Joint Programme Committee: report of seventeenth session, Cotonou, Benin, 2-4 December 1996

i + JPC17 JOINT PROGRAMME COMMITTEE ONCHOCERCIASIS CONTROL PROGRAMME IN WEST AFzuCA Seventeenth session. Cotonou. Benin 2-4December1996 REPORT CONTENTS Page OPENING OF THE SESSION ELECTION OF OFFICERS . ADOPTION OF THE AGENDA REFLECTIONS OF THE COMMITTEE OF SPONSORING AGENCIES PROGRESS REPORT OF THE WORLD HEALTH ORGANIZATION FOR 1996 REPORT OF THE EXPERT ADVISORY COMMITTEE . . PROGRESS REPORT OF THE PARTICIPATING COUNTRIES' ACTIVITIES FOR t996 7. AUDIT REPORT 13 PLAN OF ACTION AND BUDGET FOR 1997 PLAN OF OPERATIONS FOR THE PHASING-OUT PERIOD (1998-2002) . FINANCING OF THE ONCHOCERCIASIS CONTROL PROGRAMME EVALUATION OF THE FOURTH FINANCIAL PHASE (1992-Igg7) AND REVIEW OF MACROFIL . 16 t2 THE AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) ll 13. OTHER MATTERS 18 14 DATE AND PLACE OF THE EIGHTEENTH SESSION APPROVAL OF THE REPORT CLOSURE OF THE SEVENTEENTH SESSION: CONCLUSIONS AND DECISIONS . . 18 15 i8 r8 1 2 2 2 J 5 1 2 J 4 5 6. t2 8 9 I3 15 1610 I 11 l t 16 t9 - lI - ANNEX I ANNEX II ANNEX III ANNEX IV ANNEX V LIST OF PARTICIPANTS STATEMENT BY DR HIROSHI NAKAJIMA, DIRECTOR- GENERAL OF WHO OPENING ADDRESS BY H.E. ADRIEN HOUNGBEDJI THE PRIME MINISTER OF THE GOVERNMENT OF THE REPUBLIC OF BENIN REFLECTIONS OF THE COMMITTEE OF SPONSOzuNG AGENCIES PLEDGES 20 27 29 32 35 , a i JPCl7 page 1 1. OPENING OF THE SESSION: Agenda item I 1. 1 The seventeenth session of the Joint Programme Committee (JPC) of the Onchocerciasis Control Programme in West Africa (OCP) was held in Cotonou at the invitation of the Government of the Republic of Benin. The opening ceremony was held in Cotonou at the "Centre international de Conf6rence" with H.E. the Prime Minister present. The list of participants is attached as Annex I. 1.2 The Minister of Health, Social Protection and Women's Affairs, Dr Marina d'Almeida- Massougbodji, welcomed participants to the session and expressed her country's pride in hosting this seventeenth session of the Committee. 1.3 Dr d'Almeida-Massougbodji referred to the successful OCP activities which had been conducted in the Republic of Benin since 1976. It was now a prior.ity, within the next six years, for the Participating Countries to ensure that the achievements of the Programme could be maintained. 1.4 In concluding, Dr d'Almeida-Massougbodji wished the Committee a successful and fruitful session. 1.5 Dr. K.Y. Dadzie, Director of the Programme, added his welcome to ttrat of the Minister of Health. He was encouraged by the level of participation at this session which was a good demonstration of effective North-South and South-South dialogues. 1.6 The Programme Director underlined the challenge of the coming years when Participating Countries would prepare for post-OCP surveillance and control. He was convinced that the countries would live up to this challenge. He finally expressed his sincere thanla to the government and people of the Republic of Benin for the excellent organization of the session and for the warm hospitality. 1.7 Dr Ayit6 M. d'Almeida, Director, Programme Marngement of the WHO Regional Office for Africa, who represented Dr Ebrahim M. Samba, Regional Director for Africa, confirmed Dr Samba's commitment to continued support of his office to OCP in the context of strengthening national capability of integrated disease surveillance including that of onchocerciasis. i.8 He referred to a recent ministerial meeting in Ouagadougou on sub-regional cooperation concerning coordinated control of epidemics and expressed the wish of Dr Samba to see the expertise and structures of OCP assist in implementing decisions taken by the Participating Countries. Dr d'Almeida finally wished the Committee success in its deliberations during the session. 1.9 The Director-General of the World Health Organization, Dr Hiroshi Nakajima, ina statement read by Dr Ralph Henderson, Assistant Director-General, emphasized that maintaining the achievements of OCP would be the challenge of the coming years. He was therefore encouraged by the efforts of the Participating Countries to bring onchocercialis detection and control within national Multidisease Surveillance and Control systems. The recent discovery of reappearance of the infection in Bougouriba valley by the national surveillance team was a demonstration of the effectiveness of the OCP methodology of recrudescence detection and of rts transfer to Participating Countries. 1 . l0 Before expressing his gratitude to all the partners of the Programme and to its staff, Dr Nakaj ima stressed the importance of the support and assistance extended by the OCP headquarters to the African Programme for Onchocerciasis Control (APOC) during its first year of existence. Dr Nakajima's statement is attached as Annex II. i I JPC 17 page 2 1.11 H.E. the Prime Minrster of the Government of the Republic of Benin, Mr Adrien Houngb6dji, conveyed the greetings and best wishes to the meeting from the President of the Republic, U.p. frai Mathieu Kerekou, wlio had wished to be present. The Prime Minister welcomed all the participants and was particularly pleased that both the Director General of WHO and the Director of the WHO Regional Office for Africa were represented at this session of JPC. He congratulated Dr Samba, former Director of OCP, on his new position as Director of WHO-AFRO. 1.12 The Prime Minister then referred to the considerable difference inhealth rndices between North and South but saw OCP as a programme giving rise to hope as populations having deserted the fertile riverain areas because of fear of being infected by onchocerciasis were now retuining to resettle. 1.13 His Excellency finally expressed the gratitude of his governmenr and people to the Director and staff of OCP, to the Director General of WHO and the Regional Director for Africa, and thanked the Donors for their continuing support to ocP. He wished JPC success in its deliberations. The address of the Prime Minister is attached as Annex III. 1.14 The Prime Minister then declared the session opened 2. ELECTION OF OFFICERS: Agenda item 2 Z-1 The Republic of Benrn was elected to the Chair (occupied by Mme d'Almeida-Massougbodji) and the United Kingdom of Great Britain and Northern Ireland to the Vice-Chair (occupied by Mr Brian Thorpe). 3' ADOPTION OF THE AGENDA: Agenda item 3 (document JPC17.1. revisron t) 3.1 The provisional agenda as foilowed in the present report was adopted. 4 REFLECTIONS OF THE COMMITTEE OF SPONSORING AGENCIES: Agenda item 4(document JPC I 7/INF 1DOC.2) 4.7 Mr Bruce Benton, Chairman of the Committee of Sponsoring Agencies (CSA), saw the year under review as one of maturation, progress and collaboration for oCp. 4.2 Onchocerciasis was vrrtually no longer a public health problem throughour the OCp area: in theorigirnl Programme area the parasite reservoir had been practicalll, eliminated while larviciding/ivermectin control in the Extension areas had greatly relieved existing clrnrcal manifestations and interrupted transmissrolt. ,, 4'3 CSA was etlcouraged by the efforts being made by Participatrng Countnes to prepare for effective surveillance and control of onchocerciasis as an integral activity of Msltrdrsease Surveillance and Control systenls and constdered the recent detectron of focalized recrudescence in the Bougouriba valley by the Burkilla llatl()tlal survctllance tearr a demonstration of the el'frcacv ol'sucl.r systems. 4.4 In referring to the f'unclutq of the programme, Mr Benton stated that rnlbrntal rndrcations led trl believe that Phase IV opet'atrons were fully financed and that roughly one hall'.,1'thc expenditures during the Phasing-ttut Pe rro<j scented to be assured. a I 5. JPCl7 page 3 4.5 CSA was proposing to JPC that an External Evaluation of OCP and a review of Macrofil be undertaken during the first six months of 199'1, two exercises for which CSA was prepared to make the necessary organizational arrangements (see section 1l below). 4.6 The Committee of Sponsoring Agencies was impressed by the close and harmonious collaboration that had developed between OCP and APOC to the benefit of both Programmes and ensuring cost-effectiveness in the use of Donor-provided resources. 4.1 Before closing the CSA reflections, Mr Benton referred to the role of his Committee in support of socioeconomic development in areas freed from onchocerciasis and urged Participating Countries to collaborate on pilot activities with FAO, the CSA lead agency for support to socioeconomic development. He stated that there was some urgency in acting quickly to implement the policy principles agreed upon by the 11 Participating Countries in 1994 for support to sustainable settlement and development of the oncho-freed areas. Otherwise.it would soon be too late to take advantage of development opportunities arising from successful onchocerciasis control and to avoid environmental degradation. 4.8 The text of the Reflections of the Committee of Sponsoring Agencies is attached as Annex IV PROGRESS REPORT OF TIm WORLD IIEALTH ORGANIZATION FOR 1996: Agenda item 5 (document lPCl7.2) REPORT OF THE EXPERT ADVISORY COMMITTEE: Agenda item 5 (document JPC17.3) 5.1 In introducing this item the Programme Director referred to a series of administrative and technical developments which had occurred during the past twelve months. 5.2 In order to strengthen the support to Participating Countries to assume responsibility for epidemiological surveillance to detect occurrence of onchocerciasis recrudescence and its control, three former units of OCP had merged to form the Planning, Evaluation and Transfer Unit (PET). 5.3 Also OCP-sponsored workshops in all OCP countries had prepared national plans for the implementation of activities aiming at maintaining the achievements of the Programme through reinforced surveillance and ivermectin control. 5.4 The transfer of the Western Zone headquarters from Bamako to Odienn6 had been successfully carried out and Dr Dadzie thanked the Mali and C6te d'Ivoire authorities for their assistance which had greatly facilitated this transfer. 5.5 An important development had been the close collaboration with APOC following the establishment of its headquarters within the OCP compound ill Ouagadougou where daily contact and common use of resources had benefitted both programmes. 5.6 The Programnre Director emphasized, as had the Director-Genegl and the Chairman of CSA, the importance that the recrudescence in the Bougouriba valley had been detected by the national team of Burkina Faso. 5.1 As to the future of Macrofil it was now proposed that the financins of the project beyond 1997 be shared equally between OCP, TDR and APOC. Dr Dadzie hoped that this proposal would meet with the approval of iPC. He also hoped that the Committee would agree to the EAC proposal that the Programme be authorized to support sustainable community-based ivermectin treatment in deforestated areas in OCP countries outside the present Programme boundaries (paragraph 5.23 below refers). This a JPCiT page 4 would remove a potential source of reinvasion by infective blackflies into the Programme area, and eliminate, as far as possible, a risk of occurrence of recrudescence of the disease VECTOR CONTROL 5.8 One year before the end of the fourth Financial Phase, the Vector Control Unit estimated the decrease in larviciding coverage during the six years of the Phase at35% resulting in a saving of 40% (US$ 7 million) in the expendirures on insecticides, flying hours and staff. 5.9 During the period under review vector control in the Original OCP area was confined to Kank6laba in Mali; Dienkoa in Burkina Faso (ground larviciding); Kara, Keran and Mo in Togo (now in the Southern Extension area); and the lower Black Volta in Ghana. Continuation of larviciding in these areas had been necessitated by difficulties in achieving the required epidemiological status compared with other areas in the Origirnl Programme area, due either to operational problems or to infiltration of infective blackflies from sources outside of the OCP area. In these foci, larviciding was accompanied by ivermectin treatment. 5.10 Inthe Extension areas aerial larviciding, combined with ivermectin distribution, continued as in previous years. The northern part of the Western Extension area (North-West Mali, Guinea-Bissau and Senegal) remained under exclusive ivermectin treatment while northern Sierra kone was awaiting vector control to resume once the security situation so permitted. 5.11 The length of rivers under larviciding ranged from a maximum of 9 135 km during the first week of November 1995 to 1 630 km in the third week of April 1996. Eight helicopters were in use during the 1995 rainy season against four in April 1996. 5.12 During the period under review larviciding had stopped in the river basins of White Volta (Mole Kulpawn) and Alibori/Sota. 5. 13 The insecticide rotation system had reduced the risk of the development of insecticide resistance and studies indicated that this strategy had enhanced the susceptibility of Simuliutn to temephos. Certain batches of B.t. H-14 did not meet the operational standards and quality control of this product was continuously carried out by the Bouak6 laboratory. 5.14 Vectron had been introduced during the year and had proved to be environmentally acceptable. It was less toxic to crustacea (x5) and fish (x20-100) than permethrin and was an important operational insecticide particularly usable at discharges between 15 and 7Om/sec. 5.15 During the period May 1995 to April 1996 helicopter hours had been reduced by 17 % compared to the previous twelve months period, resulting in a savingi of US$ 750 000. The corresponding reduction in larvicide use resulted in a saving of US$ 107 800. 5.16 The impact of vector control continued to be satisfactory as transmission of O. volvulus was effectively interrupted throughout the OCP area. Only ten of 127 catching points produced Annual Transmission Potentials (ATPs) of human O. volvulus above 100 infected larvae per person. If the calculation of ATPs were restricted to savanna species of the S. damnosum complex, ATPs above 100 were found at only five catching points. 5.11 The routine application of DNA probes to infective larvae at the Bouak6 laboratory allowed for the separation of parasites of animal origin from those of human origin, the latter in turn differentiated into "forest" and "savanna" strains. The combination of morphological identification of blackflies with DNA probes made it possible to calculate ATPs for the transmission of human onchocerciasis by all a JPC17 page 5 S. damnosutn species and also ATPs for the transmission of O.volvulus by the savanna species of blackflies. So far, however, it has not been recommended to estimate ATPs based on the exclusive transmission of the "savanna"strain irrespective of the blackfly species due to the probable existence of intermediate level of pathogenicity in the forest-savanna transitional zones. 5.18 The vector control activities were reorgantzed during the period under review. The Western Operational Zone office was moved from Bamako (Mali) to Odienne (Cote d'Ivoire) while the Tamale (Ghana) and Kandi (Benin) sub-sectors were closed. The Bamako operational base, manned by the Mali national team, assumed responsibility for ground larviciding in the Niger basin in the Bamako area. 5.19 The national hydrobiology teams continued studies onthe long-term impact of the less selective larvicides on the non-target aquatic fauna. The teams also received training in the assessment of the effect of human activities on the aquatic environment. 5.20 The observed decrease in the density of non-target insects and the modifications of their population structures were considered to be within acceptable limits. However, the markedly reduced abundance of two fish species in C6te d'Ivoire and Guinea required further investigations although there was no suggestion that these changes were the result of OCP activities. 5.21 Professor David Molyneux, Chairman of the Expert Advisory Committee (EAC), in presenting the report of his Committee, congratulated the Programme on the progress made in vector control during the past twelve months. He emphasized that the rotational strategy of larviciding was now implemented with maximal efficiency. On the operational side, EAC endorsed the intention of OCP to resume vector control in northern Sierra kone as soon as the security situation so allowed. 5.22 The influx of infective blackflies from sources outside the boundaries of the OCP area had been reviewed by EAC which concluded that the infiltration from Nigeria did not pose a threat to the Programme area as long as ivermectin was distributed regularly to the exposed populations. 5.23 However, because reinvasion into other parts of the OCP area constituted a risk of renewed trarsmission and infection, EAC recommended that the Programme be authorized by JPC to support sustainable community-based ivermectin distribution in OCP countries beyond the boundaries of the Programme especially in southern Ghana, southern C6te d'Ivoire and Guinea where deforestation created conditions for the breeding of savanna flies. 5.24 As regards larvicides, Professor Molyneux encouraged OCP to continue its efforts, in collaboration with the Pasteur Institute in Paris, to improve the formulation of B.t. H-14 in order to increase the active ingredient of B.t. H-14 per unit volume which would result in a considerable reduction in the cost of vector control. 5.25 EAC had considered the future use of ground larvicidiilg particularly during the post-OCP era, and recommended that the potential use and application of this control method be reviewed by OCP. 5.26 Professor Molyneux stressed the crucial role played by the Bouak6 laboratory in support of control operations. EAC had reviewed its potential for eventually und-ertaking laboratory analyses beyond those connected with onchocerciasis control so as to function during the post-OCP era as an inter-country reference centre and had provided an Annex to its report emphasizing the role such a facility could play. 5.21 On behalf of the Chairman of the Ecological Group, Professor Molyneux emphasized the importance of the studies in the Programme area on ecological and environmental information and underlined the critical issues the Group had identified in its report in relation to preservatron of aquatic a JPCIT page 6 ecosystems, the management of water resources and the public health issues associated with water resources management. CSA had been advised of these issues and requested to onforward the recommendations to appropriate institutions and agencies. 5 .28 The Ecological Group report drew attention to the impact of human activities in some of the four river systems srudied in Guinea, Cote d'Ivoire, Ghana and Sierra Leone emphasizing that in cerlain non-treated areas with intense human activities, an environmental impact (reduction in fauna/water quality) greater than the impact in other areas under larviciding was observed. 5.29 The Chairman of EAC finally expressed his Committee's view that the Ecological Group should continue its activities until the end of OCP operations and that even after that there would be a need for a similar body to operate on an inter-country basis. *{<* 5.30 In response to a question regarding the future use of ground larviciding for nuisance control it was explained that such control might be warranted if the nuisance impeded socioeconomic development if the required structure was in place and sufficient funds were available for the necessary training and sustained control over prolonged periods. 5.31 As regards the situation in the Oti tributaries area in Togo where the forest gallery impeded aerial larviciding and the mountainous terrain made access to riverain communities difficult, assurance was given that the Programme would make special efforts to improve aerial larviciding and actively support community-based ivermectin delivery by training village distributors assisted by the staff of the nearest health centres. 5.32 The Committee agreed with a proposal that the future of the Bouak6 laboratory be considered by the group of experts appointed tocarry out the External Evaluation duringthe firsthalf of 1997 (see section 11 below) PLANNING, EVALUATION AND TRANSFER 5.33 Since the December 1995 session of JPC, the technical/operational activities at OCP headquarrers had been consolidated as mentioned earlier by amalgamating the units dealing with epidemiological evaluation, biostatistics and information systems, and devolution into a Planning, Evaluation and Transfer (PET) Unit which together with the Vector Control Unit now constituted the technical structure in Ouagadougou, supported by the Administration and Management Unit. The role of the PET Unit was defined to (a) plan and oversee the implementation of activities relevant to the taking-over of residual activities by the Participating Countries; (b) prom.bte the transfer of tools and techniques to the Participating Countries; (c) plan and rmplement training; and (d) plan and implement conrrol activities (e.g. ivermectin distribution). Ivermectin distribution 5.34 Ivermectin continued to be distributed to populations exposed to infection in all areas under vector control including a few foci in the Original OCP area (see paragraph 5.9 above), the Southern Extension and the southern part of the Western Extension areas. In the northern part of the Western Extension ivennectin treatment continued as the only means of control . The treatment was not possible in the southern half of Sierra Leone for security reasons. , JPC17 page 7 5'35 During the period under review, large-scale mobile distribution carried out entirely by national teams - supported financially and logistically by OCP - accounted for 63 % of all treatments while community-based ivermectin treatment was responsible for 33% - up from 26% duringthe preceding year - leaving 4% to passive, health centre-based treatment. About 33% of all treatment in the Programme area was supported financially and logistically by Non-governmental Development organizations, mainly in community-based distribution p.og.i*-... 5'36 In all, more than 2.6 million people in 11 500 villages were treated with ivermectin ar a mean coverage rate of 14.9% for large-scale, mobile distribution and19.6% for community-based treatment. 5-37 An evaluation of the delivery systems showed an average treatment coverage of 62.2%. 30% had received all of the five/six treatrnents; 26.1% claimed not ro have been treated at all - 54% of them having been absent; and2.6% had refused treatment. 5.38 Professor Molyneux, Chairman of EAC, expressed his Committee's satisfaction with the consolidation of activities into the new PET Unit and with the strengthened links between that unit and the vector control prograrnme. 5.39 As regards the move from large-scale, mobile ivermectin distribution to community-based treatment, Professor Molyneux underlined the need to take into consideration the capacities of the Participating Countries with particular emphasis on training. Also, flexibility was required in the choice of systems and distributors as well as in the issues of service charges and incentives. 5.40 EAC was satisfied that the Programme had taken appropriate action in dealing with the problem of systematic non-compliance in ivermectin distribution programmes as demonstrated by the OCp conducted evaluation. Professor Molyneux suggested that future evaluations should concentrate on coverage of target villages, coverage of arget populations and continuity of treatment. In this last respect, he also suggested that sustainability might improve with an increasl in frequency of treatment. Epidemiological evaluatior/surveillance 5 '41 Epidemiological evaluation, carried out in the field by national teams, continued to serve the dualpurpose of assisting in decision-making on cessation of vector control in the original programme area and of assessing the impact of larviciding/ivermectin treatment in the Extensio; areas. 5'42 within the original Programme area, evaluation in Kank6laba river basin in Mali showed no newinfections and prevalences ranging from O.O% to8.l%. The result of anevaluation planned for 1997 would determine whether or not vector control might come to an end in the area concerned. 5'43 Epidemiological surveillance carried out by rntional teams in 70 sentinel villages confirmed the absence of renewed transmission/infection. .r 5'44 However, the 1994195 detection of recrudescence in the Bougouriba valley in Burkina Faso bythe national epidemiological surveillance team was a matter of concern to the programme and to the national authorities. A Iikely explanation for this instance of resumed iransmission five years after cessation of vector control could be the recolonization of the area by infected flies from non-treated artificial breeding sites when larviciding ceased. Another explanation could be the failure to detectbreeding sites when exceptional hydrological conditions pertained in the mid-l9g0s allowing for the resumption of transmission. Thirdly, the migration of infected individuals could also be the cause ofthe reappearance of the infection in that area. Complementary investigation by the national teams in collaboration with oCP confirmed in 1996 the presince of recrudescence and deliminated its extent. JPCIT page 8 5.45 Biannual ivermectin distribution had been instituted with the expectation that ten years consecutive treatment would reduce the nsk of infection to less than l%. Intensive entomological, epidemiological and socio-demographic investigations had been instituted in the concerned valleys. 5.46 As regards the results of epidemiological evaluations in the Extension areas the prevalence ranged from 5.8% to 50.6% in the Como6 basin. There were uo new cases in four of the villages evaluated. In five villages in the Oueme/Okpara basin (Benin), onchocercal prevalence ranged from 5.3% to 31.5% - down from more than 50% before the start of control. 5.41 In the northern part of the Western Extension area (Rro Geba, Koliba) under exclusive ivermectin treatment for five years, assessment of onchocercal infection in children aged five years receiving treatment for the first time demonstrated absence of such infection. The all-age prevalence was found to be considerably below that revealed before ivermectin distribution began. 5.48 The prevalence of the infection in northern Sierra lrone, determined early in 1996, was essentially similar to that found before the suspension of control two years ago. 5.49 The result of ophthalmological examinations in Guinea following seven years of ivermectin treatment. compared to an evaluation carried out after five years of treatment, showed significant improvement in lesions of the anterior segment with important changes in the optic nerve disease but with no significant change in chorioretinitis. 5.50 Professor Molyneux expressed his satisfaction with the results of the epidemiological investigations which confirmed the effectiveness of OCP control. 5.51 EAC had paid particular attention to the resumption of onchocercal transmission in the Bougounba valley and Professor Molyneux endorsed the action taken by OCP in close collaboration with the national epidemiological surveillance team and the local authorities. The recommendations formulated by his Committee had been fully implemented. 5.52 Professor Molyneux firnlly referred to the request from Partrcipating Countries for training in ophthalmology, a discipline which would supplement routine epidemiological evaluation at the national level. Biostatistics and information systems 5.53 The subunit responsible for biostatistics and rnformation systems (BIS) continued its activities in the fields of processing entomological and epidemiological evaluation/surveillance data, computer application and the development, management and training in the use of data banks. 5.54 As in prevrous years, epidemiological and entomologi&l forecasts based on the ONCHOSIM rnodel had facilitated decision-making concerning cessation - or contluuatlon - of vector control in areas under larvrcidrng for extensive periods. 5 55 An rntportant contribution to the transfer of rhc know'-how rcquired by the Participating Countrres to undenake effective recrudescence detectron and control had been the intensification of tratning of nattonals in the use of OCP data, under transfer to the Particlpatrng Countries. This would allow 1'or an exchange of epidemiological and treatntel.)t results between natronal epidemiologists and OCP utcluding analyses of evaluation/surveillance data arrd rherr conlpanson with those obtained on previotrs occasrons. JPCl7 page 9 5.56 The OCP Geographical Information System (GIS) was now in use to facilitate the analysis of entomo-epidemiological data by producing maps depicting such data for the entire OCP area and in more detail on a smaller scale. Training was carried out of epidemiologist/statisticians from the Participating Countries to establish a comprehensive data bank of all villages covered by OCP. 5.57 Special studies had been initiated toanalyze inthe Original Prograrnme area, where larviciding had ceased, the trend of ophthalmological manifestations, the occurrence of recrudescence, and in the Extension areas the impact of ivermectin treatment. Results obtained so far had made it possible to improve the prediction of trends and to validate ONCHOSIM parameters. Transfer of know-how and activities to Participating Countries 5.58 During the period under review, OCP intensified, in collaboration with WHO/AFRO, its support to Participating Countries in such fields as training, awareness raising and operational research. 5.59 Particularly important in this context had been the country workshops organized by the eleven Ministries of Health with OCP financial and technical support. Plans of Action for decentralized epidemiological surveillance and installation of community-based ivermectin distribution were developed for all eleven countries. The corresponding training, mostly "on the job" connected with ongoing epidemiological evaluation/surveillance activities, had so far been undertaken in five of the countries in the Original OCP area. Intensive training for the installation of community-based ivermectin distribution had started in five countries. 5.60 Twenty-three fellowships for training in disciplines of importance for recrudescence detection and control were awarded during the preceding twelve months, bringing the OCP grants to 453 since the inception of the Programme. A survey of the employment of former OCP fellows showed 68.2% of them working for the Programme or in national onchocerciasis control activities, 8% in other d'epartments and 6.6% were still in training. 21.2% were not actively employed or could not be identified. 5.61 Furthermore, technicians and villagers had been trained in Burkina Faso, Niger and Ghana to conduct ground larviciding with a view to carrying out vector control for the purpose of nuisance abatement in cases where such nuisance impeded socio-economic development. 5.62 The Unit continued to coordinate awareness-raising sessions through the VCU field staff to sensitize villagers about the return of blackflies, explain the role of ivermectin and stress the need for community participation. 5.63 Professor Molyneux in commenting on the take-over by Participating Countries of activities related to recrudescence detection and control stressed the need to invite the views of all concerned, including the village communities, to avoid generalizations andgeneric prescriptions and seek a flexible approach when dealing wrth different health systems. 5.64 He further recommended that efforts be made to ensure that the essential elentents of onchocerciasis control be considered in national <Jevelopment plans and ii programmes of organrzatrons working in the periphery, possibly with the aid of Non-governmental Development Organizations. *** 5.65 The Committee agreed to the proposed support to sustainable community-based iven.nectllt distribution in OCP countries outside the Programnre boundaries (see para.5.23 above). JPCiT page 10 5-66 Several questions were asked regarding the trarning supported by oCp. It was suggested that there be a need for qualitative evaluation of the training programme (a) to measure the extent to which the types of training corresponded to the requirements of the Participatrng Countries and (b) to determine the adequacy of the OCP training budget to meet country needs. Also, a question was asked about the proportion of fellowships granted in relation to those requested. Furthermore, additional details were requested concerning the employment of OCP fellows in therr home countries. 5.67 The Programme Director explained that these issues had been at the centre of the discussions at the country workshops held during the past twelve months. Detailed plans for training had been prepared and it was tntended to evaluate their implementation the following year. The dialogue with the countries in this respect would continue and it was stressed that WHO/AFRO played an important role in this context. 5.68 Also, it was planned that the various aspects of OCP supporr to training would be considered at next year's meeting of National Coordinators to determine the training policy and programme of OCP in the light of countries' requirements to take on the residual activities of the programme. 5.69 A plea was made for ensuring compatibility of data transferred to Participating Countries with their computer systems. RESEARCH Macrofil 5-70 The results of a double-blind clinical study including 100 onchocerciasis patients ar the Onchocerciasis Chemotherapy Research Centre (OCRC) in Ghana were scrurinized in November 1996 at a Clinical Meetrng to determine the macrofilaricidal effect of amocarzlne. Given that no such effect was demonstrated rn the study, the Meeting concluded that no further research on this compound by Macrofil in Africa was justified. 5.71 Assays on the potential macrofilaricide UMF 078, now in the preclinical phase, had been speeded up with the appointment of a project manager on a part-time basis. A detailed development plan was prepared anticipating the earliest time for clinical studies in 1998 and the submission of regulatory documentation in 2002. 5-72 At the above Clinical Meeting a protocol for an investigation into the possible prophylactic effect of ivermectin was developed. The study would need to recruit 500-700 non-infected children in each of the study and the control groups to be followed up over a three-year period. The OCp area would not be suitable for the study given that a high transmission location is required. 5.13 Work on iverrnecttn resistance had been transferred to studres rn animal parasitic nematodes already resistant to tverlnectin. Studies on the molecular biologylof the qenes responsible for ivermectin resistance in parasrtrc nematodes had been initiated. 5.14 Professor Molyrteux stressed the potentlal importance of a freld-applrcable macrofilarrcide not only for OCP but also for the African Programme for Onchocerciasrs Ccntrol (APOC) eve n if rt only became avatlable after tlte end of OCP operations. He therefore enclorsed the request rn the Drrector's proposal for the Plan of Operations for the Phasing-out Period that the Macrofil project bc conrinued beyond 1997 u,rtlr equallv shared frnancial supporr from oCp. Ap()c and'l'DR *** JPCl7 page I 1 5.75 The Committee decided that before undertaking long-term community studies on the prophylactic action of ivermectin, existing epidemiological information on the effects of ivermectin on transmission patterns in areas such as Senegal and north-western Mali should be studied by the Programme and reviewed at the next session of EAC. 5.76 JPC recognized that a safe and effective macrofilaricide would provide better therapeutic control of onchocerciasis than ivermectin both in the life time of OCP and in the post-OCP period. Also, a field applicable macrofilaricide would reduce the period of intervention. Additionally, the occurrence of ivermectin resistance in onchocerciasis would be disastrous in a control programme based on a single drug. 5.77 The Committee asreed to the proposed financing of the Macrofil project beyond 1997 by OCP, APOC and TDR with OCP's contribution directed at UMF 078, prophylactic use of ivermectin and a test for ivermectin resistance. It was understood that this arrangement should be reviewed if UMF 078 failed during preclinical development, or Phase I clinical trials. OCP funding would be restricted to such applied development, and more fundamental work on drug discovery should be funded by TDR and APOC. The continuation of OCP support would, nevertheless, be subject to an affirmative recommendation by the 1997 External Evaluation group. Diagnostic test 5.18 A technical meeting held in Geneva in February 1996 recommended that the DEC patch resr should be provisionally adopted by OCP to eventually replace skinsnips. The test which mer the criteria of genus specificity, non-invasiveness, reliability and low-cost application was recommended in preference to immunodiagnosis and the DNA scratch test. However, its ability to detect recent onchocercal infections was still to be investigated. 5.79 In connectton with the possibility of replacing skin snipping by a DEC patch test, it was explained that this test which showed a sensitivity ar the level of 8O%, was now being field tested by OCP. If the results were satisfactory it would facilitate the work of national surveillance teams. There was a need to test for species specificity to exclude other filarial forms. ADMINISTRATION AND SUPPORT SERVICES 5.80 The Unit concerned with administration and support continued rts activities in the fields of personnel management, transport, finance and documentatlon. Particular attention was given to administration rn connection with the closure of the Western,Zone Office in Bamako and its transfer to Odienn6: initiating APOC administration; and termination'of contracts of staff whose posts were abolished. 5.81 Although the administrative costs of the Programme had reduced by 18% between l99l and 1995. the proportion of total expenditures had increased ro 15% as the operational costs irad fallen more rapidly than those of the administration. 5.82 Efforts were under way to remedy thrs deficiency through rhe use of temporary staff and the steady reductrort of posts (a total of 695 in January 1996 as agarnsr J3'l orrc year earlier). *** {<*+ JPC17 page 12 6. PROGRESS REPORT OF TIIE PARTICIPATING COUNTRIES FOR 1996: Agenda item 6 (documents JPC17.5, JpC17.6) 6.1 Dr Marina d'Almeida-Massougbodji who chaired the meeting of Ministers of Health held at the Sheraton Hotel in Cotonou on I December 1996 reported to the Joint Prograrnme Committee on the follow-up to the Resolution adopted by the Ministers in Washington in December 1995. 6.2 Country workshops, held during the past year, had resulted in plans for the decentralization of epidemiological surveillance of onchocerciasis and the installation of community-based ivermectin distribution. 6.3 The Ministries of Health had made the appropriate arrangements for attendance at the workshops and provided logistics. The recommendations of the workshops had been endorsed by the Ministers who accepted their incorporation into the health sector reforms, where appropriate. 6.4 The Ministries of Health had started training of relevant staff and increased their supporr ro community-based ivermectin distribution. One day country-specific symposia would be held to assess progress in decentralized epidemiological surveillance and community-based ivermectin treatment. 6.5 The Ministers deemed it important that from now on, they would hold consultatiorx, and to this end, agreed at the nearest opportunity, on the terms and modalities of such consultations. 6.6 Dr d'Almeida, representing the Director of the WHO Regional Office for Africa, summarized the support provided by AFRO to the Participating Countries. In addition to the activities mentioned below, the Regional Office had decided to finance, on its regular budget, the post of one epidemiologist assigned to OCP. The Office also made available to the Participating Countries the services of the five epidemiologists of the Intercountry Team based in Abidjan. 6.7 Special attention had been paid to the training of nationals in managing efficient disease surveillance systems. WHO/AFRO thus sponsored twelve fellowships in advanced epidemiology courses in Bamako (French speaking) and Nairobi (English speaking). The Regional Office, rogether with OCP, undertook training sessions for district medical officers in several of the OCP countries. 6.8 As a contribution to ensuring decentralization of epidemiological surveillance of onchocerciasis and its integration into Multidisease Surveillance and Control systems, WHOiAFRO had arranged for the employment in WHO Country Offices of local profeisionals specialized in epidemiology who were required to collaborate closely with their national colleagues. 6.9 The National Onchocerciasis Coordinator from Mali, Dr Mamadou Oumar Traor6, presented the progress report of onchocerciasis activities carried out by the eleven OCP countries during 1996. 6.10 He briefly referred to the current situation regarding tlle National Onchocerciasis Committees and summarized the firnncial contributions of the various countries to onchocerciasis control. Such financing was now being considered in connection with health sector reforms underway in Participating Countries. AIso, financial support was received from different source$e.g. the Netherlands, Helen Keller International and Non-governmental Development organizations. 6.11 lnformation, Education and Communication (IEC) surveys and activities, conducted by national teams had become routine in several OCP countries. JPCl7 page l3 6.12 Dr Traor6 then summarized the activities carried out by the Participating Countries in the fields of ivermectin distribution and epidemiological evaluation/surveillance an account of which is provided elsewhere in the present report (paras. 5.34 to 5.49 above). 6-13 In conclusion, Dr Traor6 stressed the importance of the will of Participating Countries to integrate onchocerciasis detection and control in Multidisease Surveillance Control systems as well as the ability of national teams to detect recrudescence. The genuine partnership between the Participating Countries and OCP in respect to the successful transfer of know-how and residual activities was also noted. *** 6.14 The Representative of the OCCGE explained the role of his inter-governmental organization. He mentioned the various OCCGE laboratories and institutions which could be of use in the process of preparing for, and implementing, activities at the national level connected with onchocerciasis surveillance and control. In response the Programme Director welcomed the cooperation with OCCGE which had a role to play in the implementation of health sector reform, and looked forward to a strengthened collaboration with that organization. 6.15 Several cornments were made on the move from large-scale ivermectin distribution to community-based delivery, an approach to which all the Participating Countries were committed. However, in some situations it was suggested that this transfer might have problems of acceptability, the nature and severity of which would vary from one country to another. In this connection Dr. Dadzie stressed the importance of learning from experience and the need for exchange of such experiences - in particular successes - from one country to another. 6- 16 Although ivermectin had been given to several million people without serious side-effects even during the first treatment, it was suggested that any severe reactions could become an obsLacle to the acceptance of the drug if proper sensitization was not done. 7. AUDIT REPORT: Agenda item 7 (document lpCIT .7) 7 .l The report, which was introduced by the Programme Director on behalf of the External Auditor, expressed full satisfaction with the financial statement (31 December 1995) as well as with the accounts and activities examined during visits to OCp. 7.2 The Committee noted the report 8. PLAN OF ACTION AND BUDGET FOR 197: Agenda item 8 (document IPCIT .4, JPC|7.4(Addendum i)) 8.1 The 1997 Plan of Action and Budget for US $22 million was presented to JPC and the following points were highlighted: it was foreseen that vector control in the foci still undei larviciding in the Original Programme area would cease by the end of 1991 except for the Dienkoa pocket (ground larviciding by a national team) and tributaries to the Oti river in northern Togo exposed to reinvasion from the Southern Extension area until 1988, aerial larviciding would continue in the Extension areas as in 1996; it was likely that vector control would restart in the northern part of Sierra Leone JPCIT page 14 8.2 The Tamale and Parakou sectors and the sub-sectors in Kintampo (Ghana) and Bondoukou (C6te d'Ivoire) would be closed. Also, the number of blackfly catching points would be reduced from 150 to 140. There would be a slight reduction in helicopter hours. 8.3 Applied research would be limited to quality control of larvicide formulations; studies on the B.r. H-14 toxins; and, in collaboration with the University of Alabama, studies on DNA identification of flies and parasites. 8.4 Monitoring of the impact of OCP larviciding on the aquatic fauna and the effect on the aquatic environmOnt of population activities would continue as in 1996. 8.5 The Unit of Planning. Evaluation and Transfer would continue its support to Participating Countries to ernble them to detect and control recrudescence. It would collaborate with WHO/AFRO for the integration of onchocerciasis surveillance and control within national Multidisease Surveillance and Control Systems. 8.6 Support would also be given to the implementation of the countries' plans to progressively replace large-scale, mobile ivermectin distribution by community-based treatrnent. 8.7 Epidemiological evaluation in the Original Programme area would aid in the final decision- making on cessation of vector control in the few remaining foci under larviciding. Ophthalmological evaluation would be carried out in Guinea and Sierra lrone to determine the effect of continued larviciding and ivermectin treatment on ocular morbidity. 8.8 The transfer of epidemiological data to Participating Countries would continue. Training of nationals in the use of the Geographical Information System (GIS) would be done ro enable rhem to manage the epidemiological and entomological data bases. ONCHOSIM studies of data from areas where the parasite has been virtually eliminated would be used to test and validate model predictions. 8.9 Increasing emphasis and support would be given to institutional and field training in disciplines of particular imporLance to epidemiological surveillance, health services management, health education and statistics. 8.10 Macrofil would continue its preclinical development of UMF 078 and its efforts to make available a diagnostic tool to detect ivermectin resistance. 8.11 The unit of Administration and Support Services would support the two technical units in administration, personnel and operational matters. Its activities and marngement of resources would take into consideration the trends laid down in the Director's proposed Plan of Operations for the Phasing-out Period. .t 8.12 As JPC decided to conduct an External Evaluation of the fourth Financial Phase during i997 (Agenda item 11) the budget for 1997 would be increased by US $150 000. *** 8. 13 In response to a question regarding the 20% increase in the training budget, it was explained that the increase was intended to meet the need for qualified personnel of the Participating Countries to effectively carry out surveillance and control of onchocerciasis in anticiparion of the preparation for the Phasing-out Period (see also paragraphs 5.66 and 5.61). JPC17 page i5 8.14 The Plan of Action for 1997 and the corresponding proposed budget of US $22 150 000 were approved. 9 PLAN OF OPERATIONS FOR THE PIIASING-OUT PERIOD: Agenda item 9 (document JPC17.8) 9.1 The proposal for the Plan of Operations for the Phasing-out Period was introduced by the Programme Director supported by the Chairman of the Expert Advisory Committee. It was explained that the proposal had been built on the findings and recommendations of the EAC 1994 Mid-Term (Phase IV) Prospective Evaluation and the OCP internal review meeting in 1995. The Expert Advisory Committee had also contributed to the document during its 1995 and 1996 sessions. 9.2 The proposal provided a summary of 22 years of achievement of OCP; the planned activities; a description of the winding-down process; the means to safeguard the achievements; a suggestion for a mechanism for post-OCP inter-country collaboration; and the corresponding budget estimates. Details were provided for each of these sections. 9.3 The preparation of the proposed Plan of Operations took the following points into accounr a) no change in overall strategy; b) using data of the highest quality providing the best available technical managerial and financial outcomes estimates; c) continued emphasis on adherence to technical prerequisites whilst increasing their cost- effectiveness; d) reduced research colnpatible with maintaining those components which would contribute to the achievement of the Programme's objectives; e) identification of areas for special intervention; D a clear stratification of different epidemiological situation in the Prograrnme area, andg) linkages to WHO/AFRO, TDR, CTD and APOC whilst co-tunding Macrofil. 9.4 It was emphasized that the transfer of activities over the next years should ensure efficacy and application of appropriate technologies including utilization by OCP countries of data bases; enhance country capacity to manage and ensure execution through appropriate systems; and adhere to technical excellence. Furthermore efforts should be made to promote dialogue between countries; create a memory of OCP philosophy, culture and processes; and provide in-country and intercountry support to develop appropriate health systems. 9.5 The proposed Plan of Operations offered a series of indicators for Progrartme activities. The overall performance of OCP could be assessed by health rgains as measured by the quantified achievements listed in the document and by the World Bank publication on overall rates of return. It was recognized, however, that additional work was needed to develop/improve performance rndicators relevant and capable of validation on training outputs and on the efficiency with which Partrcipating Countries assumed responsibility for residual activities until the end of OCP operations. 9.6 lt was also emphasized that in conjunction with APOC, OCP was contributing to a discussion on indicators of sustairnbility of ivermectin distnbution by community-drrected approaches which would be increasingly relevant to both Programmes. 9.7 The Chairman of EAC expressed the concern of his Committee that the staffing of the Programme had left it operating at a minimum human resource level which was in danger of compromising OCP traditional quality. He trusted that this would be addressed by JPC and CSA. JPC17 page 16 9.8 Professor Molyneux finally thanked the Programme Director for his willingness to involve EAC in the development of the PIan of operations which enjoyed EAC' full support. 9.9 The Programme Director assured the Committee that the findings of next year's External Evaluation would be reflected in the implementation of the Plans of Operations as appropriate. This would include arrangements for post-OCP intercountry collaboration. 9.10 The Committee approved the proposed Plan of Operations for the Phasing-out Period with the understanding that its implementation would take into consideration the findings of the 1997 External Evaluation. 10. FINANCING OF TIm ONCHOCERCIASIS CONTROL PROGRAMME: Agenda item 10 Financial situation 10.1 The Manager of the Onchocerciasis Coordination Unit in the World Bank, Mr Bruce Elenton, reported that the current budget forecast for the fourth Financial Phase (1992-1997) stood at US $ 147 million - $ 28 million less than that approved by JPC in 1991 in the Phase IV Plan of Operations. Furthermore, OCP was now fully financed tfuough the last year of Phase IV with a reserve of US $ 10 million. 10.2 The total financing of Phase IV would be made up by Donor contributions estimated at US $ 137 million, the surplus reserve carried over from Phase III (1986-1991) in the amount of US $ 8 million and US $ 4 million of interest earnings of the contingency reserve. The surplus of US $2 million plus the contingency reserve of US $10 million would be carried over into the Phasing-out Period. 10.3 The total expenditures for the Phasing-out Period (1998-2002) were estimated at US $ 74 million which would be met by Donor contributions supplemented by a US $ 7 million draw - down of the reserve which would leave a surplus of US $ 5 million to finance "mopping up" activities during the period immediately after OCP came to an end in2}02. 10.4 In conclusion, Mr Benton suggested that the Phasing-out Period could be fully financed if all current Donors participated in that final Phase and each contributed at least 60% of its average annual contributions to OCP during Phase IV. Pledging of Donor contributions 10.5 At the end of the announcement of Donor contributions, Dr Dadzie expressed his gratitude for the continued support by the Donor community on behalf of the Programme and the people it served. The list of pledges is attached as Annex V. : 11. BVALUATION OF THE FOURTH FINANCIAL PHASE AND RBVIEW OF MACROFIL Agenda item 11 (document JPC17.9(A), JpC17.9(8) * 11.1 This item was introduced by Mr Bruce Benton, Chairman of the Committee of Sponsoring Agencies, and Dr Bernhard Liese who referred to previous evaluations of the Programme carried out by external groups. As OCP would soon be entering its final five-year phase it was suggested that an External Evaluation of the Programme be conducted to assess the progress made so far to meet OCp's overall objective and to bring it to a successful and lasting conclusion by the year 2002. JPC17 page 17 ll.2 The Evaluation group would also be required to make recommendations concerning the implementation of the Plan of Operations for the Phasing-out Period, if warranted, and to assess what, if any, support would be required post-OCP to maintain the achievements of the Programme. 11.3 The Evaluation would be implemented during the first half of l99l and the report considered by a Donors'Conference, after scrutiny by CSA, before its submission to JPC in December 1997. CSA would assume overall responsibility for the Evaluation exercise and select the members of the expert team in consultation with JPC members. The cost was estimated to be in the order of US $150 000 reduced from the origirnl estimate of US $300 000 (doc. JPC17.4(A). See also para. g.12). Ll-4 As regards the proposed Macrofil Review, Dr Liese explained that its overall objective would be to assess the present research activities of the project for the development of a field-applicable macrofilaricide and to propose a cost-effective research strategy for the future. 11.5 The Review Group would assess the Macrofil progress to date as well as the potential and timeframe for the development of a macrofilaricide; examine the prophylactic use of filaricides, the potential of ivermectin resistance, and the need for a backup microfilaricide; evaluate the current methodology of Macrofil and its management; and propose the financial support required in future. 11.6 The Review group would be constituted by CSA and the procedure and timing would be similar to those of the OCP External Evaluation. The cost, estimated at US $20 000 would come out of the Macrofil budget. {< {< >k 11.7 In respect to the External Evaluation it was agreed that it would centre on an assessment of the progress made towards enabling Participating Countries to undertake post-OCP activities, the challenge moving the Programme from the fourth Financial Phase to the Phasing-ort period; on the relationship between oCP and APOC in terms of collaboration and common responsibility; and on the future role of the Bouak6 laboratory. 11.8 Participants of the Committee were invited to nominate experts for CSA consideration of membership of the Evaluation group. It was expected that the group would be constituted early nextyear so as to complete the exercise within the first half of igg7. 11'9 The Macrofil Review plan was agreed upon with the understanding that the Terms of Reference should specify the desirability of making available a macrofilaricide before rhe end of the OCp operations. 11.10 The Committee approved the carrying out in 199'7 of the OCP External Evaluation and theMacrofil Review along the lines proposed by CSA. t 12. THE AFRICAN PROGRAMME FOR ONCHOCERCIASIS qONTROL (APOC) l2.l Dr Dadzie, Director of APOC ad interim, and Dr S6k6t6li, Manager of ApOC. rnformed theCommittee about the structure and operations of ApOC. 13. OTHER MATTERS 13.1 No other matters were considered by the Committee JPC17 page 18 14. DATE AND PLACE OF THE EIGHTEENTH SESSION l4.l The Committee decided to hold its eighteenth session in Liverpool during the first week of December 1997 at the kind invitation of the United Kingdom of Great Britain and Northern Ireland. 15. APPROVAL OF TIIE REPORT 15.1 A draft of the report was approved with the understanding that agreed-upon modifications would be incorporated in the final version. 16. CLOSTJRE OF THE SEVENTEENTH SESSION 16.1 After the customary courtesies the Chairperson declared the seventeenth session of the Joint Programme Committee closed. J4 5 I 2 8 9 JPC17 page 19 CONCLUSIONS AND DECISIONS The future of the Bouakd laboratory would be considered by the group of experts appointed to carry out the External Evaluation in 1997 (see decision 9 below and para 5.26 of the present report). OCP was allowed to support sustainable community-based ivermectin distribution in OCP countries outside the Programme boundaries to control reinvasion of infective blackflies (paras. 5.23 and 5.65). The various aspects of OCP-supported training would be considered with the Participating Countries at the 1997 meeting of National Coordirntors (para 5.68). Before undertaking the proposed long-term studies on the prophylactic effect of ivermectin, existing OCP data should be analyzed and reviewed by EAC (para. 5.75). The financing of the Macrofil project would be shared equally between OCP, TDR and APOC as from 1998 subject to confirmation by the 1997 Macrofil Review (para. 5.77). The Committee noted the report of the External Auditor (para. 7.2) The Committee approved the 1997 Plan of Action and Budget in the amount of US $22 150 000 (para. 8.14). The Committee approved the PIan of Operations for the Phasing-out Period (1998-2002) (para. 9.10) with the understanding that its implementation would take into consideration the recommendations of the 1997 External Evaluation. The Committee approved the proposed External Evaluation of OCP and the Review of Macrofil (para. i1.10). The Committee decided to hold its eighteenth session in Liverpool, United-Kingdom, during the first week of December 1997. 6 7 10 JPCl7 Page 20 ANNEX I LIST OF PARTICIPANTS JPC MEMBERS Benin Son Excellence le Professeur Marina D'ALMEIDA MASSOUGBODJI Ministre de la Sant6, Ministdre de la Sant6, B.P. 882, Cotonou Tet. Q29) 3r.26.72133.04.64 - Fax: (229) 33.0L28 M. Thadd6e BOKO Secr6taire administratif du Comit6 national de lutte contre l'onchocercose, Ministdre de la Sant6, B.P. 882, Cotonou. TCl. (229) 31.29.41- Fax: (229) 3L 53.16 Dr Bernard GNAHOUI DAVID Coordonnateur national par int6rim du Programme de lutte contre I'onchocercose, B.P. 181, Parakou TCl. (229) 61.01.34 ou 61.09.85 Dr Doroth6e KINDE-GAZARD Parasitologue, Direction rationale de la Protection sanitaire, Ministdre de Ia Sant6, 03 B.P. 1428, Cotonou 03. Tel. (229) 33.01.85 Dr Jacques Antonin HASSAN Directeur rntional de la Protection sanitaire, B.P. 883, Cotonou, t6l. (229) 31.40.70 - Fax: (229) 31.40.70 Dr Benoit-Christophe SADELER Professeur de Parasitologie m6dicale et de Pathologie tropicale, Facult6 des Sciences de la Sant6 081 B.P. 7025, Cotonou. T6l./Fax: (229) 33.O5.69 Dr Pascal DOSSOU-TOGBE Directeur adjoint de Cabinet, MinistEre de la Sant6, B.P. 882, Cotonou. TCl. (229) 33.12.99 Burkina Faso Dr Mahamadi DIALLO Conseiller technique, Ministdre de la Sant6, 03 B.P. 7009, Ouagadougou 03 Tet. Q26\ 32.41.76 - Fax: (226) 31.70.24 M. Zacharre OUEDRAOGO t Directeur g6n6ral, Office national de l'Am6nagement des Tertoirs, 01B.P. 524, Ouagadougou 01 Tet. Q26) 30.61.09/10 - Fax. (226) 30.61.12 Dr Robert K. YAMEOGO Coordonnateur national de la d6volution par int6rim, Direction de la lvGdecine pr6ventive, 03 B.P. 7013 Ouagadougou 03. T6l. (226) 30.87 90 C6te d'lvoire Dr S. Bernard DARRET Conseiller technique charg6 de la Coop6ration internationale, MinistBre de la Sant6, B.P.V4, Abidjan Fax: (225) 22.00.11 ot 21.10.85 TPCIT Page 2I Annex I Dr Gbayoro Pierre BRIKA Directeur ex6cutif du Programme national de lutte contre l'onchocercose, 01 8.P.632 Bouak6 01 Tet. Qzs) 63.4O.s6 Dr Mamadou KONE Charg6 d'Etudes, charg6 des programmes et de la recherche, 01 B.P. 5255 Abidjan 01 T6t. (22s) 2r.12.33 France M. Jean-Marie BRUNO Sous-Directeur de la Sant6 et du D6veloppement social, Ministdre de la Coop6ration, 20 rue Monsieur, 75700 Paris. Tel. (33) 01 53 69 31 80 - Fax: (33) 01 53 69 37 t9 Mme Frangoise BERNARD Conseiller de mission, Ambassade de France, Cotonou Germany Dr Herbert KRUMBEIN Chief, Health and Population Policy Division, Federal Ministry for Economic Cooperation and Development, Friedrich-Ebert-Allee 40, 53113 Bonn. Tel. (a9) 228 535 3690 - fax (49) 228 535 3500 Ghana Dr Eunice BROOKMAN-AMISSAH Minister of Health Box M.44, Accra Dr Kofi AHMED Director, Public Health, Ministry of Health, P.o. Box M.M, Accra. Tcl. (233)zl.66.29.gz Mr James K. FOSU Executive Director, National Onchocerciasis Secretariat, Ministry of Finance and Economic Planning, P.O. Box M.76. T6l: 021 66 & 931021 66 64 94, Accra Guinea Dr Mohamed SYLLA Secr6taire g6n6ral de la Sant6, Ministdre de la Sant6, B.P. 585, Conakry. T6l. (224) 41.20.74 Dr Cyrille LOUA Conseiller charg6 de la Coop6ration, Ministdre de la Sant6, B.P. 585, Conakry Dr Nouhou Konkour6 DIALLO Coordonnateur national du Programme de lutte contre l'onchocercose, B.P. 231 , Karkan Guinea-Bissau Madame (Dr) Maria LOPES RIBEIRO Directrice g6n6rale de la Sant6 publique, Ministdre de la Sant6 publique, B.P. 50, Bissau T6l. (24s) 20.26.83 - Fax: (245) 20.17.01 JPCIT Page 22 Annex I Dr Antonio TAMBA NHAQUE Coordonrnteur national du Programme de lutte contre l'onchocercose, Gabu (s/c Ministdre de la Sant6 publique, B.P. 50, Bissau) Kuwait Dr Abdul-Ridha BAHMAN Agricultural Advisor, Kuwait Fund for Arab Economic Development, P.O. Box 2921, 13030 Safat, Tel. 965 2468800 - Fax: 965 2436289 Luxembourg M. Stanislas MYCK Chef de section, Direction des Relations Economiques Internationales et de la Coopdration, Ministdre des Affaires 6trangdres, 5, Rue Notre Dame, L-2240 Luxembourg, Grand Duch6 de Luxembourg. T6l. 00 352 - 478 2M0 - Fax: 00 352 - 22 20 48 Mali Son Excellence M. Modibo SIDIBE Ministre de la Sant6, de Ia Solidarit6 et des Personnes Ag6es, Koulouba/Bamako T6r. (223) 22.s3.01122.s3.02 - Fax: (223) 23.02.03 Professeur Moussa MAIGA Conseiller technique, Ministdre de Ia Sant6, de la Solidarit6 et des Personnes Ag6es, Koulouba/Bamako Fax: (223) 23.02.03 Dr M. Oumar TRAORE, Coordonnateur national du Programme de lutte contre I'onchocercose, Division Epid6miologie, Bamako. T6l. (223) 22.@.97 Netherlanils Dr Jan VAN DER HORST ler secr6taire, Ambassade des Pays-Bas, 8.P.2220, Bamako, Mali. T6l. (223) 22.95.72182 - Fax: (223) 22.36.17 Nieer Son Excellence Madame Mariama SAMBO ABDOULAYE Ministre de la Sant6 publique, MinistBre de Ia Sant6 publique. B.P. 623, Niamey T61. (227) 72.2s.3r112.21.82 - Fax (227) 72.24.24 t Dr Fatimata MOUSSA Directrice de la Promotron de la Sant6, Ministdre de la Sant6 publique, B.P. 623, Niamey. Tel: (227) 72.36.00 Poste 3190 Dr Aissata DIOP GUIMBA Coordonnatrice nationale de la D6volution, Ministdre de la Sant6 publique, 8.P.623, Niamey Tet. Qzt) 7s.22.19 - Fax (227) 72.24.24 JPC17 Page 23 Annex I M. Malam ARI KORI Chef du Service de la Vulgarisation agricole, Direction de I'Agriculture, Ministdre de l'Agriculture et de I'Elevage, Niamey. T6l. (227) 75.23.35 Saudi Arabia Mr Mohammed I. AL-HAIZAN Economic Adviser, Ministry of Finance and National Economy, Riyadh, Saudi Arabia llt77 Tel. 4050000i 1 168 Dr Abdulla Ahmed AL-YAFI Head of Ophthalmology Department, Director of Medical Education, King Fahd Armed Forces Hospital, Jeddah 2t43I. Fax: 966-2-6653000 exr.3059 Senegal M. Abdoul AzizDIOP Directeur de Cabinet, Ministdre de la Sant6, Dakar. TeL Qzl) 22.35.25 - Fax: (221) 22.26.09 Dr Lamine DIAWARA Coordinator National, Service de Lutte Antiparasitaire, B.P. 151, Thids. TCl. (221) 51.11.08 - Fax: (221) 24.75.49 Sierra Leone Dr Brima KARGBO Coordonnateur national du Programmi: de lutte contre I'onchocercose, B.P. 12, Makeni Switzerland M. Frangois RODUIT Chef-adjoint de la Section Afrique occidentale, Direction du D6veloppement et de la Coop6ration, D6partement f6d6ral des Affaires 6trangEres, Eigerstrasse 73, 3003 Berne. T6l. 41 31 322 3474 - Fax: 41 3132416 95, E-Mail : Francois Roduit@Sdc.admin.ch Professeur (Dr) Andr6 ROUGEMONT Directeur de l'Institut de M6decine sociale et pr6ventive, Universit6 de Gendve, CH-1211 GenEve 4 Tel. 41 22702 5910 - fax:41 22702 59tz Togo , Son Excellence Dr Koffi SAMA Ministre de Ia Sant6, Ministdre de la Sant6, B.P. 386, Lom6. TeL eZ8) 22.42.61 Fax: (228) 22.20.73 \ Dr Essosolem BATCHASSI Directeur g6n6ral de la Sant6, Ministdre de la Sant6, B.P. 336, Lom6. Tel. Q28)21.09.27 Dr Aboudou DARE Coordonrnteur rntional adjoint ONCHO, Direction Pr6fectorale de la Sant6 de Kozah, B.P. 454, Kara. T6l. (228) 60.00.47160.60.47 - Fax: (ZZS) 60.04.t4 JPCl7 Pdge 24 Annex I Unrted lKllcdals Mr Brian A. THORPE Head, International Health Section, Overseas Development Administration, 94 Victoria Street, London SWIE 5JL. Tel. 0l7l-917 0i30 - Fax: 0171- 917 0428 United States of America Dr Dennis CARROLL Programme officer, US Agency for International Development, Bureau for Global Field Support, Office of Health and Nutrition, Environmental Health Division, USAID, Washington D.C.20523-0234. Tel. 1-703-875-M80 - Fax: l-703-8754686 SPONSORING AGENCMS World Bank Mr Bruce BENTON Manager, Onchocerciasis Coordination Unit, Africa Region, Washington D.C.20433. Tel. 202 473 5031 - Fax:202 5223157 Dr Bernhard H. LIESE Director, Health Services Department, Washington D.C. 20433. Tel. (202) 458.M91 - Fax: (2OZ) 522.3t57 Dr Yves GENEVIER Public Health specialist, Washington D.C. 20433. Tel. (202) 4734659 - Fax: (202) 522 3157 Food and Aericulture Oreanization of the United Nations (FAO) Mr F6lix MOUKOKO-NDOUMBE Senior Officer, Secretary for OCP/APOC, Viale delle Terme di Caracalla, I-00100 Rome T6l. 396 5225 3010 - Fax: 396 5225 6850 United Nations Development Proeramme (UNDP) Ms Aissatou CISSE Regional Programme Officer, B.P. 1747, Abidjan. 't61. (225) 21.13.41 - Fax: (225) 21.13.67 World Health Oreanization Dr Ralph H. HENDERSON Assistant Director-General, WHO, Geneva Mr Claude-Henri VIGNES Representative of the l-egal Counsel, WHO, Geneva Dr Ayit6 M. D'ALMEIDA Director, Programme Management, WHO, Brazzaville JPCl7 Page 25 Annex I Dr Solange KOUO EPA WHO Representative, Cotonou WHO Secretariat Dr H. Yankum DADZIE Director, Onchocerciasis Control Programme, Ouagadougou Mr Frangois AGOSSOU HIP Adviser, WHO, Cotonou Dr B. BOATIN Chief, Planification, Evaluation and Transfert Unit, Onchocerciasis Control Programme, Ouagadougou Mr Jean-Frangois BLONDIAUX Budget Officer, Budget and Finance Division, WHO, Geneva Dr Comlan COMLANVI DPC Adviser, WHO, Cotonou Dr O.W. CHRISTENSEN Consultant, Onchocerciasis Control Programme, WHO, Geneva Dr A.K. DIALLO Sector Chief, Vector Control Unit, Onchocerciasis Control Programme, Parakou DT C. GINGER Manager, Macrofil Project, Onchocerciasis Control Programme, WHO, Geneva Dr J.M. HOUGARD Chief, Vector Control Unit, Onchocerciasis Control Programme, Ouagadougou Dr Marc KARAM Control of Tropical Diseases, WHO, Geneva Dr H. REMME Chief, Applied Field Research, Special Programme for Research and Training in Tropical Diseases, WHO, Geneva DT A. SEKETELI Marnger, African Programme for Onchocercrasis Control (AibC) and Coordirntor, Office of the OCP Director, Ouagadougou M. D. MILLER \ Chief, Administration and Management, Onchocerciasis Control Programme, Ouagadougou Mlle L. RAVELONANOSY Programme Officer, Office of the Director, Onchocerciasis Control Programme, Ouagadougou Dr L. YAMEOGO Chief, Entomological and hydrobiological Evaluation, Vector Control Unit, Onchocerciasis Control Programme, Ouagadougou JPCl7 Page 26 Annex I M. E. ZOUMENOU Finance Officer, Onchocerciasis Control Programme, Ouagadougou EX OFFICIO PARTICIPANTS Expert Advisorv Committee Professor David H. MOLYNEUX Director, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, TeI.0151 708 9393 (8xt.2261) - fax: 0151 707 0155 OBSERVERS MectlzarrDAnatian frcgta[s Dr Michael HEISLER Director, Mectizan Donation Program, One Copenhill, Atlanta GA 30307. Tel. 404 37I 1087 - Fax: 404 371 0466 Dr Stefanie MEREDITH Associate Director, Mectizan Donation Program, One Copenhill, Atlanta GA 30307, Tel. 1 404 371 1460 - Fax: 1 404 371 1.138 The French lnstitute of Scientific Research and Development for Cooperation (ORSTOM) Dr Bernard PHILIPPON Directeur du D6partement Sant6, ORSTOM, 213 Rue l-afayette, 75010 Paris T6l. 1 48 03 77 09 - Fax: I 42 09 32 75 Professeur Abdoulaye AG-RHALY Secr6taire g6n6ral,01 B.P. 153 Bobo-Dioulasso 01. T6l. (226)97 01 0i - 97 00 98 - Fax: (226) 97 00 99 athelparttqipants (Be nin) Madame Marie-Th6rdse HOUTOUKPE-CAPO-CHICHI Secr6taire particulidre du Ministre de la Sant6, B.P. 882, Cotonou. T6l. (229) 33.04.64 M. Zacharie AVOGNON CHD-O Ophtalmologie, Porto Novo. T6l. (229) 22.21.56 M. l-6on KLOUVI DC/MSPSCF, B.P. 882, Cotonou JPC17 Page 27 ANNEX II STATEMENT BY DR RALPH TMNDERSON, ASSISTANT DIRECTOR-GENERAL, ON BEHALF OF DR HIROSHI NAKAJIMA, DIRECTOR-GENERAL OF WHO Excellencies, l-adies and Gentlemen, A year ago, I had the pleasure of attending the Joint Programme Committee (JPC) of the Onchocerciasis Control Programme in West Africa (OCP) in Washington. On that occasion, I expressed my satisfaction with the progress made by OCP on the road to attaining its objective by the year 2002. During the coming years therefore, the challenge will be to prepare for maintaining the impressive achievements of the Programme after it has come to an end. OCP has been a good example of how a progmmme, originally launched against a specific disease and organized vertically little operational involvement of the beneficiary countries, can, with time, bring broad benefits for health development. The strategy of vector control has to be centrally directed because it requires the careful coordination of complex technology and operations. But other important activities such as ivermectin distribution, for some time a complementary control strategy, and epidemiological surveillance to detect recrudescence and its eventual control, are now fully in the hands of the Participating Countries. Increasingly, these activities are being integrated into the national Multidisease Surveillance and Control programmes. The country workshops conducted this year with OCP support have helped to determine the points at which epidemiological surveillance would be most effective for detecting recrudescence of onchocerciasis and carrying out control activities within the national health systems. This is an imporlant step towards making OCP's achievements durable. Last year we were informed that recrudescence had occurred in the Bougouriba valley. I wish to congratulate the Burkirn Faso team on its success in detecting this new transmission and working with OCP staff to investigate its source and extent, and institute control measures. Their prompt and capable response has shown that the approach to recnidescence detection and control developped by the Programme is effective and that it is being successfully transferred to the contries concerned. Madam Chairman, the Programme now has six years in which to consolidate its achievements. The Programme Director is submitting to this session of the JPC his proposal for the Plan of Operations covering the five-year Phasing-out Period. I believe that if this proposal meet with the approval of the JPC and is implemented, it will bring OCP to a successful conclusion in the year 2002. The Programme - now in its twenty-second year - has had the good fortune to enjoy the genuine and unwavering support of all parties involved : the Pqfticipating Countries, the Donors, the Committee of Sponsoring Agencres and the Expert Advisory Committee. I am grateful for this support which I trust will continue unabated during the next six years until the Programme is finally concluded. I also wish to thank all OCP staff for their dedication and hard work which have made the Programme so successful . Special thanks are due to staff members who have Ieft or will soon be leaving the Programme now that its operations are reducting as a result of their successful efforts. The past twelve months have also been a preparatory period for the African Programme for Onchocerciasis Control (APOC). An important srep has been the establishmenr of the APOC headquarters within the OCP compound in Ouagadougou. This arrangement, I understand. has greatly facilitated the implementation of APOC activities. I wish to thank the interim Director and the Manager for taking on the considerable work thls has entailed in addition to their already heavy workload in OCP. JPC17 Page 28 Annex II Finally, Madam Chairman, I would like to thank the Government of the Republic of Benin for hosting both the seventeenth session of JPC and the second session of the APOC Joint Action Forum. Excellencies, l^adies and Gentlemen, I wish you an interesting and productive session of the Joint Programme Committee. IJPC17 Page 29 ANNEX III OPENING ADDRESS BY MR. ADRIEN HOUNGBEDJI, PRIME MINISTER, RESPONSIBLE FOR THE COORDINATION OF GOVERNMENTAL ACTION AND RELATIONS WITH INSTITUTIONS Republic of Benin Mr. Assistant Director-General of the World Health Organization Mr. Director of the World Health Organization Regional Office for Africa Mr. Chairman of the 16th session of the Joint Prograrnme Committee for the Onchocercasis Control Programme in West Africa Honourable Ministers of Health of the Participating Countries of the Onchocerciasis Control Programme in West Africa Honourable members of the Committee of Sponsoring Agencies Honourable members of the Government Honourable members of the National Assembly Ladies and Gentlemen of the Constituent Bodies Your Excellencies, the Heads of Diplomatic missions l-adies and Gentlemen representing the Donors of the Onchocerciasis Control Programme in West Africa I-adies and Gentlemen of the United Nation system I-adies and Gentlemen Partners for the Development of Africa Distinguished guests Ditinguished personalities, ladies and Gentlemen, before opening of the deliberations of the 17th session of the Joint Programme Committee of the Onchocerciasis Control Programme, I will convey the greetings and best wishes to the meeting from the President of the Republic of Benin, His Excellency Mr Mathieu K6r6kou, who had wished to chair this ceremony. The Republic of Benin is proud to host this important se'ssion of the Joint Programme Committee of the Onchocerciasis Control Programme in West Africa, governing body concerning the control of this infection within our sub-region. l-adies and Gentlemen, Distinguished guests, allow me in *.t"oiing you to reiterate that you are at home in the land of Benin. I congratulate and wish success to Dr Ebrahrm Malik Samba, rhe charismatic figure of the Onchocercasis Control Programme and new Director of the World Health Organization Regional Office for Africa. Honourable Ministers, Dear Colleagues, the lTth session of the Joint Programme Committee rs being held at a time when our sub-region is experiencing an economic situation which remains difficult JPC17 Page 30 Annex III and the adverse effects of which are affecting our populations with revealing manifestations in the health situation. Development indicators analysis highlights the increasing gap between the nations from the North and those from the South, where diseases formely under control or almost eliminated reappear in epidemic form, as well as the so-called civilization diseases. Honourable Ministers, l^adies and Gentlemen, twenty years ago, our sub-region was burdened with river blindness, as exemplified by the disability of onchocerciasis patients and the depopulation of vast fertile lands plagued by this scourge. Initiated rnl9J3, the Onchocerciasis Control Programme in West Africa, with the resolute support of the Donor community, has demonstrated that hope is permitted. Indeed, today, most of the areas previously deserted has become zones of economic developement because freed from onchocerciasis. From this platform, I would like to draw your attention, all of you, populations, government authorities, sponsors, to the qualitative work done by the management staff of the Programme in order to present us the most gratifying achievements today. This is therefore a good oppornrnity for me to express my gratitude to the Director of the Onchocerciasis Control Programme in West Africa, and through him, to the members of his office, as well as, to the experts whose findings have contributed to give up with the worrying consequences of this disease which are the loss of sight, the massive migration of populations, beggary, and so on. It is proper for me now to also pay tribute to the Regional Director of the World Health Organization for Africa, Dr Ebrahim Malik Samba in gratitude for the particular attention he is giving to the monitoring of the progress made toward the elimination of Onchocerciasis from our sub-region. If you agree with me, Ladies and Gentlemen, Distinguished participants, it is an important occasion, to highlight the function of the World Health Organization in this complex undertaking. The personal support of the Director-General of our World Health authority has been one of the outstanding factors which have facilitated the Programme's success. Mr. Assistant Director-General of the World Health Organization, please receive through my voice the thanks of West-African populations and governments to Dr Hiroshi Nakajima. These thanks are also extended to all the experts who work daily in the various units of the office of the Director- General. I:dies and Gentlemen, Honourable guests, I do not forget to underline the importance of the support provided by the Donors community in the past and which continue; because they trust in African people, they shared with us the heavy responsibility of collecting the resources needed for the development of our Programme. Honourable Ministers, l-adies and Gentlemen, Iooking Et the items on the agenda of the present session, I am pleased with the relevance of the subjects you'have chosen to discuss and which are related to currenr issues to be addressed in preparation for a careful management of the future. We are rndeed six years away from the end of the Onchocercrasis Control Programme in West Africa and this implies a correct take-over by the Participating countries of the effective and effrcient management of the Programme's residual activities after the year 2002. The Programme has carefully prepared a plan for the strengthening of nattonal capacities which enable the Participating Countries to integrate onchocerciasis surveillance and control within therr primary health care systems. To ensure that the devolution phases actually initiated will be successful, it is important for each of the eleven Participating Countries to develop its own devolution plan and mobilize the required resources for its implementation. ! JPC17 Page 31 Annex III on this occasion, I draw our attention to the current situation in which only one country has already fully funded ii, a"rotution plan. Consequently, the opening of the 17th .session of the Joint programme committee gave me th,e oqnorrunity to invite all of u, to build, with all possible speed' an applopriate plan for a successful devolution' HonourableGuests,l.adiesandGentlemen,millionsofAfricanpeopleareworriedtodayabout the threat of blindness, about the fertile lands in the onchocerciasis infisted areas, about the future of theirchildren.Thesemillionsofsoulshavetheireyesandearsonyou.Theyhopethat'attheendof thislTthsessionoftheJointProgrammeCommitteeyouwillfindconcreteanswerstotheir preoccupations; tnef "*p""t yorr, .tiff managers of health systems in our countries' to meet the challenge : the ourable controt of onchocercia-sis, one of the major components of the health for all policy, a condition for our socio-economic welfare' concerning me, I have not doubt in my mind that west Africa, will request national capacities ro take up the cnailenge or "tiroi*,ing improvisation, ignorance, poverty and diseases' onthatnoteofhopeandonbehalfofthePresidentoftheRepublicofBenin,Iwishfullsuccess to your deliberation, "rd I declare opened the 17th session of the Joint Programme committee of the onchocerciasis co.rt.ol programme in west Africa, this day Monday 2 December 1996' Long live sub-regional cooperation Long live international cooperation Long tive the World Health Organization' Thank You JPCl7 Page 32 ANNEX IV REFLECTIONS OF TTM COMMITTEE OF SPONSORING ANGENCIES By Mr. Bruce Benton Chairman, Committee of Sponsoring Agencies Mme Chairperson, Excellencies, Ladies and Gentlemen : I am pleased to present the reflections of the Committee of Sponsoring Agencies. I-et me begin by expressing the gratitude of both the OCp and APOC communities for the graciousness of the Gouvernment of Benin in hosting these two major meetings in the beautiful setting which surrounds us here. We appreciate the care and organization which has gone into these meetings and the warmth with which we have been received. The Committee of Sponsoring Agencies views the past year as one of maturation, progress and collaboration for OCP. Maturation and progress can be measured by a number of milestones. Strategically, we have a clear idea where the Programme is going and how it will be brought to a lasting and successful conclusion. A detailed plan of operations for OCP's final phase has been prepared, discussed and is ready for your approval. In the core OCP area, the Programme has achieved virnrally its entire objective. The parasite reservoir and hence the source of the disease has been eliminated in major portions of the seven original countries. Moreover, encouraging progress has been achieved in strengthening national capacity to enable prompt detection of recurrence of the disease in the core area. For example, in Burkina Faso, a multi-disease surveillance and control component of a World Bank- supported project is now well established and functioning. This enhanced capacity in turn led to the early discovery this past year of recrudescent focus of onchocerciasis in the region of Bougouriba. As the Director -General of WHO emphasized in his opening statement, the fact that early recrudescence was detected entirely by national teams is solid evidence that surveillance, as refined by OCp, can and does work. Multidisease Surveillance and Control programmes in Niger and Mali, with financing from the Netherlands, are expected to secure national capability to effectively detect and control any reappearance of onchocerciasis throughout much of the remaining core area of OCP. As for the larger ll-country program area, it is fair to conclude that onchocerciasis has been virnrally eliminated as a public health problem, and that progress toward establishing integrated surveillance and control programmes in several of the larger Participating Countries has been promising. As OCP management will soon report, there are only a few areas where the disease remains active, and these are due to special circumstances. Furthermore, none of these confined areas where the disease remains active is expected to impede or otherwise delay completion of OCp beyond 2002. The CSA is pleased with the progress achieved in C6te d'Ivoire, Guinea, and Senegal in istablishing multi-disease surveillance and control components of sector-wide World Bank-supported health projects. Each of the projects is expected to become effective during 1997 and hence, by next year, half of the OCP Participating Countries will have activated functioning surveillance and conrrol maintenance programmes- an achievement which will enhancq the capacity to deal promptly with any eventual occurrence of post-OCP recrudescence. Financially, as well, OCP has matured to a largely self-sustaining position. As the programme has withdrawn from the central area, annual expenditures have declined by US$12 million - 38 percent - during the past six years. The Donor community appears determined to follow OCp through to a successful conclusion. We have already received informal indications that Phase Four is fully financed, and that well over half of the financing required to complete the Phasing-out period has been assured. Managerially, the CSA is delighted with the smooth rransfer of the OCP Direcrorship over rhe past year and a half, and Dr. Dadzie, in his low-key and competent fashion, is moving the Programme into a wrap-up mode. We believe he is ideal to lead this Programme through its final phases and ensure that OCP is brought to a lasting and successful conclusion on schedule. Furthermore, he manages the )JPCl7 Page 33 Annex IV Programme with the same standards of financial rigor and high integnty set by his predecessor, Dr. Samba, in earlier years. The CSA. in conjunction with the donors, has proposed an external evaluation to be completed during the first half of 1997. This will allow for any adjustments considered necessary before launching the Phasing-out Period. Proposed terms of reference are before you and we look forward to reaching a consensus at this meeting on the objectives and framework for the final evaluation before OCP concludes. The Government of the Netherlands has offered to sponsor and finance an ex-post impact evaluation of OCP, five years following its conclusion, in the year 2001. The CSA strongly supports this proposal and believes there is much to be learned from the long-term success and uniqueness of OCP as a regional programme which might be replicable for other widespread diseases. OCP collaboration with other programmes and agencies involved with health in Africa has been pronounced this past year. Agreement has been reached between TDR, the African Programme for Onchocerciasis Control (APOC) and OCP to share continued support for research for a macrofilaricide beyond the end of Phase Four. Should the JPC approve this proposed tripartite arrangement and an operational macrofrlaricide become available during the post-OCP era, it will become an invaluable addition to the arsenal to ensure that there is no major recurrence of onchocerciasis in the West African sub-region. Close collaboration with the newly launched APOC has been a remarkable feature of the OCP experience in 1996. It has been clear that this collaboration has been of enormous benefit to both programmes. The two programmes have shared staff, facilities, equipment, experience, ideas, and enthusiasm. From the CSA perspective, the relationship between the two programmes has brought about a major gain in synergy. Two benefits from the collaboration are particularly noteworthy. First, APOC and OCP together supported by TDR, have conducted extensive operational research as to the most effective, efficient, and sustainable approaches to treating target populations with ivermectin. The findings of this research show that community-directed treatment meets the efficiency and sustainability criteria better than any other approach, which could have profound implications for designing ivermectin distribution programmes. It is also critical to ensuring continuing control of onchocerciasis in areas falling outside the OCP area in C6te d'Ivoire, Ghana and Guinea, and within the northeast portion of the OCP area, which would protect adjacent zones inside the Programme area currently exposed to reinvasion. Second, close collaboration with APOC has enabled OCP to transfer some of its most experienced, knowledgeable, and effective staff members to APOC and thus reduce the pain associated with cutting staff commensurate with the reduction of OCP operations. The CSA would like to call the attention of the Joint Prograrnme Committee to an oncho-related issue, whrch - while not strictly within the mandate of OCP - is rmportant in its implications for sustainable development of the OCP Participating Countries. One major justification for OCP has always been rts antlcipated development impact. This boost to development of the West African sub- region was expected to derive from improved productivity Oud to better health and greatly increased agncultural production in river valleys, where onchocerciasis prevented rnhabiting and culttvating some of the best agncultural land in West Africa. At the request of the JPC. the CSA has over the years undertaken research and sponsored seminars, all of which have concluded : (1) that the OCP areas offer vast potentral for rncreased aericultural production. perhaps the largest under-utilrzed area in Africa : (2) that spotltaneous mipration to oncho-freed rlver valle','5 has treell extellslve and rapid; and (3) the ongoulg lncrease ln spontaneous settlement without the rrght policies tn place rttay lead to substantial envlroltmental rrsk. The results of this research and related work done b), ..,.r^r, ,'n" ministries were presented at a hrgh-level ministerial confereuce at the World Bank ofl'ices in Paris in 1994. That meeting reached a consensus among all OCP Participating Countrtes on thr: importance of implenienting 15 policy pnnciples for sustainable settlement and development, which are available to you here. t I JPCIT Page 34 Annex IV It is the CSA view that it is now critical to move forward expeditiously to implement rhese policy principles. It would be a tragedy if, after coming this far, the Participaring Countriis and other paitneri in the international community did not go that extra mile to reap the economic benefits stemming from successful oncho control. The CSA has requested FAO to initiate a consultative process at the country level early in 1997 to explore with the African governments what pilot activities might be undertaken within the oncho- freed areas as soon as possible to implement these policy principles. If we do not act quickly, it wili soon be too late to take advantage of development opportunities arising out of successful oncho control. Hence, the CSA urges each Head of Delegation of the Participating Countries to return to capitals and urge his or her colleagues in other ministries responsible for agriculture, environment, and planning to participate actively in the FAO-led consultations, which are noted in the in-session document before you. In closing, Mme Chairperson, let me reiterate that the CSA foresees a highly successful and lasting conclusion to OCP. Recent progress and maturation of the Programme point strongly in that direction. The CSA is proud to be associated with such a successful endeavor and expresses its gratitude to the donors and Participating Countries for working rogether and with us to make OCp a model of international partnership. Thank you, Mme Chairperson. t a JPC17 page 35 ANNEX V PLEDGESI a l' , FOR 1997 TOTAL PHASE IV France FF 15.0 million FF 45 million Germany To be determined on former years' commitrnents Kuwait Fund us $250 000 US $1.5 million Luxembourg FL 8.5 million Netherlands NLG 4.5 million (US $2.6 million) Saudi Arabia US $ 2.33 million US $14 million Switzerland CHF 2 million CHF 18 million (US $13.8 mrllion) United Kingdom f 6s0 000 USA US $ 2.5 million wHo us $ 2s0 000 World Bank US $ 2.63 million US $ 15.8 million a ' Those Donors present only