 1,64 Reporting format: Country coordinators to revise the reporting format for a) relevance of content and b) ease of collecting and reporting on the required data 165 Reporting Expectations: Countries are to prepare a complete report (s) for the preceding year to show progress and achievements relevant to CDTI, epidemiological and entomological activities, as well as about available funds and funding sources. Countries are to also prepare and present a separate short briefing report about the current year work plan, budget and implementation progress. VECTOR CONTROL 166. The entomo-epidemiological results of 2005 are essential for analysing the trend of the impact of larviciding over several years, the Group recommends: - the continuation of on-going vector control operations, in line with the current protocol in use, and in conformity with the 2002 decision of the JPC of OCP. --that the analysis of eniomological'results be conducted, taking into account those of CDTI obtained in the same'basins. SURVEILLANCE OF THE ENVIRONMENT: Aquatic surveillance 1,67. The results of the aquatic surveillance presented to us are very encouraging. The aquatic fauna did not suffer any serious damage due to larviciding. This proves that the work done by OCP in selecting insecticides and developing treatment strategies helped to maintain a good balance between the environment and vector control. The Committee praises the work done by APOC/SIZ in the area of aquatic surveillance. 168. The Committee is also inJormed that an evaluation of environmental quality (the Millennium Ecosystem Assessment) was conducted for two years under the auspices of UN agencies. Sparing you the details of the report, which clraws one's attention to the general deterioration of nafural resources, it is worth underscoring, nevertheless, that the principal philosophy of this evaluation was to consider the natural environment as a source of wealth (fishery, crop/harvest) and services (water purification, for instance) for human consumption. This economic approach of the environment was privileged, conscious of the fact that a well-rnaintained 2010612005 29 envirorunent freely provides indispensable resources for human activities. This evaluation also recommended a more integrated approach to developmental and environmental issues. For instance, approaches that are too sector-based relating to the development of rural areas have lead, in the past. to the partial neglect of the consequences of these developments on the environment and health. And ye! the building of dams or the development of irrigated farming automatically bring about an increase in parasitic diseases, such as bilharzias, malaria, and even onchocerciasis. It would, therefore, be desirable if health and environmental components were obligatorily integrated into any new development project.. The countries concerned have the onus of changing the current practice, which gives priority to development without ensuring the availability of resources to protect the populations concerned. Here too, is a way of diversifying the search funding in public health. 1,69. In this light, the Committee questions national representatives about the interest their countries have in environmental issues in general, and specifically in issues relating to activities of the control of parasitic diseases, either by aerial spraying (aerial larviciding) or ground larviciding. It must be recalled that OCP trained several aquatic environment specialists in all the countries concerned, and the expertise acquired could be mobilizecl to address the issues of aquatic environment surveillance. 170. Most of the national representatives were positive in their view that there was the need to better take the environment into account. Nevertheless, it appears that this concern is most often just formal, or comes from other administrative quarters, and that some brainstorming needs to be done for actual operational implementation. 171. Recommandationonenvironnementalsurveillance that the various results on aquatic surveillance recorded in the SIZ areas, which are currently under larviciding,be sumrned up and used for the evaluation planned for this fall season. that national coordinators examine the feasibility of involving national experts in the surveillance of the aquatic environment, where insecticides are used, be it for aerial or ground larviciding, under vector or nuisance control. POST-OCP ONCHO SURVEILLANCE ACTIVITIES IN NON.SIZ COUNTRIES 172 The work done by the MDSC in this area was presented to the Committee. The effectiveness of the surveillance activity is, however, impeded by problems that have already been raised and discussed. These have to do basically with: - The insufficient contribution of countries; - The issues of the number of flies needed for interpreting results (6000 flies), of quality and transporting of samples up to the laboratory, - Communicating results to countries; - The issue of resources allocated to the Centre. 20t06t200s 30 a17g To reinforce the surveillance activity, the Centre plans a sensitisation tour in the various countries. In order to add.ress the thorny issue of fiy sampie numbers, w-liich are often insufficient, it might be necessary to review the catching and interpretation protocols' This measure is urgent, especially when some countries put in the needed effort required of them. Recommendation 174 Acknowledging the utmost necessity of epidemiological and entomological surveillance in t(e ietection of recrudescence of the disease and warning to countries, the Committee recommends advocacy with the various countries as soon as possible, and also supports the sensitisation initiative to be taken by the MDSC' CONCERNING MDSC 1TS The committee heard with satisfaction the presentation of the new Director a'i especially about the setting uP of governance bodies (board of governors and scientific board). Once again, ttre Committee congratulated the technical team for its high quality work Recommendations 176 The Committee reiterates the previous recommendations, thus: - pro*pt feedback oi results tp the countries, failure of which might i*pu.t rrcgatively the motivation of countries" - th; Direcior of the C'entre and the WHO/AFRO should find adequate funds for its operations; one should be weary about loosing highJevel staff to greener pastures' 177 The Committee expressly recommends that a more pragmatic attitude should lead to the review of ttre objective of 6000 flies per station, since this number is actually rarely achieved. A lightened protocol, with the purpose of assisting the countries in their decision, should be submitted at the next Committee meeting' ADMINISTRATION AND FINANCE 178 The Committee appreciated the presentation made and expressed the wish to have this exercise repeated at subsequent meetings' The Committee "n.tr.ug"s the SI2 Management to continue the optimum use of resources for the effective success of the SIZ. All should be done to ensure total success of CDTI in the SIZ. 2010612005 31 CONCERNING SIZ MANAGEMENT 179 In order to address the recurrent financial problems of the MDSC, The Committee: \ ) - .Recommends that the SIZ Management continues to give support to MDSC in ,y- order@llgliolthe identification of all the samples from siz ur"u. 'ittis arrangement will contribute to the efficiency of work done under sIZ. 190 Following discussions and remarks made about the entomo-epidemiological sifuation of some "pockets", such as Tapounde in Togo, urrd yalawi in Guinea/Conakry, the Committee: recommends that particular and urgent attention be accorded to these areas (special identification of sites, actions and follow-up). 181 Given the situation in Sierra Leone, the Committee recommends to the APOC/SIZManagement to continue to give all the technical assistance it could to the national team. CONCERNING OPERATIONAL RESEARCH 182 The Committee encourages countries to undertake operational research activities to solve problems, so as to enhance Oncho controi strategies. These activities should commit reasonable financial resources, and must not be an impediment to the smooth running of CDTI, whose objectives of optimal coverage must remain the priority. 183 The research issues identified by countries should be submitted to the Committee so it can ascertain their relevance. The detailed protocols may then be reviewed by'a virtual multi-disciplinary committee, which will follow up on implementation. Reports will be presented to the SAC during its next meeting. M. OTHERS Date and place of the next week 184 The next committee meeting would be held from Tuesday 06m June toSaturday 10ft June 2006 in Ouagadougou Operational Research 185 A research proposal titled ,, Les facteurs de r6sistance des communaut6s A la motivation des distributeurs communautaires d'ivermectine " was presented by the Togo national coordinator. The objectives of the proposal were io find out why communities are not motivating their community directed distributors (CDD) and tt determine the possible methods that communities could adopt for CDD motivation. ) 20t06t2005 )z The research problems identified in the Togo CDTI programme were listed and a brief descriptiln of the study methodology and proposed budget were provided' Lg6 The committee recognized the relevance of the research objectives not oniy to the Togo programme bui also to programmes in other countries. However, the committee commented that the research questions raised were too many and required focus. There was need to provide further clarity on the background inf^ormation on the proposed study area, giving details of proposed study villages, history of incentiv"r ir, ih"r" villages, coverage data showing trends and the effect of lack of incentives on achieving the desired coverage. Details of methodology need to be provided and the study tools carefully designed to ensure precision in questions astld and clarity in responses obtained, to ensure that the results can be interpreted and data analyzed at the end of the study. The objectives of the study call for the involvement of a multidisciplinary team of researchers, if the results are to be meaningful. Reference to pr"'t iorc work in this area is necessary for lessons learnt, and a brief summary of the curriculum vitae of each member of the research team needs to be provided. ,lBT It is essential to clearly indicate how the research findings will feed into the control prograrnme and how such intervention will be monitored, to justify the study u, op"rutioial research and not just another scientific study. The proposed budget is considered too high, and cannot be justified especially in the absence of detailed information on activities proposed and in which villages' 188 The committee therefore considers the presentation as a draft proposal and encourages the Togo team to refine and finalise the proposal, taking into considerition all above comments. The budget should also be revised and the proposal represented for review. Revision of the format of the annual technical report The national coordinators revised the reporting format of the annual technical report taking into consideration all activities conducted in the SIZ(CDTI, Epidemiological and entomological surveillance) N. ADOPTION OF THE SALIENT POINTS AND RECOMMENDATIONS OF THE THIRD SESSION OF THE SAC 189 The committee members unanimously adopted the salient points and recorunendations of the third session of the SAC O. CLOSING CEREMONY 190 The third session of the SAC meeting ended on Saturday 11ft June 2005 at 9 p.m. The Chairperson in her closing remarks thanked all the participants for their ictive contributions. She particularty thanked the translators for staying on after 20t0612005 a:)J lormal working hours in order to insure continuous translation. She then suggestedthat the next meeting starts in the morning instead of the afternoon. 191. The committee mem-bers organised a special fare',^,,ell ccremony for Doctor Seketeli who is retiring next September 2005, Doctor Y6bakima on behalf of thegroup thanked Doctor Seketeli for his immense contributions to the control of Onchocerciasis. They wished him a pleasan! well deserved retirement in his village.In his response, Doctor Seketeli who was visibly very touched thanked the committee members for the honours they are giving him. He said he wished his wife was here for she is the one to receive these honours, for all that she has gone through. He then added that he is going on retirement with the hope that he had'put in a good fight. The group then gave him a symbolic gift and a group picture was taken to immortalise the moment. 2010612005 34 ANNEXES 2010612005 ))

WORLD HEALTH ORGANIZATION AFRICAN REGTON SPECIAL ADVISORY COMMITTEE Third session Ouagadougou, from 07 to 11 June 2005 ORGANISATION MONDIALE DE LA SANTE REGION DE L'AFRIQUE@ Soecial Intervention Zones (SIZ) lor., d' lnterventions SP6ciales AGENDA A. Opening Session B. AdoPtion of the agenda c. Review of the recommendations made at the second session of the Special AdvisorY Committee' D.SalientpointsofthereviewandplanningmeetingoftheslZactivitiesin November 2004' E. Elements of the tenth session of the Joint Action Forum (JAFr0) and of the 109th sessionoftheCSAinrelationwiththeactivitiesintheSlZ. F. Information on the preparation of the mid-term evaluation of the activities of the Special Intervention Zones (SIZ)' G. Information on the preparation of the second and last aerial contract for the vector control activities in the SIZ' - ' H. presentations of Progress repor{ 2005 in the SIZ and tentative planning of onchocerciasis controiactivities in the SIZ in 2006' I. Update on the situation in Sierra Leone J.Post-oCPonchosurveillanceactivitiesinareasoutsideSlZ' K. Administrative and FinancialManagement in the SIZ L. Recommendations of the Special Advisory committee (sAC) to the APoc/sz Management ;;;; tir" Nutionul Health Authorities concerning onchocerciasis control activities in the SIZ Countries M. Other maffers -Dates and place of the fourth session of SAC -Operational research -Revision of the reporting format of the annual technical report N. Adoption of the salient points and the recommendations from the third session of the SAC O. Closure 2010612005 io WORLD HEALTH ORGANIZATION AFRICANREGION SPECIAL ADVISORY COMMITTEE Third session Ouagadougou, from 07 to I I June 2005 Tues dav 005 15h00 - 1shl5 15h1s - 15h20 15h20 - 15h35 l5h3s - 15h50 15h50 - 16h20 t6h20 - 16h40 16h40 - 17h00 17h00 - 17h15 17h15 -17h45 Wednesdav 08/06/2005 08h30 - 09h10 Point H @ ORGANISATION MONDIALE DE LA SANTEREGION DE L'AFRIQUE Special Intervention Zones (SIZ) Zones d'Interventions Sp6ciales ANNOTATED PROVISIONAL AGENDA Point A: Opening Introductory remarks by the Director, APOC (l5mn) Speech by WR/Burkina Faso Speech by Director a.i, MDSC Point B: Adoption of the agenda (DTL: 5mn) Point c: Review of the recommendations made at the second session of the SpecialAdvisory Committee (DTL: 15mn) Point D: Salient points of the review and planning meeting of the SIZ activities in November 2004 (DTL: l5mn) Point E: - Elements of the tenth session of the Joint Action Forum(JAFr,) in relation with the activities in the SIZ (TL: r5mn) - Elements of the l09th session of the csA (DIR/Apoc: l5mn) Coffee break Point F: Information on the preparation of the mid-term review of the activities of the Special Intervention Zones (chair person of the SAC:20mn) Point G: Information on the preparation of the second and last aerial contract for the vector control activities in the sIZ (DIR/Apoc & TL: l5 min) Discussions on the presentations on the points C, D, E, F and G Progress reports 2005 in the SIZ and tentative pranning of the onchocerciasis activities in the SIZ in 2006 - Report of the vector control activities (CVCT: l5mn) - Report on the entomological activities in Sierra Leone by the National Oncho Programrne Manager of Sierra Leone:(l0mn) 20t06t2005 3l 09h10 - lohl0 10h10 - 10h30 10h30 - 12h00 12h00 - 15h00 15h00 - 16h00 16h00 - 16h20 16h20 -17h20 17h20 - 18h30 Thursday 0910612005 08h00 - 09h00 09h00 - 10h00 10h00 - 10h20 10h20 - 12h00 12h00 - 15h00 Lunch break 15h00 - 16h00 Point L (continued) 16h00 - 17h00 - Results of the aquatic monitoring (TL: 15mn) point H (continueii): Prugress reports 2005 in the SI7, F.piclemiological evaluation and tentative Plan of Action and Budget 2006 by the National Oncho Coordinators of Benin (30mn) and Ghana (30mn) Coffee break point H (continued): Presentations by the National Oncho Coordinators of Guinea (30mn), Sierra Leone (30mn) and Togo (3Omn) Lunch break Discussions on the presentations on the point H Coffee-break Point I: Update o the situation in Sierra Leone point J: Post-OCP oncho surveillance activities outside the Special Intervention Zones - Introductory remarks (DIRA'IDSC a'i': 10mn) -Reportonentomologicalsurveillanceactivities(MDSC: 10mn) Report on epidemiological surveillance activities (MDSC: l0mn) Reportonthepost-oCPactivitiesbytheNationaloncho Coordinators from Benin (10mn) ; Ghana (lOmn) ; Guinea (10mn) ; and Togo (10mn) Discussions Point K: Administrative and financial management of the SIZ Coffee break Point L: Recommendations from the SAC members to the APOC/SIZ Management and to the National Health authorities in the sIZ countries. Point M: - Other matters - Dates and place of the fourth session of the SAC 2010612005 38 Fridav 10/06/2005 09h00 - 10h00 10h00 - 10h20 10h20 - 12h00 12h00 - 15h00 15h00 - 17h00 Saturdav 11/06/2005 09h - 12h 12h30 - 15h00 Lunch break 15h00 - 16h00 16h30 - 17h00 Coffee break 17h - 18h30 Writing of the report of the meeting and recommendations Coffee break writing of the report of the meeting and recommendations (continued) Lunch break writing of the report of the meeting and recommendations (continued) Writing of the report of the meeting and recommendations (End) Presentation on operational research by Dr Karabou, National Coordinator of Togo Point L: Approval of draft of the report and the recommendations Point M: Closure 20/06t2005 39 woRLDHEALTIIc'RGANIZATIoN (@ AFRICANREGION ORGANISATION MONDIALE DE]'A SANTEDEI.II^N NE L'AFRIQUEItnJulvr t / ;H'"Tl Intervention zone's !slz) B p s 4e o u AGADou "ey, p:i;l{[Ti*[ru # sXf.T ?y fi-', 0 3 4 26 48 Tdl': 50 3429 53 -503429 59 -503429 3"' session du Comit6 Consultatif Sp6cial (CCS) -Ou"g"Aougou, 07-11 juin 2005 LIST OF PARTICIPANTS WHOiEXPERTS Prof (Mrs)Adenike Abiose Main Office lbadan' P'O' Box 29'711 Sightcare International Secretariat Ibadan OYo State, Nigeria ro T6l/Fax : (234)2810743 4 - E-mail 111 Dr Christian L6v6que Museum National d,Histoire Nature,e - Laboratoire d'Ichytologie, 43 rue cuvier - 75005 Paris Dr Mamadou Souncalo Traor6 ."nil.[riNational de la Sant6;ifi;; BdB' s,$:Xil; li,Yil, u74 E-mai,T6l: (223)222 64 9't Dr Andr6 Y6bakima Directeur, Centre D6partemental de d6moustication 35. avenue Pasteur giiOOFort de ntT:: -- Martinique rer. : 05 e6 60 3'7 2r -';;;' oi q?io 26 46 -;;it'' v"@Bjlfi]@e@121t il,S:?'ffll:H,T:li, 6340 Quadrangre Drive' chapre Hil NC 27517 usA Tel : 919-3 t 3-9163 g-rn"if , fy'umke I la(@r-ahoo'co'uk Dr Bernard PhiliPPon "ls.;;illea" it4oulin' 7s0l'1 Paris -.France T6l/Fax : 3l I 40 qqii'oi-'e-rn"lr: abplrilinponrij;)alroo'll' Benin Dr Valentine Kiki-Medegan Fagla ; " ;;;; ;;rtrice N atio n it'tPN r o' o 6- B P 2,s I 6' ;Z;;;{,'7;zs) 3t ii og t 33 8'7 17 - cerr *,,'f. itiia" i ""'ti; pn lobig)intnet'tri 2010612005 Cotonou - RdPublique du Bdnin - rni u il5i -'r",.;" C r 81 t1 - E-mail 40 Dr Franck Sintondji coordonnateur Naionat adjoinr/pNlo, 0I Bp gg2, cotonou - Bdninre]iFa1 : (229) 31 74 Og i 33 g7 t7 _ cell : (zzgl gz sl05 _ Fay n)o\ 72 e1 11 F _-_ .,pniobr@intnet.bj:sedjros@hotmail.ccom !-:^' \LL)i )i oi i; - b-niati; Dr Nouhou Konkour6 Diallo Coordonnateur National Oncho/C6citd/Guin6e Yirirj::..d:_la Santd publique, Bp 585 Conakry _ Guin6eTel: (224)25 33 7r - Fax : (224) 43 37 o7 -E-ma, : dnouhoufr@yahoo.fr Sierra Leone Dr foseph B. Koroma Programme Manager Sierra Leone, oncho control Programme, Ministry of Health and Sanitation, c/oWR Sierra Leone, p.O. Box 529 Freetown Sierra LeonJ P.O. Box Makeni Cell : (232) 7617 98 38 - E-mail : iwkoroma@,vahoo.co.uk Togo Dr Karabou Koffi potchoziou Directeur R6gional de la santd, R6gion de la Kara coordonnateur Nationar/pNlo, gF +sz Kara - Rdpubrique TogoraiseTdt : (228) 660 t7 t0 - Fax : (228) 660 04 t4 _ Cell : (zit) iiiit gsE-mail : karaboup@yahoo.fr ; kaiabou.potchoziou@cara#ail.com Guinea T SIZ / Mr. Ak6 Assi Chief Vector Control Team (CVCT) OMS/SZIONCHO, Bp 36, Kara_ iogo T6l : (228) 660 60 75 - Fax : (228) eA6 oe 26 - cer : (228) 94'1 7 136 _ E_mair : 4karsj@yahse=fr Dr Grace Fobi !!1{of orug Distribution Team (CDDT)OMS/SIZIONCHO, Bp 36, Kara _ Togo Tdl:(228)66060 75 - Fax :(228)660 06 26 - ceil:(228)9266455 - E-mair :g14eerqb!@yahae.rt MDSC Dr Brdhima Koumard Directeur a.i., Centre de Surveillance pluripathologique 01 BP 549 Ouagadougou 0l - Burkina Faso Tdl : (226) 50 34 29 53 - Fax : (226) 50 34 2g 75 - E-mair : koumareb@oncho.oms.bf Dr Yiriba Bissan Entomologiste 0l BP 549 Ouagadougou 0l - Burkina Faso 20t06t2005 4l T6l: (226) 50 34 29 53 - Fax : (226) 50 34 28 75 - E-mail : bissany@oncho.oms.bf Dr Laurent To6 Responsable, Laboratoire Biologie Moliculaire 01 BP 549 Ouagadougou 0i - Burkina Faso Td:l : (226) 50 34 29 53 - Fax : (226) 50 34 28 75 - E-mail : toel@oncho.oms.bf SECRETARIAT/WHO/APOC/SIZ Dr Azodoga Sdkdt6li Directeur du Programme, APOC 0l BP 549 Ouagadougou 0l - Burkina Faso Tdl : (226) 50 34 29 53 - Fax : (226) 50 34 28 75 - E-mail : seketelia@oncho.oms.bf Dr Laurent Yam6ogo Team Leader,SIZ lCoordonnateur du Bureau du Directeur, APOC 01 BP 549 Ouagadougou 01 - Burkina Faso T(:l : (226) 50 34 29 53 - Fax : (226) 50 34 28 75 - E-mail : vameogol@oncho.oms.bf Dr Lao Komlan B. Akpoboua Deputy Team Leader, SIZ 0l BP 549 Ouagadougou 0l - Burkina Faso Tdl: (226) 50 34 29 53 - Fax : (226) 50 34 28 75 - E-mail : akpobouaa@oncho.oms.bf M. Bamiky Tour6 Transport, Logistic and Maintenace Officer 01 BP 549 Ouagadougou 0l - Burkina Faso Tdl : (226) 50 34 29 66 - Fax : (226) 50 34 28 75 - E-mail : bamilq't@oncho.oms.bf M. Nikiema S6ni Pierre Data Manager Assistant, SZ 01 BP 549 Ouagadougou 0l - Burkina Faso Tdl: (226) 50 34 29 53 - Fax : (226) 50 34 28 75 - E-mail : nikiemasp@oncho.oms.bf Dr Mounkaila Noma Chief, Epidemiology and Vector Elimination Unit, APOC 0l BP 549 Ouagadougou 0l - Burkina Faso TEI : (226) 50 34 29 53 - Fax : (226) 50 34 28 75 - E-mail : nomam@oncho.oms.bf M. Saidou N'Gadjaga Information Technical Officer, APOC 0l BP 549 Ouagadougou 0l - Burkina Faso Tdl : (226) 34 29 53 - Fax :' (226) 34 28 75 - E-mail : ngadjagas@oncho.oms.bf M. Koffi Benoit Agblewonu Budget and Finance Officer, APOC 01 BP 549 Ouagadougou 01 - Burkina Faso Tdl : (226) 34 29 53 - Fax : (226) 34 28 75 - E-mail : agblewonuk@oncho.oms.bf Mlle N6n6 Oumou Keita Finance Officer, APOC 01 BP 549 Ouagadougou 0l - Burkina Faso Tdl : (226) 34 29 53 - Fax : (226) 34 28 75 - E-mail : keitano@oncho.oms.bf 2010612005 42 SPECTAL TNTERVENTTON ZONES (SIZ) ORIGINAL: English COT]NTRY Basins Administrative Division covered Renortins Pe (Month/Year): Date submitted -'i I I I I I I i I I I I I I I ANNUAL TECHNICAL REPORT I I I 20t0612005 43 II I I I I ANNUAL TECHNICAL REPORT ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. SIGNATORY of the report: National Coordinator Name Signature Date 2010612005 44 Acronyms 2010612005 45 Definitions (D Total population: the totalpopulation living in communities within the meso/hyper endemic areas. (ii) Eligible population: calculated as 85?6 of the total population in the endemic areas. (iiD Annual Treatment Objective: (ATO): the estimated number of persons living in areas that we intend to treat with ivermectin in a given year. (iv) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (v) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the zone (this should be expressed as a percentage). (vi) (vii) Epidemiological surveillance indicators Entomological surveillance indicators 20/0612005 46 Using the table below, fill in the recommendations of the last SAC and describe how they have been addressed. SAC session Table l: Follow-up on SAC recommendations No SAC RECOMMENDATIONS ACTIONS TAIGN FOR SAC ONLY (Please add more rows if necessary) 20106/200s 41 SECTION l: Background information Ll. General information llrite at the moximum, a one-page executive summary of the report Adminishation structure - Health system (specifu the number of health centres in the area). - Indicate the partners involved 20t06t2005 48 , SECTION 2: Implementation of CDTI 2.1. Period of activities Insert Plan of action indicating activities by month, which were implemented. ? 2010612005 49 t ota) o q) a V) o o9 o-EEo U o =EPE c=6tr ! L q bo o -9:BOEE o U =E .!. E c:9Ert) () CE D q) U of +oEFHE U =E -!, E 6:i\tr b0 Fi 6)e EE o Q AE rit d= (n .= .- -EQ5 z o *oEE U =EritL d:9E(t) l- U) O N \o N 0) o(j I -\ q) Uq) !? oL q)\ o N \) ciq) 5 k(c o >' 0)F o E 0) (d()k d{) (B o .o o o Cd o c) ! 0) o a c-it -l -oldl FI 2.2. Ordering, storagc and delivery of ivermcctin Table 3: Mectizan@ Inventory (Please add more rows if necessary) District Number of Mectizano tablets Requested Received Used Lost Erpired TOTAL - State activities under ivermectin delivery that are being carried out by health personnel in project area - Any other comments 2.3. Advocacy and Sensitisation State the number of policy/decision makers mobilized at each relevant level during the current year; the reasons for the sensitisation and outcome. Describe difficulties/constraints being faced and suggestions on how to improve advocacy. 2,4. Mobilization and health education of at risk communities Provide information on : The use of media and/or other local systems to disseminate information Mobilization and health education of women and minorities - method and response Response of target commu_nities/villages Accomplishments Weakne sses/Constraints Suggest ways to improve mobilization of the target communities. 20t06t2005 5r N ral c.r \o N q) .()()E ov o a)o0 E (.) t o dq o L(d o. 0)o d € C) d a 0)a o t bI) 0) -o o)r(I3 0) F oO o 50 ! 0) c) aaooed! O^96!o ou do!, €ga)7 to 9 c.r ts: b,s oo. oo qdoo. aa o= * o.r 6)i:tr- o,l I d -OEi o-9> ul e.c o^ :ESXcdd Eq6HOhnOP*H<.! oO'r a B q) .J \) q o\ q) o \ (J q) iiq) 5 F O o o. o do ^q !o .v!o c0 0.) E o(J +1 ot -l -oldlFI o0 i, e o o (_) ra N o o0(q o0Lo 9. I ; o lz 3s5c! T EAreF E=-3' aO o cg o o 006 o o o z F 9o(!o o r\ sR zl) o *Sr OE -Otr aoz F I 2.6. Capacity building 2.6.1. Training 20t06t2005 53 .t N \oO N bO o € o o \ 5 A B o 60 o\ o -B o\ sas d ln a s .E\ \ 6T !< i -ot< t; -a te 4 \) S q >\ q) L-' -a \) ri F- o (.) o. F a(-) (! o () 0) 0) .()H 0) d bI) F ii1 ol .oldlFI E A< e (, c) q) 0) o\ E o dL ch e U L() z F \ s o< i = 6v o-rF- f o c) c) v F th q) q) o Gq) la z q) 6 \ B = 0,) eg d ah o (J a q) z LF o () q) (J o\ l] F F ?) Trainees Type of naining CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(speci&) Program management How to conduct Health education Management of SAEs Data collection Data analysis Report writing Others (specifu) Table 6: Type of training done (fick the boxes where specific training was carried out during the reporting period) Any other comments 2.6.2. Equipment and human resources Table 7: Status of equipment (Please add more rows if necessary) *Condition of the equipment (Functional , Currently non-functional but repairable, Written off; How does the national team intend to maintain and replace existing equipment and other materials? - Describe the adequacy of available knowledgeable manpower at all levels. - Where fiequent transfers of trained staff occur, state what the national team is doing or intends to do to remedy the situation (The most important $sue $ what measures were taken to ,niur" adequate CDTI implementation "t'here not enough knov,ledgeable manpower was ovailable or staff often transferred during the course of the campaign). Source Type of equipment SIZ MOH DISTRICT NGDO OTHERS TOTAL Condition of the equipment * Please state l. Vehicle 2. Molor cycle 3. Computers 4. Printers 5. Fax Machines 6. Others a) b) c) 20106t2005 55 2.7, Treatments 2010612005 56 t-- OON \o N (!(l) L cdpo o 'g (!a.9o) cd .qPPocb5o.2 o.lt! ,q .r' .: _-o !rc'Ee C)F '.= 6 .EP = <r)HC0tr.h!0)Uo.= og Jtr ol E € =l Ec xt QC) -l oi tsl <.rH EI E -c !l E\ .hld =t E g$ "l : Fl * EI $ EI;3l gl'S 'El eEl !l: Elfi9J !+5 El oHl BIE slE al ql J -'il c;l fla il=fl €la EIEEt EIE zlsO0 HIr ot()l hll 'oldl €l ll il <-r I at olOl c)EI g E iil L o)$g"HEl E s,*dl 9 6Hl oc)ol o-ol o,- N^q Et EE::l o. (!Fl H B" ^l -.8 () ril FO ;;eBEeE o b r.I: €<EA o z o3bs -otrco o-ozd vhic .E E"c E E5[}EE '7E ;l* o\ ol:4 '-o€E o.C)E >ai:-t o H,o X d tr-o iot .9 d9po. i:(€obi F o oo-E .,o od Lq)o.= -o z a -.! s; SSErSSLr@--^ + c= 9? o o>EZo *6 3 .9o -c oo ii oo'ooa.'OY ov o ood oa e3gtr.= ai =FLz= E oo C) () o o -l F F -\6 B V) U)q) oq) .\ .o \) o \ s H q) 5 ll E q(d oL(€ d o L ! x -o q rr.l a -o o d() F dcir .l EIdlFI o d o- o If the project is not achievin g ]I}%geographical coverage and minimum of 85% therapeutic coverage rate or coverage rate is fluctiating, state reasons and plans being made to remedy this' 2.7 .2 What are the causes of absenteeism? 2.7.3 Briefly describe all known and verified serious adverse events (SAEs) and provide in table 9 the required information when available' In case the national team has no case of serious adverse event (SAE) during this reporting period' please tick in the box. 2;t.4. No case to report 2010612005 58 a o\ ra o9tr €* a9i= <.s b iHp EEE EE E ,E5E q q o bo oL o. tH o c) Eoo ao o o !)H E.E E!-. d.9 uo-c tril9d E90 oq-41 ll) tr tr== EfEEe 9'= P -o iiE 6 o'= o= e F d.E(d=- oO H.EE g;rrs q Eo p. U) HE ar *U clF=o #H =o .NX oX* as $ o q) h0c o.F =bo ao xo v) €) bo Ax t O N N a) \ ru 'a s q)q * s qj U .\ q: o\ L t a)q q) s ! ro o. bo tsop.() k() bo i a,(,) F oo IJ.] a q o 0) o o 13(! o () o oq 6J(J o.1 ol 5l(Bl FI o\o I q)s t) Eqr s E q) \) a \3 $ (l\\q)L !i\) : s) ti\) S 6i 0) d oq) 'a l- c) q) c) .o HI :ldl!l BI EI ol -o() bI)d o oo ! (n C) o hF H ll ll as o c.l \oO ON U \){ ll \J V) /> 0) ood() o ". i ,n E!) do o o. el o d o E o a -o\- O bI)(€ o o Eo o bod =5."do o: CL E E oo Lo -o E o 0.) o O -cl =9o(a 3og =o>- 99 '=DLO7> =\FO U9tr oo N OON ONc..l ON r- ON nl &ri N q) cn ON s NC\ NOON @ o, o\ N il 14 pi Q r- o\&t! SECTION 6: OPERATIONAL RESEARCH 6.1 Summarize in not more than half a page the operational research undertaken in the project area during the reporting period. 6.2. How were the results applied in the project? SECTION 7: Strengths, weaknesses and challenges - List the stengths and weaknesses of CDTI implementation process. - List the challenges and indicate how they were addressed. I I ? a t 2010612005 63