Report of an investigation into the location of the headquarters of APOC

African Programme for Onchocerciasis Control (APOC) Programme africain de lutte contre I'onchocercose JAF-FACJOINT ACTION FORUM Office of the Chairman JOINT ACTION FORUM Fourth session Accra. 9-11 December 1998 Provisional agenda item 10 FORUM D'ACTION COMMUNE Bureau du Prdsident JAF4/INF/DOC.6 ORIGINAL: ENGLISH September 1998 REPORT OF AN INVESTIGATION INTO THE LOCATION OF THE HEADQUARTERS OF APOC An investigation into the location of the headquarters of APOC (the African Programme for Onchocerciasis Control) Detlef PROZESKY Faculty of Medicine University of Pretoria South Africa July 1998 (ii) TO THE READER'S ATTENTION The 17 appendices (45 pages) initially attached to this self explanatory report by the researcher, have been removed by APOC Management. They will be available on request. The Management (iiD Contents Abbreviations Summary 1. Introduction 2 J 4 Methodology 2.1 The research question 2.2 lnstruments and sources of information 2.3 Sampling and data collection 2.4 Practical issues and constraints 2.5 Data analysis . . . Findings 3.1 Benefits/costs to APOC of being based in Ouagadougou 3.2 Benefits/ costs of relocating APOC 3.3 Technical and administrative costs of relocation 3.4 Futureconsiderations Conclusions, discussion and recommendations 4.1 The research sub-questions 4.2 The overall research question 4.3 Discussion - APOC in a state of flux 4.4 Recommendations 1 2 J J 4 4 5 6 7 7 9 01 t4 15 15 t6 t7 t9 (iv) Abbreviations AFRO APOC BIS CAM CDTI COM/O DOC FAX FO IATA IBRD IEC MAN MDSC NGDO NOTF OAU OCP PER PET PRO SSO TAT TCC TMO VCU wHo Regional Office for Africa of the World Health Organization African Programme for Onchocerciasis Control Biostatistics and Information Systems section of OCP Chief of Administration and Management of OCP community directed treatment with ivermectin Communications Officer of OCP Documentation Centre of OCP facsimile service of OCP Finance Officer of OCP International Air Transport Association International Bank for Reconstruction and Development (The World Bank) information, education and communication Senior management of OCP multi-disease surveillance and control non-government developmental organization National Onchocerciasis Task Force (in APOC countries) Organization for African Unity Onchocerciasis Control Programme in West Africa Personnel Officer of OCP Planning, Evaluation and Transfer unit of OCP Programme Officer of OCP Supply Services Officer of OCP travel and transport service of OCP Technical Consultative Committee of APOC Transport Management Officer of OCP Vector Control Unit of OCP World Health Organization Acknowledgements The researcher would like to thank the following persons for their kindness and cooperation: . the staff of APOC . staff members of OCP who assisted with teh enquiry . those who responded to the fax questionnaire: members of NOTFs, TCC and the NGDO group, and representatives of donor countries. (v) JAF4/INF/DOC.6 Page I Summary A study was undertaken to assess the implications of moving the Headquarters of APOC (the African Programme for Onchocerciasis Control). This is at present siruated in Ouagadougou in Burkina Faso, sharing a site with OCP (the Onchocerciasis Control Programme in West Africa). However some concerned parties feel that it should be moved to an APOC member country, or to the African Regional Office (AFRO) of the World Health Organization. The main study question was: does APOC benefit by having the Headquarters based in Ouagadougou: technically, administratively and financially? and what would the advantages be of an alternative site? To clariff this question, information was gathered from a variety of sources, so that all affected parties would be able to contribute. A variely of data collection instruments was also used: questionnaires, interviews, and study of documentation. The main findings are the following: . The benefits/ advantages of the Headquarters of APOC being based in Ouagadougou were found to be wide-ranging and generally accepted: technically (a fruitful professional relationship existing between APOC's and OCP's experts in onchocerciasis); administratively (APOC making extensive use of the existing high quality OCP infrastructure); and financially (economies of scale through sharing facilities and services). . The defects/ disadvantages of the Ouagadougou base were found to be fewer, and less widely felt: technically (OCP's ethos being different and possibly dominating inappropriately); administratively (travel being difficult and costly); and financially (Burkina Faso getting an unfair advantage). . The net financial gain for APOC of a base at Ouagadougou was calculated to amount to about US$ 240 000 per year. . Concerning moving to another site, the advantages appeared to be few. The disadvantages on the other hand were found to be substantial and serious: technically (the disruptive effect of having to set up a new administration, at a time when APOC leadership is already battling to cope with a large technical workload); administratively (an existing expert administration having to be replaced); and financially (additional costs of around: US$ 80 000 for the transfer itself; US$ 96,000 for capital expenditure, and US$ 500 000 per year for ongoing expenditure). These findings strongly favour maintaining APOC's Headquarters at Ouagadougou at present. Funders are likely lo be 'reluctant to see additional bureaucracy created where this is unnecessary for operational reasons.' However APOC's situation is characterised by change and uncertainty, in several important respects. Its work is expanding very rapidly; the situation at Ouagadougou after 2002, when OCP ceases to exist, is still unclear (although it now appears that the site will continue to be active, due to the presence of a new sub-regional Centre for Multi-Disease Surveillance and Control and its supporting laboratory); and the uncertainty surrounding the site of WHO's Regional Office for Africa, a potential home for APOC Headquarters. Against this background it is critically important to maintain adequate, expert administrative support for APOC throughout, until it comes to an end in2007. Accordingly it is recommended that APOC continue to be based in Ouagadougou for the time being, and that this decision be re-assessed in relation to the end of OCP operations. JAF4/INF/DOC.6 Page 2 1. Introduction The decision to base APOC at Ouagadougou was made because to those who established the organization it seemed the most sensible thing to do. Some of the reasons that have been advanced are: . APOC staff members are able to make use of OCP expertise on a daily basis. . APOC staff members have full access to OCP's considerable documentation centre, also on a daily basis. . Much of APOC's administration is undertaken by OCP: keeping financial and staff records, doing purchasing, controlling stock, making travel arrangements, arranging statutory meetings and conferences etc. . Expert visitors are often able to make inputs into both organizations at the same time. . The arrangement helped APOC to get going and start achieving results much more rapidly than would otherwise have been the case. It is interesting to note that paragraph 8.6 of the 1996 programme document for APOC (JAF2.2), states that 'Although the APOC and the OCP will remain separate entities, they will be closely coordinated from the governance and management point of view'. Some of the partners in APOC are not fully in agreement with this arrangement, and would prefer the organization to be based in another country in Africa. Possible reasons: . Burkina Faso is already enjoying the benefit of one onchocerciasis control programme. . Burkina Faso is itself not a member of APOC. . Ouagadougou is not really centrally located with respect to the APOC member countries. . The programme remains dependent on OCP, and this dependence will have to cease anyway at the end of 2002. The advantages to APOC of being based in Burkina Faso are claimed tobe technical, administrative andfinancial. The aim of this research is to investigate these three hypotheses. JAF4/INF/DOC.6 Page 3 2 Methodology 2.L The research question The main research question is Does APOC benefit by being based in Ouagadougou: technically, administratively and financially? . does the present arrangement provide APOC with an actual benefit, and not a deficit? Sub-questions to the main question are 1 2 3 4 What is the nature of the benefit/ deficit? What is the overall size of this benefit/ deficit? (where it can be measured) What are the potential advantages/ disadvantages of a move to another site at the present time? What are the implications for APOC of the termination of OCP in 200213, and the establishment of a sub-regional Centre for Multi- Disease Surveillance and Control? To answer these questions it was decided to conduct an enquiry that would be mainly retrospective, but with some prospective elements. JAF4/INF/DOC.6 Page 4 2.2 Instruments and sources of information The following is an outline of the process followed Copies of the instruments used are given in Appendix 15: . the faxed questionnaire (for members of JAF, CSA, TCC, national teams) . the written questionnaire (for APOC staff) . the interview schedules. 2.3 Sampling and data collection The faxed questionnaire was sent to . every member of TCC sub- question data needed data sources method of data collection 1 the specific activities or situations which benefit/ are to the disadvantage of APOC: * technically * administratively * financially * APOC and OCP staff members in Ouagadougou * members of JAF, CSA, TCC, national teams * structured interview * written questionnaire * faxed questionnaire 2 the value attached to each activity/ situation at present * APOC and OCP staff members in Ouagadougou * APOC and OCP records in Ouagadougou * structured interview * written questionnaire * inspection of records 3 * perceptions of the implications of a move * costs involved in a move * APOC and OCP staff members in Ouagadougou * members of JAF, CSA, TCC, national teams * APOC and OCP records in Ouagadougou * commercial companies in Ouagadougou * structured interview x written questionnaire * faxed questionnaire * inspection of records * written quotations of costs 4 perceptions of futr.rre developments * APOC and OCP staff members in Ouagadougou * members of JAF, CSA, TCC, national teams * structured interview * written questionnaire * faxed questionnaire aa JAF4/INF/DOC.6 Page 5 every member of CSA members of JAI' (as per the list of participants for JAF3), sampled as follows: * donor countries: one person per country * APOC countries: the national onchocerciasis coordinators of countries with project proposals approved (if s/he had a fax line) * NGDOs: one person per Organization. Interviews were conducted with: . APOC staff in Ouagadougou: (3 professional staff members) . OCP staff in Ouagadougou: the head/ deputy head of each of the following units/ sections/ offices: BIS, CAM, COM/O, DOC, FAX, FO, PER, PET, PRO, SSO, TAT, TMO, VCU, MAN. The witten questionnaire was administered to each APOC staff member that was present - 7 in all 2.4 Practical issues and constraints The research was conducted from Ouagadougou during a period of 10 days in July 1998. This time was sufficient for the local information to be collected - interviews, questionnaires and inspection of records. 2.4.1 The faxed questionnaires Returns from the faxed questionnaire were low: sent replied TCC members NGDO representatives CSA and donor countries APOC countries 10 J 14 6 5 2 4 2 Total 33 13 In two cases the faxes could not be sent successfully. If more time has been available non-responders could have been followed up with telephone calls. The opinions of those who did respond may differ from those who did not, and this should be taken into account in interpreting the results. 2.4.2 Determining the nature and quantity of support given by OCP The following procedure was followed: . Each support was listed: * as identified from interviews (OCP and APOC being a check on each other) * as identified from the following documents: Le 'fardeau' d'APOC sur Ie personnel OCP: analyse de la situntion et misures correctives prdconisdes (Dr A Sdketeli, 1997) aa JAF4/INF/DOC.6 Page 6 Soutien administratif, logistique et gestionnaire de I'OCP au nouveau programme APOC (memorandum prepared by Mr DE Miller, 1996). Its nature was described more fully, using information obtained from interviews and documents. It was quantified by obtaining information from 3 separate sources, and triangulating these to enhance validity of information: * relevant OCP staff * relevant APOC staff * records relating to the particular service/ activity performed on behalf of APOC: faxes sent, travel arrangernents made, financial procedures processed etc. It is interesting to note that the 3 sources generally supported each other. 2.4.3 The cost of moving APOC headquarters to an APOC member country It was decided to use Uganda (and therefore Kampala) as an example: . it is fairly centrally located . it is acceptable from the point of view of security . AFROI Brazzaville is not a viable option at present, for obvious reasons The following information was collected: . the actual transfer cost of staff, furnin-rre, equipment . cost of living difference . cost of additional staff and services . cost of communication with OCP sources of expertise . cost of transport difference: * compare costs of one TCC meeting in Ouagadougou and Kampala (not JAF, because this is not usually held at Headquarters) * compare costs of one visit to each APOC member country by an APOC professional, from Ouagadougou and Kampala respectively. 2.5 Data analysis Faxed and written questionnaires were analysed according to the usual method of listing answers, categorising them, coding the categories and counting the frequency of answers given. In addition quotes that were illustrative of particular majority opinions were noted. The value of time spent by OCP staff for APOC related activities was calculated by: . where there was agreement on the percentage of such a person's time spent for APOC: that percentage of their overall salary budget for the year . where there was agreement on the amount of time spent per week or month: the daily salary cost was worked out, taking 12 months per year andZl working days per month. To calculate the cost of communication between Ouagadougou and Kampala: . 'phone calls, faxes and e-mail messages take the place of visits or intercom'phone calls . the time used is the time stated to be used at present interacting . long-distance telephone calls current rates in Burkina Faso were used - e.g. to Uganda: FCFA 2 560 per minute : US$ 4.27. The cost of travel and relocation was calculated by getting quotations from commercial companies in Ouagadougou (e.g. Air Afrique, who also supplied the IATA manual listing recommended prices). L JAF4/INF/DOC.6 Page 7 To calculate administrative support overheads: . for 1997 the cost of overheads overall came to 30,7% of the staff salaries (US$ 355 5147) US$ I 158 465 - figures take from audited accounts) . this figure was therefore used for all sections, since separate records were not kept. 3 Findings these elucidate the main research 3.L Benefits/costs to APOC of being based in Ouagadougou The data below relates to the The information in the table below was obtained through interviews and scrutiny of records. The detailed information, of which the table is a summary, is given in Appendices 1 to 14. Table L Services provided to APOC by OCP Does APOC benefit by being based in Ouagadougou: technically, administratively and financially? What is the nature of the benefit/ deficit? What is the overall size of this benefit/ deficit? (where it can be measured) 1 2 unit technical /admini- strative current benefit (per annum) quantity quality/ complexity cost OS$) biostatistics/ info.systems T+A 12 days very specific (oncho. statistics) skilled general (network) 4 200 general m'ment A a lot general (services) 30 300 communication T medium fairly specific (oncho. information) 11 000 documentation T medium very specific (oncho. information) t2200 facsimile A a lot general 48 400 finance office A a lot critically local (advance) skilled general 22 800 personnel office A a lot skilled general 24 400 plan/eval. /transf T medium very specific (CDTI expertise) 9 300 programmmg A liffle skilled general (organising JAF) 4 800 supply/services A a lot skilled general 33 700 travel/transport A a lot skilled general 7 800 transp. m'ment A medium skilled general 2 600 vector control T little very specific (oncho. expertise) 5 300 senior m'ment T+A a lot skilled managerial and technical t04 200 321 000 JAF4/INF/DOC.6 Page 8 In each area of service the quality of the service provided by OCP to APOC was investigated. A judgement was made based on the assessment made by APOC staff, and the researcher's own observations. The following was found: technical quality: high throughout - a thoroughly competent specialist service relationships: friendly and supportive throughout time available: mostly sufficient, but APOC staff have had to wait, or perform a task themselves, on occasion The table above also gives in financial terms the approximate amount of advantage APOC currently enjoys yearly, from its association with OCP in Ouagadougou. Against this must be set the following data: Table 2 travel and accommodation in different * the detailed costing on which this table is based is to be found in Appendix 16 * data obtained from the current WHO catalogue for subsistence rates t currency units used by IATA in its pricing guidelines - 1 NUC : 2,2 US$ (approximately) The Kampala option is marginally more expensive for statutory meetings. An additional expense for the Kampala option would be the cost of transporting the relevant expert OCP staff members to and from Ouagadougou. On the other hand the cost of one supervisory visit per country from a base in Kampala is about 507o of what it would be from Ouagadougou. The same would be true of meetings where national coordinators are brought together, if these were to be held in Ouagadougou (however the practice of holding them in an APOC country has already started). In summary, the yearly financial benefits and costs to APOC of being based at Ouagadougou were found to be: Costs differences for Headquarterst Ouagadougou Kampala WHO per diem rate per person per day (US$)* 118 119 cost of tourist class return flight (in NUC)t for each TCC member from home base to APOC Headquarters in 19 t24 2t 2r4 cost of tourist class return flight (in NUC)t to capital ciry in each member country from APOC Headquarters in 26 378 t4 042 benefit a a from use of OCP services and facilities from cheaper travel to TCC meetings US$ 5 000 us$ 321 000 cost from cheaper travel between base and member countries (27 140 three times a year) us$ 82 000 net benefit of Ouagadougou base to APOC per year us$ 244 000 a JAF4/INF/DOC.6 Page 9 3.2 Benefits/ costs of relocating APOC The data below relates to the SU The information in the table below was obtained through interviews and scrutiny of records. The detailed information, of which the table is a summary, is given in Appendices 1 to 14. Table 3 Staffing and cost implications of relocation for OCP What are the potential advantages/ disadvantages of a move to another site at the present time? J unit relocation implications service accessibility at new site new personnel (T:top, M:mid, B :basic) capital costs 6us$) recurring costs OS$ p.a.) biostatistics/ info.systems oncho statistics: never network: yes 15 000 3 800 general m'ment advice/advance: with time general services: yes /+ administrative (basic level) 51 500 communication with time 2s 600 documentation some never, some yes Vz technical (mid - level) 7 000 20 300 facsimile yes 1 administrative (basic level) 2 100 31 000 finance office yes 3 administrative (midJevel) 7z administrative (basic level) 13 700 39 000 personnel office yes 1 administrative (mid-level) /+ administrative (basic level) 4 900 27 700 plan/eval./transf. never 6 700 programmtng with time yes yes 2 500 supply/services 1 administrative (mid-level) /+ administrative (basic level) 12 800 37 200 travel/transport t/+ administrative (mid-level) 7 500 transp.m'ment yes 1 administrative (mid-level) 2 drivers 31 900 45 100 vector control never 5 000 senior m'ment with time 1 technical (top level) 5 600 199 000 tech. 1T YLM 95 500 497 400 admin. 61/t M 41/e B JAF4/INF/DOC.6 Page 10 The additional staff is needed not only to perform tasks that OCP staff performed before, but also to provide people who according to WHO regulations are sufficiently senior and therefore have the mandate to order and pay, for instance. Table 4 Costs of the actual move* TOTAL * it is assumed here that all the technical staff will move, but only one of the general service staff (the new host country is likely to insist that its own nationals be appointed in these positions) The financial cost to APOC of moving its base from Ouagadougou to Kampala is therefore calculated to be: * this includes the new administrative staff members required to take on the duties presently undertaken by OCP staff 3.3 Technical and administrative costs of relocation The financial costs and benefits ofretaining Ouagadougou as a base, or changing it, have been described above. There are however considerations other than purely financial ones: . whether the present situation is beneficial from an operational point of view (i.e. technically and administratively) . whether a relocation of Headquarters will result in operational benefit. The data below relates to these issues, and to the following sub-questions of the original research question: 1. 2. J. What is the nature of the benefiU deficit? What is the overall size of this benefit/ deficit? (where it can be measured) What are the potential advantages/ disadvantages of a move to another site at the present time? In the tables below the information given from the questionnaires (fax and written) is summarised. The perceptions of five different groups of APOC stakeholders is given. The shading of the blocks indicates the relative importance of each option for the group concerned (white :0%, black : 10070). cost (US$) a Preparatory visits to negotiate and prepare new quarters: 6 return flights, tourist class, Ouagadougou-Kampala @ $ 1 335 each Relocation flights for 4 persons, some with their families: 12 one way flights, tourist class, Ouagadougou-Kampala @ $ 1 150 each Transporting family effects: four 20' containers Ouagadougou-Kampala (including customs clearance) @ $ 9 083 each 30 days subsistence for each staff member in Kampala Transporting APOC furniture, equipment, records: one 20' container: Ouagadougou-Kampala (including customs clearance) @ $ 9 083 a a t o 8 010 13 800 36 332 t4 280 9 083 81 505 once-only expenditure I a capital items - US$ 95 500 the actual move - US$ 8l 500 us$ 177 000 recurrent yearly expenditure a services, facilities, salaries* us$ 498 000 JAF4/INF/DOC.6 Page 11 3.3.1 Perceived advantages to APOC of a base in Ouagadougou Table 5 technical advantages administrative advantages APOC shares good OCP administration easier, quicker communications APOC's fast take-off due to this support other (no advantage) 1 financial advantages costs reduced by sharing/ economies of scale relocation/ duplication will be expensive other (none; countries will benefit financially from hosting meetings) 1 I The sense of these findings is further clarified in the following quotations taken from the questionnaires: technical: o '1 great deal of synergy would be lost if the rwo programmes did not share headquaners.' . 'Regular brainstorming is crucialfor APOC.' . 'There is a remarkable spirit of collaboration.' administrative: . 'My own vtew is that separation of the nuo programmes would be a technical and administrative disaster.' . 'We would be reluctant to see additional bureaucracy created where this is unnecessary for operational reasons.' . 'APOC is at a teething phase, a setback will be disastous. Moving the Headquarters at this early stage will be a setbackfor APOC. The management staffwill change and this will put a temporary stop to field activities.' financial: c 'l do not think the costs of sening up an entirely independent APOC headquarters within an APOC country can be justified.' ' 'With a current funding gap of nearly US$ 20 million ... it is impossible to conceive of spending substantial additional funds on transferring to a new HQ, without substantial loss of financing for APOC operations and disruption of APOC support for country-based proiects over a considerable period of time. Donors are prepared to fund disease, not administration.' TCC [N:fl donor N:4I NGDO lN=2I APOC country N=2I APOC staff N=Z sharing knowledgeiexperience gained in OCP OCP gains by sharing APOC's expertise APOC/ OCP share facilities, equipment etc APOC/ OCP share expert visitors 1: JAF4/INF/DOC.6 Page 12 The main advantages perceived are clear, are strongly expressed, and do not differ much befween stakeholders: . APOC and OCP share expertise and experience . APOC and OCP share administration and facilities . economies of scale. National onchocerciasis coordinators, while agreeing with the main technical advantages, were less convinced of the administrative and financial advantages. 3.3.2 Perceived disadvantages to APOC of a base in Ouagadougou Table 6 TCC [N:51 donor N=4I NGDO [N:2] APOC country [N:2] APOC staff [N:4 technical disadvantages OCP's different focus which may dominate no disadvantages other (distance is a technical barrier; APOC has not become adequately staffed) 2 administrative disadvantages financial disadvantages The sense of these findings is further clarified in the following quotations taken from the questionnaires: distance: travel, communication difficult should be in an APOC country OCP can't cope well with APOC's needs no disadvantages 1 1 2other (staff mostly from OCP countries; OCP style too bureaucratic; far from AFRO; APOC staff too few and therefore stressed) high cost of travel (meetings, supervision) no disadvantages APOC countries don't benefit financially JAF4/INF/DOC.6 Page 13 technical: . 'OCP was conceived as a vertical programme biased towards vector control, whereas APOC uses a completely dffirent approach, with strong community involvement. OCP staff now involved in APOC require a mental shift which may be dfficult in some cases. In addition their not being attuned to the community development nature of APOC, some may not be technically suited to the new programme.' . '... avoir trop d'experiences, ne pas avoir un regard neuf.' xdministrative: . 'The Headquaners of APOC should be located in an APOC country.' . 'Travel inconvenience .. it takes longer to travel to Ouagadougoufrom any East or Southern African country than going to Europe!' financial: . 'The member countries of APOC do not benefit from all the financial inputs. These go to Burkina Faso which is not an APOC country.' . 'Participant countries have a 'Turong"understanding of the Programme, which most often is seen as a source of funds. The main perceived disadvantages are clear: . travel and communication are felt to be more expensive and more difficult . there .is a fear that OCP as the older, larger organization has a different approach (more bureaucratic, less community friendly) which may tend to dominate . Burkina Faso is seen to get the financial advantage of hosting the programme. It must be noted that the number of advantages expressed greatly exceeds the disadvantages for 4 of the 5 groups of respondents. Several respondents perceive no disadvantages at all. 3.3.3 Suggested sources of funding for expanding or moying APOC Headquarters Table 7 Since it was clear that relocating APOC would be expensive, stakeholders were asked for their opinions about how this exercise could be funded - especially in view of the fact that there is a funding shortfall for the present phase of the programme. The main thrust of stakeholders' responses is that requesting further funding for a relocation is not a good idea at all. There are only two positive suggestions: asking existing donors for the funding (which is ruled out as an option by others) and moving some OCP posts to APOC. TCC [N:5j donor [N:4] NGDO [N:2] APOC country [N:2] APOC staff [N:4 ask partner countries 2 1 OCP posts for joint functions go to APOC 1 1 separation shouldn't happen I 1 1 1 7 can't ask donors for more, shortfall already, they won't fund administration per se 2 1 1 APOC seriously understaffed, so rather use funds for more technical posts 1 1 JAF4/INF/DOC.6 Page 14 3.4 Future considerations Not only will OCP come to an end in2002, but APOC itself has a limited lifespan. There are also other developments which may influence decisions about its future: . the temporary relocation of AFRO to Harare; uncertainty about where it will be permanently based in future, and when it will be moving again . the decision to create a sub-regional Centre for Multi-Disease Surveillance and Control in West Africa, based at the OCP campus in Ouagadougou. For ttris reason, information was also collected from stakeholders, about their perceptions about future developments. The data below relates to these issues, and to the following sub-question of the original research Table 8 Perceptions of future developments around APOC APOC relationship with OCP: 1998-2002 APOC relationship with Centre for MDSCz 2003-2007 As far as the period 1998-200213 is concerned the picture is fairly clear - close cooperation should continue, with APOC slowly becoming the 'senior partner'. From 2003 onward there is a more widely differing set of views. Partnership between APOC and the new MDSC Centre is seen as very important (although it takes different forms), and only two persons feel that APOC should move away at that time. What are the implications for APOC of the termination of OCP in 200213, and the establishment of a sub-regional Centre for Multi- Disease Surveillance and Control? 4 TCC lN=51 donor lN=4I NGDO lN=2I APOC country [N:2] APOC staff [N=4 continue partnershipi sharing with OCP APOC/CDTI grows, OCP/vector control shrinks develop into a joint centre/ programme adequate OCP support for APOC up to 2002 partnership/ close relationship Centre learns from APOC (CDTI, indicators) APOC autonomous, moves away APOC and Centre slowly merge Centre supports all OCP/ APOC countries APOC, Centre share administration costs Centre supports APOC JAF4/INFiDOC.6 Page 15 4 Conclusions, discussion and recommendations At the beginning of the study, a study question was set, together with four sub-questions. For each of these, conclusions may now be drawn, based on the data collected. 4.L The research sub-questions Sub-question L: The benefit/ deficit of the Ouagadougou base T\e benelits/ advantages were found tobe many, and are described in detail in Section 3 above. There was very good agreement between the account given of these benefits by the different parties consulted, and the observations made by the researcher. They cover the following areas: . technical: 'Synergy' - mutual support, dialogue and documentation in planning, implementation and evaluation of projects; in biostatistics and health information systems; in vector control . administrative: Sharing of an existing infrastructure covering communications, financial management, personnel management, programming, supplies and services, travel and transport. . fi.nancial: Economies of scale, due to sharing of expertise, facilities and services. Other than the.obvious financial benefit, APOC staff and other respondents stress the importance of the technical 'synergy' which they find critical to the success of APOC's work. T\e quality of the services offered to APOC by OCP is universally judged to be high - staff members are very experienced and highly skilled. Services are provided courteously and on time. The delicits/ disadvantage,s were found to be few, and are also described in Section 3. There is a considerable lack of unanimity about them, with several respondents not perceiving any disadvantages at all and some not being bome out by the observations. They cover the following areas: . technical: the OCP approach is different and may dominate inappropriately; APOC fails to develop its own identity . administrative: difficult communications (this really only applies to travel) . financial: higher cost of supervisory visits; Burkina Faso gets a financial advantage which an APOC member country could get. Sub-question 2. The size of this benefit/ deficit In most of the areas where APOC stands to benefit/ lose from being based at Ouagadougou it was possible to cost the benefit/ deficit. The data are given in Section 3. There is currently a net financial benefit to APOC of about US$ 240 000 per year, which will remain substantially in place until the end of the year 2002 when OCP ceases to exist. Sub-question 3. The advantages/ disadvantages of a move to another site This sub-question is broadly speaking the obverse of sub-question 1. The advantages of a move of APOC Headquarters, for instance to Kampala in Uganda, were found tobefew: . technical: APOC develops its own identity and approach without being unduly influenced by OCP (although the focus of OCP has also been moving towards CDTI latterly, and it is leaming from APOC). aJAF4/INF/DOC.6 Page 16 administrative.' APOC develops its own administration; supervisory visits are more easily conducted; siting the Headquarters in a member country is motivational (but probably only for that country) financial: The new host country benefits by receiving funds now being disbursed in Burkina Faso; travel is cheaper. There is also ttre strong perception (among national coordinators especially) that it is 'proper' for the headquarters of an organization to be based in one of its member countries. T\e disadvarrtages on the other hand were found tobe substantial and serious: . technical: Managing the move and setting up a new administration will be the responsibility of senior APOC management, which is also responsible for all the technical work. They are already so thin on the ground that such disruption could seriously jeopardise the outcome of the programme. ln addition the present 'fruitful professional relationship', built up over face-to- face discussions, would inevitably lapse to a greater or lesser degree. . administrative: An existing expert administration will be replaced by a new team which still has to develop expertise. . financial: Tlte move will be expensive - the transfer itself around US$ 80,000), capital expenditure (around US$ 96,000), and especially additional ongoing expenditure to the tune of US$ 500 000 per year. Sub-question 4. The implications for APOC of the end of OCP in 200213, and the establishment of a sub-regional Centre for Multi- Disease Surveillance and Control The information gathered to illuminate this sub-question is of is nature speculative. The main ideas put forward are continued close cooperation (with OCP and ttre new Centre), and the necessity for APOC to continue having adequate expert administrative support (from OCP, or the new Centre, or by developing its own capacity). 4.2 The overall research question Does APOC benefit by being based in Ouagadougou: technically, administratively and financially? does the present arrangement provide APOC with an achral benefit? The information gathered makes it clear that, at present, the benefits of remaining at Ouagadougou are very substantial, and greatly outweigh those of moving. At the same time the costs and disadvantages of moving to another country greatly outweigh those of staying in Ouagadougou. a JAF4/INF/DOC.6 Page 17 4.3 Discussion - APOC in a state of flux The situation within which APOC finds itself is characterised by flux and uncertainty, in several important respects. 4.3.1 APOC's work is expanding very rapidly Table 9 Rate of expansion of APOC projects t cumulative totals The number of technical staff on the other hand is not expanding - the decision was made at APOC's inception that it would be 'lean.' However: The three hard-pressed professional staff members based in Ouagadougou are 'bogged down' with technical and administrative matters. The two very sticky new concepts of 'community direction' and 'partnership' have to be piloted through/ integrated into the national health services of the 19 countries - and a good start is so important for confidence. This situation is not likely to improve soon. The governing bodies and donors have an understandable aversion to any expansion of project staff at this stage. At the same time there is a strong message: 'OCP reduce! OCP help APOC! APOC perform!' - which cannot but add to the stress currently experienced by APOC's (and OCP's) staff. For all these reasons, one could say that the last thing the current APOC staff members need now is to have to occupy themselves with a move, developing new routines, orientating and supervising new administrative staff etc. 4.3.2 The situation at Ouagadougou after 2002 is still unclear It is critically important that APOC must have sustained administrative support of high qualiry until it comes to an end at the end of 2007 - this concern was strongly voiced by APOC staff. The situation at Ouagadougou is likely to develop as follows: a a date of TCC meeting countries involvedt number of projects approvedf type ofproject lsr Year budget (us$)tCDTI vector controlt HQ supporrt projectsf population coveredt Oct. 1996 2 4 2 158,000 2 0 496,697 Apr.1997 5 4 9 2,485,000 2 J 2,623,219 Sep. 1997 8 29 22 7,449,000 J 4 5,893,805 March- Apr. 1998 9 38 30 11,758,000 4 4 7,572,370 Aug. 1998 11 45 36 14,r99,067 4 5 8,937,836 a aa JAF4/INF/DOC.6 Page 18 OCP ends at the end of 2002 - that is certain. The new Centre for MDSC is almost certainly going to come into being, and will then be based at the present OCP/ APOC campus in Ouagadougou. Some of the OCP laboratory facilities will be moving from Cdte d'Ivoire to the same site in Ouagadougou soon. If this scenario is correct, the present OCP administration (which is already pared to the bone) will in all likelihood simply continue to function, serving 3-4 programmes based at Ouagadougou which will be functioning at various times, as follows: It would be sensible to use the same effective, 'lean and mean' administration for all the programmes based in the same place. APOC management would have to ensure though that it is big enough to serve their needs effectively - current OCP staff is under stress, and the situation has to be monitored. This ts one option for APOC after 2002. 4.3.3 AFRO's present location is temporary, and its future uncertain There would be specific advantages in basing APOC at AFRO, but also disadvantages: A base at AFRO is theoretically therefore a second option, since it has clear advantages over a move to another country. However the uncertainty about AFRO's base may only be sorted out towards the end of APOC's life. The disadvantages of moving to AFRO also appear to be greater than those of staying in Ouagadougou. 1998 1999 2000 200t 2002 2003 2004 2005 2006 2007 ..OCP gradually gets smaller, ends APOC gradually gets bigger ..... APOC gradually gets smaller, ends Centre for MDSC starts up, grows.slawly Laboratory moves to Ouagadougou, grows slowly .... base advantages disadvantages Ouagadougou (with OCP/ the MDSC Centre) * Up to the end of 2002 the present efficient administrative and technical support is assured. * Cheap. * The nature of the remaining administration in Ouagadougou is not clear - will it support APOC as OCP has done? an APOC member country (e.g. Uganda, Cameroon) * WR's office can offer accommodation and administrative support. * National Government can provide accommodation and seconded staff. * Technical cooperation with OCP becomes more difficult. * Expensive - significantly more staff, more administrative costs. * Any move will be temporarily disruptive. AFRO (Hararel Brazzavillel elsewhere) * Can probably support APOC administratively about as well as OCP is doing. * Close to the corridors of power - a 'home in AFRO' af\er 2007 * Technical cooperation with OCP becomes more difficult. * The uncertainty: there will be a move from Harare in due course, but Brazzaville is still unstable. * The expense of moving. * Any move will be temporarily disruptive. a 1JAF4iINF/DOC.6 Page 19 4.4 Recommendations The decision about where to locate the Headquarters of APOC belongs ultimately to the executing agency, i.e. the Director General and the Regional Director of WHO. The researcher was however requested to make recommendations. In view of the findings it is strongly recommended that APOC continue to be based in Ouagadougou for the time being. In the absence of evidence of substantial technical, administrative and financial advantages to a move elsewhere, and considerable evidence of the cost and disruption that such a move would entail, it is difficult to see how funders could be persuaded to pay for what would be an essentially political act. 2. In view of the dynamic nature of the situation, it is also recommended that this decision be re- assessed regularly, bearing the following in mind: * the guaranteed existence of effective administrative support for APOC at Ouagadougou (or wherever it is based at the time) * developments in the siting and staffing of APOC. In order to minimise further the disadvantages of Ouagadougou as a base: * APOC staff are encouraged to continue developing their own approach to CDTI, being aware that OCP's past emphasis on vertically organised vector control inevitably influences its thinking. * APOC is encouraged to continue the practice of holding meetings and training events in member countries. , J t