WHO/AFRO support to devolution

Onchocerciasis Control Programme in West Africa Programme de Lutte ccntrc I'Onchocercose en Afrique de l,Ouest. JOINT PROGRAMME COMMII-|EE Office of the Chairman JOINT PROGRAMME COMMITTEE Eleventh session Conak -6 December 1 Provisiona 1 nda item JPC .CCP wHo/AFRo SUPPORT TO DEVOLUTTON COMITE CONJOINT DU PROGI'AMML Bureau du Pr6sident JPC11.7 ORIGINAL: FRENCH October 1990 WORLD HEALTH ORGANIZATION RICIONAL OPPICE FOR, APRICA ORGANISATION MONDIALE DE LA SANTE tUN.EAU RECIONAL DE L'AFR,IQUE oRGANtzAfro nuxorAL DA seuoe sEDE REGtoNrt rn irnrcr JOIN't PROGtu\Ml"lE COIlIll I i'rI ONCHOCERCIASIS CONTROL PROGRAMJ'1Ii IN \,IEST AFRICA ELEVENTIi SESSION, CONAKIIY, GUINT.A 03-06 DECEMtsER I99L) WItO/AFRO SUPPOR.'I''IO DE,VOI,J'TION I. INTRODUCT ION In his report to the renth session of the Joint Programme CommiEtee (JPc) held in the Ilague in December 1989, the Regionat DirecEor described rhe coordinaE ion mechanisms Ehat he has esEablished Ln order to improve ,,Jilo Regional Office and OCP technical and management support to Ehe devolutlorr plans of countries oi che OCP prograrnme area. In thls connecEron, he Eook a certain number of decisions, narneIy.. (i) the appointment, aE Regional office level, of Ehe prograrmre of the Prevent.ion and Control programme as fhe focal point coordinarion of support to devolution acrivities; .\lanager t or L rrr: ( ii) the setEing up at the Regional Of f ice of a SEandr-ng Cornmittee comprising the responsible officers of various technrcal units Lo coordinate supporE. to national onchocerciasis conE.rol programales; this commitEee meets periodically to examine reports received t-rom the Offices of wtlO RepresentaEives and Irom subregional healrlr deve lopment teams; ( i i i) Ehe appointment at Ehe subregional Ievel of the'fearn Leader '>l tirc Subregronal llealth Developrnent leanr based in Bamako,iind ol one ot hi-q epidemiologists as Iiaison offrcer between orrchocercLasrs endemic countries and OCP Iechnical tearns; ( iv) the estabLrshment, at counEry Ievel, f rotn 1990, of a i.jHo [ ]'r'r, ,t1)nlDristlrg ,nainI;- nationals recruitr:d on a specral lbI'jarnrtrlt'.-..tsr.s LCr lt:nd thr: agrI.rired Operatl(,t1al SuppOrt. courltr), .ierVtJr:s SLill lr;'n .: desrre Lo accel,lrafe the implt:rnr:rrL:.lLr()n of ttre rlevoluLron Drocess. the R.egionai t)irector, durrng the twelfth Regional prograrnrnc i'{eetlq.i 'RI')'l .12) lrel'd in ilrazzaville in Febrr.rary 1990, called on Ltre t,Juo R":-reseniat ives in oCP countries to consicler onchocercrasis control ancl je'.',:,irtL.)n .l'i priorrcv a.livifies. Mr:reo\.,er, ()lcho erciasis conLrol wa,; ,)lt tne agenda c': tne Iortieth session of rhe R'egional ComnritEee whicLr was 5e].d rrl Brazzaville l''rst Septenroer'. The poliricai ciecisi<>n-makers of Nlenrber States r..rt rhe R.eg1f n .rL I,trrdei Ltris ne.:t ing. 2?. PROGRESS REPORT During the tast JPC in December 1989, rhe RegionaI Director was requested ro present a report at this JPC on acrivities relating ro WHO/AFRO support to national devolution plans. These activities can be summarized as follows according to the outIine contained in the document prepared by the AFRO/OCP * Te am: 2.1 Collection, analysis and dissemination of relevant technical information Actions Eaken Technical information available to OCP on the utilization of larvicides, d istribution of ivermect in, chemoEherapy and financing of the Programme was collected and updated. These subjects were discussed in detai I during the Regional Cormnittee by the Represenratives of the lI OCP countries as well as by those of counEries outside the OCP area. Proposals were made for a better utilization of this information Eo facilicate devolution. 2.2 Provision Eo Staces of the services of Regional Office staff, r nte rcount teams and consultants for technical supporE for p annLng o evo ut Lon Actions taken The epidemiologisc of Subregion I carried our many mtssrons to support activities at couotry IeveI. In coltaboration wlth national and OCP srait, ire partic ipated in the d istribut ion of ivermect in. He a lso co [ [aborated wich naEionals in the preparation of Eheir devoluEion documenrs. He equally visited, in the company of OCP scaff and the External Review Team, a certain nrrmber of countries in order Eo evaluate national onchocerciasis conErr:l programmes. LastIy, the epidemiotogisC attended OCP statutory meet inBs and 0CP staff technical meet ings. * DnuoluLion of Ehe Onchocerciasrs Control Programme (OCP) framework of fhe Three-Phase HeaIth Development Scenarlo for the Rt:gion, prepared by AFRO/OCP Team, llrazzavtlle, November 1989' in the Af r r.can 32.3 Provision to countries of supp I ies and equ i pment sub jec t Eo the ava i labi I iry of funds Act ions taken !dHO/AFRO provides funds to OCP. The funds are used to support nationaI programnes by supplying equipmenE such as balances and microscopes and also to Erain field personnel. tn this connection, wHO/AFRO and OCp colIaborate closely to grant the requests of countries. 2.4 Encouragement of Flember States to make provision in the WHO regular budget for devolution activities Act ions taken Dur ing t he Reg iona I Programme Meet ing ( wh ich brought together a I L wHO country representatives and AFRo regional officers) held in February 1990, t^ll{o RepresenEatives in oCP counEries were insErucEed to calL upon national auchorities to accord high priority to devolution acEivities. Therefore, when programmtng therr l'lHO regular budget, naEional authorities should include a budget heading for che carrying ouE of devolution activities. A certain number of countries have already answered ttris caIl, However, the managemenE of I"JHO f unds earmarked for devolut ion shou ld be suff ic ient ly f Iex ib le so chad, i f and when necessary , these funds cou ld be used for purcnasing gquipmenE and supplies. 2.5 Mobi trzar ron oI external resources Eo supporE counEry acE rvit ies Actrons Iaken rHo/AFRo conEacted the African Development Bank, ttre World Bank and UNDp for the frrnd ins of the implemenEacion of the Three-Phase HeaLth Development Scenario which ts Ehe basis for the strengthening of primary health care at d ist r ict leve l. . I 42.6 '[raining of various cacegories of personnel Ac t ions faken Durrng rhe period under consrderatron (December [989 - December I990), wHO/AFRO pursued irs routine activities in the field of training. FelLowhr-ps were granted to nine candidaEes from OCP countries to enable rhem to take traintng courses relacing to various aspects of onchocerciasis conrrol. In I990, t'iHo/AFRO granted 28 felLowships in Ehe foIIowing fields: epidemiology and communicable diseases (21); ophrhalmology Q); primary health care (2); health educaE ion (3). WHO/AFRO rook over rhe rraining of rhe sraff of national control proBrarunes with a view to providing them orientation courses in f Le Ici rechniques ln onchocerc ias is control. It should be recalled that WHO/AFRO has made considerable efforrs ro train the nationals of onchocerciasis endemic countries. Between t978 and I989, 649 nationaLs of OCP and of countries ouEside OCP area were granted fellowships for training in Africa or abroad in various disciplines relared ro onchocerciasis control (see the following cwo tables). Advanced courses in epidemiology have been organized in Bamako ( in French) and Nairobi ( in EngIish) and are being strengthened for the training of epidemiol-ogists. The Regional Office has also prepared modules for training in epidemiologv at districr IeveI which wiIl certainly be very useful to OCP countries and to those outside OCP. 5Tab le t Natronals of OCP countries trarned by tlHO/AFRO between I978 and t989 DiscipLine Count ry Benin Burk ina Faso C6re d'Ivoire Ghana Gu inea Guinea Bissau t'ta I i Niger S ierra Leone Senega I Togo Entomo- I ogv Hydro- biology Pub I ic hea I th Paras i- tology ophrha I- mo logy Tota I 6 t [0 I a) 3 3 0 2 I 3 t2 9 8 I6 Il' 3 46 5 6 4 [0 9I 28 L4 8 L2 3 23 I4 2 6 7 l' 2 0 .) 2 0 8 0 0 0 0 6 6 4 3 2 0 J I 0 0 l0 t t6 46 36 30 30 9 83 20 IO II 30 Sub-EoEa I 33 i30 208 I5 35 421 a6 'labl,'2 Nationals of countries outs r.dt: OCP area trained by t.JHo/Ar.RO between I978 and I989 Discipline CounEry Entomo- t ogy Hydro- b io logy Pub t ic hea I rh Paras i- to logy oph r ha L- mo Iogy TotaI Cameroon CenEral Afr.ReP. Coogo Gabon Ma Iawi N iger ia Chad Tanzania Uganda Zalre 6 t 0 I 0 I i 0 I 0 L2 t0 8 3 5 t9 4 t3 t2 7 9t I8 3r r0 2 II 6 2 9 L2 t I 0 0 l' 0 0 2 0 0 6 I i I 0 0 2 t 5 0 lr6 ZL 40 l5 8 3I I3 t8 27 I9 Sub- tota L 6 96 107 4 r5 226 Grand toEaI 39 226 3r5 I9 50 649 1I 2.7 Streng ttrening of coord tnat r...>n mechanisms between LJHO/AFRO and OCP Actions Eaken Consultacive meetings have been instituted among the participatr.ng counEries, OCP and the Regional Office. This constitutes an ideal framework for the discussion of devo[ution problems. A meeting was held between the Regional Office and OCP from 3I October to 3 November 1989 in Brazzaville. It rrras chaired by the tlHO Regional Director for Africa and iE offered rhe opportunity ro Iay down the major guidelines for devolution. AFRO staff members attended a statutory OCP meetinB in Ouagadougou. The OCP DirecEor was invited to participate in the discussions of the Regional Conrnittee meering held in September I990. After Ehe meeting, Ehe OCP Director stayed behind Eo discuss devolucion activities with Ehe Regional Office officers concerned. 3. FUTURE PERSPECTIVES InEercounE.ry sErucEure after OCP It was envisaged that I.IHO/AFRO wi t I take over OCP's coordinat ion role through iCs subregional intercounEry and country teams. InsEructions were issued for rhe Eeam Ieader, epidemiologist, sanitary engineer, health educator and adminisrraEor to increasingly. parE icipate in OCP activities in preparaE ion for Ehe subsequent take-over. Furthermore, country teams for the control of the disease are beinq set up in the Offices of IIHO Representatives. The Eask of these teams wi lI be to Iend support Eo nationals in che developmenE of rheir districr healrh syst.em using the AFRO Three-Phase Health Development Scenario as the framework. I t] 4. Onchocerciasrs control in countrr(ls out side ttre OCP area Although since 1985 the onchocerc iasis control Programme has concerned only l1 countries, onchocerciasis, with ltS socioeconomic rePercussions' is found in many other counEries of the Region. The disease is considered as a public health problem in Nigeria, cameroon, zatre, chad, the central African Republic, Tanzania and Uganda. The extent of disfribufion of onchocerciasrs and Ehe severity of complications due Eo ctr! aisease are more considerable in Nigeria and Zaire than in the oEher countries outside Ehe OCP area' These counEries did noE have national control plans before E,he avaiLabilicy of ivermecEin which is an effective drug Ior onchocerciasis conErol' Since I988, however, onchocerciasis endemic countries ougside the OCP area have requesEed WHO,s help in Eerms of technical suPPorE with a view to collecting epidemiological information necessary for planning naEional conErol programmes based on the use of ivermectin aE conrnuniEy leveI. To grant these requesfs, WHo/AF.RO has collaboraEed with ocP and has called uPon the great experience of this proS,ranme in this domain' a,