Onchocerciasis Control in the Volta River Basin Area: report prepared for the governments of Dahomey, Ghana, Ivory Coast, Mali, Niger, Togo and Upper Volta; annex V-6 estimated cost of training personnel for the onchocerciasis control in the Volta River Basin Area

ocPh3.t ANNEX V-6 ONCHOCERCIASIS CONTROL lN TIIE VOLTA RIVER BASIN AREA Report prepared for the Covernments of Dahomey, Ghana, Ivory Coast, Mali, Niger Togo and Upper Volta ANNEX V-6 : ESTIMATED COST OF TRAINING PERSONNEL FOR THE ONCHOCERCIASIS CONTROL PROCRAMME IN THE VOLTA RIVER BASIN AREA Ceneva 19 73 United Nations Development Prograrnme Food and Agriculture Organlzatton of the Untted Nations International Bank for Reconstructlon and Development World HeaIth Organlzation Annex V-6 page I ESTIMATED COST OF TRAININC PERSONNEL FOR THE ONCHOCERCIASIS CONTROL PROGRAMME IN THE VOLTA RIVER BASIN AREA 1. INTRODUCTION l. A large-scale, long-term project, such as the Onchocerciasis Control Programme rn the Volta River basin area, usually devotes an apprecrable part of rts budget to personnel training. This is not clearly apparent rn the budget of the present programme, although trainlng problems are relatively important, because some of the operations have been planned and costed on the basrs of sub-contractrng. The cost of the training and re-orientatlon of the necessary qualr.fr.ed staff thus becomes one of the items in the management costs of the sub-contractor, estimated to total 20% of the basic cost of the sub-contracted activity. 2. Srnce it is not certain that operations will be sub-contracted and srnce the terms of any such contracts may include a clause on personnel training, the matn aspects of such training and re-orlentation are set out rn the followlng pages, lndicatrng the order of magnitude of the costs to be allowed for rn the entomological, medical and operational fields. (cf. Annexes V-2, V-3 and V-4). 2. BIOLOGY, VECTORIAL IMPORTAITCE AND CONTROL OF SIMULTTJM DAMNOSUM 3. The training Programme for the three main categories of personnel g entomolo- gi.stsr technicians and laboratory assistants, should deal essentrally with the biology, vectorial importance and control of S. damnosum. However, the vectors of the other maJor diseases in the volta River basin area, such as malarra, trypanosomiasi5, ye110w feve1, etc., cannot be completely neglected. 2.L Entomologlsts 4' T\rro main possibilities should be considered: (a) tne training of speciarrsts, starting with graduates of universities or any other centre of higher education who have merery a good knowledge of general zoology, or better, of general entomorogy;(b) ttre re-orientation of professional entomologists, erther medrcal, or, faiting that, agricultural, who have no special knowledge of Simulium biology, onchocerciasrs epidemiology or vector contral. 5' In the first case, the eandidate must first be given a solid technical grounding in the field of applied medical entomorogy, so that he can be transferred to category (b). The simplest way of providing such basic training consists in sending the person concerned to follow specialized training in a country with whose language he is famiriar. There are very good training centres in this fierd in many countries, those in Great Britain and France having the advantage of giving instruction specially directed towards African problems. The length of such instruction is generarly a year or fifteen months. Together with this basic training the candidate should be given instruction in whichever of the two languages of the Annex V-6 page 2 programrne area he does not speak fIuentIy. Training costs would include travelling and living expenses as welL as those of study and technical documentation. The average costs may be estimated at $ 81OOI per person for a fifteen month training per rod . 6. In the second case, re-orientation or supplementary specialized trainrng should take place either in the immediate proximity of the progranme area or under very similar ecological conditions, giving the trainee the possibility c,f working with the vectors and taking part ln evaluation and control operations. The length of the trainlng period should be six months, rncluding at least two in a blackfly control campargn, which might be the Onchocerciasis Control Programme in the Volta River basrn area itself. The laboratory at present best equipped to receive trarnees during the frrst four months is that of the Onchocerciasis Section of the Organisation de Coordination et de Coop6ration pour la Iutte contre les Grandes End6mres (OCCGE), situated in Bouak6, Ivory Coast; this laboratory also has the advantage of being in the immediate neighbourhood of the control programme. Another Iaboratory where this training could probably be grven is the Helminthiasis Research Unit, Kumba, Cameroon. The cost of such re-orientation, including travelllng and lrvrng expenses as well as study and movements in the field, can be estrmated as, on the average, $ 6000 per trainee. 2.2 Technicrans 7. Persons who have completed their secondary education or have commenced uni- versrty studies in the field of biology or technology can be trained as ordinary grade technicl.ans. They should receive specialized training lasting four months, rncluding at least two months work in a blackfly control campaign. Their scientific and technical training should cover all aspects of the life cycle and control of the vector and of related problems, while stressing practical and operational features. 8. Higher grade technicians, who will be responsible as medical entomologists in certain fietds, should have good experience of blackfty control campaigns; failing thrs, the best of the ordinary grade technicians could be trained in two months to the higher grade level, after having served at least one year in the field. Training should deal essentially with data analysis and interpretation, as well as the general organization and programming of insecticide treatment and entomological surveys in an entomological surveillance sector. I US $ at the July 1972 exchange rate. aAnnex V-6 page 3 sr. The general conditions of such tralning would not differ greatly Jrom those applyrng to the medrcal entomologists during their re-orientation. The average cost can be estimated as $ 32OO for the traininq of an ordinary grade technician (4 months) and $ ITOO for the supplementary training converting such a technician into a hrgher grade one (2 months), if his intrinslc abilitres and efficiency :'n the field make it possible to consider him for such promotion. 2.3 Laboratory assistants 10. Laboratory assistants will be one of the essential elements in the entomological surveillance system, but they will bear no responsibility for the planning or modi- fying of treatment operations. They should be recrulted among young people who have a good primary education record or have even followed a course of secondary studies, if there are any candidates on that level. I1. The training proBramme will be essentially practical, centred on problems of vector trapping, identifrcation and dissection, and the keeping up-to-date of survey cards and laboratory records. The training, lasting two months, could be given in the laboratory of the Onchocercrasis Section of the OCCGE ln Bouak6, or in that of the natronal Onchocerciasis Control Unit in Bolgatanga, Chana. The average cost of trarning 1s estimated to be $ 8OO per tralnee, subject to there being at least four tralnees at a time. 3. PARASITOLOGY AND CLINICAL FEATURES OF ONCIIOCER,CIASIS 12. Training programmes can also be envisaged for the two categories of staff, physlcians and nurses, who will work for the Onchocerciasi.s Control Programme by evaluating the results and perhaps later on organizing chemotherapeutic treatment of onchocerciasis sufferers. 3. I Physician s 13. Physicians can hardly be given specialized training ln the parasitology and clinical aspects of onchocerciasis other than on a regional basis, by using the research and training centres situated in the endemic onchocerciasis areas and provided with both qualified personnel and suitable equipment. The number of specialists to be trained every year will not be high, so that there will be no serious problems as regards supervisory staff or transport. Training will bear essentially on the epidemiology of the disease, its differentral diagnosis, classi- fication of lesions, standardi.zed survey methods, planning of surveys, interpretation of the results, and problems of individual and collective chemotherapy. The work done in the clinic and the freld, as a whole, should famlliarize the physician with aII aspects of the disease and all the problems he will have to solve in epidemio- logical evaluation surveys during the campaign. Such training should last some four months and rts average cost can be estimated at $ 3600 per tralnee. Annex V-6 page 4 14. The need should also be consrdered of grvrng certarn physrcians addltlonal training in statistics and publrc health so as to prepare in each country lor the organizatlon and implementation of possiLrle onchocercrasis chemotherapy campatgns. These training periods, lasting a year, should take place r.n suitable publrc health schools; therr average cost has been estlmated at $ 9OOO. 3.2 Nurses 15. The tralntng of nurses speclalized in onchocerciasrs (and rn the other marn parasitic diseases of West Africa) has been undertaken for many years by the Parasitology and Ophthalmology Sections of the OCCCE. The present system of periods of training in Bobo-Droulasso, Upper Volta and Bamako, [!lal1, mrght be slightly modified to satisfy the requlrements of parasitology evaluatron teams for qualifled staff. 16. The general trarning conditions would be close to those proposed in 2.2 trbove for ordinary grade technicians, but the cost would be apprecrably less, of the or(lc'r of $ 23OO per trainee for four months, slnce the maln part of the trarnrng could bc given in the laboratory and the ophthalmology clinic, without costly freld travel specially arranged for the trainees. 4. OPERATIONAL STAFF 17. The training of radio operators, aircraft mechanics, engineers and pilots, could be planned along the same lines as that of speclallsts on the vector and the disease. If aerial treatment is carried out by a private company, the latter wlll certainly reserve to itself the right to recruit and possibly traln its flytng staff, atthough it might be invited to help in the training of srmilar staff of regronal ori gin. I8. For the time being training has been systematically planned to take place in Europe, where facitities are greater than in West Africa. Consequently, the cost of such training periods will vary more according to their duration (sr.x months for radio operators and mechanics, two years for engineers and pilots) than to the level of recruitment. However, the WHO centre in Lom6, training specialists for the maintenance of medical equipment, might be requested to extend 1ts trainlng activities to cover radio operators; thls would considerably reduce expenses. In the present study the average cost of the training periods has been estimated as follows: - mechanic or radio operator, 6 months; $ 28OO - engineer, 2 years: $ fO fOO - pilot, 2 years: $ 2f 600 (including the cost of hours of ftight). IAnnex V-6 page 5 5. NTJIIIBER OF SPECIALISTS TO BE TRAINED AND TRAINING TIMETABLE 19. In the fields of vector blology and control and aerral treatment, lt ls proposed to train - between 1974 and I97? - a number of specialrsts in proportion to the long-term requirements of the programme, allowing for a replacement ratio of 5 to IOTo per year for the higher grades and lO to 2O7o for the 3unior grades. 20. In the medlcal field, the tralning plans are more ambltious, so as to take into account needs closely lrnked with the Onchocerciasls Control Programme in the Volta River basin area, but not costed, namely those requrred by probable mass chemo- therapy and those arising from the epidemiological surveillance of population groups moving as a consequence of operations for the economic reclamation of abandoned and uninhabited land. Training can therefore be planned from 1974 onwards throughout the duration of the programme, with the aim of one physrcran to every 20 OOO oncho- cerciasis sufferers registered and one public health specialrst to every 66 OOO. These estimates exceed the strict needs of the regronal programme, so that a zero annual replacement rate has been allowed for. 2L. The training timetable envisaged is given in Table V-6.f and the corresponding costs in Table V-6.2. Allowing for 15% unforeseen expenses in this field, the overall cost of the traini.ng programme would be $ I 913 ?15f for the period 1974-1993, or an average annual expenditure of $ 95 686 r us $ at the Juty L9?2 exchange rate. Annex V-6 page 6 TABLE V-6.r. TIMETABLE FOR TRAININC SPECIALISTS FOR THE ONCHOCERCIASIS CONTROL PROGRAMME IN THE VOLTA RIVER BASIN AREA Category r974 I 975 1976 rs?7 r978 -199 3 TotaI Entomologi st s Trarnrng Re-orrentation Technicians Ordinary grade Higher grade Laboratory asslstants I 8 2 10 I I 8 2 lo I 2 8 3 10 I 2 3 IO 7 I 24 t2 40 10 I5 48 22 80 Physrcians PubIrc health Re-orientat ion Nurses I 3 4 t 3 4 2 6 6 6 6 8 32 roo 15 50 r20 Pl lot s Engi neers Mechani cs Radlo operators 2 2 2 IO 2 2 I I1 4 2 2 2 4 2 3 2 4 3 5 30 16 11 13 55 I Annex V-6 page 7 3 TABLE V-6.2. OVERALL COSTS OF TRATNING SPECIALISTS FOR THE ONCHOCERCIASIS CONTROL PROGRAIIIME IN THE VOLTA RIVER BASIN AREA(IN US $ AT THE JIJLY L972 EXCHANGE RATE) Incorporating 15% for unforeseen expenses.* a Category t974 1975 r976 r977 r978 -1993 Total En tomo Iogi s t s Training Re-orientation Techn ici ans Ordinary grade Higher grade Laboratory assistants 6 000 25 600 3 400 8 000 8 loo 6 000 25 600 3 400 8 000 I 100 12 000 25 600 5 100 8 000 8 100 12 000 5 100 8 000 56 700 54 000 76 800 20 4@ 32 000 81 000 90 000 r53 600 37 400 64 000 Physicians Public health Re-orientation Nurses 9 000 ro 800 9 200 I OOO ro 800 9 200 18 000 2t 600 13 800 27 000 21 600 13 800 ?2 o,o,0 115 200 230 000 135 000 180 000 276 0o,0 Pilots Engineers Mechan i cs Radio operators 43 2o,0 20 2o,0 s 600 28 000 43 2o,0 20 2o,0 2 800 30 800 86 400 20 200 5 600 5 600 86 400 20 200 I 400 5 600 86 400 30 300 14 000 84 000 345 600 tlr loo 36 400 I54 000 Total' 194 350 203 665 264 500 248 630 I OO2 570 r 913 715