Progress report on the implementation of transfer activities of the Onchocerciais Control Programme (1st September 1997 - 31 August 1998): Guinea

Onchocerciasis Control Programme in West Africa Programme de Lutte contre I'Onchocercose en Afrique de l'Ouest JOINT PROGRAMME COMMITTEE Office of the Chairman JOINT PROGRAMME COMMITTEE Nineteenth session Accra. 7-9 December 1998 JPC . CCP COMITE CONJOINT DU PROGRAMME Bureau du Pr6sident JPC19.8(e) ORIGINAL: FRENCH September 1998 Provisional asenda item 6 PROGRESS REPORT ON THE IMPLEMENTATION OF TRANSFER ACTIVITIES OF THE ONCHOCERCIASIS CONTROL PROGRAMME (lst September- 3l August 1998) GUINEA JPC 19.8(e) Page 2 TABLE OF CONTENTS INTRODUCTION 2 THE, NATIONAL HEALTH SYSTEM 2.1 . The national health policy 2.2. The health pyramid 2.3. Organization chart of the Disease Prevention and Control Division aJ IMPLEMENTATION OF CDTI 3.1. Training... 3.2. Retraining of health workers for the introduction of the 3mg Mectizan@ tablets 3.3. Ivermectin distribution . INTEGRATION OF THE EPIDEMIOLOGICAL EVALUATION OF ONCHOCERCIASIS Page 1 J J 3 4 5 6 7 8 9 4 10 JPCl9.8(e) Page 3 1 INTRODUCTION The political will expressed by the Ministers of Health at the I 7th session of the Joint Programme Committee held in December 1995 conceming the take over of the residual activities of OCP by their respective countries forecast the integration of these activities into the national health systems. It emerged from the discussions that the Community-Directed Treatment with ivermectin (CDTI) and the epidemiological surveillance of onchocerciasis could be effectively carried out by the rural communities and the national health structures. As a result, the mass or large scale treatment which was ensured by the mobile teams was abolished. A three-day national workshop bringing together all the field workers involved in onchocerciasis control was organized in March 1996 in Conakry. It had two objectives: to set up a community-based system for the distribution of ivermectin to integrate and and decentralize the epidemiological surveillance of onchocerciasis Thus, this workshop actually laid down the foundation for the planned integration which necessarily required the training of all those involved. 2. THE NATIONAL HEALTH SYSTEM 2.1 The national health policy Basically, the national health policy derives from the primary health care strategy adopted since 1978 after the Alma Ata Conference and which was confirmed by the government of the second republic during the national health conference of July 1984. This strategy consists in making accessible to the greatest proportion of the population the health care it needs at a reasonable cost affordable by the country. This policy was revised in November 1991 in response to the prevailing situation. It rests on: the harmonious integration of all curative, preventive or health-promoting health care, the promotion of individual, family and community health; the participation of the beneficiaries in the design, implementation and evaluation of the health programmes. a a a JPC19.8(e) Page 4 The main objectives of this policy are to ensure the availability of quality health care services at an affordable cost at all levels of the health pyramid; to make available to the populations geographically accessible and culturally acceptable health services; to ensure the sustainability and durability of the health system. 2.2 The Health Pyramid The implementation of the national health policy is carried out through a health system having a pyramidal structure closely modelled after the administrative division of the country. The health pyramid of Ministry of Health comprises three basic levels: peripheral, intermediate and central. a a a Prefectoral Hospitals' Board of Directors, Health Centres' Management Committees *N.B The Prefectoral Health Technical Committee (CTPS) meets every six months at the Chief town of the prefectoral directorate of health (health district). It brings together all the health staff (doctors, the head nurses of the health centres, the pharmacists and the administrative authorities) to review the monitoring status of the prefectoral health centres and hospital. It is during this session that all the problems and constraints related to their activities are discussed including onchocerciasis control activities (CDTI and epidemiological surveillance). Level Administrative structures Health care structures Technical coordination units Orientation & Management units National (Central) National Directorates Support Services Attached units corporate organizations University Hospitals (cHU) Technical Coordination Committee National Health Council, National Commissions, University Hospitals' Boards of Directors Regional (lntermediate) Regional Inspectorates of Health Regional Hospitals Regional Health Technical Committee Regional Health Committee, Regional Hospital Board of Directors Prefectoral (Peripheral) Prefectoral Directorates of Health Prefectoral Hospitals, Health Centres *Prefectoral Health Technical Commiftee JPC19.B(e) Page 5 2.3 ORGANIZATION CHART OF THE DISEASE PREVENTION AND CONTROL DIVISION MtuListry of llealth General Secre tary Private secretary of tlre ttinister - Principal secretary - Aduisors - Office attadrc Sqport Senrice . DAAF - SSEI - IGS National Directorate of Health care facil i ties National Direc tora te of Health of Pharmacies and Laboratories I\hEional Division of Disease Pre- vention and Control Division of Health Promotion Division of Tradi t ional Medicine Division of Reproduct,ive Health Emergency and Epidemics Sec t ion fmmunization Sec t ion Endernic Diseases Sec t ion Leprosy Tuberculosis Onchocerciasis Malaria Schis tosomias is osomras].s STD/HIV Diarrtpeal JPC 19.8(e) Page 6 The division of disease prevention and control is one of the four components of the Nation Directorate of Public Health: It is, among other things, responsible for: designing and implementing policy and programme actions regarding disease prevention and control; monitoring the epidemiological situation of endemic and epiendemic diseases in order to determine the appropriate means of preventing or controlling them; elaborating and following-up on the implementation of operational plans for the control of local endemics and epidemics; monitoring the health status of migrants, refugees or displaced persons; enforcing the provisions of international health regulations; promoting and participating in the research programme on disease prevention and control; participating in and moitoring the training and retraining of health workers in the surveillance, early alert and case management of endemic diseases. The division of disease prevention and control comprises: an endemics section (leprosy, tuberculosis, onchocerciasis, malaria, schistosomiasis, trypanosomiasis...) ; an immuni zation section ; an epidemics and emergency section. The endemics section into which the onchocerciasis control programme has been integrated is responsible for: assisting the division chief in the design and implementation of policy and programme actions for the control of endemic diseases; ensuring the epidemiological surveillance of endemic diseases; planning, supervising and evaluating activities aimed at the prevention and control of the principal endemic diseases; monitoring the enforcement of international health regulations; ensuring the training of health workers and medical officers in epidemiological surveillance and the integrated case management of diseases. 3. IMPLEMENTATION OF CDTI As early as in 1993. the NGOs Sight Savers International (SSI) and the Organization fbr the prevention of Blindness (OPC) were supporting the Prefectoral Directorates of Health (DPS) of Mamou and Mandiana respectively, in the community-based treatment of some villages. a a a a JPC 19.8(e) Page 7 3.1 Training In the context of the transfer of OCP activities to the Participating Countries and in line with the integration of the onchocerciasis control prograrnme into the Guinean health system, the strategy adopted has made it possible to install CDTI (Community-Directed Treatment with Ivermectin) in all the villages exposed to onchocercal infection (see summary table of the training activities carried out by the National Team from November 1996 to May 1998). TABLE 1: SCHEDULE OF THE TRAINING PLAN DEVELOPED AT THE MARCH 1996 WORKSHOP TABLE 2: SUMMARY OF TRAINING ACTIVITIES CARRIED OUT BY THE NATIONAL TEAM FOR THE IMPLEMENTATION OF CDTI IN 1997 ACTIVITY BASIN PERIOD RESPONSIBLE Training of trainers Kolente Niandan Sankarani Tinkisso/Bakoye Niger/Mafou Bafing Koulountou/Koliba November 1996 December 1996 February 1997 March 1997 Aprll1997 May 1997 JunelJuly 1997 OCP +National team+DPS OCP+\a1isnal team+DPS OCP+]r1a1isnal team+DP S +oPC (NGO) OCP+National team OCP+National team National team+Sight Savers International Q.{GO) National team+Sight Savers International (NGO) Place of training Period DPS Number of CS/DPS Number of villages/DPS Kindia 20-24/tt/96 Kindia Fo16cariah J J 142 138 Faranah 2-6112t96 Faranah Kouroussa Kissidougou Kankan ll t2 J t2 372 279 113 457 Sinko Beyla r5-19t02t97 Beyla l4 548 a Kouroussa Mamou Koundara 24-2810297 3-7103197 4-8104191 Siguiri Dabola Mamou Dinguiraye Koubia Tougu6 Mali Koundara Gaoual L6louma l3 9 7 8 6 7 5 7 8 4 360 293 291 489 252 160 110 390 552 t49 Mandiana 28104-2105/97 Mandiana Kerouan6 12 8 219 310 TOTAL r52 5684 JPC19.8(e) Page 8 3.2 Retraining of health workers for the introduction of the 3mg Mectizan@ tablets In connexion with the introduction of the 3mg Mectizan tablets for community-based treatment, the National team, with support from OCP and the NGOs SSI-OPC organized seminars for the nurses in charge of health centres and the district medical officers (DPS). Thus, 152 nurses and 53 doctors were trained to train the village distributors, and in CDTI monitoring (see table below). TABLE 3: SUMMARY OF HEALTH WORKER RETRAINING SEMINARS FOR CDTI BASIN DPS NUMBER OF NURSES NUMBER OF DOCTORS Milo Niandan aJ Z) 9 Tinkinsso J 30 6 Niger Mafou 2 23 7 Bafing 2 t4 7 Dion Sankarani 2 26 4 Kolente 2 6 8 Gambie 2 11 5 Koulountou Koliba J t9 7 Total t9 152 53 a { IJPC 19.8(e) Page 9 3.3 Ivermectin distribution 3.3.1 Overall situation of the management of the 6mg Mectizan tablets in 1997 Quantity supplied to national team by OCP: | 648 357 Quantity intended for CDTI : I 540 219 Quantity intended for passive treatment 108 138 3.3.2 Treatment results The overall results of the communty-directed treatment with ivermectin (CDTI) and passive treatment carried out in the health facilities from September 1996 to December l99J are shown in tables 3b and 4. TABLE 3b: SUMMARY OF CDTI RESULTS FROM SEPTEMBER 1996 TO DECEMBER 1997 TABLE 4: SUMMARY OF PASSIVE TREATMENT RESULTS FROM SEPTEMBER 1996 TO DECEMBER 1997 RESPONSIBLE NUMBER OF PEOPLE TREATED NUMBER OF TABLETS USED Phil Africaine VCU Team Epidem iological Laboratory l0 Health posts and National Programme l2 000 7 582 1 541 7 982 20 861 t2 379.5 2 905.5 10 928 TOTAL 29 105 41 074 TABLE 5: SUMMARY OF CDTI RESULTS FROM JANUARY TO JUNE T998 Number ofDPS Number of Health centres Number of villages treated Population of villages Mectizan tablets usedRegistered Treated % 19 152 3 594 1 349 897 977 985 72.45 t 360 468 Number of DPS Number of Health centres Number of villages treated Population of villages Mectizan tablets usedRegistered Treated n/70 4 44 671 t6t 317 126 616 78.49 3s3 129 t JPC 19.8(e) Page l0 3.3.3 Ivermectin supply Up to now, it has been processed through the following channel: OCP (BL) { National team (BL) { DPS (stock card) { Health centre (stock card) { Village (treatment record book). From 1999 onwards, it will be processed as follows MSD { Ministry of Health (essential drugs unit + PCG) { Regional Pharmacy Depot { Prefectoral Pharmacy { Health centres { Village Procurement orders will be processed the other way round 3.3.4 Monitoring of CDTI In 199711998, all the distribution reports which were received were analysed at the national coordination level with the feedback systematically sent out to the peripheral level. This has made it possible for the prefectoral teams to carefully review, at their level, all the reports received from the health centres to make them more exploitable. As a result, the analysis of the results obtained and the preparation of corrective strategies became easier during the CTP and CTR sessions. 3.3.5 Channel followed by a CDTI report A CDTI report is processed as follows: Health centre { Prefectoral Directorate of Health { Regional Inspectorate of Health { National Team { OCP and NGOs 3.3.6 Supervision of CDTI It is performed in the following way: National { IRS + DPS { DPS { Health centres { Villages. INTEGRATION OF THE EPIDEMIOLOGICAL EVALUATION OF ONCHOCERCIASIS A plan for the active epidemiological surveillance of onchocerciasis was developped by tlie National team and supported by OCP. At the conclusion of the various training seminars, 17 Prefectoral Directorates of Health in the onchocerciasis endemic zones now each has its own surveillance team comprising a census clerk, a skin snipper and a microscopist, except for the DPS of Kankan which, because of its Iarge number of villages to be monitored (17164), has 2 surveillance teams. That is, in total, 18 census clerks, 18 skin snippers and l8 microscopists. I a ( JPCl9.8(e) Page I I TABLE 6: SUMMARY OF TRAINING SEIVIINARS FOR EPIDEMIOLOGICAL EVALUATION OF ONCHOCERCIASIS It must be noted that equipping these surveillance units poses many problems; however, regrouping them into Regional Inspectorates of Health (IRS) would minimise the costs. Thus, at the chief town of each IRS, standard equipment to be made available to the evaluation, teams will be kept at a central point (town) and drawn on according to a pre-determined work plan. However, at each DPS, it would be desirable for the trained microscopist to have a binocular microscope which would allow him to provide the clinicians with a more reliable diagnosis of onchocerciasis. In addition, some refresher courses would have to be planned for the trained teams. The traditional evaluation missions to the selected villages would still have to be made by the national onchocerciasis control team in concert with the prefectoral teams. In this way, the members of these prefectoral teams will be able to assume full responsibility for their activities before the definitive withdrawal of OCP. I DPS NUMBER OF PREFECTORAL TEAMS DATE OF TRAINING Kindia Forecariah December 1997 Kankan Kerouand Kissidougou 2 I I May 1998 Tougue Lelouma Koundara Gaoual July 1998 I I I I I I