Committee of Sponsoring Agencies (CSA): report of the hundred and seventh session World Bank Office, Paris, 11-12 October 2004

RESTRICTED APOC CSA 107 THE AFRICA}I PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) COMMITTEE OF SPONSORING AGENCIES (CSA) Report of the hundred and seventh session World Bank Office, paris, ll-12 October 2004 Draft 28 October 2004 OPENING OF THE SESSION l. The 107ft session of CSA was held at the World Bank office in Paris from I l-12 October2004 under the chairmanship of Bruce Benton. Bruce welcomed and introduced Alexandre Abrantes, Human Resources Development Manager at the World Bank and Ousmane Bangoura, the new Coordinator (as from Dec 2004) of the Onchocerciasis Coordination Unit at the World Bank, who were both attending the session for the first time. He also welcomed the participation of Anarfi Asamoa-Baah (AB), Assistant Director-General of WHO in charge of Communicable Diseases. A list of participants is attached as Annex l. ADOPTION OF TIIE PROYISIONAL AGENDA 2. The provisional agenda attached as Annex 2 was adopted and the items rearranged to enable AB, who was attending only the first day of the meeting, to be able to participateln the discussion of a number of issues. APPROVAL OF'THE DRAFT CSA1O6 REPORT AND MATTERS ARISING THEREFROM 3.- With regard to the external evaluation of APOC, the Committee was informed that most of the experts had been identified but there was still need to identify a team leader - somebody w]th 1 strong background in national health systems in Africa. It was suggested that the profiles of retired WHO specialists in this area could be consulted for potential candidates. 4. The report of the 106ft session of CSA was adopted after minor editorial suggestions which have been reflected in the final report. FOLLOW-UP OF THE DONORS' CONFERENCE & REPORT ON THE FINANCIALSITUATION OF APOC 5. Bruce highlighted 3 main outcomes of the Donors,conference, namely: i. the Conference recommended that the very effective donor partnership in ApOC be maintained until the end of the programme in 2010; donors pledged not to abandon the programme before 2010 and would consider supplemental contributions in the future; iii. donors recognized that APOC offered a unique opportunity to broaden the scope of national health systems to reach out to populations in the remote areas. 9 Following the conference, supplemental increments have been received from Kuwait,Belgium and OPEC Fund for International Development, reducing the funding gap from US$lg million to US$13.2 million. It was, however, wamed that the Neiherland. ,riy"U. reducing the level of their contribution. ll 27. Bruce projected the presentation he intended to make at JAFI0 in Kinshasa on the financing of APOC and called for comments. 8. There was a question as to why country contributions and those of NGDOs were not shown in the presentation. It was stressed that it would be important to show how much resources countries needed to contribute to CDTI activities so that they were constantly reminded of that responsibility. Bruce explained that his presentation only concerned the management of the APOC Trust Fund and thus did not include contributions from other sources at the country level (NGDO, country, etc.). REPORT OF THE TWENTY.FOTJRTII NGDO GROUP MEETING 9. An account of the 24d' NGDO Coordination Group meeting held in Atlanta from 7-9 September 2004 was given by Adrian Hopkins. Integration, NGDO support to CDTI projects, competition for funding, governments' financial contributions particularly after 2010, u"j management of SAE cases in Bas Congo, were among the main issues discussed at the meeting. 10. As to the need to involve new NGDOs, CSA was informed that it was becoming more and more difficult to find NGDOs to support new projects. ll. Merck announced the contribution of US$l million, over a period of five years, to the NGDOs working on onchocerciasis in Africa, particularly those in countries where CDTI was making less progress. NGDOs may apply to Merck & Co. Inc. for the funds but would be expected to contribute an equal amount they receive to CDTI activities. CONCLUSIONS AI\D RECOMMENDATIONS OF THE NINETEENTH SESSION OF TCC 12. Dr S6k6t6li reported on the outcome of TCCIS and specifically highlighted the cost per treatment study which was still ongoing. He underscored the importance of the study for governments in APOC countries. 13. It was stressed that there would be a need to have a peer review mechanism to look at the study before the next TCC. 14. Dr S6kdt6li also informed CSA of the participation of 2 national coordinators and a representative of Micronutrient Initiative (MI) at the session and TCC's recommendation that national coordinators be invited in future to attend TCC sessions on a rotational basis. PREPARATIONS FOR, AND TERMS OF REFERENCE OF, THE APOC EXTERNAL EVALUATION AI\D THE MID.TERM REYIEW OF SIZ 15. CSA reviewed and suggested improvements to the TORs for the Extemal Evaluation of APOC with particular emphasis on ensuring an integrated and programmatic financing mechanism within national budgets. 't 316. The evaluation team was still being put together and the need for a strong team leader was stressed, preferably, someone specialized in national health systems management. 17. It was agreed that the World Bank will pay the honorarium of the evaluators while APOCpay their travel cost and per diem. The total cost of the APOC evaluation was estimated at us$220,000. l8' CSA also reviewed and suggested modifications to the TORs for the Mid-term Review ofSV. lt was suggested that the review of the SIZ activities should also be extended to other ex-OCP countries and expressed the need for the evaluation to review the adequacy of the institutional structures for decision-making and surveillance in the ex-OCP countries. The Committee was reassured that such extension would have no cost to the SZ budget as funds would be mobilized by the World Bank for the extra cost. SIZ may however be required to advance some money for the exercise. The World Bank was to work out the budgei for the evaluation. 19. There was concern about how the results of the Review would be reported as there was a structural vacuum since the Multidisease Surveillance Center (MDSCj was not yet fully functional. 20. As to whether both the APOC External Evaluation and the SIZ Mid-term Review could be linked for presentation to JAF through CSA because of the vacuum for reporting on SIZ activities, it was made clear that only the World Bank and WHO had the mandatl to discuss the SIZ and not the entire CSA. PROPOSAL(S) TO THE MELINDA & BILL GATES FOUNDATION 21. The outcome of the Melinda & Bill Gates Foundation meeting on integration of parasitic diseases held in Seattle in July 2004 was given. It was felt that uttt orgt, the meeting was constructive, it was not clear how integration would work. 22. The Foundation had invited projects willing to request funding for integration to submit Letters of Inquiry (LOD to the Foundation by 1l October 2004. The World Bank had been discussing with NGDOs and the Micronutrient Initiative and was planning to submit LOI seeking funds for integrating Vitamin A supplementation in some APbC projects. It was also planned to seek funds for other integration interventions such as reproductive health. 23. It was suggested that perhaps it would be useful to invite Rick or Regina of the Melinda & Bill Gates Foundation to JAFI0. UPDATES 24. MI staff was undertaking missions to DRC, Nigeria, Sudan and Tanzania to consult with stakeholders and to develop concept papers for integrating other health interttentions into CDTI activities with special emphasis on Yitamin A &rpplementation. See also paragraph 22 above. 4?!. A meeting of all national coordinators of ex-OCP countries was to be held from 17-19November 2004 to review progress of onchocerciasis activities in the SIZ and in the other ex-OCP countries. The World Bank was also planning to convene a ministerial meeting of the ex- ocP countries sometime in early zo06,to review the ex-ocp evaluation. 26. The SIZ budget for 2005 was estimated at US$2,285,525. This budget may have to beincreased it SV was to advance US$150,000 for the Mid-term Review as stiggestei earlier (ref. to paragraph 18). 27 ' Hans Remme briefed CSA on progress of ongoing operational research issues includingMacrofil: the safety incidents involving a veterinari* .o-pornd of moxidectin; the need topursue the development of moxidectin; the multi-country studies on Community-directedTntervention (CDI) and preparations for its introduction, the feasibility studies on local elimination of onchocerciasis transmission and the cessation of ivermectin treatment. 28. CSA acknowledged the usefulness of the albendazole pre-treatment study in Loa loa endemic areas which was estimated to cost US100,000 of which ApOC t lurugl-rnt had agreedto pay US$50,000 while US$40,000 was to come from the LF Elimination riogramme and theWorld Bank agreed to top up the remaining US$10,000. Janis Lazdins of Macrofil was to submit aLettw of Request for each of these contributions no later than mid November. 29' CSA was informed about progress on CDTI implementation and partnership in SouthSudan, Burundi, CAR, Chad, DRC, Liberia and Angola whichcan be rr*-u.ir"d as follows: i. 2 out of 5 approved projects _were beginning in South Sudan where CBM had agreed to coordinate the activities of the NGDos operating there; ii. leadership problem in the CDTI project in Chad and the ongoing negotiations to get back OPC to support CDTI activities; iii. the WHO/AFRO restrictions for financial management of WHO funds by country officials in Burundi and the recent approval by RD/AFRO for the WHO country- office to manage the Apoc funds sent for GDTI activities; iv' the total loss of project equipment due to civil unrest in CAR and Liberia. The recovery of 2 vehicles in Liberia and steps underway to fully resume CDTI activities in CAR as soon as the situation had been assessed; v. absence of NGDO partner for 12 CDTI projects in Angola, Burundi, Cameroon, DRC, Ethiopia and South Sudan. 30. There were reciprocal concems expressed by APOC Management and CBM regarding the release of funds for CDTI activities in CAR and Burundi. CSA emphasized that a mechanism should be put in place for smooth communication between partners, especially in conflict areas. 31. CSA noted a report by Bjorn Thylefors on the various missions undertaken to DRCfollowing the SAE cases in Bas Congo, the management of the cases and the current situation ) 5which was now under control. Treatment in the area was to resume according to the MEC/TCCguidelines after RAPLOA validation. It was suggested that treatment be carried out in the dry season only, to facilitate referral of SAE patients to the appropriate clinical structures. 32. Dr S6k6t6li also outlined his recommendations, endorsed by TCCI9, which he sent to theNOTF/DRC on the steps and precautions to take with regard to future CDTI activities in the atea. 33' The importance ofjoint missions, by the various partners, to conflict areas such as those undertaken to Liberia and DRC was stressed. 34 - Bruce reported on a recent meeting held on 6-7 Octobe r 2004 to review progress of theMultidisease Surveillance Center (MDSC). Notably, among participants were: Dr AnarfiAsamoa-Baah, ADG, CDS/WHO, Dr Ebrahim M. Samba, Rolan'nb, Dr Antoine Kabor6,DDC/AFRO, Bruce Benton and Bernhard Liese of the World Bank, representatives from theCanadian International Development Agency (CIDA), the African Union (AU) and zparticipating counhies. The governance issue now seemed to be resolved. A steering committeehad been set up comprising the World Bank, wHo , 5 participating countries (on a rotationalbasis) and donors contributing to the MDSC. The committee will be chaired by DDC/AFRO.MDSC remained a WHo-executed Center but its Director will report directly to the steering committee. The Center will start with onchocerciasis and meningitis surveillancl and scale up to other diseases over time. 35' A2-page strategic plan and a Plan of Action and Budget for 2005 and 2006 were beingprepared and the strategic plan was to be presented to the Global Fund for funding. The WorliBank and CIDA were also willing to fund the Center. PREPARATIONS FOR JAFIO, REYIEW OF'JAFIO DOCUMENTS & REFLECTIONSOF CSA 36. It was reconfirmed that JAF10 was to be held in Kinshasa, DRC, from 7-9 December2004' Ajoint World Bank/APOC Management mission to Kinshasa was to be undertaken soon to review preparations and logistics for the meeting. 37. The Committee reviewed and commented on all JAF documents except documentJAFI0/INF/DOC.4 (Community Self-Monitoring Guide) which was not ready yet. pending clarification of some data, it was suggested that the document on "REMO and the prevalence of onchocerciasis in APOC countries" (JAFIO/INF/DOC.5) should not be presented to JAFI0 butthat mention be made of the new prevalence figures in the presentation of the wHo progress report by APOC Management. 38' A list of issues to be raised in the CSA reflections to JAFI0 was brought to the attention of the Committee which commented on the content and order of presentation oithe issues. 6CHAIRMAI\SHIP OF CSA AND ATTENDANCE OF CSA SESSIONS BY MEMBERS 39. Explanation was given of the history and rules regarding the chairmanship of CSA since the OCP days. In principle, the chairmanship should be rotational among the 4 UN agencies(wHo, World Bank, UNDP and FAo). It was remarked that the CommitteJhad expand"j u.roe.APOC to include the NGDOs and the chair of the Mectizan Expert Committee; and that the affendance of UNDP and FAO to CSA sessions had been spoiadic since the end of OCp.Therefore, the need to review the membership of the Committee and the rules pertaining to the chairmanship was expressed. However, it was also acknowledged that any suggested ch-ange to the structure of CSA at this point would require revising the Memorandum of epOC which-was deemed cumbersome and not worthwhile 40. It was suggested and agreed that WHO will take the chair of CSA as from January z}o5. For the sake of continuity, it was important for the chair to attend all CSA meetings and, ai much as possible, all the statutory meetings of ApOC (TCC and JAF). 41. It was difficult in the past to separate what Bruce Benton was doing as chairman of CSA and what he did as Manager of the Onchocerciasis Coordination Uniiat the World Bank, because the Oncho Unit had a Secretariat function with respect to the Oncho controlprogralnmes. With WHO taking over the chair, it was deemed ,"".rrary to distinguish thefunctions of the chairman of cSA from those of wHo as a co-sponsoring ug"r"y. FINANCING AI\ID IMPLEMENTATION OF CDTI ACTIVITIES BY APOCCOUNTRIES IN TIIE CONTEXT OF PRSP, SWAP, PRSC AND HIPC SCHEMES. 42. Alexandre Abrantes and Ousmane Bangoura explained the different funding mechanisms used at the World Bank which APOC projects could explore for funding at the country level. These included the PRSP, SWAP, PRSC and HIPC. Information on ih"r, various iunding mechanisms was available on the World Bank website and Ousmane agreed to compile aZ-pagZprofile on these mechanisms for dissemination to APOC countries. m aaOition, it was ug.""O io hold a sensitization workshop in the first quarter of 2005 for NOTFs to which the Ministries of Health, Ministries of Finance and Planning, National Coordinators, and NGDOs, were to be invited. 43. In order to be able to benefit from the various funding mechanisms, it was imperative to ensure that onchocerciasis was included in the national budget (programmatic financing mechanism). 44. CSA thanked Alexandre and Ousmane for their very useful presentation. OTHER MATTERS 45. It was suggested that APOC Management prepare itself to answer questions from donors on the number of CDTI sustainability plans which may come up at JAFI0 in Kinshasa. 7DATES AND VENUES OF CSAlO8 AND OF SUBSEQUENT CSA SESSIONS 46. CSA agreed to meet before and after JAFI0 in Kinshasa, DRC, on 6 December at 15.00, and on 9 December 2004 at 17.30, for the l08th session. 47 . The Committee also suggested to hold CSAIO9 in Geneva either on 30-31 March or 6-7April 2005. At the time of sending out this report, it was still undetermined which of the dates to retain. 48. CSA1 l0 was scheduled to meet in Washington, D.C. on 19-20 October 2005. 8Annex I LIST OF PARTICIPANTS 1. Bruce Benton, World Bank 2. Bernhard Liese, World Bank 3. Alexandre Abrantes, World Bank 4. Ousmane Bangoura, World Bank 5. Jesse Bump, World Bank 6. Adrian Hopkins, CBM 7. Bjdrn Thylefors, MDP 8. Brenda Colatrella, Merck & Co. Inc. 9. Anarfi Asamoa-Baah, WHO 10. Azodoga S6k6t6li, WHO/APOC I l. Hans Remme, WHO/TDR 12. Tony llkety, WHO/PBL, NGDO Coordinator 13. Ole Christensen, WHO Consultant 14. Abdulai Daribi, WHO, AFRO/APOC Liaison Office 9Annex 2 PROVISIONAL AGENDA (Rev. 2) HUNDRED AND SEVENTH SESSION OF CSA Paris, 11-12 October 2004 The World Bank Office, Turquoise Room 1. Opening of the session 2. Adoption of the provisional agenda 3. Approval of the draft cSAl06 report and matters arising therefrom 4. Follow-up of the Donors'Conference and report on the financial situation of ApOC 5. Report of the twenty-fourth NGDO Group meeting 6. conclusions and recommendations of the nineteenth session of TCC 7 ' Preparations for, and Terms of Reference of, the APOC External Evaluation and the Mid-Term Review of SIZ 8. Proposal(s) to the Melinda & Bill Gates Foundation 9. Update on:(i) integrating other health interventions into CDTI activities with special emphasis onVitamin A Supplementation and Reproductive Health(ii) progress of onchocerciasis activities in the Special Interventio n Zones(iii) ongoing research activities(iv) CDTI implementation and partnership in South Sudan, Burundi, CAR, DRC, Chad, Liberia and Angola.(v) Severe Adverse Events (SAEs) in APOC countries with particular reference to DRC(vi) progress of the Multidisease Surveillance Center (MDSC) 10. Preparations for JAFIO, review of JAFI0 documents and cSA reflections I l- chairmanship of csA and attendance of cSA sessions by its members 12' Financing and implementation of CDTI activities by APOC countries in the context ofPRSP, SWAP, PRSC and HIpC schemes 13. Other matters 14. Dates and venues of cSAl08 and of subsequent cSA sessions