Plan of action and budget for 1999

JOINT PROGRAMME COMMITTEE Office of the Chairman Onchocerciasis Control Programme in West Africa Programme de Lutte contre I'Onchocercose en Afrique de I'Ouest JPC - CCP t COMITE CONJOINT DU PROGRAMME Bureau du Pr6sident JPC19.4 ORIGINAL: ENGLISH September 1998 JOINT PROGRAMME COMMITTEE Nineteenth session Accra. 7 - 9 December 1998 Provisional agenda item 11 PLAN OF ACTION AND BUDGET FOR 1999 a I JPC19.4 ONCHOCERCIASIS CONTROL PROGRAMME in West Africa PLAN OF ACTION AND BUDGET FOR 1999 I WORLD HEALTH ORGANIZATION t TABLE OF CONTENTS 1. INTRODUCTION OVERVIEW OF THE PLAN OF ACTION OVERVIEW OF THE BUDGET FOR 1999 ESTIMATED COST BY PROGRAMME ACTIVITY 4.1. Vector Control Unit 4.2. Planning Evaluation and Transfer Unit 4.3. Macrofil Chemotherapy Project . . . . . . 4.4. Office of the Director 4.5. Administration and Support Services Unit 4.6. Statutory meetings 4.7. Capital costs I. II. I[. IV. V. VI. VII. VIII x. x. ANNEXES OCP ORGANIZATION CHART AVERAGE COSTS USED FOR BUDGETARY CALCULATIONS RATES OF EXCHANGE OF THE US DOLLAR/CFA FROM 1997 TO 1998 . . . COST OF PERSONNEL FROM 1992TO 1999 AERIAL OPERATIONS FROM I992TO 1999 MAP - PROPOSED VCU PLAN OF OPERATIONS FOR 1999 MAP - VCU SECTORS, NATIONAL BASES, OPERATIONAL BASES FOR 1999 MAP - LARGE-SCALE IVERMECTIN TREATMENT PLAN FOR 1999 MACROFIL CHEMOTHERAPY PROJECT VEHICLES IN OPERATION FROM I992TO 1999 . Page 1 (i) 15 20 J 6 15 2. J. 4. 28 30 JJ 38 39 I 42 43 44 45 46 47 48 49 50 53 (ii) LIST OF TABLES TABLE 1. BUDGET BY PROGRAMME ACTIVITY TABLE 2. BUDGET BY CATEGORY OF EXPENDITURE TABLE 3. BUDGET FOR 1999 - SUMMARY BY PROGRAMME ACTIVITY AND CATEGORY OF EXPENDITURE Page .10 .t2 TABLE 4. TABLE 5. TABLE 6. TABLE 7. TABLE 8. TABLE 9. TABLE 10 TABLE 11 VECTOR CONTROL UNIT PLANNING, EVALUATION AND TRANSFER UNIT MACROFIL CHEMOTHERAPY PROJECT OFFICE OF THE DIRECTOR ADMINISTRATION AND SUPPORT SERVICES . . . OVERVIEW OF ADMINISTRATIVE COSTS STATUTORY MEETINGS CAPITAL COSTS t4 t9 27 29 32 35 36 38 40 a JPC19.4 Page 1 1. INTRODUCTION The Plan of Action and Budget for 1999 has been prepared on the same general format as in previous years, to facilitate comparisons. This is the second budget in Phase V of the Programme, which is the phase of progressive disengagement. It gives clear evidence that the winding down of the prograrnme is under way, as evidenced by the continuing reduction in vector control activities. At the same time, the Participating Countries are increasing their capacity to effectively detect and control recrudescence of the disease, with active support from the Planning Evaluation and Transfer Unit. The amount proposed for the 1999 budget is US$15,546,000, a figure which continues the steep downward trend of the past six years. It includes provision for continuation of seasonal treatment in the Sassandra basin as recently recommended by the Expert Advisory Committee, and the engagement of a senior public health expert as approved by JPC18 on the recommendation of the Extemal Evaluation Group. Both measures are considered essential to the successful and orderly closure of the Prograrnme. Although this budget is 6.55 % higher than the amount projected for 1999 in the Phase V Plan of Operations, it is 16.55 % lower than the 1998 budget approved by JPC last year. 1.1. Vector control operations The 1999 budget for vector control operations, takes into account the cessation of aerial larviciding in the southern extension, C6te d'Ivoire, except for the Sassandra basin, but with continuation of aerial operations in the South-eastern Extension (Ghana, Togo, B6nin) and the Western Extension (Guinea). It also reflects the principle of using in rotation only the four most cost effective insecticides (temephos, pyraclofos, permethrin and B.t. H-14 ). The costs included for aerial operations are those in the new four-year contract starting in 1999, with Evergreen Helicopters Inc. The standard Ecological Surveillance activities will continue, and will be broadened to include studies of how factors other than larvicides, affect the quality of the habitat/aquatic environment. 1.2. Planning, Evaluation and Transfer Activities In 1999, this unit will have a budget of $ 450,000 for Training, which will be at the foundation of all its activities. It will concentrate on direct support to countries towards making them technically capable of taking over the responsibility for detecting any recrudescence of onchocerciasis infection and for its control within the framework of their national health systems. Emphasis will be given to activities involving community-directed treatment with ivermectin, analysis and interpretation of data and operational research. Modelling of different epidemiological situations using the ONCHOSIM model will continue. Additional data collected from epidemiological surveillance in the initial Programme area will be used to test and validate predictions of the simulation, with reference to recrudescence detection and its control with ivermectin. Training of nationals will be concentrated on the following disciplines : epidemiology, public health, health planning and management, health education, statistics and the use of computers. Retraining at the community level for community-directed treatment with ivermectin will be carried out. JPC 19.4 Page 2 1.3. The Macrofil Project The complete Macrofil Project is set out in Annexe IX (pages 50-52). In 1999, OCP is contributing US$ 700,000 towards the project and it is expected that APOC and TDR will contribute equal amounts to give a total of US$ 2. 1 million. OCP will continue to fund the scientist and a secretary, as part of its contribution. As far as possible, OCP and APOC funds will be used for clinical and pre-clinical development of drugs for onchocerciasis, in which regard Moxidectin has been identified as a lead compound, for the development of a novel macrofilaricide as a replacement to UMF078. TDR's funds will be used for strategic research and fundamental work on identifying molecular targets for drug development. 1.4. The Office of the Director The Office of the Director will ensure close liaison with the Statutory Bodies, the Donors, the Participating Countries and the Scientific community. Is main activities will be in the management of the Programme and the implementation of general policy. This implies coordinating all programme activities, including research contracts, public relations and statutory meetings. The Director of OCP was appointed to act as Director, ad interim, of the new APOC Programme from February 1996. He delegated the day to day management of the APOC programme to the Co-ordinator, Office of the Director, who functions as Programme Manager APOC. The APOC prograrnme is expected to re-imburse OCP for 25 percent of the Director's salary and 75 percent of the Co-ordinator's salary. 1.5. Administration and Management Support Services The Administration and Support Services Unit will manage the resources of the Programme as it winds down towards closure in the year 2002. Special attention will be paid to ensuring that the required competence is maintained and emphasis will be put on maintaining staff morale. There will be increasing use of temporary and short-term staff. It is planned to institutionalize a programme of counselling for staff to prepare them psychologically for the end of a Programme which has gone on for 25 years, and which for some, has been their life. Much practical advice will be given to national staff, so that they can plan for and face up to a life when OCP will no longer be in existence in their countries. The use of consultants is foreseen on this programme. The Committee of Sponsoring Agencies has expressed concern that the staffing at OCP-HQ was nearing the critical level, below which efficient management would be in jeopardy. JPC I9.4 Page 3 2. OVERVIEW OF THE PLAN OF ACTION The Plan of Action sets out the work which will be done by the various units viz: larviciding, planning, evaluation and transfer to countries of responsibility for recrudescence detection and control, entomological surveillance, epidemiological evaluation, ivermectin distribution, operational research, epidemiological modelling, data processing and administration. 2.1. Office of the Director In 1999, the Office of the Director will continue to decide on the main orientations of the Programme, to define the general policies and to co-ordinate the management activities. The Director of OCP, will continue to direct both OCP and APOC in 1999. A secretary has been transferred from another unit into this office, and a general service post has been upgraded to National Professional Officer (NPO) level. Because of the increasing volume of documents requiring translation for both prograrnmes, a post for a translator was created in 1998, at the National Professional Officer level. The liaisonoffice in Geneva will be maintained, and its cost will continue to be shared with the WHO Regional Ofhce for Africa. 2.2. Vector Control (VC[D The plan of action for vector control activities is shown on a map at Annexe VL It may be summarized as follows. In 1999 vector control activities will already have ceased throughout the Original Programme area except for two pockets namely the Dienkoa, where ground larviciding is being done by the national team of Burkina Faso, and the Keran, Kara and Mo tributaries of the Oti, in northern Togo. Aerial treatment will cease in the Southern Extension area of C6te d'Ivoire, except for seasonal treatment in the Sassandra basin, but will continue in the Western Extension area (Guinea and Sierra Leone if the security situation returns to normal there) and in the South-eastern Extension area (southern Ghana, Togo and Benin). The principle of rotation of insecticides will be maintained in 1999, concentrating on the four most cost effective ones i.e. temephos, pyraclofos, permethrin and Bacillus thuringiensls H-14 (8.t. H-r4). From 1999, there will no longer be any "OMS" type entomological sectors or subsectors. The Vector Control Unit will consist of three "National team" sectors, five "National Bases" and 11 Operational Bases. The total number of entomological capture points will be reduced from 132 in 1998 to 116 in 1999. The year 1999 will be the first year of a four-year aerial spraying contract with Evergreen Helicopters Inc.This contract takes into account the following three essential points : (i) the cessation of larviciding in C6te d'Ivoire from 1 January 1999, (ii) the stabilisation of the larvicide coverage between 1999 and 2001, and (iii) the significant reduction in aerial operations in 2001. JPC 19.4 Page 4 There will be a slight reduction in Applied Research activities in comparison to the 1998 level. Collaboration with the molecular biology laboratory of the University of Alabama in Birmingham (USA) and with the molecular biology laboratory of ORSTOM in Montpellier (France), will continue at the same level as in previous years. Monitoring of the aquatic environment will be carried out within the context of the plan of work established by the Ecological Group, at its nineteenth session held in Odiennd in February 1998. The normal surveillance will be done of the long term effects on the non targetted fauna of the least selective insecticides. Studies will also be undertaken on the quality of the habitats to improve understanding of the influence on the results of surveillance of the aquatic environment, of factors other than larvicides. 2.3. Planning Evaluation and Transfer Unit The Planning Evaluation and Transfer Unit (PET) will, as in the previous year, give technical, logistic and financial support to the countries in 1999. The general aim of this support is to make the countries technically capable of taking over the responsibility for detecting any recrudescence of onchocerciasis infection and its control, within the framework of their national health systems. Efforts already made towards promoting the process of integrating onchocerciasis control into the national health systems will be reinforced. The Unit will continue to support national activities involving community-directed treatment with ivermectin, analysis and interpretation of data and operational research. The objective is to safeguard the health improvements and economic gains which have resulted from the Onchocerciasis Control Programme. large scale ivermectin distribution through the community-directed approach will be carried out in 1999 in more than the 27,000 villages. It is therefore expected that more than 9.5 million people will be treated. About a third of this number represents those individuals who are continuing treatment and who live in the previously high risk areas that needed urgent ivermectin treatment. The rest come from the low to moderate risk areas where large-scale ivermectin treatment is desirable and for which advantage is being taken of the more practical CDTI approach. Experience from the campaign in the preceding year suggests a need for reinforcement of Information, Education and Communication (IEC) interventions. The Unit will support this activity, working closely with national/local experts. Epidemiological evaluations planned by this unit will be carried out by national teams, in the villages, in basins where cessation of larviciding is planned. Similarly, evaluations will be carried out in the areas with only ivermectin treatment, as a follow-up to the study on the effect of long term ivermectin treatment on transmission. Ophthalmological evaluations will be conducted in a number of villages in the Programme area, to help assess the impact of combined vector control and ivermectin treatment on (a) the transmission of infection and (b) on onchocercal eye disease. The unit will continue the ongoing transfer of the epidemiological data collected by OCP to the countries, the training in data entry, validation of data, analysis and interpretation of results. Data entry and validation programmes will be tested and installed in each of the countries to render the nationals completely and independently operational in data management. Modelling of different epidemiological scenarios will continue in OCP in 1999, using the ONCHOSIM modet. Additional data collected from epidemiological surveillance in the original Programme area, where the parasite reservoir is virtually eliminated, will be used to test and validate predictions of the simulation, with particular reference to recrudescence detection and its control with ivermectin. JPC19.4 Page 5 Training will be at the foundation of all activities. The unit will concentrate on the following disciplines : epidemiology, public health, health planning and management, health education, statistics and the use of computers. Higher level training will generally be undertaken in institutions in Africa. There will also be emphasis on field training, on{he-job training and training through seminars and workshops. Retraining at the communiry level, for community-directed treatment with ivermectin, will be carried out. 2.4. Macrofil Chemotherapy Project OIACROFIL) The primary objective of the Macrofil Project continues to be the discovery and development of safe and effective macrofiliaricides for onchocerciasis and lymphatic filiariasis. For 1999, funding for the project will be shared equally betwen OCP, APOC and TDR, each contributing $700,000. The funds of OCP and APOC will be used for preclinical and clinical development of drugs for onchocerciasis, while TDR funds will be used for development of drugs for lymphatic filiariasis and strategic research on identifying molecular targets for drug development. Moxidectin has been identihed as a lead compound, for the development of a novel macrofilaricide in place of UMF078, and clinical srudies could begin in 1999 at the Onchocerciasis Chemotherapy Research Centre in Ghana. Within the Drug Discovery Committee of TDR, other novel compounds will be obtained and tested for anti-filarial activity. 2.5. Administration(ADM) The Administration and Management Support Services Unit will assist the technical units to achieve the aims of the Programme. It will manage the available human, financial and other resources towards this end. With the closure of the sectors and subsectors, the number of staff engaged in field work reduces proportionately without adverse effects on operations. At headquarters, however, the workload is increasing, to deal with more meetings, with PET Support to Participating Countries, with ad-hoc support to socio-economic development and with cash flow management for APOC projects. The Ouagadougou staff are working to their limit. Much use will therefore be made of temporary and short-term staff to meet peak loads of work. At the professional level, National Professional Officers (NPO's) will be employed, and at the general service level, Special Services Agreements competitive with local private sector salaries, will be offered - (SSA new formula). The numbers of posts occupied by those two categories of staff are likely to increase each year as they replace WHO fixed-term posts which are abolished. Both the Expert Advisory Committee and the Committee of Sponsoring Agencies have expressed concern that the staffing at OCP-HQ was nearing the critical level at which efficient management and quality of output would be in jeopardy. The year 1999 is the second year of the phasing-out period. A medium-term (four-year) perspective will therefore be brought to bear on decisions relating to the management of resources. JPC 19.4 Page 6 3. OVERVIEW OF THE BI]DGET FOR 1999 3.1. General structure The Plan of Action and Budget for 1999 is presented by "Programme activity" (sections 4.1 to 4.7) and, by "Category of expenditure" which are the components of the Programrne activities. It is structured according to the organization chart of OCP shown in Annexe 1. Table 1 presents a summary of the expenditure by Programme activity for each year since 1994. Figure 1 is a pie-chart of the 1999 budget classified according to Programme activities. Table 2 presents a summary of the expenditures by category for each year since 1994. Figure 2 presents a pie-chart of the 1999 budget classified according to category of expenditure. Table 3 combines Tables I and2 for 1999: the category of expenditure being shown for each Programme Activity. 3.2. General remarks 3.3 During the preparation of the budget, the activities and the posts in the various units were reviewed with the aim of retaining only those which were essential. The amount proposed for the 1999 budget is US$ 15,546,000. It includes provision for continuation of seasonal treatment in the Sassandra basin, as recently recommended by the Expert Advisory Committee, and for the engagement of a senior public health expert, as approved by JPC18 on the recommendation of the External Evaluation Group. Both measures are considered essential to the successful and orderly closure of the Prograrnme. Although this budget is 6.55 % above the amount projected for 1999 in the Phase V Plan of Operations, covering 1998 to 2002, it is 16.55 % less than the 1998 budget approved by JPC last year. It continues the steep downward trend of the past six years. The average costs used for the calculation of the budget are set out in Annexe II. The trend in the exchange rate of the US dollar to the CFA franc for 1997 and 1998 is shown in Annexe III. Categories of expenditure An examination of the categories of expenditure shows the various factors which have an effect on the budget level. The categories are reviewed in the order followed in Table 2. 3.3.1. Personnel services There will be a small reduction in the number of posts in 1999 with the abolition of 24 posts of the WHO/OCP category (Professionals and General Service staff). However temporary staff on Special Services Agreements or NPO's will be taken on as and when necessary to meet peak loads. There will also be reallocation of tasks. The continuous reduction in personnel over the period 1993 to 1999 is shown in the chart on the following page and indicates a staff reduction of 33 % over the period. The proposed expenditure of US$ 4,800,000 is 2l % less than the amount approved for 1998. 900 800 700 600 500 400 300 200 100 JPC I9.4 Page 7 1 993 19 5 1 997 19 919 1 996 1 998 National Staff ffi Harmonized Staff The following definitions are offered for a better understanding of the above figure WHO/OCP Staff Professional and General Service Staff whose salaries and allowances are paid by WHO/OCP, according to the UN salary scales. SSA Staff (Harmonized) General Service Staff whose employment status was changed on 1 January 1993 and whose salaries and allowances are paid by WHO/OCP, according to national government salary scales. SSA Staff (New formula) General Service Staff with salaries competitive to that in the private sector and paid by WHO-OCP. National Staff The Western Extension National teams whose salaries and allowances are being paid by their respective governments. OCP will pay individual lump sums to the harmonized staff as well as to the national team staff in the western extersion and daily subsistence allowances to national staff in the whole Programme area when they are on dury travel. 0 737 570 8s0 834 5 620 JPC19.4 Page 8 3.3.2. Consultancy services These services include consultants used by OCP, particularly for activities related to capacity building in countries, and experts who contribute to work in the fields of insecticides, entomology, hydrology, hydrobiology and cytotaxonomy; included also are the short-term professionals employed on Programme activities, and the high level public health expert recommended by the External Evaluation group and approved by JPC18. The planned expenditure, of US$ 873,000, is9.72 % less than that of 1998. 3.3.3. Operational travel Strict controls will be applied to this budget item 3.3.4. Contracts This category covers research and service contracts signed with companies, universities and other institutions in support of specific OCP activities, e.8., aquatic monitoring, Argos teletransmission, maintenance of hydrological stations. Also included are some research contracts relating to the Macrofil Chemotherapy Project. The expenditure proposed under this category, is 3,65 % less than that approved for 1998. 3.3.5. Aerial operations The amount estimated for aerial operations in 1999, is US$ 3,530,000, based on the cessation of aerial operations in Cdte d'Ivoire, and taking into consideration the rates included in the new aerial larviciding contract. 3.3.6. Operating costs These are costs which concern the logistics needs of the Programme (vehicle fuel, spare parts) and infrastructure-related services (electricity, water, telephone). Despite the increase in the costs of these services in general, the Programme should manage to reduce expenditure on this item by 28.69% compared to that of 1998, considering the closure of operations in Bouak6. 3.3.7. Larvicides After careful analysis of the 1997 stoclcs and usage rates and the larviciding activities projected for 1998, it is estimated that the cost of purchasing the minimum quantity of larvicides in 1999 will be US$ 2,321,000. 3.3.8. Supplies and Office Administration This concerns the procurement of recurrent items such as office materials, and supervision of small contracts for security, office cleaning and office equipment servicing. A budget of 30.94% less than that of 1998 is envisaged. 3.3.9. Statutory meetings The amount estimated under this category is 16.67 % Iess than that of the previous year and the OCP activities are the same. Tight control over expenditure should make it possible to remain within the limits of this budget. The APOC statutory meetings will also receive support from same OCP staff. JPC I9.4 Page 9 3.3.f0. Fellowships and training This category will continue to cover current fellowships, new ones and in-service and field training. These are fundamental activities to increase the technical capacity of countries, to take up responsibility for the residual activities of onchocerciasis control. The estimated amount, is US$ 450,000, which is 19.09% less than the amount approved for 1998. 3.3.11. National teams The governments of the Western Extension countries continue to put under the technical supervision of the Programme, national teams to undertake vector control activities such as ground larviciding, and entomological evaluation. National teams are also placed under the supervision of the Programme to carry out epidemiological evaluation, distribution of ivermectin and awareness- raising. OCP provides technical and financial support to these activities. The amount required for 1999 is 12.30% less than that of 1998, despite the increased involvement of the teams in ivermectin distribution and in taking over responsibilities for onchocerciasis control in their countries. 3.4. Other categories For Administrative Support from Geneva the amount proposed is the same as for 1998. As regards Capital Costs, they are lower than the 1998 estimates, in continuation of the phasing-out process which began in 1998. 3.5. Budget summary The proposed budget requirements are summarized in tables I to 3 and figures 1 to 3 by "Programme Activity" and "Category of Expenditure". Specific details are given in Tables 4 to 1l for each Unit or category of expenditure. JPC19.4 Page 10 TABLE I BUDGET BY PROGRAMME ACTIVITY(us $) Programme Activity PHASE V Proposed 1999 Approved 1998 9,955,000 1,919,000 12,109,000 2,123p@ 7(x),OOO 869,O00 1,278,OOO 475,OOO 250,OOO 100,ooo 700,000 947,000 1,708,000 475,000 300,000 267,000 PHASE IV Expenditu 1997 Expenditu 1 996 Expend Expend 1995 1994 Vector control (Planning Evaluation and Transfer Unit) P E Tl Eprdemiological Evaluation Biostatistics & lnformation Systems PET Devolutron Chemotherapy Project Office of the Director Admrnistratrve & Support Servtces Ad ministrative Support Geneva Statutory meetlngs Capital Costs 13,572,558 1,958,417 1,730,528 765,967 1 ,715,580 311,467 206,201 851,853 21,112,571 13,985,652 1,703297 1,747,6W 1,411,59 1,842,570 348,451 173,600 579,880 13,496,365 1,1 1 1 ,450 207,105 1,006,895 1,779,421 718,5m 1 ,910,737 405,480 320,7N 658,O28 TOTAL 15,546,O0O 18,629,000 21,792,694 21,614,710 23,150,289 15,375, 1,047,685 190,151 1,177,624 1,622,235 656,831 1,842,485 451 ,274 238,090 548,764 Note lvermectin : 5,OOO,OOO tablets, valued at US $ 3 a tablet, wtll be provided free of charge by Merck and Company lnc. JPC19.4 Page 11 FIGURE 1 BUDGET BY PROGRAMME ACTIVIW - 1999 78 (us $) 1 Vector control 9,955,000 2 Planning Evaluation and Transfer 1 ,919,000 3 Administrative & Support Services 1,278,000 4 Office of the Director 869,000 5 Chemotherapy Project (Macrofil) 700,000 6 Administrative Support Geneva 475,000 7 Statutory Meetings 250,000 8 Capital Costs 100,000 6 5 4 3 2 1 ('/.) 64.04 12,34 8.22 5.59 4.50 3.06 1.61 0.64 TOTAL 15,546,000 100.00 JPC19.4 Page 12 TABLE 2 BUDGET BY CATEGORY OF EXPENDITURE(us $) 7, 1 66,1 00 1,O24,822 445,289 1,572,610 4,856,683 1,22758 3,888,411 318,7n 238,090 625,637 786,326 451,274 62,086 390,609 94,467 1,602 Category of Expenditure PHASE V PHASE IV Proposed 1999 Approved 1 998 Expenditure 1 997 Expenditure 1 996 Expenditu 1 995 Expenditure 1 994 4,800,o0o 873,OOO 365,OOO 502,OOO 3,530,0OO 917,OOO 2,321,O0O 103,000 250,OOO 450,OOO 780,OOO 475,OOO 6,075,000 879,300 560,000 521,000 4,150,0m 1,286,000 2,406,300 265,000 300,000 555,000 889,400 475,000 5,311 ,648 1,036,251 399,618 1,764,419 4,O93,475 1,344,247 3,774,667 544,873 206,201 422,767 1,051 ,O85 311,467 6,395,360 1,O19,779 605,820 1,465,751 4,020,990 1,493,493 3,659,214 420,763 173,600 529,393 1,080,200 348,451 6,378,882 1,228,664 530,989 1 ,523,133 3,895,615 1,710,656 3,096,100 491,791 320,7N 536,214 838,429 405,480 15,446.OOO 18,362,000 20,260,718 21,212,814 20,956,682 22,601,525 2,OOO 30,ooo 60,ooo 3,OOO 5,000 20,000 50,000 97,000 80,000 20,000 34,269 90,105 590,690 136,789 37,870 65,930 359,011 104,992 12,O77 31 ,103 126,827 417,589 78,627 3,882 100,ooo 267,000 851,853 579,880 658,028 54A,764 15,546,O00 18,629,000 21,112,571 21,792,694 21,614,710 23,150,289 BECURRENT COSTS Personnel Services Consultants Operational travel Contracts (Research & Others) Aerial Operations Operating Costs Larvrcides Supplies Statutory Meetings Fellowships and Traintng National Teams Administratve Support Geneva Subtotal CAPITAL COSTS Office Furniture Data Processing Equipment Vehicles Technical Equipment Buildings Subtotal TOTAL JPC19.4 Page 13 FIGURE 2 BUDGET BY CATEGORY OF EXPENDITURE - 1999 10 11 12 3 I 8 7 1 6 5 4 3 2 1 Personnel Services 2 Aerial Operations 3 Laruicides 4 Operating Costs 5 Consultants 6 National Teams 7 Contracts (Research & Others)I Administrative Support Geneva 9 Fellowships and Training 10 Operational Travel 11 Statutory Meetings 12 Supplies 13 Capital Costs (us $) 4,800,000 3,530,000 2,321,000 917,000 873,000 780,000 502,000 475,000 450,000 365,000 250,000 183,000 100,000 ('/r) 30.87 22.71 14,93 5.90 5.62 5.02 3,23 3.05 2.89 2.35 1.61 1 .18 0.64 TOTAL 15,546,000 100.00 JPCI9.4 Page 14 TABLE 3 SUMMARY BY PROGRAMME ACTIVITY AND CATEGORY OF EXPENDITURE(us $) Activity Category of Expehditure Office of the Director Vector Control Planning Evaluation & Transfer Chemo- therapy project Adminis- tration Total 1 999 RECURRENTCOSTS Personnel Services Consultants Operational Travel Contracts(Research & Others) Aerial Operations Operating Costs Larvicrdes Suppltes Statutory Meetings Fellowships and Training National Teams Administrative Support Geneva 769,000 40,000 40,000 10,000 10,000 250,000 2,068,000 300,000 200,000 203,000 3,530,000 705,000 2,321,000 98,000 530,000 661,000 348,000 50,000 70,000 60,000 30,000 450,0m 250,000 285,000 185,000 25,000 205,000 1,017,000 50,000 24,000 142,000 45,000 475,000 4,BOO,OOO 873,OOO 365,000 502,OOO 3,53O,OOO 9'l7,OOO 2,321 ,OOO 183,OOO 250,OOO 450,OOO TBO,OOO 475,OOO 15,446,OOOSubtotal 1,119,000 9,955,000 1,919,000 700,000 1.753.000 CAPITAL COSTS Office Furniture Data Processing Equipment Vehicles Technical Equipment Buildings 3,000 3,000 1,500 1,000 4,000 60,000 1,500 1,000 20,000 5,000 2,OOO 30,ooo 6O,OOO 3,OOO 5,OOO 100,oooSubtotal 3,000 4,500 66,500 0 26,OOO TOTAL 1,122,O@ 9,9s9,500 1,98s,s00 700,000 1,779,000 15,546,OOO JPC19.4 Page 15 4. ESTIMATED COSTS BY PROGRAMME ACTIVITY 4.1. Vector Control Unit (VCLD 4,1.1. Zones to be treated (Annexe VI) Original Programme Area Since the cessation of larviciding on the Kankelaba in June 1997, no river in the original Programme area has been treated from the air (the tributaries of the Oti, Keran, Kara and Md being considered as part of the South-Eastern Extension). Ground larviciding will continue on the Dienkoa under the responsibiliry of the national team of Burkina Faso with technical and financial support from OCP. Southern extension Cdte d'Ivoire The results of the latest epidemiological surveys carried out on lower Comoe, Iower Nzi and lower Bandama are satisfactory, which is supportive of the decision to cease aerial spraying in C6te d'lvoire at the end of 1998, except for the Sassandra basin. Given the size of these basins (more than a quarter of those currently treated), this measure will have in 1999, significant effects on the operation and budget of the Vector Control Unit. South-eastern and Western Extensions The larviciding coverage for basins of the South-eastern Extension will remain unchanged in 1999. In the Western Extension, ground larviciding of the Niger and its tributaries in the Bamako area will continue to be ensured, as in 1998, by the national team of Mali with technical and financial support from the Vector Control Unit. In Guinea, larviciding coverage will remain the same as in 1998. In Sierra kone however, the insecurity persists. Consequently the EAC at its 196 session in June, recommended that OCP does not resume larviciding in this country, regardless of the evolution of the situation. It should be recalled that no river in Sierra Leone has been treated since April 1994 (except for a short time in 1997). 4.1.2. Larvicides Based on a recommendation in the Plan of Operations for the phase of gradual disengagement (Phase V), the principle of the rotation of insecticides will, as of 1999, concentrate on the four most cost-effective products. These are temephos, pyraclofos, permethrin and Bacillus thuringiensi.s H-14 (8.t. H-14). This change in the strategy is mainly related to the cessation of larviciding in C6te d'Ivoire, on hydrological basins where resistance to temephos has led to the use of replacement insecticides which were less efficient, such as etofenprox and carbosulfan, and to a lesser extent, phoxim. However, this strategy should not completely exclude these three products which may be resorted to in case of necessity. B.t. H-I4, marketed under the name of Vectobac, will remain the insecticide for low discharges and will not be used beyond 15 m3/s (unless is performance is improved). Promising trials done in 1997 with another formulation of B.t. H-14 (Teknar), gave indications that it may be used in discharges ranging from 15 to 70 m3/s because of a longer carry (almost twice) and a lower operational dose (three quarters of the current dose). However, both suppliers will be retained due to the difficulties in mastering fermentation parameters to produce on a large scale, batches of B.r. H-14 of constant quality. JPC19.4 Page 16 The requirements for 1999 are as follows - Temephos - B.t. H-14 (Vectobac) - B.t. H-14 (Tecknar) - Pyraclofos - Permethrin - Phoxim Iitres (2 containers) litres (8 containers) litres (4 containers) litres (1 container) litres (1 container) litres (2 containers) 24 400 100 000 48 800 14 000 7 000 8 000 4.1.3. Entomological evaluation network In accordance with the Plan of Action for the phase of progressive disengagement, cessation of larviciding in C6te d'Ivoire will result in the closure of the Bouak6 sector and of its two sub- sectors, Bouak6 and Odienn6. The molecular biology laboratory will be transferred to Ouagadougou as of January I, 1999 and the remaining research activities will be redistributed between the Kara and Odienn6 bases. In accordance with the gradual withdrawal process initiated on January 1, 1998, the Kara, Atakpam6, Hohoe, Parakou and Bohicon subsectors in the eastern zone will acquire the status of National Base (NB) with officers under local contracts of the SSA type. These NB Chiefs will report directly to the Eastern zone office at Kara and no longer to the Kara sector office which is scheduled for closure on December 31, 1998. As a result, there will no longer be either entomological sectors or subsectors of the "WHO" rype as of 1999 (Annexe VII). The Vector Control Unit will thus be represented by three (3) "national team" type sectors (Kankan, Faranah and Makeni), five (5) National Bases (Bohicon, Parakou, Atakpame, Kara, Hohoe) and eleven (11) Operational Bases (Bamako, Beyla, Dabola, Faranah, Kankan, Kerouane, Kissidougou, Kouroussa, Mamou, Makeni and Siguiri). With the cessation of larviciding in C6te d'Ivoire, the number of catching points regularly visited will decrease from 147 in 1998 to 124 in 1999. 4.1.4. Aerial operations In close collaboration with the Programme, negotiations between the legal office of WHO Headquarters in Geneva and the Evergreen Helicopter International company have resulted in a contract-agreement covering the last four years of the Programme. Technically, this contract takes account of three basic facts, namely i) cessation of larviciding in C6te d'Ivoire as of January I , 1999 , ii) stabilization of the larviciding coverage between 1999 and 2001 and iii) significant reduction in aerial operations in 2002. 4.1.5. Applied research In 1999, research activities on insecticides will be slightly reduced compared to 1998. The preparation of genetically recombined formulations of B.t. H-14 as well as the development of a hemolytic technique for quality control of the operational batches will continue in collaboration with the entomopathogenous bacteria unit of the Pasteur Institute in Paris. The results achieved in 1999 will be carefuly reviewed, as the future of this collaboration, which is done under a Technical Services Agreement (TSA), will depend on the progress of the work. Regarding the activities of the DNA laboratory, cooperation with the molecular biology laboratory of the Universiry of Alabama in Birmingham (USA) and the molecular biology laboratory of ORSTOM in Montpellier (France) wilt be pursued at the same level as in past years. JPC19.4 Page 17 4.1.6. Monitoring of the aquatic environment Monitoring of the aquatic environment will continue on the basis of the workplan established by the Ecological Group during its 19th Session held in Odienn6 in February 1998. In addition to the regular activities of monitoring the long term effects of less selective larvicides on the non target acquatic fauna, study of the quality of settlements will be introduced, so as to better assess the influence of factors, other than larvicides, on the results of the monitoring of the acquatic environment. With the cessation of larviciding on many watercourses, emphasis will be placed on the evaluation of the reinvasion of these by invertebrate essentially and to a lesser extent by fish. Monitoring is likely to be pursued in Cdte d'Ivoire, Ghana and Guinea, but will be interrupted in Sierra Leone where numerous suspensions of data collection due to security problems, make the data practically unusable. The workplan will include major activities of publicising and promotion of the work done by OCP in the fields of the selection of larvicides and monitoring of the acquatic environment. 4.1.7. Research contracts Research contracts will be limited to those signed in 1998 with the Pasteur Institute in Paris (8.t. H-14), the University of Alabama in Birmingham (DNA probes) and the ORSTOM Laboratory in Montpellier (DNA microsatellites). As in 1998, an amount will be earmarked for special studies. In 1999, it is planned to initiate further entomological studies on the upper basin of the Niger in Guinea and on the tributaries of the Oti in Togo. 4.1.8. Service contracts As in previous years, service contracts will be signed with organizations working in the fields of hydrobiology (data analysis, assistance to national teams) and hydrology (teletransmission, maintenance of the hydrological network). Cessation of larviciding in C6te d'lvoire in 1999 will result in a significant reduction in the number of hydrological beacons (-16) which, whatever their future, will no longer be used by the Programme. As a result, only 54 beacons in "backup" service, or 11 hydrological platforms (10.8 PTT) will cover the hydrological network of the basins of the Western and South-eastern Extensions in 1999. JPC19.4 Page 18 4.1.9. Personnel The number of staff members on WHO contracts (Professionals and General Service) will decrease by 24 in 1999 compared to 1998, as shown in the table below. As in the previous year, this reduction will be partly made up with the opening of 13 local contract type posts (SSAs) at grade levels 4 to 7. 4.1.10. Consultants In 1999, the scientists working for less than thirty days within the Programme will no longer be awarded the status of consultant but that of temporary adviser. CSA type contracts will be also proposed for hydrobiology to carry out quality control of the studies of settlements and to provide support to the CSH in the investigations to be carried out on non-treated watercourses. - Insecticides (temporary adviser) - Control strategy (temporary adviser) - Cytotaxonomy (temporary adviser) 20 days 21 days 21 days Total temporary adviser: 2 months - Hydrobiology (CSA type) 2 months 4.1.11. Budget The budget proposed for the Vector Control Unit (VCU) for 1999 is US$ 9,955,000 WHO/OCP Professionals P6-D2 P4-P5 P1-P3 STP General Service Subtotal WHO SSA "Harmonized" "New formula" Sub-total SSA National staff TOTAL L99y 1998 1997 1996 1995 1994 L993 L992 ; J 5 27 1 5 4 5 48 1 5 5 5 56 I 5 5 5 65 I 6 5 7 83 1 8 6 6 110 1 8 5 7 110 3 1 9 8 4 ,6 1 39 63 72 81 102 131 131 383 106 ,) 130t3 130 t54 185 2t0 2234 233 244 247 260 259 299 290 274 400 450 453 495 546 640 644 657 TABLE 4 VECTOR CONTBOL UNIT(us $) JPC 19.4 Page 19 Category of Expenditure PHASE V PHASE IV Proposed Approved 1 998 Expenditure 1 997 Expenditu 1 996 Expend Expenditur 1 995 1 994 PERSONNEL SERVICES WHO / OCP Staff Chief VCU Scientists Technical Officers Administrative Assistants, Clerks, Stenographers and other General Service Statl Personnel SSA SSA Harmonized SSA newformula Temporary Statf 145,000 435,000 345,OOO 540,000 424,OOO 168,000 11.000 't 55,000 725,000 510,000 980,000 520.000 78.000 12,000 Subtotal 2.O68.0O0 2,980,000 2,946,689 419,398 253,937 4,O93,475 326,018 625,895 885,365 3,774,667 247,114 3,461,038 3,397,974 4,133,798 Consultants Operational Travel Aerial Operations Contracts (Research & Others) National Teams Operating Costs Larvicides Supplies 300,ooo 200,000 3.530,000 203,OOO 530.OOO 705.000 2,321,OOO 98.OOO 405,300 340,000 4,150,000 177,OOO 509,400 1,001,000 2,406,300 140,000 9,129,000 12,109,000 375,174 326,432 4,020,990 173,185 591 ,815 1 ,136,498 3,659,2'14 241,306 578,383 326,600 3,89s,615 221 ,897 451 ,464 1,270,281 3,096,100 258,051 477,759 295,075 4,856,683 194,627 489,938 855,348 3,888,41 1 183,51 1 Subtotal 7,887,OO0 .10,625,869 10,524,614 10,098,391 11 ,241 ,352 TOTAL 9.955,OO0 1s,572,558 13,985,652 13,496,365 15,375,150 JPC19.4 Page 20 4.2. The Planning, Evaluation and Transfer (PET) Unit 4.2.1 Introduction The activities of the Planning, Evaluation and Transfer Unit (PET) for 1999, will focus, as in the previous year, on the direct support to the Participating Countries particularly in the areas of the transfer of the tools for diagnosis, the consolidation of the orientation towards community-directed treatment with ivermectin (CDTI), the transfer of appropriate technical skills for epidemiological evaluation and surveillance, and data management. Support for entomological activities as they pertain to the maintenance of residual activities of the OCP will also be provided by the Unit. As the process of decentralisation and integration of onchocerciasis control activities into national health systems gains momentum, the Unit will reinforce the national skills in the area of Information, Education and Communication (IEC) interventions. A special emphasis will be placed on the transfer of skills for data management to the countries, as well as the provision of the necessary equipment. The necessary logistics and financial support will be provided to enable the countries to absorb these techniques and skills. Training will be necessary for all categories of health staff at the different levels in the health services. For higher level institutional training, emphasis will be placed on epidemiology, public health, health education and health planning and management. The process of "on-the-job" training and retraining in simple epidemiological evaluation/surveillance methods in the field, for middle- level staff in the districts, will continue. This will help to make available in the countries, staff with the appropriate skills for decentralized epidemiological surveillance for onchocerciasis. The Unit will also train staff of the countries in simple entomological methods. Impact assessment of the control activities through epidemiological evaluations, will continue to be carried out by the Unit. Furthermore, the Unit will ensure that patient treatment through ivermectin distribution, data analysis and interpre[ation, operational research and informatics support, are suitably adapted to the realities of the last four years of OCP's Phase of progressive disengagement. The Unit will liaise closely with the Health Education services in the Participating Countries to develop materials for, and reinforce, IEC intervention campaigns at all levels, including government and community levels. These will aim at giving a wider exposure to the new approach of CDTI and decentralized integrated post-control epidemiological surveillance. In collaboration with WHO-AFRO and the Participating Countries, the Unit will play a catalytic role in the integration of CDTI and the decentralized epidemiological surveillance/ evaluation activities into the health delivery systems of the countries. This collaboration will focus attention on integrating post-control onchocerciasis surveillance into the multi-disease surveillance and control divisions of the national ministries of health. 4.2.2 Specific action plans Eoidemiolosical evaluations Following the decision to interrupt larviciding, post-larviciding epidemiological surveillance villages will be selected in collaboration with the national coordination to form part of the network of villages for surveillance activities. The Unit will lend its support in the form of supervision, quality control, logistics and funding to national staff to undertake evaluations in their respective countries as follows : JPC19.4 Page 2l - evaluation of villages in the areas scheduled for definitive cessation of larviciding. The basins in question are: the Lower Bandama and N'Zi, and the Como6 in C6te d'Ivoire. Other basins in which epidemiological evaluations will be carried out are the Niger near Bamako and its tributaries of Dylamba, Faya, and Fi6. - evaluations to assess the impact of combined vector control and ivermectin on: (a) the transmission of infection, and (b) on onchocercal eye disease. Consultants from the Participating Countries as in the past will be called upon to carry out the ophthalmological examinations and surveys, which will include photographic documentation as well as angiographic recordings where necessary. - continuation of the general epidemiological evaluation in the entire Programlne area to record the general epidemiological situation in the Final Phase of the Programme. This will include migration surveys, in selected foci or in some of the "residual foci". Through the DNA laboratory of OCP, the deoxyribonucleic acid (DNA) studies to characterize strains of onchocerciasis using the microfilaria obtained from the epidemiological evaluations will continue. This will be very important in determining the nature of infection still encountered in some of the "residual foci". The laboratory will take on training of molecular biologists from some of the Participating Countries in the molecular biology methods currently being developed in Bouak6 to help with epidemiological surveillance. The refinement of the alternative community diagnostic tools for epidemiological surveillance/evaluation will continue. To this end, further emphasis will be placed on a) the validation of the diethylcarbamazine (DEC) patch tesr which will be introduced in all the countries to run side by side with the skin snip test, b) the search for a locally effective "carrier" for the DEC to replace the Nivea cream presently used, and c) the improvement of the Polymerase Chain Reaction (PCR) scratch test. 4.2.3 Distribution of ivermectin Large-scale ivermectin distribution will continue. This will be based entirely on the community-directed approach which will have been installed in most of the basins of the Participating Countries. It will be carried out in the extension areas as well as in specific areas in the Original Programme area. Additional basins will be included in the treatment within the southern parts of Cdte d'Ivoire, Ghana, and Guinea. Furthermore, after all persons in the areas of high and moderate risk of onchocercal blindness are under treafinent, distribution will be extended to include all individuals living in the "endemic area". Thus there will be a considerable increase in the number of villages to be treated. It is foreseen that over 27,N0 villages will be treated in 1999, and the number of persons to be treated will increase by about a million over the nine millions envisaged for 1998. The Unit will continue to ensure the regular monitoring of the ivermectin distribution campaigns. This will be carried out with the field staff of the Vector Control Unit (VCU) as well as with external independent observers. An independent evaluation of the CDTI installed since 1997, will be carried out by a team consisting of a consultant epidemiologist, a member of the PET Unit, a sociologist, and national coordinators. JPC19.4 Page 22 The installation of the system of CDTI which started in 1997 is expected to be completed by the end of 1998. The year 1999 will see the retraining of the community distributors and consolidation of this approach of large-scale treatment with ivermectin. The national teams and trained nurses in the districts concerned, together with non-governmental organizations (NGOs) and voluntary organizations, will carry out training and retraining of community distributors. The Unit will provide technical, logistic and financial support for this training. No serious adverse reactions to ivermectin are on record in recent years. However, monitoring and documentation of any adverse reactions to ivermectin will continue. The services of the peripheral health units witl be solicited, they being responsible for the immediate supervision of the CDTI. 4.2.4. Entomological activities The PET Unit will continue its programme of transferring to the countries the simple activities required for entomological control. It will provide support and training in ground larviciding to enable countries to carry out the minimal entomological activities required, in specific areas needing such intervention. Additionally, the Unit will reinforce national awareness-raising activities, in relation to the harmlessness of the blackflies returning into an area after the cessation of larviciding. 4.2.5. Data Management A priority for 1999 will be the continuation of the training of nationals in data analysis and the interpretation of survey data collected from epidemiological evaluations and post-control epidemiological surveillance activities carried out by national staff. There will be updating of entry and validation programs that have been installed in 1998 in each of the countries, to render them completely and independently operational in data management. Furthermore, the unit will continue ro transfer the large body of accumulated epidemiological and entomological data to the Participating Countries with the accompanying training to help them access and use such data. Training of nationals will continue in the use of mapping software, and the Global Positioning System (GPS) in the field for village locations. This training will be contracted out to experts in this field if necessary. In this way, skills in the management of the epidemiological and entomological databases, using the Geographic Information System (GIS), will be trarsferred to the countries. For this purpose, the computer equipment installed in the countries by OCP will be used extensively by national teams in this training activity. The GIS data banls will be updated and cross- checked by OCP and the Countries. The Unit will carry out the routine analysis and interpretation of the Programme's epidemiological and entomological evaluation data. This is to study the medium and long-term impact of thi combination of ivermectin distribution and larviciding on transmission and on ocular manifestations. Data entry for such analysis will be carried out by staff from OCP and the countries concerned, but temporary staff wilt be recruited to help when the need arises. Supervision and coordination of the development of data banks on operational research, aerial operations, administration and documentation will continue. Epidemiological modelling will continue to play an important role in the interpretation of epidemiological surveillance results. The results from the basins in the Original Programme atea where larviiiding has ceased, will be tested and compared to the predicted trends generated by the ONCHOSIM. JPC19.4 Page 23 The prospective evaluations of the different OCP strategies based on epidemiological modelling will be refined as new epidemiological results become available, particularly with regard to recrudescence detection and the monitoring/distribution of ivermectin and its impact on transmission. Furthermore, the estimation of the other important parameters (entomological criteria, migration, etc.) of the recrudescence of onchocercal infection will continue, taking into account observations made in the field. In this context, a contract will be signed with the Erasmus University of Rotterdam where a considerable number of simulations will be made in order to continue the validation of the model's important parameters, in the light of the new epidemiological results. 4.2.6. National tearns and national medical personnel of health centres The Unit will support health personnel in the countries as well as community workers in routine field activities concerning epidemiological evaluation, ivermectin distribution and awareness- raising. The national teams in the Participating countries presently consist of a coordinator, his deputy and six other technicians who are called upon for specific duties. They will be responsible for "on-the-job" training of district staff for epidemiological surveillance and for qualiry control of the evaluation to be carried out by decentralized teams. The national teams will be supported to undertake supervision of the activities carried out by the decentralized teams. With the full decentralization of ivermectin distribution, doctors and nurses in the local health centres will be responsible for the supervision of CDTI in their respective districts. To consolidate CDTI, members of the national team will be called upon to make additional supervisory visits, as well as carry out corrective measures and the retraining of community distributors where necessary. For the residual control in the Dienkoa basin in Burkina Faso, a national entomological team based in Bobo-Dioulasso will be supported by the Unit through a Technical Service Agreement with the country. JPC19.4 Page 24 4.2.7. Personnel The staff of the Planning, Evaluation and Transfer Unit is set out in the table below. The expertise of all the other units of the Programme will be called upon where indicated for support. In particular, the Unit will use VCU chiefs of zones, and their entomological staff to carry oui i6 programme of information and awareness-raising of the local authorities and population. eaaitionatiy the field staff of VCU will be used for the training of nationals and communities in ground larviciding techniques as well as the monitoring of ivermectin treatment' STAFFING FOR PLANNING EVALUATION AND TRANSFER UNIT 1999 Professionals P4-P5 Pz-P3 STP (short+erm) General Service Subtotal (i) SSA Harmonized (iD SSA new formula National Staff Subtotal TOTAL 1999 2 3 7 1998 2 t997 2 2 8 r996 3 1995 J 1 4 15 t994 4 2 4 16 3 7 4 t4 tz t2 t2 2l 23 26 5 3 5 7 J J 70 70 70 70 70 70 76 78 77 73 73 70 88 90 89 94 96 96 4.2.8. Consultants A special emphasis is to be laid on IEC interventions. For this purpose experts in this field within the Participating Countries will be called upon to develop the appropriate training materials for carrying out this u.iiuity. Experts in social and behavioural sciences will be contracted for specific studies to be conducted as part of the Unit's support to operational research. Subjects for srudy include general human migratory movements within large tracts of the original Programme area, impact o1diff.r"nt aids on the raising of the awareness of rural communities, and the acceptability of diagnostic methods in the communities selected for post-control epidemiological surveillance' They will also conduct follow-up studies on the ivermectin distribution system as well as studies to ascertain the communities' perception of blackfly nuisance. The services of a senior public health expert will be engaged to help *ith ti," integration of the residual control activities into the national health services. Consultant ophthalmologists will also be engaged for the detailed evaluation of villages in the programme area. The Unit will, if necessary, use temporary general service staff to help in ivermeciin monitoring and in epidemiological evaluation especially for qualiry control purposes, data entry, data processing and analysis, and ophthalmological evaluation. Forty-two man-months of professional level consultancy and nine staff from the general service category, all under SSA type contracts, have been earmarked for 1999' JPC19.4 Page 25 4.2.9. Operational travel An amount of US$ 50,000 will be required in 1999 for duty travel of OCP professional staff and the travel of national coordinators and some of their assistants, mainly to Ouagadougou to review and plan specific activities with OCP. 4.2.10. Service contracts A service contract for US$ 20,000 will be signed with the Erasmus University, Rotterdam, in support of the epidemiological modelling activities. In addition, an amount of US$ 15,000 will be required for research on the different diagnostic tests, and an amount of US$ 5,000 will be needed to cover the cost of local contractual services for the updating of the software for the transfer of epidemiological data to the Participating Countries. Contracts for training on the use of the geographical information system (GIS) will require US$ 30,000. 4.2.L1. Training Training in these disciplines will be provided, through the award of fellowships for higher level training in institutions in Africa and through "on-the-job", in-service and field training. Refresher courses, in the form of seminars and workshops will be undertaken. This will be in continuation of OCP's policy for the transfer of skills and appropriate techniques to the countries. The following disciplines will receive special attention: epidemiology, public health, health planning and management, health education, statistics and data processing. Priority will be given to epidemiological training, particularly at the district level. The Unit will undertake consultations with the countries to establish what will constitute the "critical mass"of trained personnel in these disciplines. An amounr of US$ 450,000 will be required in 1999 to furance new fellowships and in-service training as well as to complete on-going fellowships. 4.2.12. Computer Operations Management The Bio-sratistics and Information Systems (BIS) sub-unit will continue to supervise the computer training of the personnel of OCP and of the Participating Countries. It will also carry out the routine tasks required to run the computer systems in OCP. For 1999, emphasis will continue to be placed on transferring data to the Participating Countries in the computers installed in the countries by OCP in 1998. Cleaning and updating the data and the computer prograrns will be a major part of the activities in BIS. In this context, the targeted training of selected national staff in the Participating Countries will be done to enable them to continue independent analysis of the data. JPC19.4 Page 26 The local area computer network installed in the OCP headquarters is now functional but it will need human and financial resources to ensure its proper maintenance. The software required for financial management will be operational in this network for staff of the finance office. Thus it is expected that in 1999 over a dozen obsolete computers will have to be replaced by the Pentium chip models to use the new operating system, Windows NT. The above will require an investment of $30,000 and a further $25,000 for consumables and software. 4.2.13. Budget In view of the above, the budget proposed for the Planning, Evaluation and Transfer Unit for 1999 is US$ 1,919,000. JPCI9.4 Page 27 TABLE 5 PLANNING EVALUATION AND TRANSFEB UNIT(us $) Category of Expenditure PHASE V PHASE IV Proposed Approved 1 998 Expenditure 1 997 Expenditure 1 996999 145,O00 145,OOO 195,OOO 40,ooo 60,ooo 40,ooo 145,0@ 145,000 195,0@ 40,000 60,000 40,000 36.OOO 12,000 30,000 661,OOO 667,000 497,6A4 538,O01 34B,OOO 50,ooo 60,ooo 30,ooo 70,ooo 250,OOO 450,OOO 231,000 80,000 70,000 40,000 100,000 380,000 555,000 295,787 50,870 157,039 63,763 45,317 42519o 422,767 390,298 91,782 1 17 ,144 60,886 16,801 4BB,385 1,258,OO0 1.456.000 1,460,733 1 ,165,296 1,919,OOO 2,123,OOO 1 ,958,417 1,703,297 PERSONNEL SERVICES WHO OCP Staff Chief PET Brostatrsticran Professronnel temp. (STP) Secretarres Laboratory Assistants Administrative assrstants Personnel SSA SSA Harmonized SSA new formula Temporarre Staff Subtotal Consultants Operational Travel Operatrng Costs Supplies Contracts (Others) Natronal Teams Fellowshrps and Trainr ng Subtotal TOTAL JPC19.4 Page 28 4.3. Macrofil Chemotherapy Project (Macrofil) 4.3.1. Objectives for the Macrofil Project in 1999 The primary objective of the Macrofil Chemotherapy Project continues to be the development of safe and effective adulticidal drugs (macrofilaricides) for onchocerciasis and lymphatic filariasis. In view of the inclusion of lymphatic filariasis, additional financial support is provided by the Special Programme for Research and Training in Tropical Diseases (TDR). At its meeting in Cotonou in December 1996, the Joint Programme Committee (JPC) recognized that a safe and effective macrofilaricide would provide better therapeutic control of onchocerciasis than ivermectin, both in the life time of OCP and in the post-OCP period. Also, a field applicable macrofilaricide would reduce the period of intervention. Additionally, the occurrence of ivermectin resis[ance in onchocerciasis would be disastrous in a control programme based on a single drug. The Committee therefore agreed to the proposed financing of the Macrof,rl project beyond 1997 by OCP, APOC and TDR with OCP's contribution directed as far as possible for preclinical and clinical development of drugs for onchocerciasis and a test for ivermectin resistance. The continuation of OCP support was subject to an affirmative recommendation by the 1997 External Evaluation group, which recommendation was made to JPC in December L997 and approved. 4.3.2. Activities The complete jointly funded Macrofil Project is set out in Annex IX, pages 50 to 52. It indicates that Moxidectin has been identified as a lead compound for the development of a novel macrofilaricide to replace the benzimidazole UMF 078. The Onchocerciasis Chemotherapy Research Centre (OCRC) in Ghana will continue conducting clinical studies of drug combinations. Drug screening centres will continue high output primary assays, and strategic research will be supported to identify the mechanism(s) of ivermectin drug resistance in parasitic nematodes. 4.3.3. Budget For 1999 funding of the Macrofil Project will be shared equally between OCP, APOC and TDR, each contributing US$ 700,000, to give a total of $ 2.1 million. The poss of a P5 scientist and a G5 secretary and the costs of the Onchocerciasis Chemotherapy Research Centre in Ghana will continue to be funded directly by OCP as part of its contribution. JPC19.4 Page 29 TABLE 6 MACROFIL CHEMOTHERAPY PROJECT(us $) PERSONNEL SERVICES yVHO / OCP Staff Scientist Secretary Subtotal (1) Costs of meetings are included under "Consultants/Temporary advisers" Category of Expenditure PHASE V Proposed 1 999 Approved 1 998 180,OOO 't05,ooo 180,000 105,000 PHASE IV Expend Expend Expenditu 1 995 Expend 1 997 1 996 1 994 Subtotal 285,OOO 285,000 165,005 249,675 242,912 195,505 Consultants/Temporary advisers (t ) Operational Travel Research Contracts Supplies Other Activities 185,OOO 25,000 205,OOO 150,000 25,000 220,0m 20,000 415,000 415,000 700,o00 700,000 164,406 7,046 1,362,676 21,395 10,000 1,565,523 1,730,528 196,505 15,255 1,223,464 32,791 30,000 218,695 1 1,004 1,258,009 28,80'l 20,000 144,643 17,055 't,220,833 24,199 20,000 1,498,015 1,536,50S 1,426,7n TOTAL 1,747,6W 1,779,421 1,622,235 JPC19.4 Page 30 4.4. Office of the Programme Director 4.4.1. Activities The Office of the Director will ensure close liaison with the Statutory Bodies, the Donors, the Participating Countries and the scientific community. Its main activities will be in the management of the Programme and the implementation of general policy. This implies coordinating all programme activities including research contracts, public relations and statutory meetings, through the phase of progressive disengagement towards the end of activities in 2002. Within the framework of the setting up of the new African Programme for Onchocerciasis Control (APOC), the Programme Director continues to be the ad interim Director of APOC. Consequently, part of his satary will be charged to the APOC budget. The following activities and services will come directly under the Office of the Director and will be charged thereto : - operating the Office of the Co-ordinator who assists the Director in the co-ordination of the programme's activities and the definition and implementation of general policy and the management of the new APOC prograrnme; because of this latter function, an important part of the Co-ordinator/Programme Administrator's salary will be charged to the APOC budget; - operating the Documentation Centre which serves an internal and external clientele; - organization of meetings, dissemination of information and raising awareness, at all levels, of the different objectives pursued by the Programme; - operating the liaison office in Geneva which is responsible for facilitating communicatton between the structures of the Programme, WHO/Geneva and the exterior. 4.4.2. Personnel After the staff reduction which took place in the Office of the Director in 1997 , negotiations were undertaken with WHO Headquarters to establish NPO posts. These will permit OCP to maintain the quality of its work at reduced cost and at the same time reduce the current overload on the staff. One higtr level post of the general services category will be abolished and replaced by a "National professional Officer" posiiion (NPO). A second NPO will be employed to handle the increasing workload in translation. To strengthen the secretariat of the different services attached to the Office of the Director, one of the VCU secretarial positions was transferred to the Director's Office. The figures in the table below take into account these staff changes. JPC19.4 Page 31 OFFICE OF THE DIRECTOR : STAFF 4.4.3. Consultants The services of external consultants may be needed to assist the Office of the Director in the areas of general policy definition and Programme management. 4.4.4. Budget The budget proposed for the Office of the Programme Director for 1999 is US$ 869,000 WHO/OCP Professionals P6-D2 P5 P1-P3 STP (short-term) NPO General Service Subtotal SSA contracts new formula Harmonized Staff TOTAL T999 1998 1997 1996 1995 t994 ,) I I ) 7 2 1 2 I ) 2 1 1 2 1 6 1 1 2 1 5 I 2 I2 J 5 I I 1 9 1 2 8 1 2 11 9 9 2 2 2 t2 L2 ll 13 11 11 JPCI9.4 Page 32 TABLE 7 OFFICE OF THE DIRECTOR(us $) The ApOC Programme will reimburse 75 percent of the salary of the Co-ordinator/Programme Manager and 25 percent of the salary of the Director. 51,836 55,689 55,33 19,283 Category of Expenditure PHASE V PHASE IV Proposed 1999 Approved 1998 Expenditu 1 997 Expenditu 1996 Expenditu 1 995 Expenditu 1 994 PERSONNEL SERVICES WHO/ OCP statf Programme Director Coordinator,D irector Off ice Administrative Officers Ad ministrative Assistants Secretary (Geneva) Clerk Stenographers Personnel SSA SSA Harmonized SSA new formula 155,OOO 't55,OOO 280,OOO 40,ooo 105,OOO 20,000 8,OOO 6.000 769,OOO 155,000 155,000 280,000 40,000 105,0@ 20,000 8,000 6,000 450,499Subtotal 769,000 734,800 547,792 474,691 Consultants Operational Travel Operating Costs Supplies Fellqwships and Training 40,000 40,ooo 10,ooo 10.ooo 93,000 50,000 15,000 20,000 131 ,150 34,983 46,802 102,533 12,505 76,420 24,713 33,723 529,393 60,481 67,729 15,287 27,211 Subtotal lOO,OOO 178,000 869,000 947,000 315,468 765,967 676,754 170,708 182,1& TOTAL 1,411,554 718,500 656,831 Note JPC19.4 Page 33 4.5. Administration and Support Services Unit 4.5.1. Ouagadougou The Administration and Management Support Services Unit in Ouagadougou will provide the necessary support for the technical units to achieve the objectives of the Programme. It will manage the available human, financial and other resources towards this end. The year 1999 is the second year of Phase V, which is the Phase of progressive disengagement. Since the Programme will end in the year 2002, a four-year perspective will be brought to bear on the acquisition and disposal of resources. The Personnel Service will see to the recruitment of staff (mostly temporaries), the management of staff contracts and the orderly separation of staff from the Programme. This includes the routine treatment of medical examinations, Ieave, the performance evaluation system and discipline. It has the responsibility to see that the process of gradual staff reduction is just and equitable and that the Programme retains the technical competence and versatility of its remaining human resources. There will be increasing use of short-term contracts. Emphasis will be put on maintaining staff morale, and counselling will be provided for staff to help them re-integrate into their national systems when they leave the Programme. The Supply and Administration Services will see to the procurement of goods and services including the management of contracts. They will also maintain appropriate inventories of the goods and equipment belonging to the Prograrrune, and see to their orderly disposal in accordance with the rules. They will continue to maintain the infrastrucrure and services in the Ouagadougou office and to support the field offices with stationery and office equipment. In 1999, the policy of rationalization by rururing down stocks of materials and equipment and disposing of obsolete and surplus materials, will continue. The Transport and Communications Services will operate the fleet of nearly 300 vehicles in support of the training and field activities of the technical units. Vehicles bought in 1987 and before will continue to be progressively phased out. As the Programme moves into the phasing-out period, fewer cars and station wagons will be needed and as sectors and subsectors close down, there will be fewer Toyota Hilux vehicles. In 1999, the fleet will be maintained at 255 (see chapter 4.7 . Capital Costs). The services will also maintain the existing radio communication system, which is indispensable to OCP at this stage. The Budget and Finance Services will manage the 1999 budget, in accordance with the principles of WHO and operate 12 bank accounts in the Participating Countries. Because of the closure of the Bouake sector in December 1998 the bank account in Bouake will be closed during 1999. They will handle the payroll, make payments to suppliers of goods and services, settle staff claims, keep the bools of accounts and report monthly to WHO headquarters. They will continue to exercise rigorous control over financial commitments to ensure that expenditure remains within the approved budget. 4.5.2. Geneva The Programme will continue to benefit from the administrative support of WHO Headquarters. This support normally covers the fields of Legal services, Personnel administration, budget, finance, insurance and procurement of supplies. For these services, WHO is authorized to charge OCP 13% of the Prograrlme budget (since it is a programme supported from extra-budgetary sources). However, WHO Headquarters has decided to waive this requirement in the case of OCP, and charges OCP on a cost-recovery basis. JPC19.4 Page 34 4.5.3. Personnel The staff requirements for the administrative and managerial duties will diminish, but not directly in step with, nor in proportion to, the trend of the operational activities. The staff requirements include the four general service positions in Geneva. WHO/OCP Professionals P6-D2 P4-P5 P1-P3 National Professionals (NPO's) STP (short-term) General Service Subtotal Harmonized Staff SSA - New formula TOTAL 1999 1998 t997 1996 199s 1994 l 1 3 1 I 1 2 1 1 2 1 1 2 2J 2 1 2 1 1 1 1 ?6 30 38 46 47 50 32 12 I 36 33 7 43 51 33 52 50 33 31 31 T2 76 76 84 83 87 4.5.4. Budget The budget proposed for the Administration and Management Support Services Unit for 1999 is US$ 1,753,000. TABLE 8 ADMINISTRATION AND SUPPORT SERVICES(us $) ( Ouagadougou and Geneva ) JPC19.4 Page 35 Category of Expenditure PHASE V PHASE IV Expend Expe Expenditu 1 994 Proposed Approved 1998 Expend 1 1997 1 996 1995 155,000 145000 50,ooo 65,OOO so,ooo 115,OOO 50,ooo 50,ooo 1 15,000 50,000 1 15,000 't 15,000 360,000 600,0m 128,OOO 54,OOO 475,OOO 132,000 42,000 475,000 1,492,O00 1,849,0@ 1,251,771 1 ,411,846 1,389,721 1,892,705 25,510 52,782 20,408 255,041 1 10,068 45,297 95,931 22,301 215,138 52,O57 63,354 61,589 22,801 321,252 52,O20 54,780 41,848 22,868 255,573 25,985 50,ooo 24,OOO 142,OOO 45,OOO 65,000 24,OOO 200,000 45,000 261,000 334,000 463,809 430,724 521,016 1,753,OOO 2,183,000 1 ,715,580 1,842,570 1,910,737 PERSONNEL SERVICES WHO / OCP Staff Chief Administration & Management Administration & Finance Officer Transportation & Commu. Officer Finance Officer Budget Officer Personnel Officer Supply Officer Administrative assistants,Clerks Typists & Storekeepers Personnel SSA SSA Harmonized SSA new formula Administrative Support Geneva Subtotal Consultants Operational Travel Contracts (Others) Operating Costs Supplies Subtotal TOTAL 401 ,Oil 2,293,759 JPC19.4 Page 36 TABLE 9 OVERVIEW OF ADMINISTRATIVE AND EXECUTIVE MANAGEMENT COSTS *(us $) table 7 - Otfice of the Director ; table 8 - Administration and support services ( ouagadougou and Geneva ) Category of Expenditure PHASE V PHASE IV Proposed 1 999 Approved 1998 Expenditure 1997 Expenditu 1996 Expend Expenditu 1 9941 995 't 55,OOO 1s5,000 145,OOO 50,o00 445,OOO 'l 15,OOO 155,000 1s5,000 155,000 50,000 560,000 1 15,000 420.000 105,OOO 475,000 660,000 105,000 475,0m 't36,OOO 60,ooo 140,000 48,000 2,261,OAO 2,618,000 1,702270 2,145,579 2,342,993 2,367,396 40,ooo 90,000 24,OOO 152,OOO 55,OOO 93,OOO 115,000 24,OOO 215,000 65,000 156,660 87,765 20,408 301,843 212,601 57,802 172,355 23,301 239,851 85,780 529,393 123,835 129,318 22,801 336,539 79,231 106,616 97,537 22,868 310,905 45,268 361,OOO 512,000 779,277 1,108,482 691,724 583,194 2,622,000 3,130,000 2,481,547 3,254,061 3,O34,717 2,950,590 PERSONNEL SERVICES WHO / OCP Staff Programme Director Coordinator, D irector Off ice Chief Administration & Management Transport & Communications Officer Finance & Tech. Officers Personnel Officer Administrative & Technical Assistants, Clerks, Steno. Secretary (Geneva) Administrative support Geneva Personnel SSA SSA Harmonized SSA new formula Subtotal Consultants Operational Travel Contracts (Others) Operating Costs Supplies Fellowships and Training Subtotal TOTAL * Summaly of FIGURE 3 BUDGET BY PROGRAMME ACTIVITY - 1999 OVERVIEW AOMINISTRATIVE AND EXECUTIVE MANAGEMENT COSTS JPC19.4 Page 37 7 6 B 5 2 4 3 1 Vector Control 2 Planning Evaluation and Transfer 3 Chemotherapy Project (Macrofil) 4 Statutory Meetings 8 Capital Costs TOTAL 100,000 (us $) 9,955,000 1 ,919,000 700,000 250,000 ('/") 64.O4 12.34 4.50 1.61 0.64 1 5 Office of thg Director 869,000 5'59'-] 8.22>16.87 3.oq,l 6 Administrative & Support Services,;t,;278,000 7 Administrative,support Geneva ' 475,000 2,622,440 15,546,000 100.00 JPC19.4 Page 38 4.6. Statutory meetings The meetings planned for 1999 are similar to those of the past years: the Ecological Group, the Expert Advisory Committee, three or four sessions of the Committee of Sponsoring Agencies and the Joint Programme Committee. The budgetary provision for these different meetings mainly covers the costs of travel and per diem, interpretation services, translation of documents, and various supplies. The costs of the participation of experts in meetings other than those mentioned above (research, ivermectin distribution, hydrology, hydrobiology, national coordinators) have been included in the "Operational travel" category of the budgets of the host units. One full+ime administrative officer and a secretary, budgeted for in the Office of the Director, are assigned to the organization of meetings. They are also being required to handle an additional workload for the Starutory Meetings of APOC. The budget proposed for 1999 is US$ 250,000 which is a reduction of 16.67 % as compared to the budget for 1998. TABLE 10 STATUTORY MEETINGS(us $) Category of ExPenditure PHASE V PHASE IV Proposed 1 999 Approved 1998 Expenditu 1997 Expenditu 1996 Expend Expe 1 995 1994 PERSONNEL SERVICES 35,OOO 30,000 39,143 43,977 Subtotal 35,OOO 30,000 39,143 43,977 51,926 44,864 Consultants/Te mPo rary Advise rs Operational Travel Operating Costs Contracts / Translation 100,ooo 90,ooo 15,OOO 10,o00 145,000 1 15,000 5,000 5,000 90,122 74,O92 2,444 90,101 37,521 2,001 1 13,093 154,531 't,179 93,784 95,995 3,447 Subtotal 215,000 270,000 250,OOO 300,000 167,058 129,623 268,803 193,2b TOTAL 206,201 173,6m 320,7N 238,090 JPCI9.4 Page 39 4.7. Capital costs 4.7.1. Oflice equipment $ 2,ooo The purchase of new equipment will be strictly limited to essential items; most of the needs for office furniture will be satisfied by the redeployment of materials from closed installations. However there is need to replace some old calculators or other small items. A budget of US$2,000 is reserved for this kind of expenditure. 4.7.2. Computer equipment $ 3o,ooo The purchases will be focused mainly on the more powerful computer equipment adopted in recent years. These will facilitate the transfer of data to the Participating Countries and enhance the testing of data entry and validation programmes for irntallation in computers already installed in countries in 1998. Internal to OCP, over a dozen machines remain to be upgraded with modems and larger memories to accommodate the current software for office work, e.g. Windows 95, and Excel. A budget of US$ 30,000 is necessary. 4.7.3. Technical equipment $ 3,ooo A small amount of routine replacements for scientific equipment is needed for the research laboratories. A token budget of US$ 3,000 is reserved for this kind of expenditure. 4.7.4. Vehicles $ 60,000 Only four new vehicles will be bought in 1999, as the fleet is stabilized at255 vehicles to meet the most recent estimate of transport requirements.There is also a real need for support to the countries for the supervision of community based ivermectin distribution, as they switch from the OCP supervised mobile team distribution method. A budget of US$60,000 is proposed for vehicles. 4.7.5. Buildings $ 5,000 When, we close the entomological sector in Bouakd in December 1998 and transfer the ADN laboratory from Bouak6 to Ouagadougou, there will be need to refurbish the two buildings vacated, to hand them back in good condition. The amount of US$ 5,000 is provided in the budget for this exercise. JPC19.4 Page 40 TABLE 11 CAPITAL COSTS us $) Category of Expenditure PHASE V Proposed 1 999 Approved 1 998 2,000 20,000 so,o00 50,000 3,OOO 80,ooo 60,0o0 97,000 5,OOO 20,000 100,000 267,O@ PHASE IV Expenditu 1997 Expenditu 1 996 Expenditu 1 995 Expenditu 1994 34,269 37,870 31,103 90,105 65,930 126,827 62,086 136,789 104,992 78,627 94,467 590,690 359,0'r1 417,589 390,609 12,O77 3,882 1,602 851,8s3 579,880 658,028 548,7U Offrce Furniture Data Processing Equtpment Technical Equipment Vehicles Buildings Total JPC19.4 Page 41 ANNEXES I. OCP ORGANIZATION CHART II. AVERAGECOSTSUSEDFORBUDGETARYCALCULATIONS III. RATES OF EXCHANGE OF THE US DOLLAR/F CFA FROM 1997 TO 1998 IV. PERSONNEL COST FROM T992TO 1999 V. AERIAL OPERATIONS FROM 1992TO 1999 VI. MAP - PROPOSED VCU PLAN OF OPERATIONS FOR 1999 VII. MAP - VCU SECTORS, NATIONAL BASES AND OPERATIONAL BASES - 1999 VIII. MAP - LARGE-SCALE IVERMECTIN TREATMENT PLAN - 1999 Ix. MACROFIL CHEMOTHERAPY PROJECT X. VEHICLES IN OPERATION FROM 1992TO 1999 Page 42 43 44 45 46 47 48 49 50 53 JPC19.4 Page 42 ANNEXE I B I E c .9 i , .T E a E =o o o(L o o o)(6 E E o E E(! o) o o- ,9j o o d) .:o o E o oo oj o d .EE' 8o o F Et o o(L o o o o .=o o)c E63 d & Eo .9 o U o .:o o EFgI (L o F : tu E. CI o E.(LE r( IEoFz <o ,l oK CD=z- PS I,IJ o oI oz o Er EE fi( 2tr El, 6 Jixoy tsa <uJGOuuCG o oz rQ =EEEfrS o JI E o E oF(.) U 2-Jyz EEH q I6 r t tc ztr H lr, ' U o E o z oa f a E o Fou Eo zzooEE 6 EEUI EEEE ir, HE8 r=Etrr- 6 J oFrItr 3EPt)E' ciG 8(, Psotc .JA PHl=alE CEOgt z^ 9E 5e dE 2AZFz6<2d< IE oFo IJJE o IIJ = =sI tc o. =oo3 8 0 =o 6 EE =,#ErE6! 5E EgE" Eh* 2frEUkE EIzc dilFdooE. b o d oifi >q dE)ao ?8 EE Efr uoz z E EI)o JPC19.4 Page 43 ANNEXE II AVERAGE COSTS USED FOR BT]DGETARY CALCULATIONS (US$) 1999 1998 1997 1996 Personnel Professionals - D2-P6 - P5-P4 - P3-P1 National Professional Officer General Service SSA New formula Programme area Geneva Programme area Geneva 50,000 50,000 155,0fl) 145,000 180,000 115,0m "gs;000 10s,flru 4,000 7,000 8SS 155,000 145,000 180,000 115,000 20,000 105,000 4,000 7,000 800 155,000 145,000 175,000 115,000 150,000 143,000 175,000 110,500 20,000 19,500 6,m 6,000 National Personnel - Consultants/month - Temporary (General Service/month) 4,000 7,000 800 3,500 7,000 800 Aerial Operations Cost per flying hour (incl. fuel) - Guaranteed helicopter hours - Excess helicopter hours 722 924 722 .050 .sss ' :;1 ,1 924 864 748 Insecticides - Cost per litre (CIF) - Vectobac (B.t. H-14) - Tecknar (B.t. H-14) - Temephos 20 % EC - Permethrin}O% EC - Carbosulfan21% EC - Pyraclofos 50% EC - Phoxim - Vectron 6.54 8.28 15.96 10.19 go^8:, 26:45 14.71 24.15 4.93 15.58 ro.29 20.82 26.45 16.05 24.15 4.64 t3.94 r0.29 20.82 26.45 t7.02 24.t5 4.64 t3.94 t0.29 20.82 26.45 17.02 24.t5 Value of US dollar - CFA Franc - French Franc - Swiss Franc - Pound Sterling - Deutsche Mark - Canadian Dollar - Japanese Yen 550.00 5.50 t-46 0-60 1.80 1.49 1X5^00 500.00 5.00 t.43 0.62 1.60 t.36 115.00 500.00 5.00 1,t4 0.62 t.37 t.36 102.00 450.00 4.50 l.l4 0.62 r.37 1.36 84.00 The average cost of US$ 20,000 used for General Service staff refers to higher-grade staff members who will maintain the OCP status. (*) @ o) o) o- -oo LL (E = (U c(u f IUF CE Ftu(, ol c0 z o trl o a @ U):f n Cff o- -oq) LL (d E6? O oo o o o)f oz o- oa Ef (E o) o) oooooaaaa6OtDotootooto(o(orolorf$(f)(f)N vrc -$ sn JPC19.4 Page 44 ANNEXE III +o(o t (o o (o @o(o o) @ rO (f) @ lO o) o) LO o(o LL o E. I =co(Jo)Oo) @N ;o)Jo)r (\I7(o o F f o IU sf C! o)lo oo ro rf 1r) o ro @(o LO JPC19.4 Page 45 ANNEXE IV q + o) o) o) @ o)o o) o) F-d N 8N oa(d l- CL o ci o o) o) P oF C\ o) P 6-,L)tz @A 8sjeEq I.U P@ ,_* .o r.u 6z2ZEo;aZ CEu TL L) Fa oO a .a-(U o <oEo)No'E o E(U + LrO +EAro :E e a9.6(U JI bE6@ o a, E 5 aOO:=\.JEEE: o o6 LLoox -o-ovtr trE JJAorzzF emlN q @ oooooo)co N ol (o @ ol lnd ot ot u? @ ooooN(oro$ anlp^ 2661. lo e6eluecra6 o(f)(t oo$ slN oa(E .CL o(f) o(f) + (f) t-$+ - @it to(o ooN ooCo o)9o&o9 o G'L tr o(.) 3oz <- .oAoaoEf JPC19.4 Page 46 ANNEXE V OI(oolo o)(f) $ oloo(f) od) 1I)6 oo AItfo F-N!t =5 xgt Hq6) .$ .a ilrcL-] X) 0)a(d .C o- og c oo Boz o(U C oo 3oz {- o) o) (o o) o) ro o) o) t+ o) o) (r) o) o) N o) o) 3 \f rooo$ (o (r)( (9 coln$ @tf,o(o oa(d -c(L o, o, o, o N o,o) 'arO oSa L.' a EE a9 Z- ,-aOE kt-tl ': IJJ T(L o tr LU @ $ <-- cr)o co+F-I(o Fr @ o)lo(o(\T o)F. o$t(f)$to(o@o) !JPCI9.4 Page 47 ANNEXE VI ;,' i-, f \. o) o) o) tl o o_ fo uJo U)z o tr E. LU o- o b z J o- O) O) o) t o lJ- (r) z o tr t LU o_ o LL o z J o- f C) i :c, o o oo o aC .9oco xo @oE o =E J -G EC l o -o oo o co oco o c @ c =oo EC6 C o oo = o GE .c o .=o o -_E = -o!c o -o Go o o E EG o)o o- 6 .c o) o j-^> l. r c-P3 -=lo3g coi96<bgEE .5sCOO^ '51-o E 6E5;! Cc 6! €*ic! o,\ o 3_30 5 o 3e 3() o g!oa*? =96oEe.a3u'EoLC=](LoJo ou3g6 6-:9o:5 9:>iiE .occo .9.6a co E o =G F co E oo Ecoooo o ta t- tl aa a oo eecoo:o@ "- -EE8 >.>_ EEloot <ta 0 1.,rt , I :o n {J ,i ) ''irr f ( ( t, '.j-'\, ,\ tl 'r' -{. ( { .( L, "1 ( )' \t) r j., o o, ,@ Co L oI oEc -o 6C o oz I I I JPC I9.4 Page 48 ANNEXE VII l t;.9o(, _cEc) Eboc Xd) a-a\(g .Dc)(D\ (U(/l, co)Oq) =(g(I,-Oz-(, al7 cC)Oo'aC,o@z 0( UJ o = o) o, o) o)- o) z- oLU -azu _J CDJ tU I.Uaz<zcoo J-<k 6ffiEo- <o ffin6? 6co =rlaal uJ ull zil a.zl ,Ol( r-lz<t 9.zl Enlz- @)pff Oui 5q AF 1 'ci o o ooJo oc .oocoxo ooD o -_E '= -6ro cJo -o 6o o co 6c o uo c oE fo ! c o C o6o o .6 =c o =G o Ej z.6 -o c l o -o o o o E E6 cl,o (L oc ,9 o oofo oC -ooCo o c o^ =.oqb o- 6! oo-o/\ oXoLJb oo =oUTLr oC6O 2t)EO -:l)a a6! c= Es6oCi9o EE _ol aD5o -CLCOO!_Calo o! O-! al CX6u- LO a- ofLOCLo o c co -o o ooG(D o o -o E o I o9 3Eo!2 eE(.{ !?oi6o IHOco o O6Oc6oD- -6Q= ooaooo z@ lo oo a o oo U) I @ ocoN o ! .9 o oc(-) a I ocoN l t.* i { \:., H;')QOco 3I(,' IIt o co .9E o(D foxo G(L oe z llJ c0 o o o b--d. Y o lug o -a txl- o o uJzz uJ / / / / / ( \ l I I I , I I I I I t a I , I I =u-lx [s2 0(XIUU(4J !! ooEoI / I a I z I o I I I I ) a o o =o o)foE 'o o E zg I I z E. tL I =o Eo IEoo =o foY o o .E ao U) 6 o -ooo IJJ e) o oq u* =vq) c0 lx ul e5 o f, c\o: IaDr cr\ 8o OI<vl oI (D!o CL o) o o) 3 ooo(U -o o .9 o_ o od U) L o o o)a I oo o c .9oC o! o) oo o o (E L .o o- o ,(! -o o0 oL f o) o c) e oa t! .) I 6 o co v- JPCI9.4 Page 49 ANNEXE VIIIqt! '-=*Q-- a t_\. 6' o, ^O)E= o)o- :Eq;J o@ vL *o -tuZ-- _ .z_ FFz<) Lu ul lff<il H=FJ z< Fg r.x ;1 >+E-o 5H l'UOJZ otqo UTt+ <fi a>",otrlr< @t I.U F 6xN-a tUz oN oc o o E o .z .6 c o E o =c 3 l oo o: o .= 'il o c o N c o E 6 o cE o o E o ot .c ! o!l o _c o! o oc oN oc o o E o ,6 c o E o -_o o! oc oN o o o a o E o o c o o E o2 o o) ..9. C o t! oo .E oEC =o -o EC .o 6z I !f a 6 a .o) >f EE 3o;cr=o = Q'4 o! Loo-9 -O!Eko)6:o s b€99aEEE > ctJ a6oc lo -o G o) (E o ECO 6-q o=o.=ie 5'6co o'= 'trtoi I I I I I € B^^ E aU -:ta .Yg€6E € ;Ee$;eE35E:8EEE E E5o !.=;i f co oJa>o o b6 !C 3F -od o-o oE o> Z-eo!O6O-(L9 I a I ,--'t I rl\1 \ l a" ll rol o .,1 E l I a -,1 ,,=l.- al-al -ll .__w a oI TL € B 6 ?I 3: ,, 3I ,8 a ( (. J o UJ e i) a I )-r I a JPC19.4 Page 50 ANNEXE IX MACROFIL CHEMOTHERAPY PROJECT (MACROFIL) FOR TRIPARTITE FI.INDING BY OCP, APOC AND TDR Breakdown of 1999 Budget 1. Objectives for the Macrofil Project in 1999 The primary objective of the Macrofil Project continues to be the discovery and development of safe and effective adulticidal drugs (macrofilaricides) for onchocerciasis and lymphatic filariasis. Additionally, Macrofil will evaluate all compounds showing anti-filarial activity in primary screening, since is secondary objectives include development of drugs which, while not killing adult worms, would permanently sterilize them, or of alternative microfilaricides to ivermectin. From 1998 onward, funding of the Macrofil Project has been shared equally between OCP, APOC and TDR, each contributing US$ 700,000 to give a total of US$ 2. 1 million per annum. In 1999, the posts of a P5 scientist and a GS staff secretary will continue to be funded by OCP, and as far as possible OCP and APOC funds will be utilized for preclinical and clinical development of drugs for onchocerciasis, while TDR funds will be utilized for development of drugs for lymphatic filariasis, and for more fundamental work on identification of molecular targets for drug development. Work will also continue on the development of diagnostic methods able to detect resistance to ivermectin, at the molecular level, in O.volvulus to allow early detection of such resistance in the field. Background The lead compound for development of a novel macrofilaricide is currently the benzimidazole UMF 078. Efforts were made to complete preclinical development during 1997. During the course of these studies, two concerns emerged. First, it was noted that oral administration of UMF 078 to rats, dogs and cattle produced peak blood levels of drug so high that severe CNS toxicity was observed. Second, though negative in the bacterial Ames test, the drug proved to be mutagenic, after metabolic activation, both in vitro and in vivo, in mammalian systems. A report was commissioned from an outside independent toxicologist to assess the significance of these results in the tight of the available pharmacokinetic and efficacy data' This report has now been circulated and will be reviewed by the UMF 078 Product Development Team as soon as possible and a decision on the future development of UMF 078 will then be made. Moxidectin has been identified as an alternative lead compound. Initial experimental studies suggest it may either permanently sterilize adult female worrns, or even kill them. Further experimental studies are in progress in attempts to substantiate these observations. Moxidectin wis developed for the animal healthcare market and therefore all the necessary technical and preclinical development required prior to clinicat studies in man have been completed. Thus if additional experimental results justify them, clinical studies could begin in 1999' As a component within the newly established Drug Discovery Committee of TDR, novel compounds will iontinue to be obtained and tested for anti-filarial activity. Four of particular interist have been identified recently. These will be investigated in depth in established secondary and tertiary animal model systems. Their potential for technical and preclinical development will also be assessed, so that decisions can be made as to whether any are robust enough to be put into full development. 2. (JPC19.4 Page 51 Annexe IX 3. Clinical centres During 1998, the Onchocerciasis Chemotherapy Research Centre (OCRC) in Ghana, is conducting clinical studies of drug combinations. These will continue into 1999. It now seems unlikely that clinical studies with UMF 078 will be justified, but moxidectin appears to be a strong candidate for such investigations. Possibly Phase IA and certainly Phase IB studies will be carried out, if justified, once ethical clearance has been obtained and the combination studies have been completed. Costs of monitors for all clinical trials need also to be included. It is estimated that approximately US$ 225,OOO will be required for all clinical studies, plus US$ 115,000 for Dr Awadzi's consultancy fee. 4. Registration and legal costs Patent cover may have to be maintained on UMF 078 and established for new molecules of interest, at an approximate cost of US$ 10,000. 5. Drug screening centres High throughput primary in vivo assays using Brugia pahangi in the gerbil, with the B.pahangildog and O.ochengilcattle models as subsequent development assays will continue. Extended prophylactic studies of ivermectin and moxidectin in cattle will increase costs in this model: an approximate total cost of US$ 500,000 for compound screening is estimated. 6. Chemicalsynthesis/Preclinicaldevelopment If any of the new lead compounds shows sufficient activity for assay in the dog and cattle systems, large-scale synthesis by a contract company will be required. Estimated costs are based on development of two compounds per annum. If good efficacy for either compound is shown then preliminary toxicology in vitro and in the rodent would be initiated, and a total estimated cost of US$ 390,000 would be needed for all preclinical activities. 7. Strategic Research Laboratories to identify molecular drug targeS and develop automated assays for their use in high throughput screening assays will be supported, together with laboratories working to identify the mechanism(s) of ivermectin drug resistance in parasitic nematodes, and the genes changes responsible for this resistance. Such strategic research will cost approximately us$ 460,000. 8. Meetings/Temporary Advisers The coss of the Drug Discovery Steering Committee will be met from TDP/TDR central funds, and Macrofil will be expected to contribute towards the cost of its meetings. Meetings of clinical drug screening and specific product development teams for macrofilaricides will still be required. The total costs of bringing temporary advisers to such meetings is estimated at us$ 70,000. 9, Operational travel The scientist employed to develop macrofilaricides will need to visit collaborating laboratories, screening and clinical centres, pharmaceutical companies, etc., and attend statutory meetings of OCP and APOC when required. Approximately US$ 25,000 will be spent on such travel. JPC19.4 Page 52 Annexe IX 10. Personnel Personnel requirements for the Macrofil Project remain unchanged for 1999, namely one scientific post at the P5 level and one secretary at the G5 level. A total personnel cost of approximately US$ 285,000 (as in 1998) is estimated. 11. Miscellaneous supplies and service It is recommended that a sum of US$ 20,000 be set aside for small purchases of equipment, books, journals, etc. 12. Total budget It is therefore proposed that a total budget of approximately US$ 2.1 million be allocated to the Macrofil Project in 1999, in this second year of operation of the collaborative funding system, with APOC, OCP and TDR each contributing US$ 700,000. MACROFIL STJMMARY BI.'DGET 1999 t Clinical Patents Screening Technical/Preclinical Development Strategic Research * Consultants (Awadzi) * Meetings/Temp Advisers * Operational travel x Personnel Misc. Supplies TOTAL US$ 225 000 10 000 500 000 390 000 460 000 115 000 70 000 25 000 285 000 20 000 2 100 000 t ,k To be retained by OCP JPC19.4 Page 53 ANNEXE X O) O) O) \t N + (\I lo rO(\I lr)lo ol o o t oF N a op .C o E Eir I @ o) O) o) O) (o o) O) a op .C o c oa '6 = m aJof L sf o) o) (r) o)o ol o) o) @(\I G) o(Y) rO (r)(o O)(o $6t6l (o ot ot (9 (Y) N (\l o OI FAI oN LrO o) o)lo sf $(\t(\I lO 1'-N sfN(\I lO @N Cf)o6l (7)o(Y) o, O) P ot- .a sto) -cr9 =Eo,9 cELLI'L ui o) (JE r-- o)k= u6L'6O= z0ta=tIIF IIoE$ t-N rf ot \l(\l(\I t-(r) st st $ ol N(Y) (Y) I Ec o o) 3 o LO oooLO r oo(\l oloN oo c) o rO a) a o I t a a