Devolution activities of the OCP participating countries 1995

WOR.LD tIEA.LTII ORGANIZA,TION ORGANIS^TION MONDI^LE DE LA stANTE JPCI6.6 ORIGINAL: FRENCI{ Scptcrnbcr 1995 Pagc . ..2 2 2 n,og,".noJ!':X*J:',il'*:.:..,%:fi ::::T:':.y3,$I1T,.o,"., ,orNr PRoGnAxx,l,?*YMrrrEE JPC - CCP coMrrE cof?jx.3[p.RocRAMME lbwr PRoGRAMME coMMITTEE Sixteenth session Washington. 6-8 December 1995 provisional aecnda item 6 DEVOLUTION ACTTUTIES OF THE OCP PARTICTPATTNG COUNTzuES (1995) Table of Contents TNTRODUCTION NATIONAL DEVOLUTION COMMITTEES NATIONAL DEVOLUTION PLAI{S ONCHOCERCTASIS-RELATED DEVOLUTION ACTTVITIES AND BLACKFLY NUISANCE" . l ,) 5 4 5 6 7 Original area Information, Education, Communication (tEC) -. Community mobilization and nuisance control Ivermectin trcatment . Passive treatmeil . Treatment of positive cases detected actively . Iarge-scale treatnrcnt by mobite teams EpidemiologicaI surveillancc . Active surueillance (seruinet vittages) . Passive suneillance Migration survey Ertcnsion arcas Ivermectin treatnrent . La.rge-scale treatment by ntobite rcanls . Contmuniry trcattnet,t (see also aoc. lfCte .21 OTHER ENDEMIC DTSEASES' CONTROL ACTIVITIES EFFORT TO INTEGRATE DEVOLUTION ACTIVITIES FINANCIAL CONTRIBUTION OF TI{E COUNTRIES TO TI{E DEVOLUTION PROCESS CONCLUSION ANNEXI]S 4 4 4 4 4 4 4 .5 5 5 6 6 8 8 8 8 9 9 l0 r0 II ti JPCI6.6 Pagc 2 I. INTRODUCTTON I. t. Dcvolution "sensu stricto" is dcfincd as (hc proccss of transfcr to ttrc participating Countrics of the rcsponsibility-and skills for the rcgular.cpidemiotogical survcillancc of onchoccrciasis and t'e control of a possible recrudesccncc of this discasc. 1.2. Dcvolution "sinsu lato". onthc other ltand, is dcfincd as thc intcgrationof r6csc onchocerciasis surveillance and concrol activities into the health systerrts of the particiiating corn,.i"r, which, in the tong run, should lead to a strengrhening of multidisease surveillance 1.3. It tto,ita be pointed out that, contrary to devolution "sensu stricto,,, devolution .sensu laro,, is . ou6ide oCP's mandate' This means that the activities related to the control of the endemic diseases other than onchocerciasilyll be-the responsibitity of the countries which .rn, no*Lr.r, be supported in this field by wHo/AFRo and other partners in developmenc, such as the World Bank. 2. NATIONAL DEVOLUTION COMIVIITTEES (NDCOs) 2.1. To date, there have been official ac$ in Senegal, Burkina Faso, C6te d,[voire, Ghana, Mali, Niger and Togo setting up their national devolution Committees. As regards Guinea, Guinea-Bissau, Benin and sierra [rone, the.official acrs are in the process of being ad-opred. 2.2. The national devolutioncommittees for onchocerciasis conrrol programme (NDC9) already have many achievements to their credit: - Burkina Faso's.NDco organized from 7 to 10 February 1995 its first rvorkshop/review meetiug on the implementation of its national devolution plan; - Ghana's NDCO has estabtished onchocerciasis control Committees in four districts in theforest area outside ocP and carried out an evaluarion of the epiaemioiogicat siruation using the method of rapid-epidemiological mapping of onchocerciasis lGluoy; - Senegal's NDco organized, with ocP's suppon, a rvorking visit with the key teams in thedistricts forming pan of the onchocerciasis iiogra**e area and officially launched comrnunicy-based ivermectin treatment in the Timuacounda and Kolda regions in July 1994. - Mali's NDco has decided to prepare a devolution documenr which will take inro accounrthe socioeconomic development aspects in the onchocerciasis-freed zon.s; - Atl the national devolution comntittees continue to sensirize the politico-adnrinistrative ' autltorities and populations to the onchocerciasis contror programnre, particularly to tle ocpdevolution Process. 3. NATIONAL DtrVOLUTION PLANS 3.1. tlli tablc I belorv sltorvs tltc currcrtt s(are of rhe devolution plans of rhe elevcn participating Countrics. JPCl6.6 Pagc 3 Tablc [. Prcscnta(ion of (hc dcvolu(ion plars of the Participating Cotrntrics (Junc 1995) Country Bcnin2 Burkina Fasor C6te dilvoircr Plan rcvised and finalized New plan PrePared and finalized 3.2. T5e srate of the financing of the devolution plans is as follorvs ir! ; Only Burkina Faso bcnefits frorn an external financing of its plarr; this finnnciug has been obtained frorrr tlte World Bank: Mali has entercd into ncgotiations wittr thc Netherlands; Cotc d'lvoire lt:rs stlrtcd discussiors with thc World B:rnk <lrr an cndcrrric disc:rscs' corttrol projcct: Scrteg:rl lt:ts rcccivc<l rt lcttcr froru (ltc World llrrrrk proposirrg rtrc (irn<lirrrl <rl' u spcci('ic cndcnric discuscs'conrr<ll Jlrojcct rvhich could takc cl'l'ccr in 199(r: Date of finalization Discascs combincd rviG Onchoccrciasis Cost pcr 5 ycars Junc 1993 - African l{uman Trypanosomiasis - Schistosomiasis 635 985 887 FCFA April 1992 - African Human Trypanosomiasis - Dracunculosis r 610 884 256 FCFA April 1993 - African Human Trypanosomiasis - Schistosomiasis - Dracunculosis 9'16 660 630 FCFA Ghanar Cuinea2 July 1993 - Dracunculosis - Malaria - Leprosy - Yaws uss 3 19? 000 August 1993 - African Human Trypanosomiasis - Schistosomiasis uss 7 483 491 Guinea-Bissau2 April I992 - 'schistosomiasis - Malaria uss 4 4'17 t09 Mali' October 1993 - African Human Tqr?anosomiasis - Schistosomiasis r 00s 054 703 FCFA ).{igerr Novcmber 1994 - Schistosomiasis - Dracunculosis '155 273 0?3 FCFA Senegalr Scptember 1994 - Schistosomiasis - Dracunculosis 550 953 375 FCFA Sierra Leone2 July 1994 - Schistosomiasis - Malaria - lrprosy - Tuberculosis uss 8 333 303 Togo2 April t994 - African Human Trypanosomiasis - Schistosomiasis - Dracunculosis 833 216 779 FCFA J PC I6.6 l'agc 4 4. Thc o(lrcrcoun(rics (Bcnin, Ghana, Guinca. Guinca-Bissau, Nigcr, Sicrra Lconc and Togo) arc looking for donors or having discussions with thc World Bank for (tlc nnancing of t6cir devolution Plans. ONCI{OCBRCIASIS.RE,LATED DE,VOLUTION ACTTI{TTTtrS ^ND BLACKFLY MJISA}.{CE Original area 4.L. Today (1995), in almost 90% of the original Programme area, the transmission of onchoccrciasis has been definitively intermpted through many years of vector conrrol and OCP has ceased larviciding opcrations tltere. [t is therefore this completely freed originat area which is eligible for devolution activities in the proper sense of the word. Information-Education-Communication (lEC) 4.2. I(AP (ttrowledge, Attirude and Practice) surveys on onchocerciasis have been carried our in Burkina Faso and Niger with tlte support of the NGO Helen Keller Internationat (HKI). These.kAP surveys have led to the preParation of teaching materials on onchocerciasis (posters, picrures) rvhich have 6een testcd and validated. The training of trainers in the use of these materials has bccn carried out through national workshoPs' 4.3. The national teams, OCP teams and the other actors in the field regularty carry out IEC activiries, using different comtnunication techniques, aids and information materials available (talks/discussions, radio and TV programmes, film shows on onchocerciasis). 4.4. .The imiact of tEC is perceptible it all levels through a greater community mobilization with a high rare of particiPation in the ivermectin distribution and epidemiological evaluation campaigns. R gieater and greater number of village volunteers has also been noted in the different onchocerciasis controt aotivities as well as a more marked involvement of the authorities in these same acrivities. Communitv mobilization and nuisance control 4.5. Technicians of the national teams and trained villagers are mobilizing themsetvcs more and more and carry out ground larviciding in some sensitive zones where blackfly nuisance poses problems (Mali, C6te d'Ivoire, Chana, T9g9t Benin and Niger). Furthermore, socioeconomic bevelopmsnt companies are getting involved'willingly in the bearing of the cosr of ground larviciding for nuisance control' 4.6. Horvever, it is constantly borne irr nrind that, in vierv of rhe rclatively high cost of t6e operation and the risk of blackfly resistatrce to tltc iosccticides, grourrd larviciding for conrrolling biackfly nuisance has to be vcry selectivc. It should be instituted only whcn blackfly bites bcconre ulbearable and could jeopardizc devcloltnrent projects. Thc training in this technique should be conrinueg and IEC intensificd in ordcr to raise (lte awarcness of the aurhoriries and populations conccrning ihe returtr of uninfcctcd blackflics after tlte ccssation of lrrviciding. OCP givcs training to trainers in this ficld (scc docuttrctt( JPCl6.2). Ivermectin treatnrent Passive Ireoltttcttt 4.7. I:roru Marclt l99a to l:ctrrtr;rt'y 1995. ti4.5til pcolllc wctc lrc:r(ctt lxrssivcly rvirh 119.558 rvctrrrcc(in t;rtllcts. rvlticlt rcl)t'cscll(s:ttrtltrt 4.1',1i, <lf (ltc tot:rl rurrrrhcr rrl'Pcolllc (tc:ttcd (:rll srrutcgics corrrhirrcrl). 'l'lrcsc figtrrcs lt:tvc ltcctt ttttttctcs(irtur(crl sittcc ttrlt ;rll (lrc ccrr(rcs lt;rvc scrlt rlrcir.(rc:r(rrtcnt r cl)()( ts. JPCI6.6 Pagc 5 Treatment of positive cas.es detected actively t B. During thc epidemiological evalua(ions in the sentinel villagcs in 1994, some 400 pcople a.i""r"a were treated rvith some 600 tablets of ivermectin. I-arge-scale treatment by mobile teams A o In the original area, this large-scale treatment is carried out in river basins in which the ]niomo*pidemiotogical rcsulb are not satisfactory for various reasons (reinvasion, resistance it"no*.non, residual transmission not detected in time) (sec doc. JPC16.2). 4.L0. The results of these ivermectin treatments carried out by the national mobile reams from June ig9+ ,o May 1995 are given in Table 2' Table 2. Largc-scale iverzlectin trcatuent in that part of the original arca not yet completely cleared (June 1994-May 1995) Country Burk:r. so* l.{ali * Counrry in which tirere are river basins treated twice per year. In Niger, today, no zone is etigible for large-scale ivermectin treatmenr. In other words, that part of the original area is completely cleared. trnirlemioloeical surveillance Activc surveillance (sentinel villiges) 4.I1. The nrap attaclted ltereto as Annex I shows the zones eligible for activc epidemiological surveillance in thosc parts of tlte original Progranrme area frced from onchocerciasis. 4.12. To date. a minimurn of 253 sentirtcl villagcs (Anrrex 2) have been selected in the freed zones of r5e original arca for periodic tttonitoring, once every thrce years, through skin-snip epidenriological survcys. During-tlte past tltrce ycars, 175 scntincl vill:rgcs havc becn the subject of a parasitological cvaluation including 83 irt 1994. Tablc 3 surttnrerizcs thc rcsuks obraincd in thesc 175 vitlagcs. Iu :rlrrrost all tlrese localitics. (ltc rcsults arc c.xccllcrtt, rvith prcv:rlcncc ratcs rlnging tlctrvccn A atd 5o/o lnd CMFLst of lcss tltan 0.5 ttrf/s2 cvcrywhcrc. Vitlages Census population Number of people treated Tablets used 7L 19,570 L23M 23 149t 3& 166,865 123,734 136,102 C6te d'Ivoire 74 r67 24,700 L9,417 21,801. Ghana* 50,009 40,346 71,989.5 Togo r90 59,612 43,6'70 57,735 Benin* 244 68,214 49,836 55 690 Total 1t l0 388,970 289,307 366,466.5 , CN4l:L: Q<lrrrnttrnrry rrrrcro(il:rri:rl ltl,r<l JPCI6.6 Pagc 6 4.13. I{owcver, tltcse 1994 cvaluations (Tablc 3), revcaled prevalencc ra(cs of morc rhan l0% in two villagcs: Tchri on thc Oti Pendjari in Togo (raw rate of 10.8%); Zoulo on rhe Bougouriba in Burkina Faso (standard rate of lO.7%). Following thc results on (he Bougouribal furthcr investigation in 15 villagcs around Taulo in Fcbruary-March 1995 were carried oui. A*ong t6e lg0 positive subjccts detected out of the 4566 examined during this complemenrary evaluarion, 29 were icss than 20 years old wltile three were four, six and cight yea.s old respeitivcly and 5ad ncvcr migrated. A mole letailed analysis of the d-ata is in progress. The national coordination office plans ro i"r.y oi:t another.evaluation in order to better circumscribe the zonc at risk and possibly institute large-scale ivermecttn treatment' 4.14, All these- results from Togo and Burkina Faso will be validated as soon as possibte by WHO/OCP rvhich will carry out quality control examinations with the national technicians. 4.15. Between January and May 1995 active epidemiologicat surveillance were carried out in 32 other sentinel villages in Mali, Niger, Ghana and Benin. These surveys also revealed excellent results with raw prevalence rates ranging from 0 to 5%. Passive suneillance 4.L6. Passive epidemiological surveillance should, in principle, be carried our by the health cenrres and comrnunities, pafticularly for suspected cases of onchoceiciasis (migranrs or natives). Emphasis will be laid on the-retraining of staff of the fixed health centres and on the equipment of these cenrres with a view to making this passive epidemiologicat surveillance more effectivi (see doc. JpCl6.2). Migration surveY 4.17. A migration survey is conducted routinely, when any positive case is detected during epidemiological surveys, in order to get precise informacion on rhe movemenrs of these patients s6 as to identify the source of the infection. 2 mf/s: Microfil;rriac pcr skin snip JPC16.6 Pa6c 7 o\ o\ E J E() o .q o oo o o\o o oq o r\q o oo c; o oq o t-qo C\o o a o 'Et ()o c\oN oo. €io cr EEEcq66 t\ o o o ol o ct T(\Iq o (.l \o o o cft c- o + € o s o !3v@ .G o- ol ol \o ol \o o @ cn o\ o\ E -lt& (J s Cq ci oq o o\co oq o o oo o o\cl o oq o o c.l o oo o €q o oq o \c o cfro o !oc)N()qq 5o\ Gt6a)EBEga =i(f o ct o\o o o Cr! '(n aq o al o o F!\oq o 6 oi o\ o € or a 6l rgds >= o o o ol @ (\r o\ o\ a E -ll& o coq o oo c; !(l c.l o oq o c! o oq o .oouN9 E!o-6€!J:iEsa <./) \o o o q q o (..! rq o Egdszi o\ s o o o o s Bq a oU o Gllr (E .sx c! G o .dlz oE o 'o o .o(J €c6s,|J o or) oF .s .: @ oF ao 6 tt, et o c, c)k I oo GI 6.'tr E c, .A o c,o G, c, La .4 I boo o Ec) a.frl d et D <!F o GIt< CId, {. a JPCI6.6 Pagc 8 Extctrsion arcas 4.18. In the westcrn and southern cxtension zones, all the ivcrmcctin trcatmcnt activitics are carricd out by narional teams practically without the technical participation of OCP. Thcse ivcrmcctin distribution campaigns are combined, as in the original area, with IEC activities. I{owevcr, rhese activities in ttre extension zones cannot be described as devolution. They can be secn simply as a gradual and increasing participation of nationals in the onchoccrciasis control operations. Ivermeccin trcatment l-arge-scale treatment by mobtle teanls 4.1g. As shown in Table 4 below, from June 1994 to May 1995, 1,290,778 people were treared rvith 1,636,343.5 ivermectin tablets in 8,816 villages. Table 4. Rcsulb of large-sc^te treatment in the rvcstcrn and southern exteruion areas from June 1994 to May 1995 * Country in whiclt some basins arc (reated trvice per year Conuttuniry-bascd trcatnrctu (see also doc. JPCt6.2) 4.ZO; fablc 5 sltorvs tlte results of the conrnrunitv-based trcatnren(s carricd out in seven OCp countries'fronl Junc 1994 to May 1995. As can be observed, it is mainly in Mali and Guiuca aud, to a lcsser extetlt, Scrtcgal tltat tltis mode of treatnlent is best establishcd. Thc main reason is that thcsi three countries get finartcial support frorrr NGOs lSigtrt Srvers arrd OPC). As in 1994, rvhilc rccognizing tltc uscfulrtcss lnd inrportancc of thc contributions of NGOs ro tlrc cstablistulerrr of rltis cournrunity sclf-trclttttcnt. (llc Natiorral Coordinetors/OCP rrrccting put ntuch crnphasis ou rlc lccd tbr rhc Statcs to do cvcrlllling llossiblc to cotr(ittuc and irrtcnsify rhis irrrp<lrtant prirrrury 5calr1 crrc activity thcrttsclvcs artd rvitlt (ltcir orvrt rcsourccs. Country Number of villages visited Census population Number of people treated Tablets used Guinea 1,397 202,627 146,744 L72,749.5 Guinca-Bissau* 30r. 52,930 38,027 70,124 Senegal* 157 2,820 36,408 26,026 52,479 Sierra Leone 435,839 314,133 390,715 MaIi 527 96.31I ?3,984 126,124.5 Ghana+ 2t5 t14,997 89,215 t39,26t.5 Benin+ 918 239,299 164,109 17S;175 Togo t,27r 264,927 r87,041 224,732.5 C6ce d'Ivoire 1,2I0 33t,773 25r,499 28I,993.5 Total 8,816 I,775,000 r,290,778 t,636,343.5 JPCI6.6 Pagc 9' Tablc 5. Rcsults of community-based treatmcnts in sonrc countries irr thc Progranune area (Junc lgg6May 1995) 5. oTHER EI.{DEIvfiC DISEASES' CONTROL ACTIVITIES 5.1. The endemic diseases, such as dracunculosis, African human tr)?anosomiasis, leprosy, tuberculosis, schistosomiasis, malatia and yaws, are the subject of a more or less satisfactory active and passive epidemiological surveillance in most of the Participating Countries. However, only Burkina Faso, whose devolution plan is being financed, has been able. to plan and carry out in concrete terms an active and passive surveillance of trypanosomiasis, dracunculosis and onchocerciasis. The preparation and implementation of a multidisease surveillance programme has come up agairst the difficulty of an absence of a joint prografirme for the control of the endemic diseases integrated into the national health systems. S.Z. Togo carried out an investigation on three suspected cascs of trypanosomiasis reported by GTZ (German Cooperation). Tlte diagnosis of the cases was not confirmed. 5.3. C6te d'Ivoire has trained 192 community health rvorkers (CI{Ws) and trvo nurses as part of .rrlpanosomiasis control. These CHWs enumerated 60,043 persons tnd24,34 frlter-paper bloodspots'nave Uecn analysed. Out of 402 seropositives, 34 patients have bcen confirmed. it -has ptannei ro esrablisfi a laboratory for the diagnosis and monitoring of trypanosontiasis patients. 5.4. Senegal ltas nrade a joint revierv of community treatment and dracunculosis eradication activities. 6. EFFORT TO INTEGRATE DtrVOLUTION ACTIVTTIES 6.1. As regards ltealth activities in general, the integration is already bcir:g done at rhe district and conrnrunity levcls bccause (he resources are limited and thc field staff are used joitrtly by the different progranlmcs. It is nrainly at the central and regional levels that (here are still problenrs because sonrc of tirc programmes arc vertical in nature. 6.2. With rcgard to ottcltoccrciasis-rclatcd activitics, thc Participeting Countrics arc rrrlkipg l)rog,ress iu thc intcgratiott, particularly tlrrouglt intcgratc<.t trairring progranllucs. Thc hcalrh workcrs irr tlc onchoccrcal z-otlcs particip;rtc activcly, in tltc ortchoccrci:rsis con(rol activi(ics (eJlidcrniologicll cyllut(ions. ivcrtttcctitt trc:tttllcll(. grourtd larvicidirrg, lr\\,:lrcllcss-raising c:rrrr1:eigls). Ccrrcrally sllc:rking, (llc c()ullt.lcs :ttc gr:tdtr:rlly rrrtcgrlttittg tlttcltrrccrcursis c()n(r'(,1 ln(() lllc rurtiorr:rl lrculrlt s)'s(cllls. Country Number of Viltagcs Census Population Numbcr of pcople trcated Tables uscd Mali t,02[ 566,531 440,989 685,903 Guinea t77 106,024 83,553 t42,974 Senegal 128 42,939 27,993 44,039 Sierra [*one 105 21,149 16,403 27,460 Southern Extension (C6te d'lvoire' Benin, Togo) 249 23,755 29,02L 39,103 Total 1,680 760,399 597,959 939,379 7JPCI6.6 Pagc 10 6.3. Somc of thc coun(rics ltavc s(arted carrying out cpidcrniological survcys on onchoccrciasis and/or ivermectin distribution along with thc survcillance of otlter cndcnric diseascs such as schistosomiasis, dracunculosis and the othcr blinding discases. ANANCIAL CONTRIBUTTON OF TI{E, COUNTRTES TO TI{8, DEVOLUTION PROCESS Apart from salari0s and contributions in othcr forms which must be evaluated in furure, financial iontributions were recorded for nine countries in 1994 and at the end of June 1995 for five countries (see Table 6 bclow)' Table 6. Financial contribution of the States in 1994 and estimates for 1995 8. CONCLUSTON g.l...inspiteoftheeconomicdifficulties,theParticipatingCountriesconrinuetomakee[[ortsto maintain and streogthen (lte acltievements of tlte Oncltocerciasis'Control Programme. g.Z. This is reflected, in thc field, in concrete activities rvhich are already considerable despite thc absence of funding for tlte devolution plans. In any case, the countries rvill have to rely nrore ou rheir own resources even if thc support of the partners in dcvelopmcnt is unavoidable. In the short tcrnr. rSey hdve to strepgtlten. tlte national capabilities and perfcct the tools neccssary for carrying our acvotiftion activities'in thc field, in collaboration with OCP. g.3. Eventually, the challcnge to be taken up is the integration of thcsc dcvolution activities irrto the healtlt systems of the countrics' Country t994 199s Benin 2,910,000 cFA 1,450,000 FCFA Burkina Faso us $ 16,857 C6te d'lvoire us $ 72,000 61,000,000 FCFA Gh6na us $ 34,367 Guinea- us $ 13,764 Guinea-Bissau us $ 4,773 Mali us $ 19,064 14,OOO,UOO FCFA Niger Senegal 9,270.000 FCFA Sierra lrone us $ 33,334 Togo us $ 4,700 437,OOO FCFA 3. 9 ,l I c c<I;!: tO CE96Ii.:; : 4:aot': otsg-;3! E oo- €i5i! iitc9b:E \:l€ il;E .'9: i!E: E;i; Eri: 6"^i! olo.! < :9 b63: "tI <@uo I o ) o 2 o I i ? :3 : l -r ei ii : : ;s e-I i :i :: ;: 1 ::!:'"! i'i:;: ::- -:! 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