Committee of Sponsoring Agencies (CSA): report of the hundred and thirteenth session Paris, France, 28 and 29 June 2006

tf RESTRICTED APOC CSA 113 THE AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) COMMITTEE OF SPONSORING AGENCIES (CSA) Report of the hundred and thirteenth session Paris, France, 28 and29 June 2006 OPENING OF THE SESSION l. The hundred and thirteenth session of the Committee of Sponsoring Agencies (CSA) of the African Programme for Onchocerciasis Control (APOC) was held at the Conference Centre of the World Bank Office in Paris from 28 to 29 June 2006 in conjunction with the third meeting of the Working Group on the future of APOC and the control of onchocerciasis in Africa. The list of participants is attached as Annex 1. 2. The session was chaired by Dr James Mwanzia, Director of the Division of Disease Control of the Africa Regional Office of the World Health Organization (WHO). He informed the participants that Mr. Abdulai Daribi, secretary of the CSA of APOC, is no longer a staff member of the Africa Regional Office of WHO. APOC management was therefore asked to clariff the issue of secretary to CSA for the present and the forthcoming sessions as well as secretary to the APOC Technical Consultative Committee (TCC) and the Joint Action Forum (JAF). 3. Dr Mwanzia also informed the participants of changes being adopted by WHO/AFRO concerning the Multi-Disease Surveillance Center (MDSC). The changes will include the appointment of a full time Director, the reorganization and repositioning of the MDSC taking into account the views of potential donors and partners so that the Center could play a major role in disease surveillance in the region. 4. The Director of APOC,DT Amazigo, acknowledged the role played by Mr Daribi in OCP and during the last few years in APOC but, with the decision of AFRO to abolish the post of Mr Daribi, the upcoming retirement of Ms Fiona (secretary to the Coordinator of the NGDO group, Dr Ukety) and the need for APOC Management to strengthen its structure at the headquarters level in Ouagadougou, it became necessary to review all staff positions including the secretary to the statutory meetings. After consultation with Dr S. Resnikoff, it was decided that a full time support staff should be recruited for the NGDO group and APOC Management. The post description is being prepared and APOC will pay for this post. 5. The CSA discussed the effect the new situation would have on Dr Tony Ukety, the NGDO coordinator based in Geneva and the technical background and writing skills of the new person. It was agreed that the person to be hired should be more than a secretary. Dr Amazigo informed the CSA that Dr Ukety and Dr Serge Resnikoff had been consulted on this issue and the change will have no adverse effect on Dr Ukety's tasks. On the contrary, it will provide effective support to the NGDO coordinator and the coalition. She reassured the CSA that their concems are well noted and will be taken into account. The chair of the NGDO coalition, Dr Adrian Hopkins indicated that the arrangement is agreeable to his organization. The CSA requested that any situation of this nature be shared with all members and insisted that a solution be found for the Programme considering the issue of cost and the staffing at APOC/HQ. 6. Dr Mwanzia, chair of the CSA, considering the forthcoming events (APOC Partners' Meeting, CSAl14, and JAFI2), the new contextual environment and staffing of the Programme observed that it is not an appropriate time to change the secretary to the CSA. He recommended that a competent person be hired as secretary but before this person is recruited, Mr Daribi should continue to perform this function. I 2ADOPTION OF THE PROVISIONAL AGENDA 7. The provisional agenda attached as Annex 2 was adopted. CONSIDERATION AND ADOPTION OF THE DRAFT REPORT OF CSA112 8. CSAI 12 report was adopted without amendment. However, it was requested that Mr Daribi circulate to all CSA members the revised version of CSAI I I report taking into account the observations made during CSAI12. REVIEW OF THE REPORT OF THE WORKING GROUP ON THE FUTURE OF ONCHOCERCIASIS CONTROL IN AFRICA 9. As decided by the eleventh session of the Joint Action Forum (JAFl l), a concept paper on the future of onchocerciasis control in Africa was prepared by the Working Group (WG) established by CSA. The document which was circulated to CSA members a week before the meeting was presented by the chair of the Working Group, Ms Catherine Hodgkin. In her presentation, she highlighted the Group's future vision of APOC, four issues on the future of onchocerciasis control in Africa, reflections and key strategic recommendations: The Group recommended that APOC's main objective of establishing sustainable CDTI to allow for the building of fully sustainable national programmes in all endemic countries, including fragile states, be endorsed. a. The mandate of APOC be expanded to include all oncho endemic countries in Africa where the epidemiological situation requires sustainable CDTI. APOC should thus ensure continuity of support to the Special Intervention Zones (SIZ) in Togo, Guinea, Benin and Ghana; assist Sierra Leone and Ivory Coast and any other areas in the former OCP where sustainable CDTI needs to continue after 2007. The Group emphasized that it is unnecessary to maintain the historical boundaries of former OCP and APOC. b. APOC partners should promote actions to strengthen the capacity of MDSC to fulfill its anticipated role to onchocerciasis surveillance. The Group recommended strenglhening integration of CDTI into the health systems and co- implementation of interventions with CDTI to effectively provide multiple health benefits to large populations. a. The Group stressed that co-implementation should be a country led process. Thus, APOC should develop plans for facilitation, advocacy, and exchange of best practices between countries; b. Encourage joint financing and advocacy for Neglected Tropical Disease (NTD) partnerships; c. And strengthen operational research on co-implementation. 3il1. The Group recommended that APOC operations should be extended to 2015 to enable it fulfill its original objectives. This would allow the CDTI projects to be launched in 2007 to benefit from 8 years of APOC support, necessary to be sustainable. The Working Group stressed that sustainability of country programmes is priority and premature closure of APOC would be detrimental and unethical. The Working Group advised that extending the duration of the Programme is important, however: a. APOC should initiate a long-term planning process of an exit strategy; b. APOC should develop long-term support mechanisms to provide limited assistance to CDTI projects that will continue to distribute ivermectin after its closure. c. to develop effective surveillance programmes that would continue after CDTI cessation to ensure detection ofany recrudescence. tv The Group further recommended that APOC take on the additional objective of developing the evidence base to determine where and when ivermectin treatment can be stopped, and to provide guidance to countries on how to prepare for and evaluate cessation of ivermectin treatment. The Working Group deliberated also on financing the extension of APOC to 2015, planning for longer-term surveillance and support to posrAPOC. It stressed that while fund mobilization for onchocerciasis control should build on existing traditional donors of the Programme, new financing mechanisms should be explored. And therefore recommended that APOC partners: a. Explore opportunities to diversiff funding base and take opportunities offered by NTD initiatives and the Global Fund; b. Explore country level opportunities for sustained national financing; c. Maintain and expand NGDO commitment to support CDTI. 10. CSA expressed satisfaction with the reflection paper of the Working Group. The committee agreed to the above recommendations and suggested the following issues be addressed in the paper: (i) The role of the NGDOs and strengthening the APOC partnership;(ii) Expanding APOC partnership to new members - countries, NGOs and NTDs;(iii) The dearth of supporting data in the paper;(iv) Highlighting interventions for co-implementation and the benefits of the ComDT approach;(v) The financing of the co-implementation;(vi) Emphasizing the pivotal role and functions the WHO/AFRO, WHO country offices and other actors will play in maintaining onchocerciasis control after the exit of APOC in 2015 whether or not a macrofiliaricidal drug is in place in 201I as anticipated. 4I l. CSA observed that the gains of the former OCP may be lost if there is spillage and disease recrudescence. There was concern about the complexity, difficulties and high cost of implementing the remaining projects in conflict countries or in those co-endemic for loiasis. 12. CSA and the WG agreed that additional funding would be required for the extension of APOC to 2015. Funds will be required to address the new objective of when, where and how to stop ivermectin treatment, co-implementation and expansion of the geographical scope of the Programme. The Working Group will submit its final report to the CSA through APOC management by 30 July, 2006. APOC management will make the report available in two languages by September 2006. PLAN OF ACTION ON THE 2OO5 EXTERNAL EVALUATION REPORT OF APOC 13. In response to a recommendation approved by the llft session of the Joint Action Forum (JAFI l), APOC management presented to the CSA a draft action plan based on the 2005 External Evaluation. The plan put forward as essential to achieve the strategic recommendations of the evaluators was divided into sections- introduction and rationale, initiation dates and expected outcomes for the period 2006-2009. 14. APOC management was congratulated for the initiative and for having put the plan in context. The CSA reviewed the draft action plan and suggested an alternative module. The members advised that the title of the document be changed to reflect the content, and the general and specific objectives should be distinct from the introduction (background), role and responsibilities of partners, timeline, the rationale behind the timeline and budget. 15. The committee advised also thatthe plan should include recommendations of the evaluation addressed to the CSA and the NGDOs. And further suggested that the action plan be repackaged in six priority areas: i. scaling up the implementation of CDTI projects; ii. strengthening the CDTI approach; iii. strengthening accountability at country level and commitment; iv. programme management at district and regional levels; v. knowledge dissemination; vi. increase in information sharing. lmprovlng countries financial 15. The expected outcome need to be more focused, precise, and the key recommendations conceptualized. There was consensus among members that a detailed plan of action drawn from the recommendations of the External evaluation team would be an important implementation tool for the management of the Programme. THE STRATEGIC FRAMEWORK AND ACTION PLAN OF APOC (2007-2015) 16. Following the presentation of the reflection paper of the Working Group on the future of onchocerciasis control in Africa and the draft action plan based on the evaluation report, the CSA discussed in depth whether there should be two separate documents: (i) the plan of action prepared by 5APOC management and (ii) the strategic action plan of APOC 2007 to 2015 -an implementation document of the Working Group reflection paper. The CSA agreed to a single document - a strategic action plan that will take account of the reflections of the Working Group, the action plan developed by APOC management informed by the recommendations of the 2005 External Evaluation of APOC and the Programme document of Phase I and Phasing-out period of APOC. 17. Acknowledging the lean staffing and heavy workload on APOC management as well as the need to accelerate the preparation of the above-mentioned important document to be ready for the partners meeting, the CSA advised that a consultant be hired by APOC management to assist with the preparation of the document. The meeting also advised that the Programme document for Phase II and the Phasing-out period be taken as the basis for the strategic framework and plan of action, reviewed and adjusted with the reflection paper of the Working Group and the 2005 APOC External evaluation report. The budget component of the document will be reviewed also based on the new dimensions in the reflection paper. The document will be presented at the Partners' Meeting as draft until approved by the Joint Action Forum. PREPARATIONS FOR THE PARTNERS' MEETING 18. The eleventh session of the Joint Action Forum in Paris requested that a Partners' Meeting be held in an African country in 2006 to: a. review a reflection paper prepared by the Working Group and agree on the strategies for the future of onchocerciasis control in Africa; b. review and provide guidance on the strategic framework and the plan of action derived from the report of the 2005 Extemal Evaluation 19. During a teleconference of the CSA held on Monday 22May 2006, the members agreed to suggest the dates of 26-27 September 2006 to the government of Cameroon for the Partners' meeting to be held in Yaound6. The information has been conveyed to the Minister of Health of Cameroon by APOC management. 20. Regarding participation in the Partners' Meeting, the CSA considered two scenarios - to invite the ministers of health and national onchocerciasis coordinators, or to invite only the ministers of health. Following careful deliberation on the cost and expected outcomes of the meeting, the CSA approved the invitation of the ministers of health and the national onchocerciasis coordinators. The committee approved also that the cost of the Partners' Meeting be covered from APOC Trust Fund approved budget of 2006. 21. Furthermore, the CSA decided that the Honourable Minister of Health, Cameroon should invite the Ministers of Health of the onchocerciasis endemic countries while the chair of the JAFIl should invite the donors. The committee was informed that few donors, including Canada, Belgium and France, had so far confirmed their participation to the World Bank and an invitation will be extended shortly to the USAID. Also, Dr Catherine Hodgkin has been requested to lobby for the participation of the Netherlands and Prof. David Molyneux would be requested to approach the United Kingdom representative. 622. The Committee stressed on the need for series of high level advocacy to secure the participation in the Partners' Meeting of as many endemic countries and partners (donors, NGDOs and others) as possible. The ownership of onchocerciasis control, disease surveillance and of the new vision by participating governments is implicit to achieve the elimination of onchocerciasis as a public health problem. The CSA advised that the 57'h session of the Regional Committee in Addis Ababa provided an opportunity to lobby the Ministers of Health for the Partners' Meeting. UPDATE ON THE PREPARATION FOR JAF12 23. The Director of APOC informed the CSA that the Government of Tanzania has confirmed the dates of the twelfth Joint Action Forum as 5-8 December 2006. The session will be held in Dar-es- Salaam. APOC management is in contact with the government of Tanzania for the preparatory alrangements. The government has set up an organizing committee and the national onchocerciasis coordinator is the focal person. The Director of APOC requested the guidance of CSA in restructuring the agenda of JAF to allow sufficient time for discussion as requested by the Forum in December 2005. 24. Discussions of the CSA on the agenda of JAF focussed primarily on how to reduce the duration of presentations of country representatives while maintaining content and high level quality. The CSA observed some overlap of contents in the country and WHO Progress Report. In concluding, the management of APOC was asked to present to the next session of the CSA in October 2006, a provisional annotated agenda of JAFI2 that allows enough time for discussion. 25. The CSA discussed the suggestion for a special invitation to be sent to the African Development Bank. It was decided that the invitation should come from WHO/AFRO. Therefore, the Chair of the CSA would request the Regional Director to invite the President of the African Development Bank to the Joint Action Forum. This will encourage donor financing of the control of onchocerciasis and other NTDs. UPDATE ON THE FINANCIAL SITUATION OF APOC 26. Dr Bangoura informed the committee that in2002, US$59 million dollars was received from the donors as contribution to Phase II of APOC .In 2006, out of US$ I 8.5 million expected, I I million had been received as of June 2006. The funding gap is currently estimated at US$7 million. 27. APOC Management should update JAF on the expenditures as compared to the approved budgets. OTHER MATTERS 28. As requested by CSA1I2, APOC Management circulated to all CSA members in January 2006 the CVs of candidates for consideration. Feedbacks received from some members of the CSA 7were positive except for one candidate. In summary, CSA endorsed the recommendation by APOC management to request the DG of WHO for the appointment of four independent scientists to the Technical Consultaiive Committee (TCC) as replacement of four out-going members. In addition, the membership of three members will be extended. The mandates of four other members are still valid making the total of members of the TCC eleven. Provision should therefore be made to appoint one additional member to complete the number of TCC members to l2 as indicated in the Memorandum of Understanding. 29. Prof. B. Koumar6 presented to the committee the activities carried out by the MDSC on onchocerciasis surveillanci and research in collaboration with other WHO entities. The new developments on the governance structure and the financial constraints facing the MDSC were brought to the attention of the committee and discussed. 30. Dr Bangoura informed the CSA the sum of US $ 400,000 was released by the World Bank to MDSC. The Center, Dr Bangoura stressed, should provide activity plan showing support to Onchocerciasis surveillance. He suggested also that a l0-year plan from the MDSC would help in fund mobilization for the Centre. He advised that an agreement should be signed between APOC or SIZ with MDSC for financial support to be provided by these entities to the MDSC. A document should also exist in the case of co-financing by the entities. CSA agreed to assist with lobbying the donors for resources to strengthen the capacity of the MDSC for disease surveillance activities' 31. The chair of the NGDO coalition informed the CSA of changes in the USAID policy concerning fragile states. Under the new policy, the western provinces of DRC are no more eligible to USAID funds. Thus, Interchurch Medical Assistance Inc. (IMA), a USAlD-supported NGDO co- funding CDTI projects in the eastern part of DRC is no longer able to continue its support to CDTI projecti in this zone. Arrangements are therefore being made with other NGDO operating in DRC to fill the gap. DATE AND VENUE OF CSA114 32. The Committee agreed to hold its one hundred and fourteenth session in Abuja, Nigeria from l2-13 October 2006. It was suggested that members set aside October 11,2006 for advocacy visits to government officials in Abuja. 8Annex I LIST OF PARTICIPANT^S HUNDRED AND THIRTEENTH SESSION OF CSA 28 & 29 June 2006 World Bank Conference Centre, Paris, France L Dr James Mwanzia, WHO/AFRO (Chair) 2. Dr Ousmane Bangoura, World Bank 3. Dr Bernhard Liese, World Bank 4. Dr Dirk Engels, WHONTD 5. Dr Adrian Hopkins, CBM, NGDO Group Chair 6. Dr Bj6rn Thylefors, MDP 7. Mr Ken Gustavsen, Merck & Co., Inc. 8. Dr Uche Amazigo, WHO/APOC 9. Dr Laurent Yam6ogo, WHO/APOC 10. Dr Noma Mounkaila, WHO/APOC 11. Professor Brehima Kumar6, WHO/AFRO, MDSC 12.Dr Hans Remme, WHO/TDR Members of the Working Group l. Prof. Adenike Abiose, 2. Mrs Catherine Hodgkin (Chair) 3. Prof David Molyneux 4. Prof. Bernard Philippon 5. Prof. Michael Reich (absent) 6. Dr Hans Remme 7. Dr Bjorn Thylefors, 8. Dr Mamadou Souncalo Traord (Vice-Chair) a9 Annex 2 PROPOS ED ANNOTATE D AGENDA HUNDRED AND THIRTEENTH SESSION OF CSA 28-29 June 2006 World Bank Office, Paris Wednesduy, 28 June 09.30-10.00 10.00-10.05 10.05-10.10 10.10- 10.30 10.30-12.30 12.30-14.00 14.00-16.00 16.00-16.30 16.30-18.00 Tea/Coffee 1. Opening Welcome address by the chair 2. Adoption of the Agenda 3. Consideration and adoption of the draft report of CSAl12 Review and adoption of the draft report of CSAI 12. 4. Review of the report of the CSA Working Group on the future of onchocerciasis control in Africa The Working Group will present the draft of its report to CSA. Followed by a general discussion of issues arising therefrom and comments. Lunch break 4. Review of the report of the CSA Working Group on the future of onchocerciasis control in Africa General discussion and comments on the draft report of the Working Group continues. Tea/Coffee break 5. Preparation of the draft strategic framework and plan of action based on the 2005 External Evaluation Report and the outcomes of the Working group JAFI l requested CSA to elaborate a plan of action based on the recommendations of the 2005 External Evaluation Report. CSA will brainstorm on the modalities of preparation of a strategicframework and a plan of action. CSA members will then be divided into 2 or j groups to identify key issues, actions and expected results to be included in the draft strategic framework and plan of action t-) Thursday r 29 June 09.00-10.30 l0 5. Preparation of the draft strategic framework and plan of action based on the 2005 External Evaluation Report Presentation and rynthesis in plenary session of the reports of the 2 or 3 groups. A committee will be established by CSA to consolidate the perspectives of CSA, the Working Group during a special session scheduled on June 30, 2006. The product of the Committee will thereafter be refined by APOC Management supported eventually by consultant(s) with skills in editing and in planning, monitoring and evaluation. Tea/Coffee break 6. Preparations for the Partners' Meeting Review of the progress of preparationsfor the Partners'Meeting: confirmation of dates, invitations, logistics, funding and update by the World Bank, WHO and APOC Monagement on any informal contacts with donors and Participating countries regarding the meeting. 7. Update on preparations for JAF12 APOC Management to update CSA on progress of preparations for JAFI2 8. Update on the financial situation of APOC The World Bank to provide an update on the curuent situation of the Trust Fund. APOC Management will also give an update on the financial situation of the Progromme for 2006. 9. Other matters Consideration of any other motters including TTC membership and Update on the activities of MDSC 10. Dates and venues of CSA114 and CSA115 Confirmotion of the dates and venues of CSAI 14 and CSAI 15. It is proposed that CSAL l4 should be held in Abuja, Nigeria to provide on opportunity to CSA to advocate for increased support of the Federal Government to CDTI projects in the country. A CSA session is usually held in conjunction with the JAF, thus CSAI l5 will be in Dar-es-Salaam, Tanzania. 10.30-l 1.00 I1.00-l1.20 I 1.20-l 1.40 I1.40-12.00 t2.00-12.15 12.15-12.25 12.30 Closure of the meeting Geneva, 26 May 2006 (revl)