Summary of progress report on the implementation of transfered activities to the national onchocerciasis control programmes

,Onchocerciasis Control programme in West Africa (OCp) Programme de lutte contre Ponchocercose en Afrique de l,ouest JOINT PROGRAMME COMMITIEE Office of the Chairman JOINT PROGRAMME COMMITEE Twenfy-f,rrst session Yaound6, 14 - 15 December 2000 Provisional agenda item 7 JPC - CCP - BENIN - BURKINA FASO . COTE D'IVOIRE - GHANA - GUINEE BISSAU . GUINEE - MALI . NIGER - SENEGAL - SIERRA LEONE - TOGO COMITE CONJOINT DU PROGRAMME Bureau du Pr6sident tPczt.6 ENGLISH VERSION December 2000 SUMMARY oF PROGRESS REPORT oN THE tit/tPLEMENTATtoN oF TRANSFEREDACTIVITTES TO THE NATIONAL ONCHOCERCIASTS CONTROL PROGRAMMES BENIN SUMMARY OF THE CONTRIBUTION TO JPC2I Report of Benin on the progress of implementation of OCP transferred activities (1" September 1999 - 3l August 2000). From l" September 1999 to 31 August 2000, Benin has carried out cornmuniry directed treatment with ivermectin (CDTD, undertaken epidemiological evaluation, one entomological study, as well as IEC activities. CDTI As the main activity transferred to the countries, CDTI was given particular attention by national authorities at all levels. The treatment was carried out in the selected villages by the communiry distributors (CDDs) under the supervision of staff from ttre District health centres (complexes communaux de sant6). During the period under review,3,277,502 3mg Mectizan tablets were used to treat the populations. Geographical coverage ranged ftom73.0% to 95.5% with an average of 85.5Vo. As for therapeutic coverage, it ranged from74,87% to8l,3OTo. Supervision of CDDs was carried out by the health staff of the District health centres. Monitoring of CDTI activities was carried out by the national team with the participation of the peripheral health centre medical officers. Overall, 192 health centres and 248 villages were visited. 658 community members were interviewed. Epidemiolo gical evaluation An epidemiological evaluation was conducted both in the basins still under larviciding as well as those where larviciding has stopped. After a full census of the village inhabitants, skin snips were taken and DEC patch tests applied, along with visual acuity measurements. Results: In March and April 2000, seventeen (17) villages were evaluated in the Koumongou, Mekrou, Terou, Alibori and Zou river basins. In all, five thousand eight hundred and ninety three (5893) people were registered, of whom three thousand two hundred and seventy two (3272) were examined. The number of individuals found positive was two hundred and twenty three (223) . The standardized prevalence rate ranged benveen O and 46,6Vo and sixteen ( 16) villages out of seventeen (17) had a prevalence between O and 16.67o. The CMFL was 0 in sixteen (16) villages. The epidemiological trend was therefore good in all of the basins except in the Koumongou river basin. Entomological study A study on the impact of ivermectin on the transmission of onchocerciasis was carried out in the Alibori river basin. The percentage of infective flies was zero. IEC Radio broadcasts were carried out as well as production and dissemination of IEC materials Funding of activities The funding of activities is ensured through rwo sources viz. the national budget and OCP Challenges They were identical to those reported in the previous years. The solutions envisaged are beginning to bear fruit. These challenges included : CDD attrition due to the voluntary nature of the work, high mobility of health center staff and delays in transmission of project reports. BURKINA FASO SUMMARY OF THE CONTRIBUTION TO JPCLI The entire territory of Burkina Faso is qart of the original prograrnme area, where the disease is virtually eliminated. Aerial larviciding has ceased since 1990 on all the river basins of the country. What is left for us to do, is to detect, on a timely basis, any recrudescence. To this end, 4 strategies are being implemented. They are: c Epidemiologicalsurveillance o Entomological surveillance o Treatment with ivermectin o Information-Education-communication (IEC) on onchocerciasis Active epidemiological surveillance in the sentinel villages, along the main watercourses, is carried out by two zonal teams, and is done on ayearly basis. The results are excellent in all the basins. Entomological surveillance is carried out by a central team, and is meant to: - Control an area under ground vector control treatment : Dienkoa River - Detect any recrudescence - Evaluate the efficiency of the treatment with ivermectin on the Bougouriba River. Treatment with ivermectin is community-directed, and has to do with the above-mentioned basins. The rates of geographical and therapeutic coverage are good. 285 villages, whose reports have been received, were treated, out of the 304 that are concerned. This gives a geographical coverage rate of 93.75 %. Therapeutic coverage by district varies between 66 % (in the Dano health district) *a gq % $n that ofBobo sector 22). Efforts need to be made in 36 villages of the health districts of Dano and Gaoua, which have a coverage rate ofbetween 40 and 64 %o. IEC is carried out in all the other activities, and is planned and implemented at the health district level. The political will to ensure the sustainability of the control of this disease is evidenced both in speeches and concrete actions, especially in the area of financing of activities. COTE D'IVOIRE SUMMARY OF THE CONTRIBUTION TO JPC2l As part of the 1998-2002 operational plan, which rvas drawn up for managing residual activities thar rvert handed over to C6te d'lvoire, the Executive Directorate of the National Programme, in spite of enormou, constraints relating to the particularly difficult social and economic situation, carried out activities geare( toward maintaining and consolidating gains of OCP. The activities conducted during the past year centre( on Community-Directed Treatment with Ivermectin: Epidemiological surveillance; Control of blackflr nuisance and IEC l. Communify-Directed T ent with lvermectin Drug distribution is ongoing in villages, and the results of this, as transmitted by the Districts are no1 complete. However, it is worth noting that a number of constraints (low-level integration of CDTI in action plans of Districts and health centres, low community participation, lack of motivation o1 community health workers and health workers, logistics problems) are still an impediment to the smooth implementation of CDTI activities. Efforts made to ensure a good geographical and therapeutic coverage have proved to be inadequate. While there is a will to effectively involve actors, the mobilization o1 logistics, especially, remains a major obstacle to the programme. 2. Epidemioloqical surryeillance In the Southern extension zone (villages under CDTI). the results obtained show an epidemiological situation that is generally satisfactory. The standardized prevalence rates are between 00o/o and 9.2% (KOBADARA on the N'ZI) for the skin snip, and between OToh and 4.59 (GHANHALA on the GBANHALA) for the DEC test. The microfilarial load is nil or close to zero in almost all the villages. 5 children of less than 15 years (4 from Kobadara and I from Namayeredougou) were positive to the skin snip test. Incidence rates are between 00o/o and 0.94oh (at Namayeredougou on the N'zi river) 3. Control of blackfly nuisance A project was set up to control blackfly nuisance on the lower Bandanra and on the N'zi in the Tiassale region, at a total cost of more than CFA 19,000,000F for the first year, out of which more than CFA16,000,000F was used to buy TEKNAR. 4 . Information-Education-Comrnunication In order to support CDTI activilies in particular, and oncho control in general, tn Cote d'lvoire, a budgeted action plan (which is alrejrdy being implemented) was drawn up in agreement with IIKI fbr 2000-2001. The are4 of activity is, forthe moment. limited to Districts rn thc lorest region. a GHANA SUMMARY OF THE CONTRIBUTION TO JPC2I The activities carried out were mostly to the reinforce the transfer of ocp activities in the country. Epidemiological surveillance and evaluation activities were carried out in 34 communities in l0river basins in the extension zones of Brong Ahafo and volta Regions, which are south of theoriginal areas' Trained health teams from eaJh region carried out th; activities with some supportfrom the national level' Skin snip and DEC Patch test methods were used. The oncho microfilariaprevalence rate, ranged from 0 to 47%o and the CMFL, below one per skin snip. compared to theresults of the immediate last surveys, a downward trend in these indices was observed. The year's needs of ivermectin were ordered for the first time, directly from Mectizan DonationProgramme (MDP) through the Ministry's drug procurement system. The order for 2001 had alreadybeen placed' A pharmacist was designaied responsible ior the management of the ivermectin. At theregional levels, the regional pharmacists have been made in chirge. rne community DirectedTreatment with Ivermectin (GDTI) strategy was used to deliver the" drug throughout the countryhowever, there were some passive distribution in some hospitals in trr" irigi""i;;; u[j;ffi"regional capitals' CDTI has been established in 3 of the 5 endemic regionsln the forest zone. In1999 the geographical coverage was 74.7Yo in 50 of the 55 endemic diJtricts. g90,049 people weretreated with 3,004,988 tables of ivermectin. The national ivermectin treatment coverage was 63.9o/ocompared to 60.9%o in 199g. Entomological activities carried out were mainly post control activities and included i.) theentomological surveillance to detect recrudescence at the Zongoiri rapids, ii) studying the impact ofivermectin on transmission in the Kulpawn and Mole river basins and iii) the monitoring ofIarviciding activities in the Pru and Asukawkaw river basins. The were still some indications oftransmission in the Kulpawn and Mole river basins. Several activities enhancing the integration of oncho into the health system were carried out at boththe regional and district levels. Mosiof the activities were carried oui at the under the charge of thehead of the level with the colraboration of the sub district level staff. The main partners in the oncho confrol"activities were ssl, HKI, TINICEF and wHo/oCp. In thearea of IEC, two TV stations showed films and carried out discussions on oncho control. There werea'number of feature articles on oncho in the rocar newspapers. A budget line has been created at the national headquarters for oncho control to meet some of thecost, however most of the recurrent costs of the contiol activities were bome by the partners. Somedistricts and local assemblies funded some of the activities from their local budgets. GUINEA BISSAU SUMMARY OF TTIE CONTRIBUTION TO JPC?I 1. Epidemiological situation The last epidemiological evaluations were conducted in the Rio Geba and Rio Corubal basins in 1997 and the results *"r" "*""llent after 5 years of large-scale ivermectin treatment in the two basins' 2. Entomological Evaluation The results of the entomological evaluation which,,vas also carried out in June and July 1997 in the Rio Corubal and Geba basins were satisfactory with 88.6% reduction in the infectivity rate. 3. Overall situation after the politicaumilitary conflict of 1998 Following the military conflict of 1998, equipment and materials belonging to the national Oncho team in Gabu *.i. .o.pleteiy destroyed; a situation that hindered the re-start of Oncho control activities in Guinea Bissau. 4. Projections We planned the following activities in order to re-start activities in Guinea Bissau: a) training (re-training) of Oncho national teams, as well as the regional ones of Gabu and Bafata; and also of nurse-technicians of the Health centres and Base units (CS and USB) of the Gabu and Bafata regions to undertake Oncho control activities b) epidemioiogical evaluation in villages of the Rio Geba and Corubal basins, r.e. 20 villages of Rio Corubal and 15 villages of Rio Geba; c) re-start of community-based ivermectin treatment activities. These acrivities will be put in place right at the end of the year 2000, with the collaboration of OCP. .l ) GUINEA SUMMARY OF THE CONTRIBUTION TO JPC2I l. Overvieu' The Onchocerciasis covers an area of about 85o/o of the national tenitory, and spans 9 river basins, namely the Milo-Niandan, the Sankarani Dion, the Tinkisso-Bakoye, the Bafing, the Kolente, the Niger- Mafou, the Mongo-Kaba, the Koulountou-Koliba and the Gambia. The activities that were transferred and implemented by the national team are as follows: training, CDTI and epidemiological evaluation. The latter, is carried out solely by national stafl with quality control from OCP, and is yet to be integrated into the national health system. Community-Directed Treatment with Ivermectin cover more than 7,000 villages in the entire 9 basins. On the whole, 210 health centres spread over 24 health directorates (DPS) supervise this activity. 2.1 Results Trainine activities This year, 62 doctors and 250 health workers undei'went refresher courses as part of training for community distributors, and CDTI follow-up, thanks to the financial assistance of some NGOs namely, Sight Savers International and the Organisation for the Prevention of Blindness, and OCP. 2.2. Ivennectiu supply With respect to the CDTI 2000 cycle, the Ministry of Public Health, through the Essential Drugs Unit of PEV/SSP/E, ordered and received from MDP, 6,270,980 3mg Mectizan tablets tax-free. 2.3 CDTI results as of October 3l 2000 Out of 7,257 villages planned, 7,226 were treated, i.e. 99.6% of geographical coverage, and out of a total population of 2,552,614,2,068,980 were treated, giving a therapeutic coverage rate of 8lYo. With respect to Mectizan management, it was observed that for 6,314,134 available tablets, 5,614,202 of them were used, giving a consumption rate of 89.87%. 20,978 tablets were estimated to be lost, i.e. a lossrateof 0.33%) and620,591 tabletsremained,whichgivesarateof 9.8%oof ivermectintabletsthat were not consumed. The distribution activity was carried out by 12,590 community distributors, who were trained in the various villages involved in the activity. Generally, the results were quite_satisfactory. However, it was observed in some prefectures that there were low therapeutic coverage rates (<65%o), and very high coverage rates (>85%). Analysis of reports also brought to the fore very low proportions of children of less than 5 years, and of pregnant women.. Also brought to the fore are quite remarkable rates of absence, several calculation elrors, and sometimes columns of reports that are left unfrlled. These lapses, which were noticed, including others, were related to the incomplete nature of the census carried out, and the inadequacy of follow-up/supervision of the activity by Health District and Regional teams. 2.4. Results of epidemiolo gical evaluations The epidemiological evaluation was conducted in 89 villages out of the i05 that were projected, for in some villages, treatment with ivermectin had already taken place, despite the messages that were sent in this direction to field teams. At the end of the activity, it was observed that Oncho prevalence rate in Guinea has dropped from 80% in 1985 to less than llohin 2000 in some basins, thereby enabling the country to be classified in the zone of low oncho endemicity. However, positive skin snip results, recorded for children of less than l0 years in some prefectures in the basin of the Koulountou Koliba River, give cause for fresh concerns, and challenge all field actors to undertake mandatory annual treatment of all villages, and of all the population that is eligible for CDTI. 3. Follow-up/evaluation ofactivities Consultations at the prefecture and regional levels (Technical Health Committee), which are organized each semester in the Districts and Regions. offer officers of the central services of the Ministry of Health and partners (NGOs) that are involved in Oncho control, the opporlunity to follow up and evaluate CDTI activities with those of the Districts and Regions. Additionally, the annual review of Oncho control activities, which is organized in the month of November, gives the same officers the opportunity to determine the strengths and weaknesses of integration, and to draw lessons for improving upon output. 4. Eiaanqingofactivities The State, OCP and NGOs (SSI and OPC) ensure funding of Oncho control activities. This year, the Guinean State projected in her National Development Budget, under its investment component, an zunount of 134,881,900 Guinea francs, out of which 58,482,000 was disbursed in a rather diffi cult socio-economic situation. Sight Savers Intemational (SSI) offered 53,089,700 GF as part of its support to the training/re-training, and for covering fuel and allowances of health workers, District and Regional teams, as well as of the National Coordination. The Organization for the Prevention of Blindness (OPC) also committed 52,000,000 GF to support its area of intervention, along the same line as SSI. OCP, through letters of agreement, financed part of the on the job training, and also of the follow-up/evaluation, and the entire epidemiological evaluations (i.e. a rotal of 27,000,000GF). 5. Difficultiesencountered Lack of literate persons in some villages, thus causing lateness in the writing up of treatment reports. Multiplicity of programmes, which brought about another concept of community participation; in this case, the same village agent oversees different programmes under the responsibility of the village. Hence, the increasing claims for incertives. Rebel incursions into border villages of Siena Leone and Liberia. 6. Reconrnrended solutions - Augrnent sensi{ization of communities for greater involvement in the CDTI process. - Enhance follow-up/supervision of the activity at all levels. Health workers will have to assist distributors in the thorough count of the population, especially in the areas at risk. - Avoid treating incidence villages before the date slated for evaluation. MALI SUMMARY OF THE CONTRIBUTION TO JPCZI From September 1999 to August 2000, Oncho control activities that were carried out in Mali centred mainly on: the supply of ivermectin, community-directed treatment with ivermectin (CDTI), epidemiological surveillance/evaluation, IEC, entomological surveillance, and nuisance control, training, supervision, follow-up/evaluation of activities. The following were the results, which were deemed satisfactory: o The Ministry of Health has, since June 1999, been ordering ivermectin itself from the Mectizan Donation Programme (MDP) o 3249 villages, out of the planned 3484, were treated (i.e. 93.25%); I a25 874 persons were treated out of I 836 071 counted (17.65%), and 3 942 733 3mg ivermectin tablets were distributed. . Prevalence rates vary between 0.34 and 3l.8lyo, and microfilarial loads of the communiry (MFLC) are equal to 0. o The Annual Transmission Potential (ATP) is below the tolerable threshold (ATP<I00) at all the capture points that are monitored on a regular basis. o Development operations take part in the control of blackfly nuisance. o Educational materials that are developed on Onchocerciasis (picture boxes, audio/video cassettes and drama shows (Koteba), help to sensitize communities in order to improve their knowledge and participation in Oncho control. . 3 8 doctors, I 84 health technicians, 6 1 80 community distributors of ivermectin, and 5 regional teams, trained or re-trained on CDTI implementation and epidemiological surveillance participate in maintaining the gains of the Programme, as part of the integration of Oncho control activities into the national health system. . The supervision of Oncho control activities is integrated into that of other health activities. o Follow-up/evaluation of activities is carried out through quarterly meetings in the Circles, regional semester meetings, and through the annual review. The State, OCP, WHO/AFRO and some NGOs including Sight Savers International (SSf, Organization for the Prevention of Blindness and Helen Keller Intemational (H2) finance Oncho control activities. The difficulties encountered in Oncho control implementation are taken into account in the plans of action of national health outfits, and include the following: o Strengthening information and sensitization of the community and health personnel in charge of implementation/follow-up of maintaining the gains of the Oncho control Programme, on their role in ensuring its quccess. o Re-training of personnel of the health centres and community workers. . . Supplying logistics to health centres that are in need. . Equipping regional epidemiological surveillance teams. . Follow-up, supervision and evaluation of activities at all levels. NIGER SUMMARY OF THE CONTRIBUTION TO JPC?I I. EPIDEMIOLOGICAL SURVEILLANCE Since the cessation of vector control activities in 1989 in Niger, our main activity has been and remains epidemiological surveillance. This has to do with 84 villages in 6 basins; the work is carried out by the National and district teams. In 2000, 14 villages were evaluated, 4801 persons were counted,2582 persons were examined and only one positive case was recorded. Management strategies : There are six of them: Annual epidemiological evaluation, use of ivermectin to treat cases, personnel training, IEC, equipping and ground larviciding. Blackfly nuisance : Since the cessation of vector control activities, the problem of nuisance has become critical. Consequently, each year, we trained and re-trained20 village brigadiers, who carry out ground larviciding. Community health workers, teachers and health workers were also trained on Oncho IEC to sensitize the population on the prevention of onchocerciasis (use of Ioose clothes, long sleeves and trousers for protection against blackfly bites). Distribution of ivermectin On the whole, 87 patients found positive during the epidemiological evaluations , were treated in 26 villages with 215 3mg tablets. The Health Region of Say was the most affected area (55 patients in l7 villages). Constraints : (a) Hesitation on the part of the population to accept skin snip test; (b) Mobility of trained health workers; (c) Population movement; (d) Incentive for the community (village brigadiers and Community Health workers) and (e) Lack of funds for making programme activities sustainable. Solutions : (a) Strengthening IEC, especially in former villages; (b) Maintaining health workers for at least 3 years at their post after training; (c) Finding some incentives for the community; and (d) Mobilizing resources in order to make prograrnme activities sustainable. Resource mobilization . Funds from the Netherlands stopped coming in December 1999; o Already we have funding from: HKI, for IEC activities; WHOiAFRO, for epidemiological evaluation activities, supervision, training/re-training of village brigadiers; Niger goverrunent, for premises, staff salaries, maintenance of vehicle fleet. water and electricity. CONCLUSION Epidemiological results of Oncho surveillance are satiSfactory, ten yeals after cessation of vector Decentralizationhnd integration of control and multi-disease activities are underway. II a a SENEGAL SUMMARY OF THE CONTRIBUTION TO JPC2I Senegal has, since 1986, been part of the Western Extension of the Onchocerciasis Control Programme in West Africa (OCP). The disease was causing havoc in Senegal, especially in the southeastern pa.t of tlr. country, which span l SYo of the national territory. The watercourses forming the endemic Uea are the Gambia and Faleme rivers, including their tributaries. The Faleme River is, of course, a tributary of the Senegal River. Four health districts are affected with 590 village communities, the majority of *hi.h u.. found in the Kedougou district (319). The only strategy applied in Senegal is that of treatment with ivermectin under CDTI, since vector control has proved to be ineffective in controlling the endemic disease. There is a network of 73 villages, which undergo epidemiological evaluation in turns, within at least 5 months, per evaluated village community. Entomological studies to assess the impact of ivermectin on transmission started two years ugo, in collaboration with the OCP molecular biology laboratory. The CDTI results showed a geographical coverage of IOO% (590 villages treated/596 eligible villages), with an effective therapeutic coverage (at least 65% of persons treated in the community) among 570 villages. On the whole, of the total population of l5l 740 persons, l2l 428 were treated, i.e. an overall therapeutic coverage of 80%o, during the frst exercise between January and June 2000. The outcomes of the second exercise (November 1999) also showed a geographical coverage of IOO% among the 120 eligible villages in the Gambia basin. Only 2 villages here did not attain the efficiency levei of 65%o, having recorded a therapeutic coverage of 63% and 55% respectively. An epidemiological evaluation canied out with the skin snip was carried out in 20 villages in the Gambia, Faleme and Kofla Kabe basins, and had to do with the 4 Oncho districts. A total of 3 595 persons underwent skin sampling, I l9 of who were found to be carriers of the Onchocerca volvulus, i.e. a gross prevalence rate of 3.3yo, varying between 0 and 8.3%. No child of between 0 and 9 years was found to be positive, while 6 between l0 and 14 years were positive. The majority of infected persons were adults of more than 20 years (l0l/l l9). As part of efforts to strengthen the capacity to accelerate the implementation of CDTI, training session were organized on behalf of senior nurses of health posts in 2 districts. Emphasis was placed on supervision at the various levels. The annual technical review of the Programme, as well as internal reviews at the district level, made for better coordination of activities of the National Control Programme for maintaining the gains made. The political will was made manifest-when Oncho control was ezumarked for financing by the Ministry of Health (under the Endemic Disease Control Project, which brought together, in addition to onchocerciasis, malaria and schistosomiases), and also the inclusion of its activities in the various annual' plans of action. Financing of Oncho control activities is taken care of by Senegal, OCP and the NGO called "Organisation for the Control of Blindness in West Africa - OPC". aSIERRA LEONE PROG REPORT ON E IMPLEMENTATION OF TRANSF ERRED ACTIVITIES OF THE ONCHOCE IASIS CONTROL RAMME The Onchocerciasis Control Programnte continues to suffer a series of setbacks in its programme implementation. The 9-year civil war led to a total disruption of control activities with Ivermectin distribution as the only mainstay of oncho control in the country. Treatment with Ivermectin of affected persons continues in most of our functional health centers and in collaboration rvith our NGO partners, Sight Savers International and the Lunsar Baptist Eye Hospital. During this period the following activities were carried out: l. Training A training of trainers(ToT) workshop on the management of Onchocerciasis and in the concept of CDTI A training workshop for health workers in displaced camps on the management of onchocerciasis 2. IEC Continued sensitization and awareness raising in the mass media, radio and TV Development of posters 3. DISTRIB I 00,000 tablets distributed - 20,00 by Sight Savers International - 25,000 by Lunsar Baptist Eye Hospital - 55,000 by various health centers F iTOGO SUMMARY OF THE CONTzuBUTION TO JPC?I I. Epidemiological Evaluation As part of the follow-up process of prevalence trends, 64 villages out of the 70 planned for (91%) benefited from an epidemiological evaluation. The techniques of skin snip and DEC were used. 13074 persons were examined. A downward trend of the prevalence rate could be observed generally in all the evaluated villages. Prevalence rates vary between lYo and ll%o on the Mono River and its tributaries, from 0% to 260/0 on the main Oti River, and from 0%o to 53Yo on the Kara-Keran-Mo. The Community Microfilarial Load (CMFL) is almost nil in the villages (0.0 to 0.28mfls). It should be noted that all the basins are under ivermectin treatment and larviciding, except the main Oti River, which is under ivermectin only. II. Entomolosical surveillance. A study on the impact of ivermectin on onchocerciasis transmission was undertaken for the second time in the village of Tchountchounga on the Oti River. During this activity, the community was sensitized on the interest of entomological surveillance. Village captors were trained, with a total of 10,158 blackflies being captured over 27 weeks. These were sent to the DNA laboratory in Ouagadougou for identification, since the national system for sending lab specimen to Ouagadougou is yet to be independent of OCP. III. Communitv-Directed with Ivermectin Considerable improvements have been made in the area of coverage rates, with geographical coverage rates going fiom 95o/o to l00Yo, i.e. an average of 98% (4,452 villages treatedl4542 planned). Therapeutic coverage was between 67Yo and 82%o, i.e. an average of 72Yo (1,447,767 persons treated/2,000,961 planned). In all, 4,050,693 tablets were distributed. The problem of report collection is still pending. This problem has to do with motivation of actors, but solutions are being experimented. (For instance, the use of distributors as vaccination agents during National Inoculation Days, and the use of dispensary cash as incentives etc..). These outcomes are likely to be modified, since results keep coming in at the Coordination office. ry. Other activities. - Activities for consolidating strat-egids (community mobilization, follow-up/supervision of CDTI) on the Kara-Keran-Mo made for good epidemiological and CDTI results. -' The orders placed for ivermectin for 2001 arrived in Togo in November this year 2000. - Sight Savers Intemational has just signed a protocol of understanding for financing some activities in the area of blindness control in Togo.