Joint Programme Committee: report of the fourth session, Paris, France, 12-15 December 1983

JPCI4 ,'l JOINT PROGRAMME COM}IITTEE ONCHOCERCIASIS CONTROL PROGRA}4ME IN THE VOLTA RIVER BASIN AREA Fourth session Paris France I2-15 December 1983 REPORT CONTENTS INTRODUCTION AND OPENING OF THE SESSION ELECTION OF OFFICERS ADOPTION OF THE AGENDA ADOPTION OF THE THIRD SESSION OF THE JPC REPORT OF THE COWITTEE OF SPONSORING AGENCIES PROGRESS REPORT OF THE WORLD HEALTH ORGANIZATION FOR 198 3 R.EPORT OF THE EXPERT ADVISORY COI-IMITTEE 1 2 3 4 5 6 Page 2 3 3 3 4 7 8 9 PROGRESS REPORT ON LONG-TERM STRATEGY ..... REPORT ON ONCHOCERCIASIS CHEI'IOTHERAPY PROJECT RXPORTS OF MRY COAST, NIGER, TOGO AND UPPER VOLIA 5 13 15 L7 19 19 20 23 25 26 27 35 10. 11. L2. 13. L4. ANNEX I ANNEX II ANNEX III ON SOCIOECONOMIC DEVELOPMENT AUDITOR'S REPORT FINANCING OF THE ONCHOCERCIASIS CONTROL PROGRAMME ... PI.AN OF ACTION AND BUDGET OF THE PROGRAMME FOR 1984 OTHER MATTERS CI.OSURE OF THE FOURTH SESSION AGENDA LIST OF PARTICIPANTS ONCHOCERCIASIS FUND I : 1JPCI4 Page 2 INTRODUCTION AND OPENING OF THE SESSION: Agenda item 1 1.1 The fourth session of the Joint Progranune CorunitEee (JpC) of ttre onchocerciasis Control Progranrne (ocp) in the Volta River Basin area was held at the International Conference Centre, Paris, from 12 to 15 December 1983. The session rras atEended by representatives of Belgium, Benin, Canada, France, Federal Republic of Gennany, Ghana, IEaIy, Ivory Coast, Kuwait, Mali, Netherlands, Niger, Saudi Arabia, Switzerland, Togo, United Kingdon of Great BriEain and Northern Ireland, United SEates of fuuerica, Upper VolEa, Ehe African Development Bank (ADB), the United Nations Development Progranrne(UNDP), the Food and AgriculEure organization of the United Nations (rAo), ttre World Bank (IBRD) the l^Iorld Health Organization (WttO). Observers from Guinea, Senegal, the Cormuission of the European Corununities (CEC) and the French Office for Scientific and Technical Research Overseas (OnSfOU) r.rere present. The session rras also attended by the Chairman and a member of the Expert Advisory Committee (EAC), the Chairman of the Ecological Group and two representatives of the External Auditor. A List of Participants is attached as Annex II. L.2 Mr Christian Nucci, Minister for Cooperation and Development under the responsibility of che Minister for Foreign Affairs, welcomed the participants on behalf of the French Government. He reviewed the history of onchocerciasis control in West Africa during the pasE 50 years, highlighting the conEributions made by M6decin-G6n6ra1 Richet who died in 1983, by ORSTOM, by the OCCGE, and finally by OCP. The Progrartrne was an outstanding example of an approach to development, for several reasons. It called for solidarity on the part of all the counEries concerned, it atEacked Ehe root cause of disease transmission; it rras a rnultidisciplinary and integrated prograrune, and it had proved itself adaptable in the face of problems and changing circumstances. 1.3 He reaffirmed the major objectives of Francets policy on health development. Ihe first was to puE an end to the purely medical approach. Health policy must form parE of a general development policy. The second was to encourage decentralized activities which benefit the most underprivileged groups, in particular through primary health care. The fhird was to improve the Eraining of healEh and allied personnel. The final objective, Eo create the conditions for greater national self-reliance, was being pursued by OCP in its strategy with a view to Eransferring the Prograurne activities gradually to Ehe ParEicipating Countries. The organizational and financial implications of such devolution were crucial problems which must be faced by everyone involved in OCP. 1.4 At the half-way point in the scheduled life of the Progranme, it was appropriate to look back on its achievements. Onchocerciasis was in fu11 retreat, annual incidence having fallen from 302 to less than 1Z in the majority of the Programme area. As a result, settlers were arriving in uninhabited valleys to culEivate previously unused land. 1.5 The outgoing Chairman, His Excellency Dr NrGolo Traor6, MinisEer of Public Health and Social Affairs of Ma1i, expressed the participantsr thanks for the hospitality and excellent working facilities provided by the French Government. He paid tribute to the valuable contributions France had made to onchocerciasis control over many years. lr JPC/4 Page 3 ? 1.5 In a message read to the meeE.ing, Dr Comlan A.A. Quenum, WHO Regional Director for Africa, pointed out that some major health problems could be tackled only by "o.r""it"d international efforts. OCP was a shining example of internationil iolidarity and cooperation in which various donor countries and agencies had joined forces with the international scientific communiuy. 1.7 Despite serious problems, such as reinvasion by blackflies and resisLance to insecEicides, the Programme had attained its firsE objective: i.n 9OZ of the original Progranrne area, transmission had been interrupted and onchocerciasis was no longer a public health problem or an obstacle Eo socioeconomic development. Extension of the Programme area Eo the westr as agreed upon in principle at the Ehird session of the JPC, would subsEantially reduce reinvasion. The research on blackfly larvicides was producing promising results and would help to overcome the problem of resisEance. To safeguard t.he resulEs already achieved it was essenEial Eo PrePare very carefully for the devolution of Programme activities to the national structures of the Participating Countries. Victory over onchocerciasis would be a major step tovrards achieving Health for all by the Year 2000. 2 ELECTION OF OFFICERS: Agenda item 2 2.1 Mr Robert Thomas, AssisEant DirecE.or, Development Projects, France, was unanimously elecEed Chairman of Ehe session. His Excellency Dr Moudi Abdou, MinisEer of HealEh, Niger, was elected Vice-Chainnan. 3 ADOPTION OF THE AGENDA: Agenda item 3 3.1 The represenEaEive of Canada proposed the inclusion of a supplemenEary item, t'Adoption of the report on the third session of the JPC". The provisional agenda was adopted with the inclusion of Ehe supplemenEary iEem and a number of changes in the order of items (see Annex I). 4 ADOPTION OF THE REPORT ON THE THIRD SESSION OF THE JPC: Agenda irem 4 4.1 A donor representative drew attention to paragraph 10.6 of the report(documenE JPC/3), which indicated thaE an amounE of US $O:Z fOO was to be sPent on PreparaCory work on Lhe Western extension. The JPC had not approved a specific budgeE aE its Ehird session and had noE auEhorized the extension inquestion. The representaEive stressed the importance of making clear and precise decisions on budgetary matters. Support was given to Ehe reconrnendation of the External Auditor thaE the budget be adopted in clear terms by the JPC. 4.2 The Programme Director agreed with the need for clear-cut budgetary decisions. No OCP funds had in facE been spenE on Ehe preparaEory studies for the Western exEension, but the Regional Director had made WHO funds availablefor Ehat purpose. 4.3 The report of Ehe third session of the JpC was adopted. JPc/4 Page 4 5 REPORT OF THE COI'IMITTEE OF SPONSoRING AGENCIES: Agenda item 5 5.1 The current chairman of the CSA presented a paper entitled "Reflections of the Conrnittee of Sponsoring Agencies,t(CSA) subsequently distributed as document JPC4.3. He explained thaE this represented aninnovation but CSA felt the need to discharge its responsiUitity to the JPC by infonning iE of iEs role in supporting the Prograrmne and in ensuring the best use of available resources. The CSA is in a position to do this effectively Ehrough a systematic review of OCPrs activities based on attendance at all meet.ings of its statutory bodies and analysis of the rerevant financialpolitical and Eechnical data. 5.2 Compared with 1980 - the beginning of the second phase, when the Independent Conunission had confirmed thaE the Programme was viable - there had been progress in several domains: (1) instead of only one larvicide there rJere now three, and two other insecticides were under advanced developmentr so thaE by the end of the second phase there might be five; (2) research was under way on a practical macrofilaricide; (3) resistance was controllable by appropriate straEegy even when there was only one main back-up insecticide, and the risk of reinvasion could be appreciably reduced by destroying fly populations at source; (4) epidemiological findings indicaEed that onchocerciasis would cease to be a Ehreat to socioeconomic development in the Progranme area in the foreseeable future, and (5) a Long-Term Strategy was being developed for the conEinuation of operations along the lines recommended by the Independent Conrnission in 1980. 5.3 Ihe three priorities esE.ablished by the third session of JPC remained. These were (1) developmenE of new insecticides, (2) cherotherapy, and (3) Western exEension. However, with some long-term objectives now moving into closer range, the evolution of these priorities may change, but this wil-1 come into perspecEive in the Long-Term Strategy. 5.4 The CSA had decided to support the preparation of the Long-Term SErategy (LtS) wittrout waiEing for its approval by the current session of JPC because oEherwise the plan of action for the third phase would have been delayed until 1986 and its financing endangered. AlEhough financing for the LTS had noE been provided in the 1983 budgeE it had been possible to accornmodate it under present budget headings as iE mainly involved recruitment of consultants. CSA had accordingly elaborated terms of reference for the Long-Term SErategy. The proposed budgec for 1984 included special provision for the LTS which CSA reconrnended JPC should aPprove. 5.5 Priority had righrly been given Eo larvicides and chemoEherapy over westward extension in 1983; the needs of extension as well as chemotherapy could noE have been financed. Thanks Eo WHOts help with exploratory work in the counEries concerned, more information had been collected. Extension was necessary to the Long-Term Strategy, helping, as it wou1d, to combat reinvasion of the existing Prograrnme area. It could be foreseen that savings made as this reinvasion was controlled could be transferred to oPerations for extension. The Programme's financial position was now satisfacEory and CSA therefore reconmended approval of the exploraEory activiries in the Western extension detailed in the Plan of Action and Budget for 1984. rl 6JPCI4 Page 5 5.6 Devolution of responsibilities in the central area was a steP closer since the Participacing Countries had reached a consensus at the 1983 meeting of National Onchocerciasis Committees in Lom6. The need Eo decide on deEails of the transfer of surveillance measures Eo the countries had become imminent. JPC should seek Ehe means Eo ensure thaE such measures r.rere incorporated in general development plans for the maximum benefit of Ehe ParEicipating Countries. 5.7 With the progress in developing larvicides, CSA would see no reason Lo delay Southern exEension beyond the end of the second phase Eo the exEenE that funds became available to supplement possible savings in oEher areas. 5.8 CSA favoured a change in t.he timetable of annual meetings and proposed that JPC should meet mid-year as from 1986. The overall advanEages in shifting sessions away from the end-of-year period of major activity in che field would outweigh the budgetary inconvenience. 5.9 Finally, CSA joined EAC in congratulaEing the Director and sEaff of OCP on the gains achieved in terms of proEecEion of children and the esEablishrnent of new communifies in Ehe Programme area, as well as in the training of technicians and the related transfer of knowledge throughout west Af ric a. PROGR-ESS REPORT OF THE I,JORLD HEALTH ORGANIZATION FOR 1983; Agenda item 6 (documenE JPC4.2) REPORT OF THE EXPERT ADVISORY COMMITTEE: Agenda item 8 (document JPC4.7) 6.1 The Progranrne Director reported E.hat 1983 had not been the year of recuperation hoped for. In spite of Che six Posts approved in 1982 the workload had increased concomitanc with the preparation of the Long-Term Strategy and all that implied, the development of new larvicides, Ehe launching of the chemotherapy project, coping with the problems of resisEance and reinvasion, aEEending to E.he related research and training needs and responding to demands for exEension. 6.2 In the interests of effective control a more inEegraEed approach was sought, combining all disciplines concerned. It must be remembered that OCP has to contend wiEh noE one fly species, as had originally been Lhought, but seven, and also 27 different possible paEterns thaE Ehe rainy season might follow in any year in Ehe area covered by the Progranrne. 6.3 The dreaded appearance of resistance to Eemephos in the savanna species of the S.damnosum vecEor, on the lower Bandama river in Ivory Coast had been a bitrer blow, but emergency plans immediately implemented had brought it under control. In fact the entomological results overall in I983 were amongst the besE since OCP had sEart.ed. 6.4 The mounting evidence of transmission being interrupEed was most encouraging. A study among children born in 907" of. the original Progranrme area since the beginning of activities showed all of them were free from onchocerciasis. 6.5 Definire progress had also been made in the research into alternative larvicides and new chemoEherapeutic agenEs. The long-Eerm resulEs of such research would long outlive OCP, stimulatingr as it already had, interest in the United SEates of America, Canada, European countries and Japan, as well as in Participating Countries. JPC/4 Page 6 6,6 The anticipated socioeconomic development Lras now also evident in the very marked and significant settlement of some of the controlled river valleys previously uninhabited and the cultivation of lands hitherto unused. 6.7 The Lom6 meeting of National Onchocerciasis Corunittees had produced valuable support to the concepE of devolution from the Ministers in the seven Participating Countries, so that a transfer of responsibilities could now be positively and mutually planned. 6.8 Training activities for the Progranrme were most satisfactory and was providing a cadre of personnel in the countries in preparation for when devolution became a fact. 6.9 The management of OCP had been streanlined and overhead costs were down. The only really bad news was that OCP had seen its first fatal helicopter accident in operations in Benin in 1983. 6.10 Reinvasion remained a problem but had to be seen in the coutext of the proposed extension, which, as the Independent Cormnission had reconnnended in 1980, was Ehe only measure in the long-Eerm to contain it and promise a definitive and successful conclusion to OCP. Without extension maintenance costs rdere likely to remain perennially high. The Director expressed appreciation for the support already received for that vieur at the meeting from the French Minister for Cooperation and Development, the Minister of Public Health from Mali and the Chairman of the CSA. 6.11 The understanding and cooperative efforEs of Ministers in the Participating Countries, as well as Heads of State, were very much appreciated, as was the grateful response of the people. Entomological situation 6.12 Control of the vector had been maintained. This meant Ehat transmission had been interrupted in 9OZ of the Progranrne area. S.damnosum had, in fact, almost completely disappeared in the northern half. Progress was also appreciable in the east and south-east, thanks Eo greater expertise and experience in aerial operations in relaEion to hydrological conditions', 1983 was a remarkably dry year. ^Surveillance had also improved, and nowcovered approximarery fob boo t*2 (654 oo0 km2 in 1977 , an increase of 382) in spite of a 3lZ saving in terms of surveillance staff and resources. Through this more effective surveillance and the favourable hydrological conditions it had been possible to make savings in 1983 of 4OZ in terms of rivers treated and approximately 1000 hours of flying time. 6.13 Transmission is high in the hyperendemic proposed southern extension area and it was presumably from this area that reinvasion threatened northern Togo and northern Benin. JPC I4 page 7 6.14 There had been no spread of the temephos- or chlorphoxim-resistant forest species beyond their previously known distribution. However, resistance to these organophosphorous compounds was nov/ reported outside the Prograrnrne area in southern Ghana. In a small zone in the southern extension area in southern Togo and Benin susceptibility of forest species to temephos was also in doubt. Resistance to chlorphoxim had been shown to be reversible, i.e. to regress during the dry season when treatments are inrerrupted, and this gave latitude for interchange of insecticides at the height of the rains. 6.15 The discovery of resistance to organophosphorous compounds in a savanna species of the vector in southern Ivory Coast, had come as a shock but it had been dealt with effecrively and oCP could be reasonably confident thaE it had the means to control it again, especially with the strategy it had developed. 6.L6 Nevertheless, extreme vigilance must be maintained because once such resistance had emerged it could reappear. The emergency plan of action against resistance, which had proved effective, must be maintained and improved, as appropriate, with experience. The need to develop new insecticides \ras urgenE and extended beyond the production and laboratory testing to preparedness in the field to introduce them operationally. It was also necessary to carry out research into the mechanisms leading to or precluding resistance, using such methods as comparative genetics. Re invas ion 6.17 Reinvasion in 1983 had followed the classic paEtern of other years on the river basins of the Baou16, and Upper Sassandra in the west, and the Sota and M6 in the east. It was recalled that, in 1982, the rains had come early(in February) at a time when Bacillus th"ringlensis serotype H-14 (B.t. H-14) wasbeingusedexperimenta11y@enbeenpart1yil_dog..,o,,(having its origin within the Progranrme area). rt had been possible to control that, but excgenous reinvasion had continued, causing "importedtttransmission and rnaking resettlement in affected valleys hazardous up to 3kn from the riverside. rt also made continuous treatmenE of these rivers necessary because of the threaE of further endogenous reinvasion. 6.18 Experimental suspension of EreatmenE on the Bagoe had shown that the risk of reinvasion disappeared in September and that increase in density at the end of the rainy season could be controlled by operations on the ground, thus economizing aircraft flying Eime, fuel and insecticides. 6.19 In August 1983 a smal1 adulticiding trial using permethrin was conducted in a typical OCP reinvasion zone, the Faya River in Mali, in orderto determine the impact of ground application of a persistant adulticide toforest galleries ac the centre of the reinvasion zone of S.damnosum s.l. The effect of the single spray application of permethrin resulted in a reductionin the number of flies caught in the area without drastic effect on non-target organisms. 6.20 While it was fairly certain that Western extension would have animportant influence on exogenous reinvasion, there remained and would remainthe localized problems of endogenous reinfestation due to incomplete effecEiveness of larvicide operations. That was an additional reason forinsisting on the need for pursuing an active applied research progranrne forimproving larvicide formulations and application systems. JPC/4 Page 8 Pesticide Screening 6.21 In the 20 years of the IaIHO programme for screening of new insecticides and pesticides over 2000 insecticides from over 50 major companies had been tested in laboratories in many parts of the world. Candidate larvicides having passed the earlier testing stages were subjected to trials in the tropics wtrich until four years ago were mostly on malaria mosquito larvae. Compared with 15 years ago, when there rrere some 200 new compounds received for testing each year, there were now only two or three a year. This was because of environmental safety requirements, Ehe enormous cost of developing a single compound (US $8-12 million), and the delay for cornrnercialization (7-8 years). As well as that, sales to the health sector were only a hundredth of those to the agricultural sector and so not so attractive to industry. 6.22 However, response to I^IIIOts call at a meeting of the industry in Geneva in June 1983 after the appe arance cf resistance in S.soubrense/sanctipauli had been good, and the follow-up by circular letter had resulted in submission of 15-20 new compounds, with similar prospecEs indicated for 1984. News of rhe positive effects of some of them on blackflies resistant Eo oLher insecticides was having an encouraging influence on the industry, and collaboration had never been closer. Epidemiological Situation 6.23 Details were given of the study carried out in I50 villages in the Prograrune area. The villages had been examined before the Progranmre had started and in mnay of them, particularly in the Bougouriba Va1ley (Upper Volta) and Baou16 (Mali), mosE children were infected, in some cases 1002 by the age of 10 years. By contrast only a few cases had been found in the age-group 0-5 in 1983 and the villages with under fives still infected were on the edges of the Progranrne area, notably in the Sassandra river basin (Ivory Coast) and the Kara and M6 river basins, in the Koza Prefecture (fogo) where two infected children had been found. In contrast, inside the Programme area only one case was found in Pendie village (Upper Volta). It is estimated that some 2 millicn children born since the Progrannne started and now under the age of five had been protected. Villages in the Progranrne periphery in Benin, Ivory Coast, Mali and Togo were to be the subject of a systematic investigation by the OCP statistician. 6.24 The virtual interruption of onchocerciasis transmission in the Progranmre area raised the question of what effect this satisfactory entomological situaEion had on those people already infected. Data from 69 villages where at least three EPI surveys had been completed showed initial filarial loads varying from heavy in high-transmission areas like Bougouriba to light as in Koulpeolgo, but, in virtually all, the infecEion load index (an index of rhe number of active rrorms in a given population as revealed by skin snips) riras decreasing and was, on average, one-third after 8 years. The present interpretation of this finding is that more thar. 702 of worms had died or had become inactive since the beginning of OCP. Average fecundity of adult r4rorms vras now estimated at 10-12 years. Thus prevalence would be radically affected in 2-4 years - a trend more rapid Ehan earlier predicted. There were a few excepgions such as in northern Ghana, where vector control has been complicatei, and in Kara and part of the Bandama area in Ivory Coast which are are;s of heavy reinvasion. Epidemiological and entomological data were consistent overa1l, discrepancies being identified by factors such as re invas ion. JPC/ 4 page 9 EAC conunents 6.25 The Chairman of Ehe Expert Advisory Cormnitfee reported on the appreciable improvements to be seen in the insecticide application, surveillance of resistance, control of reinvasion, experimental reduction in the entomological surveillance network, advances in statistical analysis and the measurement of visual acuity and resettlement. 6.26 EAC considered the development of new larvicides to be of the highest priority, and particularly welcomed the progress made with a new formulation of B.t. H-14 (Bactimos) and in identifying potenEially suitable pyrethroids for OCP. It reaffirmed its agreement with the Ecological Group testing requirements for new compounds and Ehe procedures foreseen for emergency use, reconunending that trials be accelerated. 5.27 EAC had reconrnended a higher priority for adulticiding, using additional technical staff and equipment. Noting that knowledge of adulr fly behaviour was inadequate, it had reconnnended the setting-up of a working group on adult fly behaviour and Erapping. It had further recornrnended the collection of epidemiological data on the impact of reinvasion and on onchocerciasis prevalence in human populations in the OCP area. Studies should be carried out on the effects of vector conErol on reinvasion from suspected river sources in the eastern part of the proposed extension area, meanwhile assessing the capacity of national teans. EAC was pleased to see that the Director and his staff had already taken up some of the reconmenda t ions . 6.28 In reviewing epidemiological activities EAC had conrmended OCP for rhe high quality of specimens provided to investigators but reconnnended improved means for collection of O.volvulus nodules in the fie1d. Recognizing the need to folIow-up studies of ffrEJffirence of ocular lesions EAC had endorsed plans to survey 25 more villages in the OCP area. It had expressed interest in the "visual field testrr being used and was in favour of its adoption as a routine measure. 6.29 EAC had furEher recornrnended fu1l cooperaEion with TDR on irrnunodiagnostic tests and hybridoma Eechniques, and Ehe stimulation of inununological research in oCP. 6.30 EAC approved the adoption of che "force of onchocercal infection modelt'as a new statistical tool and sEressed its importance for the Long-Term StraEegy in response to a requesE for further explanation of this concept. 5.31 EAC approved the plans to carry out exploratory studies in the WesEern extension areas but emphasized the maintenance of the priorities it had established in 1982. 6.32 EAC confirmed its opinion on the technical desirability of Southern extension, but maintained Ehe proviso that tlro operational larvicides should be available before it could start. Meanwhile a great deal of necessary work could be undertaken in the area, in particular on Ehe focus of resistance already deEected in rhat area, and on the testing of new insecEicides. 6.33 EAC noted that it was not known whether there were different forms of the worm in the forest and in the savanna, whether rhe difference in the form of the disease was due to different vecEor species or whether iE was a question of human meEabolism in foresE or savanna conditions. Research on that question was a prerequisite for a long-term sErategy. Tolerance levels in terms of annual transmission poEenEial might also vary in forest and savanna zones. JPC/4 Page 10 Ecological Group ReporE 6.34 Good collaboration had continued between the Group and those responsible for monitoring within OCP, particularly the hydrobiologists. The situation with regard to river ecology was saEisfactory, and, in particular, the use of temephos had given rise to no major problems affecting non-target organisms. The information collected by the ORSTOM team over the years and by national hydrobiology teams had shown that any effects on fauna were reversible when not the whole river system was treated. 6.35 The finding of alternative methods of vecEor control was becoming more and more importanE and, in this respect, the Group was pleased with the promising situation in selection of candidate compounds. It approved trials of azamethifos and permethrin, and was optimistic about the prospects for extens ion. 6.36 With the disbanding of the ORSTOM Hydrobiological Unit in Bouak6 maintenance of the standard of monitoring work and coordination of teams of hydrobiologists required that the hydrobiology section of OCP shourd be strengthened. Monitoring of statistical data of the Programrne was also a neces s i ty. 6.37 The ecological aspects of resettlement needed careful consideration, in particular with regard to the preservation of riverine forest as an important part of the river ecosystem, and the protection of targe marmnals. Discuss ions 6.38 The JPC welcomed the advances achieved in the Prograrmne and congratulated the Director and his staff on the yearts work. RepresenEatives of donors expressed their belief in OCP as a means of primary health care, a part of overall socioeconomic development. 6.39 A donor representative, recognizing the value of applied research in the Progrartrne, recolTtrnended increased attention to reporting on fundarnental research and a more systematic approach to research within the Long-Term Strategy, including institution-strengthening with a view to devolution. Training should receive greater emphasis, with in,creased budgetary allocations being provided accordingly. The responsibility lay primarily with Participating Countries to make the necessary provisions for self-reliance in national budgets. 6.40 A donor representative suggested an "early warning systemtt against resistance. Another asked whether aerial application was stil1 the method of choice for application of insecticides. OCP replied that its application equipmenE was no\,r adapted to new insecticides. White there was also increasing complementary application on the ground by the entomorogical evaluation teams as it had become possible to suspend aerial operations for large areas over longer periods of Eime, there eras currenEly no viable alternative to the use of aircraft over such an extensive series of river systems. Research within the framework of the entomological evaluation network on the length of larval life should continue in order to help determine the ideal length of treatment cycles. JPC/4 Page 11 6.4t Regarding resistance, and in reply to another question abouE the elaboraEion of the emergency plan of action, OCP gave details of the plan that had already existed for combatting resistance in a savanna population, for which a warning system had been in operation for three years. The plan had come into effect in thettcleaning-upt'operation in southern Ivory Coast with the appearance of resistance to temephos, application of which had inrnediaEely b."., i.rferrupted and replaced by mass B.t. H-14 treatment (Teknar) using a larger capacity helicopter. Surveillance measures had been redoubled for all species in Ehe area, and replacement insecticide stocks had been built-up. Ihe plan had worked perfectly and, wiEh the inclusion of measures suggested by EAC it was now adaptable ro other situations. I,Iith Ehe increased reserves of insecticides now available it should be possible to face up to any emergency. 6.42 Representatives recognized the effectiveness of the measures to control reinvasion and agreed with EACts emphasis on research on adulticides, adult fly behaviour and sampling rnethods in that connexion. 6.43 A donor representative suggesfed Lhat the time had come for trials of adulticiding on a larger sca1e, and asked about the use of synEhetic pyrethroids for control of adulEs. OCP replied that a research programme on adulticides had started with Erials in the reinvasion area, and it would include synthetic pyrethroids and other compounds. 6.44 Donor represenEatives requested clarification on the number of children proEected by vector control and the available evidence Eo conclude that transmission had been virtually interrupted in 90% of the Prograrune area. OCP answered rhat the estimaEed number of children under the age of five years who are free of onchocerciasis infection is over 2 million. This figure was arrived at using a baseline population of 11 to 12 million in 1975, an annual population growth rate of 2.57", a proportion of 16.52 of the population being below the age of 5 years and the absence of infection in this age group tn 907. of Ehe original OCP area. 6.45 Instead of referring to underfives it is preferable to reckon protection rates in terms of the newborn (over 3.5 million in 1983) and compare the prevalence among newborns with the prevalence among the same age groups and in the same villages before control operations. In all 5548 newborns had been examined up co mid-1983. Of the three infected newborns seen in 1983, two were from reinvasion areas and only one from the central 9O7" protected area. This was the only confirmed infected newborn in this area since the beginning of vector control, cornpared to more than 200 expected cases if there had been no vector control. Future reporting will emphasize more on the protection rates among newborns instead of the prevalence among underfives, and consequently the number of protected children will increase annua 1 ly . 6.46 The sampling rnethods were based on a concentration of investigations on hyperendemic villages, with 8OZ of the villages covered in that category, and the epidemiological results are therefore particularly representative for high risk areas. Abseenteeism was relatively low given the long periods involved. In mosE villages which had three surveys, about 40-507" of the adults examined at the first survey had been seen at every subsequent survey. The consistency between the entomological results, the absence of infection of newborns and the trend in the infection load among adults is also importanE evidence of che virtual interruption of Eransmission in 9O7" of the original OCP area. 6.47 In reply to a poinE raised by a donor representative it was agreed thaE the proposed sErengthening of the Epidemiological Evaluation Unit would continue. JPC/4 page 12 6.48 A representative asked for clarification as to whether Itlestern extension would or would not provide a safeguard for the advances made in existing Progranrne area. Tn view of the compounded problems of reinvasion resistance, extension should be decided according to objective data rather than to scientific speculation. He further asked whether it was proposed keep teams in situ only for purposes of experimenting with new larvicides. the aflrl to 6.49 Another represenEative asked what would happen if encountered from the start in the Western extension area. res 1s tance e/as 6.50 A third rePresentative emphasized the importance of recognizing that extension would provide safeguards and urged that there should be no going back on the decision of the Bamako session on that point. the political will which Guinea, Mali and Senegal had displayed consistently since 1977 should receive recognition through their acceptance into an enlarged OCP. There was also a matter of protecting important investments already conrnitted in wtrat was potentially some of the richest soil in west Africa. He appealed for consistency, especially as success was within sight. 6.51 The representative of a donor said that he understood priority to have been given to maintaining the goals in the current OCP area. Another confirmed that priority had been given to completion of the second phase of OCP, including the development of new larvicides, to chemotherapy, and then Western extension. 6.52 The JPC expressed agreement with the proposal to carry out exploratory studies in the Western extension area in 1984. 6.53 A donor representaEive said knowledge on forest and savanna onchocerciasis was not yet sufficient to permit OCP to concentrate exclusively on savanna areas. Another noted thaE the Progrannne was launched with rhe objective of controlling the disease in the savanna area. 6.54 In reply to a question on research on forest onchocerciasis in relation to the Long-Term Strategy, it was stated Ehat in connexion with the extension into southern Ivory Coast in 1978, OCP had investigated vector species, ocular symptoms, socioeconomic complications and logistic problems of the forest form. A working group had met in 1982 and medical and entomological evaluation had been carried out to determine risks within the Programme area in collaboration with OCCGE. Studies were also underway in the southern extension area in Benin and Togo and contracts had been established with a Johns Hopkins University team in Liberia and another medical evaluation team in Sierra Leone. Activities were thus covering most of the forest belt in southern West Africa. Results would be reported in due course and used for elaboration of the Strategy. 6.55 A donor representative asked about the performance and composition of national hydrobiological surveillance teams, and whether they were formed also in the proposed Wesrern extension area. OCP replied Lhat there were seven teams altogether coordinated by a hydrobiologist in Ouagadougou. Standardization of data was reviewed at the annual meeLing of hydrobiologists, as well as by the Ecological Group, and by consultation with experts who were asked to carry out independent evaluations. JPC/4 Page 13 6.56 Referring to the Ecological Group position (see para 6.37) a representative asked whether resettlement was not in danger of being effected on a lfirsE come, first servedttbasis, with the earlier settlers taking the lionts share, which would not be in the interests of harmonious socioeconomic deve loprnent . 5.57 Another representative urged more sysEemaEic evaluation of the effects of resettlement in terms of deforestation, desertification and soil depletion in close collaboration with UNEP and its information services. OCP explained that it could only urge countries to make Eheir own plans for resettlement taking these aspects into account; its collaboration could be counted upon as always where modes of vector control and containment of the disease were involved. 6.58 Representatives recognized training as an essential activity in OCP that had been successfully increased ia L982/83. This represented a satisfactory trend vital as it rras to devolution. 6.59 In reply to a donor representative it was explained that training in all disciplines relevant Eo the Progranune and to the transfer of responsibilities, whether medical, entomological, epidemiological or hydrobiological, had been stepped up at various leve1s. In particular Ehe Vector Control Unit included a training officer specializing in new techniques and retraining of technicians in their use. Training was continuous noE only within OCP, but also for national sEaff through contracts rrith OCCGE and other institutes; 64 candidates had already been thus trained in 4-6 month courses, most of them entomology technicians. Medical entomologists had also been trained in higher-1eve1 courses, as had hydrobiologists and economists; 42 university-leve1 or postgraduate candidates had been trained. Mention was made of collaboration with the TDR supported centre for training of medical entomologists in the Ivory Coast. 5.60 Some 602 of the professional oCP staff vrere African nationals, including those responsible for the evaluation network and aerial operations. 6.51 In all, 237. of the persons trained since 1977 were in the professional category, 772 io the technical grades. 6.62 In response to a request for more details of the meeting of National Onchocerciasis Cornnrittees in Lom6 in 1983 and on Ehe plans for devolution, it was stated that a report on devolution was expected at the next session of JPC and it was hoped it would give a clearer picEure for a Long-Term Strategy. 6.63 It was generally appreciated that the Progrartrne management was sound and appropriate but a donor representative expressed concern Ehat there should be continuous evaluation using systems within and outside OCP. 7 PROGRESS REPORT ON LONG-TERM STRATEGY: Agenda item 5 7.L At its third session the JPC had decided Ehat a Long-Term Strategy(LtS) for OCP should be worked ouE before the completion of Phase II of the Prograrune in 1985. A progress report on the preparation of Ehe StraEegy(document JPC4.9) was introduced by OCP. JPC/4 page t4 7.2 For many years the Prograrmnets strategy had largely been based on the reconmendations made by the PAG mission in 1973. The Independent Conrnission on the long-term ProsPects of the Progrannne had made recornrnendations in 1981 on a number of specific technical and operational issues, but had not been asked to produce a comprehensive long-term strategy. The cormnittee of sponsoring Agencies (csa) laa drawn up terms of reference to guide ocp inpreparing a Long-Term Strategy which wou1d, inter alia , permit ParticipatingCountries to plan and make preparation for the transfer to them of OCp activities and would enable the donor cormnunity to make medium-term andlong-term plans for contributions to the prograrnme, and would serve as a management tool for OCP. 7.3 It was intended that the preparation of the LTS document should be the entire responsibility of the Progranrne Director and his staff. The strategy would need to be flexible in order to acconunodate new operational developments and scientific findings. Work on the LTS doeument would continue throughout 1984 in consultation with the various statutory bodies of the progranrne, andthe final version would be submitted to the JPC for consideration and approvalin December 1984. 7-4 As a baseline for the preparation of the LTS, and to high1ight areas which would need strengtheninB, a 5O-page review of itre activities iarried outby the Programme itself or under contract during the past nine years was beingprepared. This review was in six parts dealing with the organizationalhistory of OCP, entomological evaluation (including the problems of reinvasion and resistance), epidemiological evaluation, research on entomology, on the human ecology of onchocerciasis, on Ehe environmental effects of insecticides, on the development of new insecticides and on chemotherapy, the socioeconomicimpact of the Progranrne (with particular reference to the settlement of onchocerciasis-controlled areas and the increase in productivity through the reduction in blindness), and, finally, training activities. 7.5 The Chairman of the FjAC drew attention to the new definition of the oCP objective arrived at by the EAC at its fourth session in September 1983 viz.: "to eliminate onchocerciasis as a disease of public health and socioeconomic importance throughout the OCP area and to ensure that there is no recrudescence of the disease thereaftertt. 7.6 The irnportance of finding effective and inexpensive methods wherebythe Participating Countries could take over responsibility for the prograrrne, was recognized. In this connexion the CSA stressed the need to consult thosecountries in the development of the LTS from the outset, to make use of theinstitutions already existing there, and to develop their managerial capacity. 7.7 Many representatives welcomed the preparation of the LTS. rtsimportance, not only as a plan of work and as a management toor, but alsoproviding a full picture of future needs and an indication of the cost of meeting them was stressed. The world Bank suggested Lhat those donorcountries which wished to do so might each norninate a person to follow thedevelopment of the strategy and act as a sounding-board in this respect.proposal was welcomed by donors and the programrne Director. The JPCI4 PaSe 15 7.8 Some representaEives expressed a fear Ehat the sEudy on the LTS mighE overlap ,itt ttrat made by the Independent Commission. Consequently they felE iE essential for the JPC Eo become acquainEed with the Eerms of reference for ih" pr"p.rarion of the Strategy. In iesponse to Ehat request, the terms of reference were distribuEed to parEiciPants during the meeting. The Programme Director pointed out thaE the IndependenE Commission had been set the task of defining th" f,rtu." needs of t.he Programme, such as replacement larvicides, new drugs for chemotherapy, the Southern and WesEern exEensions, and devolution. IEs report was being used as a basic policy document for the LTS, the Strategy itself would seek to bring together Ehe needs already identified, and any which had emerged since Ehe IndependenE Commission rePort, in an integrated plan of work, with cost estimates. 7.9 Concern was expressed at the facE thaE subsEantial amounEs were being spenE on preparing the LTS, even though the JPC had noE allocated any sPecific funds for Ehat purpose. Questions were asked as to whether the Prografime Director, or the CSA, had authority to reallocate funds between the various lines of Ehe approved budget, wir.hout prior consulEation wiEh JPC and whether the amounE of US $ZO: OOO earmarked for consulEant.s in 1984 would be the only furEher expenditure on the LTS? 7.10 The Chairman of the CSA replied that the JPC, aE its third session, had formally requested that a Long-Term Strategy be prepared, and had stressed its imporrance and urgency. In keeping with its responsibilities for implementing the decisions of the JPC, the CSA had looked at the cost of the LTS exercise and concluded that iE would be reasonable if the exercise were conducted over a cwo-year period. The firsE year would cost much less than the second and there were no financial problerns to prevenE a start being made, so Ehe CSA had requested the DirecEor to take the necessary stePs, exercising flexibility in the utilization of his budget. Such flexibility was absolutely essential in a prograrrne such as OCP, where the need Eo cope with unforeseen occurrences was common. The Programme Director added thaE Ehe Independent Commission study had cost over US $1 000 000, whereas the LTS had so far cost only US $rrO OOO. 7.11 Some representaEives stressed that Ehe Programme objective as defined by Ehe EAC could only be achieved after devolution of responsibilities to ParEicipating Countries, and were in agreemenE Ehat such devolution must proceed gradually and cautiously. One representative ca1led for detaileC documentaEion on the manpower, institutional and financial requirements for devoluEion. A major prerequisice was informaEion and training for staff in the Participating Countries. There should be a long-term manpower Eraining plan, with specific budgeE allocaEions. Another representative suggested that it would be helpful to draw up a list of other bilateral and multilaterel assistance projects in West Africa so that the devolution of onchocerciasis control could be coordinated with that of other activities, particularly primary health care. The need Eo set up an intercountry organization when OCP was EerminaEed was acknowledge<i and it was suggesEed thaE consideration be given to the possible future role of the Organization for Coordination and Cooperation in the Control of the Major Endemic Diseases (OCCGE) in this re spec t . 8 REPORT ON ONCHOCERCIASIS CHEX.,IOTHERAPY PROJECT: Agenda item 7 8.1 lhe Onchocerciasis ChemoEherapy ProjecE was instituted at Ehe beginning of 1983, and the first progress report (document JPC4.8) was inEroduced by the Chairman of the TDR Scientific and Technical Advisory ConrnitEee who is also a member of the EAC. JPC/4 Page 16 8.2 The rnost promising short-term prospect was Ivermectin. Trials in human subjects were under eray, or about to start, in Ghana, Liberia and Senegal. Preliminary evidence suggested that Ivermectin was effective as a single-dose microfilaricide for a period of at least three months. Side effects seemed mild, and it might even interfere with reproduction in the adult worm. It should be possible to make a definite assessment of the value of the drug within the next year. 8.3 Attempts were being made to produce a less painful formulation of flubendazoLe for intramuscular administration, but trials would not be completed until mid-1985. 8.4 Three macrofilaricides had survived the animal screens prior to testing in man. One of them had been selected for phase I clinical trials at Ehe Tamale Centre. It was hoped that the effective dosage level in man could be determined by the end of 1984, but it would take five to seven years to complete all the necessary clinical trials. 8.5 One basic research group was already at full strength, and it was expected that another such group would be selected within a few months. 8.6 In 1983 the projecE had spent almost US $1 million. The estimaEe for 1984 of US $2 500 000 was lower than had originally been envisaged because noE all the planned activities were as yet under way. 8.7 In the ensuing discussion it was pointed out that a controlled trial of Ivermectin was also being conducted by Ehe Institute of African Tropical Ophthalmology in Bamako on about 100 human subjects. One representative asked wtrether the 17 patients involved in the Ivermectin trial at Tamale were sufficient. EAC explained thaE there were not yet sufficient data on the efficacy and safety of the drug to justify large-sca1e trials. It was essential to proceed with caution and increase the number of subjecEs gradually. In reply to a further question, EAC confirmed that extensive animal studies on the drug had been conducted in the USA, where it was in veterinary use. Wtrile the development of a macrofilaricide remained the long-term objective of the project, the microfilaricide Ivermectin might well prove a saEisfacEory short-term solution- 8.8 In response to a query EAC stated that it would be 18 months before a new flubendazole formulation could be tried out in man; although the active ingredient remained the same, the inactive ingredients h'ere being changed and new efficacy and safety studies would be required. 8.9 A representative asked whether the amount of US $fZ ZfO 000 budgeted for the project was 1ikely to be sPenE within the planned five-year period' The Prograrnme and EAC replied that the response from the pharmaceutical industry was greater than had been anticipated and a considerable amount of work was being done at no cost to the Programme. Clearly that represented a saving, but it was too early Eo say whether the full amount budgeted would be spenE by 1987. 9JPC/4 Page T7 REPORTS OF IVORY COAST, NIGER, TOGO AND UPPER VOLTA ON SOCIOECONOMIC DEVELOPMENT: Agenda item 10 9.1 Reports on socioeconomic development in onchocerciasis-controlled areas were presented by Ivory Coast (document JPC4.44), Niger (document JPC4.48), Togo (document JPC4.4C) and Upper Volta (docurnenE JPc4.4D). Representatives cormrended the reports for their clarity, detail and preciseness. They were becoming more relevant to the needs of rhe JPC and reflected heartening developments in Ehe controlled area. Socioeconomic development was crucial to the Progrannne, for it was this objeccive which had attracted donors in the first p1ace. 9.2 The representative of Upper Volta outlined the history of the VoIta Valleys Development Authority (.tVV) over the pasE decade. The Authority had been set up in 1974 to study, promote, coordinate, implement and supervise all activities required for fu11 economic and social development of the uninhabited or underpopulated fertile valleys of Upper Vo1ta. Unfortunately, the methods adopted for achieving this objective had been dependent not on national capabilities but on external funding. Funds had been plentiful, but badly administered. Each donor wanted Eo do things its own \ray, which produced chaos and led to disenchantment. The new Government had adopted a policy of relying essentially on the country's own resources, and using external assistance as a back-up. Big expensive projects would give way to sma1l simple projects that used appropriate technology and would lead to rapid economic and social development based on effecEive participation by the rural inhabitants. Aid was still needed, but the best aid was that which enabled the people to do without aid. 9.3 Other Participating Countries underlined their political connnitment Eo the socioeconomic development of the onchocerciasis-conErolled areas and to the redistribution of resources to rural populations so as to achieve integrated and equitable conmunity development. The African Development Bank drew aEtention to the difficulties experienced by countries in formulating convincing and bankable projects. The Bank was not at PresenE spending all the money it had available, and was most willing to assisE counEries in project formulation. 9.4 Some representatives felt that in their rePorts ParticipaEing CounEries should make more effort to show the links between the achievemenEs of OCP and their economic development, and show which projecEs had been created or expanded as a direct result of onchocerciasis control. Ttre representative of Ivory Coast replied that almost all socioeconomic development schemes in the northern and central parts of his country were closely related to OCP activities. The six sugar complexes set uP since 1977, for example, were all located close to major Lratercourses in areas where onchocerciasis used to be hyperendemic or mesoendemic. Indeed, the entire national campaign for self-sufficiency in food was a consequence of OCP's achievements. Other representatives of Participating Countries made similar comments. 9.5 The Participating Countries were asked about the position regarding land ownership in the resettlement areas. The Upper Volfa rePresentative said that a great deal of fertile land in his country was being farmed on behalf of absentee landlords. His Government intended to take sEePs to redistribute the land to the people who acEually lived on it and farmed it. The represenrative of Togo said his country had a traditional land ownership system. He drew attention to the Kara Va1ley Agricultural DeveloPment Project, under which seEtlers were each allocated five hectares of land. JPC/4 Page 18 9.6 Participating Countries called attention to parEs of the Prograrmne area where large-scale investment in development projects was endangered because onchocerciasis was not yet under control. One such project was Ehe sugar development scheme around Borotou, in the west of Ivory Coast, where control efforts were frustrated by consEant reinvasion from neighbouring Guinea. ExEensions to the Progrartrne area were essential in order to protect inves tments . 9.7 Some representatives referred to possible adverse effects of certain development schemes. Dam construction and rice-growing projects, for example, could lead to an increase in diseases such as schistosomiasis. MovemenEs of migrant workers to work on new projects could also lead to the importation of other diseases and to sociological upheavals. On the whole, however, the effects of development were undeniably favourable. 9.8 The FAO representative described the direct assistance his Organization was providing for Participating Countries in the farming and rural development of onchocerciasis-controlled areas. Technical support included advice on planningr an early-warning system for migratory locust swarms, cereal banks, price stabilization prograrmnes, and schemes ior the development of forestry and fisheries. To evaluate the increase in development activities, FAOts Remote Sensing Centre had underEaken a land use study of 130 km2 in the centre of the OCP area, using enhanced satellite imagery to compare the siEuation in 1973'5 with that in 198I-2. Detailed results should be available within a few months, and it was hoped to extend the study to the entire Progranrne area. 9.9 FAO was also providing technical support for Ehe Programme's Economic Development Unit (EDU). A farm management study had been launched, and the initial data showed improvements in income and in the qualicy of life in the resettled areas. In 1984 further such studies were planned and a workshop was to be held in Ma1i. EDU's documentalist was being briefed in Rome on the use of information systems. The initial Ehrust of the African Animal Trypanosomiasis Programme would be in West Africa, and the Programme would cooperate very closely with the EDU. Several representatives expressed appreciation of FAOrs grorving contribution to the work of OCP. 9.10 The Committee recognized the importance of the Economic Development Unit. It was considered to be a useful EooI in the elaboration of a Long-Term Strategy, carrying out field studies on problems of acceptation by the population and needs in institution-strengthening. Ministers of Health and of Planning in Participating Countries, together with UNDP representatives and those of other agencies involved should coordinate activities 1oca11y, particularly for primary health care. 9.11 Some donors cornmented that they had heard a great deal in the past about the role of the EDU, and very little abouE its achievements. It was regrettable that the Unit's chief had left the Progranme at a time when the Unit was beginning to make some real progress. It was suggested that the Unit could advise Participating Countries on environmental and ecological management during the resettlement process. The Unit could become more actively involved in collecting socioeconomic data and provide coordination, liaison and guidance. In reply to a query, the Prografltrne Director assured the Committee that the EDU was collaborating closely with the socioeconomic development section of the WHO Special Prograrmne for Research and Training in Tropical Diseases (fOn). JPCI4 page 19 9.L2 The UNDP representative described the faci.lity offered by the regional training centre for sugar industry workers set up in Port-Louis in Mauritius, in collaboration between his agency and the Government of Mauritius. So far French-speaking countries of Africa were not making sufficient use of the centre. 10. AUDIToRTS REPoRT: Agenda item 12 10.1 The report of the External Auditor, Mr Gordon Downey, (document JPC4.6), uras presented on his behalf by Mr Dobson. It dealt principally with the authority for the decision to spend $Z gOO 000 on maintaining the infrastructure in the Southern extension area, and on the need to have the OCP budget formally adopted by the JPC at each session. The Progranune Director had been shown Ehe draft report, and had agreed it was a fair summary; the finat report Eook account of the coments of the Director-General of I"IHO. 10.2 A donor representative confirmed thaE there had been a consensus at the third session of the JPC in 1982 to maintain the facilities in the Southern extension area. Donors and the Programme Director reiterated the need for the JPC to take clear budgetary decisions (see also sections 4.1 and 4.2) . 11. FINANCING OF THE ONCHOCERCIASIS CONTROL PROGRAMME: Agenda item 13 11.1 The represenEative of the World Bank welcomed a new donor, WIIO, which in addition to acting as Ehe executing agency for OCP, had pledged US $1.5 million in annual instalments of $500 000 up to the end of Phase II. IL.z The Plan of Action and Budget for 1984 provided for a total expenditure of $fZZ rnitfion in Phase II, and pledged contributions stood at approximately $110 mil1ion. However, expenditure for Ehe Prograrune in 1983 had been considerably lower than foreseen: some $16 million instead of $22 mit-1ion. Accordingly, the deficit was therefore only $6 million and not $tZ mittion as calculated at the last session. The Trust Fund would thus be in a position Eo cover all the priority activities, including the exploratory activities in the WesEern extension area recommended by EAC. 11.3 However, fluctuating exchange rates were bound to affect the actual value of income, and the effect of a number of factors on expenditure, which had had a favourable inftuence in 1983, were also unforseeable. Supplementary contributions to help cover the remaining deficit would give Ehe financial stability necessary to ensure Ehe conEinued efficacy of OCP in the field and to conscitute a reserve for Ehe transition from Phase II to Phase III. The reserve should be $14-17 million, representing six to eight monthst operation. 11.4 fn considering the financing of Phase III particular attention should be given Eo Ehe Long-Term Strategy and the application of the results of the progress in research reported at the current session. 11.5 The represenEaEive of France pledged a supplementary contribution of FF 2 million for 1984 - an increase of FFI million over that pledged at the Bamako session in view of the proposed Western extension - in addition to the regular annual contribution of FF5 million. JPC/4 page 20 11.6 The representative of the United States of America pledged $Z.S miilion for the coming year in accordance with its decision the preceding year to increase its regular contribution of $2 million by 252. 11.7 The representative of Canada announced a supplementary contribution of Can.$ 50 000, bringing the total 1984 contribution, subject to parliamentary approval, to C.$f fSO OOO. Canada could not comrnit itself beyond Phase II until the Long-Term Strategy had been prepared with estimates of costs. An explanation was requested of the increase in the World Bank estimates of the reserve, which had been set at $10 million at the last session of JPC. The representative of the World Bank explained that it would be a sound financial practice to have a reserve covering eight months of operations in view of bridging the gap between the second and third phase. 11.8 The representative of the Netherlands said that its last contribution of Dutch guilders 7 rnillion had been transferred in 1983, but was pleased to announce that a modest supplementary contribution was being considered and would be discussed with the World Bank. 11.9 The representaEive of the United Kingdom announced a contribution of f 600 000 for 1984. Commitments for Phase III would depend on the Long-Term Strategy. With regard to the proposed reserve, confirmation was sought and given that no sums had yet been accumulated for the reserve, so that with the remaining deficit of $6 million, a total of $ZO million was sought in supplementary contributions. 11.I0 The represenEative of Italy said that the exact ltalian contribution in 1984 could not be specified but it was hoped to be able to continue support, in particular in vievr of the Western extension, at a level similar to that in 1983, when $Z mittion had been transferred. 11.11 The representative of the Federal Republic of Germany announced a supplementary contribution of DM 1 million in 1984 in view of the need to prepare the Long-Term Strategy and to intensify collaboration with the chemical industry, paying particular attention to reducing rhe effects of insecticides on non-target organisms. 11.12 The representative II had been increased from Kuwait announced that its contribution for Phase million ro $7.5 million. of $o 11.13 In reply to a question on the prospects of attracting new donors, the representative of I^Iorld Bank said that it should be possible ro broaden the basis of support for OCP in planning for Phase III using a strategy that canvassed not only new potential sources such as the Scandinavian and Arab Gulf countries which were among the targets of current fund-raising hopes, but also among research institutions and foundations, for example. t2. PLAN OF ACTION AND BUDGET OF THE PROGRAI'{ME FOR 1984: Agenda item 11 L2.l The Plan of Action and Budget for 1984 (document JPC4.5 (OCP/83.1)) were introduced by OCP. A clearer and more logical form of presentation had been adopted, in close collaboration with the World Bank. The proposed 1984 budget of US $Ztr ZOZ 000 represented an increase of US $f 000 000 or 7Z over the 1983 budget. The Connnittee was shown a diagram which gave a breakdown of the 1984 budget by progrannne activity and by category of expenditure. JPCI4 Page 2 I L2.2 Donors pointed out that although the proposed 1984 budget represented an increase of only 7Z over the approved 1983 budget, it represented an increase of some 502 over the acEual 1983 expenditure as intimated by the World Bank (see section 11.2). OCP confirmed that, because some activities had not got under way as quickly as anticipaEed, there were substantial savings on iEs 1983 budget, e.g. US $637 000 for the Western extension, US $ 2 600 000 for research on chemotherapy, and US $800 000 for applied research. It was also expected thaE US $400 000 would be saved on salaries because of vacant posts, and that the rise in value of the US dollar over the main PrograrrEne currencies would produce a saving of US $f aOO 000, making a roral saving in 1983 of some US $5.8 million. The difference of US $1 660 000 between the 1983 and 1984 approved budgets was, grosso modo, accounted for by an increase of us $oas ooo ior the wesiern extenEiEilE$728 000 for the Long-Term Strategy, and an increase of US $f A+Z 000 for the purchase of insecticides, and a decrease of US $SSO OOO in the budget for chemotherapy. The Programme Director added that in 1983 OCP had enjoyed particularly favourable weather conditions, which had kept costs downl also a number of activities planned in 1983 and not yet carried out would be implemented in 1984. He needed some kind of financial reserve as a cushion against adverse weather conditions, resistance and reinvasion problems, and currency fluctuations. Some representetives felt that the proposed budget gave the Prograrnrne Director too large a financial cushion, and suggested that some other form of contingency mechanism should be developed to provide the necessary flexibil ity. L2.3 A donor drew attention to some major differences between proposed and actual expenditure for 1982, and urged that OCP, either in its budget document or in the oral presentation to the JPC5, should highlight and explain any significant differences of that nature. L2.4 Several representaEives expressed concern at the upward trend in administrative costs, and one urged that a distinction be made betrreen administrative and support costs. Another questioned the need for the new professional posts indicated in Table 25. The Prograrmne Director replied that administrative costs would have remained stable in 1984 but for Ehe study on the Long-Term Strategy requested by the JPC. The new professional posts referred to had been recormnended by Ehe Expert Advisory Cormnittee and agreed to by rhe JPC in 1982. L2.5 Attention was drawn to the apparent contradiction of placing the professional staff of the Liaison Office in Geneva in the budget line for the Office of the Programne Director in Ouagadougou. The Programme Director promised to review the practice. 12.6 It was felt that the Prograrrnets statistician should have full-time access to a microcomputer. OCP announced that such equipment had already been ordered. L2.7 Some representatives expressed concern aE the small proporEion of the budget allocated for training, increased by only 4.77., it view of the growing emphasis on devolution. OCP replied that rhe figure of US $Z:O OOO related only to fellowships, and did not rePresent the entire allocation for training. Some training activities were included in the budget for the I,{estern extension, the Prograrmne conducted a great deal of in-service training, and some help was also received from the Regional Office for Africa and from Headquarters. JPC/4 Page 22 12.8 A number of donors wondered why expenditure on vector control wasbeing increased from 53.92 to 56.22 of the total budget at a time when 902 ofthe initial Progrannne area was under effective onchocerciasis control. ocp replied that costs were falling steadily in most of the inirial prograrnme area, but the saving r^ras more than offset by cost increases in the areas subject to resistance or reinvasion and by the cost of operations in the extension area in lvory Coast. The net increase of US $ 1 462 OOO in the l9g4budget for vector control was more than accounted for by an increase of US $1842 000 in the allocation for insecticides. The needs for 1984 had been calculated on the basis of estimated expenditure in 1983, which was already US $SSO OOO over the budget because of resistance-related problems, and in theIight of the need to replenish dwindling stocks of Abate and build-up stocks of replacement larvicides as a safeguard against further resistance problems. The Progranrme Director confirmed that OCPrs expenditure would by now have beendropping substantially but for its recent conrnitment to control in southernIvory Coast. l2-9 The JPC reaffirmed its agreemenr to the principle of carrying out the western extension as soon as funds became available. However, it-waJ agreedthat some exploratory work could be carried out in the Western extension zone, on the identification of sources of reinvasion and on susceptibility testing,but such studies should not be taken as a conrnitment to carry out vector control operations there. The observer from Senegal drew attention to certain socioeconomic develoPment projects near his countiyrs frontier with Mali which were in grave danger because of onchocerciasis. It would be helpful if OCp could conduct susceptibility tests in that area. 12.10 one representative questioned the level of expenditure on basic chemotheraPy research groups and the amount of assistance the progranrme wasgiving to the pharmaceutical industry. oCP stressed that it was receiving far more than it was giving. The amounts charged by certain companies for testing compounds were well below the real cost. The Prograrnme Director confirmedthat the post of SecreLary to the Steering Cormnittee of the Onchocerciasis chemotherapy Project was included in the budget for that pro-iect. 12.11 In reply to a request for clarification, OCP said the 1984 allocationfor operational travel for the Economic Development Unit, reduced from $15 OO0to $13 000, was based on estimated expenditure in the current year. The allocation of $rO 000 for technical equipment was for the renewal of some ofthe Unitts equipment and for the purchase of tape recorders for use in field survevs. 12.12 The FAo representative, asked about his Organizationts financial contribution to the Progranme, pointed out that FAo \./as not a funding organization but a technical agency. Its staff devoted a great deal of tirneto development projects in the ocp area (see also sections 9.g and 9.9).Direct FAO/UNDP assistance in planning in the area rotalled some $l 5OO 0OOPer annum- FAO also administered a number of trusE fund projects. Two suchprojecrs for tractor mechanization in Ghana and Upper Volta in 1983-g4, fundedby the Italian Government, represented some $fO OOO OOO. 12.13 The JPC formally approved ocprs plan of Acrion and Budget for 19g4. JPC/4 Page 23 13. OTHER MATTERS: Agenda itern 14 Proposed Schedule of Meetings 13.1 Attention was drawn to a proposal, annexed Eo the rePort of CSA (document JPC4.3), to reschedule meetings so that the JPC session would be held in July instead of December from 1986 onwards. Ihe EAC would convene in June in 1984 and 1985 and be moved forward to March for 1986 and subsequent years. This would greatly ease the pressure on the Programme which currently had to prepare reports during the period of intense activity in the field- Apart from allowing such report-writing to to be done in the dry season such a change in schedule would also allow a complete yearrs data to be presented to Ehe statutory bodies. L3.2 It was recognized that there wculd be some administrative and financial inconvenience as a result of the shift, but it was generally recognized thaE it was necessary in Ehe interests of efficacy in the operations of OCP. In particular the World Bank recognized the necessity of adapting the financial period of OCP and the budget presentation accordinglY, and the Director of OCP guaranteed the collaboration of its administrative and financial staff. Contingency mechanisms were discussed, as was the possibility of adopting a biennial budget cycle. Terms of Reference (for the Long-Term Strategy) 13.3 It was agreed that further proposals to the Terms of Reference for the Long-Term Strategy would be acceptable, but the time factor would rnake it difficult to increase the scope of the terms of reference in any way. Revision of the Long-Term Strategy would be continual to cope with the evolution of the Prograrrme into a fourth and, possibly, a fifth financial phase. 13.4 A donor representative sought confirmation thaE OCP was, according to its original mandate, concerned only with the savanna form of onchocerciasis. Flexibility of recruitment procedures 13.5 The Director reported that the composition of staff of OCP, currently 806 (including 56 professionals and 750 general service staff) depended on numbers of applicants from each country and to their selecEion according to criteria of quality and geographical distribution. 13.6 The WIIO Legal Counsel explained the rules and regulations of llllO, the executing agency, which had to be applied. He supported the statement of the DirecEor of OCP, adding that only the Director-General of WHO had the right to make exceptions to the criterion of geographical distribution. He could, for example, authorize the recruitment of a person from an over-represented country on grounds of professional qualification. 13.7 It was pointed out that the latter type of exception could apply to technical field project staff. The interest was expressed in having a higher proportion of staff representing the Participating Countries in a Progranune approaching devolution. JPC/4 Page 24 13.8 rt was agreed that the Director of ocp should consult the Director-General of wHo on possible measures to free the recruitment procedures from the quota constraints, and that the matter be put before thegoverning bodies of WHO. Final Corrnuniqu6 13.9 At the conclusion of its discussions the JpCfinal conununiqu6: approved the following "(a) The JPC expressed unanimous satisfaction with the achievements of rhe onchocerciasis control Progranrne. Not only has there been a dramatic reduction in the incidence and severity of the disease amongst adults but, in 9OZ of the original Programne area, the children born since operations began are without risk of contracting the disease. (b) Ihe JPC also conunended the Prograrmne on its success in containing reinvasion and controlling the spread of resistance. It welcomed the progress towards developing additional larvicides and the response of the pharmaceutical industry to the Onchocerciasis Chemocherapy Project. (c) Reaffirming its intention to maintain the progress achieved, the JPC recalled the three priorities adopted at its Ehird session, viz. larvicide development, chemotherapy and I^Iestern extension. It also confirmed thaE control in the Southern exEension area should not be started ur:til two reserve, operational larvicides were available. (d) The JPC welcomed the action taken towards preparing a Long-Term Stretegy for the Prograrmne and took note of the terms of reference drawn up by the Conrnittee of Sponsoring Agencies. It underlined the importance of having such a strategy on which to base decisions for the financial aspects of the third phase and beyond, particularly in respecE to the WesEern extension and devolution. The importance of involving Participating Countries and Donors in the exercise was stressed. (e) The JPC eras encouraged at the progress in the resettlement and cultivation of controlled river valleys and in the general socioeconomic development of the area as reported by the Participating Countries. It ca11ed for Ehe Economic Development Unit of the Prograrmne to be more active in collaboration with FAO and other agencies in assisting the countries where necessary in coordinating their activities in the Programme area. (f) The JPC approved the 1984 Budget for the Prograrnme of US $Zq ZOZ OOO. This included the commencement of exploratory work in the Western extension area. It invited Ehe Secretariat to submit at its next session a proposal for a mechanism to meet contingencies. (g) A number of Donors announced rheir intention to augment their contributions to the second phase. The World Bank reported that, in view of the additional contributions announced to date the level of funding secured was approximately us $110 million for the second phase compared with an estimated requirement of US $116 mil1ion. In view of the anticipated requirements for the third phase and the need Eo have a reserve in hand at the end of the second phase, the Bank was encouraged to search for additional donors. (h) The JpC accepted in principle a December to mid-year from 1986 onwards. JPC/4 page 25 proposal to reschedule the JpC from (i) The JPC agreed to hold 1984 at the kind inviration of its next meeting in Niamey from 3 to 5 December the Government of Niger.tt 13.10 The JPC agreed to hold its fifrh session in Niamey from 3 to 6 December 1984 at the kind invitation of the Government of Niger. Place and Date of the fifth session of rhe JPC CLOSURE OF THE FOURTH SESSION: Agenda item 15 1 The Chairman declared the session closed. L4 L4 JPC/4 Page 26 ANNEX I 1. ) 3. 4. 5. 6. 7. 8. 9. 10 AGENDA Opening of the session Election of Officers Adoption of the Agenda Adoption of Ehe report on the third session of the JPC Report of the Cormnittee of Sponsoring Agencies Progress report of the World Health Organization for 1983 Report on Onchocerciasis Chemotherapy Project Report of the Expert Advisory Conunittee Progress report on Long-Term Strategy Reports of Ivory Coast, Niger, Togo and Upper Volta on socioeconomic development Plan of Action and Budget of the Progranune for 1984 Auditor I s Report Financing of the Onchocerciasis Control Progranune Other maEters Closure of the fourth session 11. L2. 13. L4. 15. LIST OF PARTICIPANTS PARTICIPATING GOVERNMENTS Son Excellence le Commandant Philippe Akpo Ministre de la Sant6 Publique M. Aquilas S. Doumatey Sec16taire administratif, Comit6 naEional de AdministraEeur Sant6 PubLique Lutte conEre ltOnchocercose, Ivory Coast Dr F61ix SErie Inspecteur g6n6ral de la Sant6, MinisElre de la SanE6 publique et de la Popu lat ion Dr Ibrahim Kon6 Directeur des R6lations internationales, MinistEre de la Sant6 publique de 1a Population JPC/4 page 27 ANNEX II et M. Seydou Traor6 Sous-Directeur des Investissements Ghana His Excellency Dr Charles Yaw Buadu SecreEary of Health Mr James Kojo Fosu Executive Director, NaEional Onchocerciasis SecretariaE Upper VolEa Son Excellence 1e Cormnandant Pharmacien Abdoul-Sa1am Kabor6 Ministre de la Santd publique Dr Alain Dominique Zoubga 56creEaire g6n6ra1, MinistEre de 1a Sant6 publique M. Cora Mathias BaE,ab6 Conseiller technique, Direction g6n€rale de IrAVV Mme GeorgetEe Combary AtEach6e dtArnbassade, charg6e des Affaires sociales, Ambassade de Haute-Vo1ta, Paris Peoplels Reoublic of Benin JPC/4 Page 28 ANNEX II Mal i Son Excellence 1e Dr NrGoIo Traor6 Ministre de la Sant6 publique et des Affaires sociales M. Denis Traor6 Directeur, Ce1lule Onchocercose, MinistEre du Plan Dr Zakaria M. Maiga Division Epiddmiologie et Prevention, MinistEre de 1a Sant6 publique et des Affaires sociales M. S6kou Traor6 DirecEeur adjoint, Ce1lu1e Onchocercose, MinistEre du Plan Niger Son Excellence le Dr Moudi Abdou Ministre de 1a Sant6 publique et des Affaires sociales Dr Alfa Ibrahim Ciss6 Directeur de lrHygiEne et de la M6decine mobile M. Mayaou Harouna Direction des Programmes et du Plan, MinistEre du Plan Togo Son Excellence Mr Hodabalo Bodjona Ministre de la Sant6 publique et des Affaires sociales Dr Tchasseu Karsa Directeur, Division Epid6miologie, MinistEre de la Sant6 publique et des Affaires sociales CONTRIBUTING PARTIES Federal Repub lic of Germany Mr Erhard O.G. Voelzke Prograrmne Officer, Federal Ministry for Economic Cooperation JPCI4 Page 29 ANNEX II Saudi Arabia Mr Ayed Al-Jeaid Economic Adviser, Ministry of Finance, Intr. Economic Relation Department Dr Ali Mohamed Shata Eye Specialist, Zahir Hospital African Develo t BANK (ADB) Dr Berhane Teoume-Lessane Principal Health Expert Belgium Mme Suzanne Vervalcke Directeur dtAdninisEration de la Coopdration multi1at6rale Dr Jean J.P. Mahaut Medecin, MinistEre de la Coop6ration au Ddveloppement Professor Dr P. Janssens Canada Mrs Elizabeth Racicot Section Head, UN Progranunes Division, MultilateraI Programmes Branch Canadian International Development Agency Mr Jean Couturier Senior Programne Officer, UN Progranunes Division, MuItilateral Programnes Branch, Canadian International Development Agency United States of America Dr Joe L. Stockard Medical Officer, Health and NutriEion Division, Bureau for Africa, Agency for Interna t ional DeveloPment JPCI4 page 30 ANMX II France M. Robert Thomas (Chairman, JPC) Directeur adjoint des Projets de D6veloppement, MinistEre des Relations ext6rieures, Coop6ration et D6veloppement M. Ren6 Courty Sous-Directeur de 1a Coordination l la Direction des Projets de D6veloppement, Ministlre des Relations ext6rieures, Coopdration et D6veloppement Dr Bernard Durand Sous-Directeur de la Sant6 I la Direction des Projets de D6veloppement, MinistEre des Relations ext€rieures, Coop€ration et D6veloppement Dr Bruno Floury Charg6 de Mission, Sous-Direction de la Sant6 de 1a Direction des Projets de D6veloppement, MinistEre des Relations ext6rieures I taly Dr Guido Bertolaso Medical Section, DepartnenE for Development, Cooperation, Ministry of Foreign Affairs Kuwait Dr Mustapha Kadhi Adviser, Kuwait Fund for Arab Economic Development Dr Talaat Zaghloul Head, Insect and Rodent Control Department, Ministry of Health Dr Abdul-Aziz Alatzi Deputy Director, Infectious Diseases Hospital Nether lands Mr WiIlem Jan Veenstra Coordinator, Special Prograrmnes, Directorate General International Cooperation, Ministry of Foreign Affairs Hr Klaas G. Wit Public Health Adviser, Directorate General International Cooperation, Ministry of Foreign Affairs JPC /4 Page 31 ANNEX II United Kingdom of Great Britain and Northern Ireland Mr William Hobman Head of Eastern and Western Africa DePartment, Overseas Development Adminis trat ion Switzer land l,lme H61Ene Attinger Collaboratrice, Section Afrique occidentale, Direction de 1a Coop6ration au D6veloppement et de lrAide humanitaire Dr Andr6 C. Rougemont Facult6 de M6decine, Geneva SPONSORING AGENCIES Food and Agriculture organization of the United ttations (fAp) Mr Mowbray S.O. Nicholas Director, AgriculEural Services Division, Rome, Italy Mr C.G. Groom Senior Programme and Planning Officer, Agricultural Services Division, Rome, ItaIy World Bank Mr Bi1eel Alisbah DirecEor, West Africa Prograrnmes, Washington, USA Mr Jean-Paul DaiIly Onchocerciasis Coordinator, LIest Africa Region, Washington, USA Mr Lawrence Earle Hinkle Division Chief , Country Progranrmes I, West Africa Region, I.Iashington, USA Dr Bernhard Liese Deputy Division Chief, Population and Nutrition Department, Washington, USA Mr Dirk Mattheisen Onchocerciasis Project, Country Prograrmnes I, I.Iest Africa Region, Weshington USA JPC/4 Page 32 ANNEX II United Nations el nt Pro (UNDP ) Mr Salif NrDiaye chief, Division for Regional Projects, Regional Bureau for Africa, New york, USA Mrs Jocelline Baaile-Finley Regional ProjectC Administrator, Regional Bureau for Africa, New York, USA World Health Orgdnization (WttO) Dr Ebrahim M. Samba Director, Onchocf,rciasis Control Programme, Ouagadougou, Upper Volta Dr F.G. Glokpor Regional Officer I negional Office for Africa, Brazzaville, Congo WllO SecreEariaE Dr N.G. Gratz DirecEor, Division of Vector Biology and Control, WHO/HQ Mr A. Groenendijlk Director, Divisilon of Budget and Finance, wHo/HQ Mr J. Ling Director, Divis Dr A.O. Lucas Director, Speci wHo/HQ I ilo, of Public Information and Education for Health, WHO/HQ I I{1 l.ogt"*ne for Research and Training in Tropical Diseases I , Dr C.-H. Vignes i Legal Counsel, tftto/uq IDrO. Ba IParasitologist, lfpiaemiological Evaluarion Unit, Onchocerciasis ControlProgramrne I t Dr I{. G. Baker I Consultant, oCelliaison office, wllo/HQ I Dr D.A.T. Baldrf Entomologist, V{ctor Control Unit, Onchocerciasis Control Progranrne tDr O.W. Christefsen Consultant, OCP Liaison Office, WHO/HQ JPCI4 page 33 ANNEX II Mr G.B. Cliff Chief, Aerial Operations, Vector Control Unit, Onchocerciasis Control Programme Mr B. Colussa Technician, Project ICP/MPD/007, Bamako Dr B.O.L. Duke Chief, Filarial Infections, Malaria and Parasitic Diseases Programme, WHO/HQ Mr A.K. Equagoo Budget and Finance Officer, Onchocerciasis Control Progranrne Mr J. Grey-Johnson Information Officer, Onchocerciasis Control Programme Dr J. Grunewald Entomologist, VecEor Control Unit, Onchocerciasis Control Progranme Dr M. Karam Parasitologist, Epidemiological Evaluation Unit, Onchocerciasis Control Progranrre Mr J.D.M. Marr, OCP Liaison Officer, I,HO/HQ Dr J. Mouchet Consul tant Mr G.A. Pauquet Chief, Administration and Management, Onchocerciasis Control Prograrnme Dr B. Philippon Chief, Vector Control Unit, Onchocerciasis Control Programme Miss M.L. Ravelonanosy Progranrne Officer, Onchocerciasis Control Progranrme Mr J. Renrne Statistician, Onchocerciasis Control Progranrne Dr R. Subra Entomologist, Vector Control Unit, Onchocerciasis Control Progranrne Dr R. Yang Chief, Epidemiological EvaluaEion Unit, Onchocerciasis Control Progranrne Mr D.G. Zerbo Entornologist, Vector Control Unit, Onchocerciasis Control Prograrnrne EX OFFICIO PARTICIPANTS Expert Advisory ConrnriEtee (EAc) Professor Dr Thierry A. Freyvogel Director, Swiss Tropical Institute, Bas1e, Switzerland Dr Alexander B. Morrison Assistant Deputy Minister, Health ProtecEion Branch, Ottawa, Canada JPC/4 PaSe 34 ANNEX II E"olr€tr.1!r4yp Professor Dr Jan II. Koeman Department of Toxicology, AgriculEural University, Wageningen, External AudiEor Mr Tony Dobsori External Audi4, Exchequer & Audit Department, London IMr Richard Gadwood External Audit, c/o WltO/HQ OBSERVERS Comrnission of lErrropean Conmrunities (Cnc) Ne ther lands Mr Roger Vise Fonct ionnaire tl t, Direction g6n6rale du D6veIoppemenE, Bruxelles Guinea Itr Mohamed Kader Directeur natIona1 des Services de Pr6vention, MinistEre de 1a Sant6 publique Dr Yaya Kass6 Directeur, Prpjet 0nchocercose, Minist0re de 1a SantE publique Sene ga 1 Son Excellenc Ministre de 1 Mons ier-rr Mamadou Diop Sant6 pub I ique Baye te hnique, MinistEre de 1a Sant6 publique Dr Alassane Conseiller Office for Sc entific and Technical Research Overseas (ORSTOM) Mr Max Damie Responsable J M. ce.rnri., Idil D6partement "Sant6", Paris t I I I i I ) JPC/4 Page 35 ANNEX III ONCHOCERCIASIS FUND JANUARY L, tg74 TO SEPTEMBER 30, 1983(expressed in millions of US dollars) RECEIPTS PHASE I(r974-79) PHASE IIJanuary 1, 1980 - SepE .30, 1983 TOTAL January L, L974 to Sept.30, 1983 Contributions: African Development Bank Be1 gium Canada France Germany, Federal Republic of Iraq Italy Ivory Coast Japan Kuwa i t Nether lands Norway OPEC Fund for International Deve lopment A1 Sabah Foundation Saudi Arabia Swi tzer 1 and United Kingdom of Great Britain and Northern Ireland UNDP United States of America I.lHo World Bank Sub-Total Income from Investment Total Disbursements: Advances to WHO Balance carried forward ZlL L.4 t.sl 3.5 3.4 t:, 2.0 1.1 2.4/L 3.3 5.8 5.2 0.05 6.3 4.0 11 .3 2.0 10. L7. 3. 2 3 6 9 8 0 2 2 11 1.5 0. 18 9.0 5.2 8.0 1.9 16 .3 13 .5 6 9 8 2 4 05 0 4 3 0 8 3 2.4/L 5.0 6.0 6.5 1.1 o.r 33tL L.5 /4 0 .08 5.7 5.2 5.6 0.5/5 7.7 2.4 L.414 8.6 - -/! 7.5o.o 62.0 1.5 71.0 6.4 133.0 7.9 63 .5 s6.213 7,3 77 .4 58.0 L9.4 140 .9 LL4.2 26.7 /L t)l= /2/t /2 A portion of this amount was received in 1980 Contribution received a year late Includes US $4 million for first quarrer of 1980 Further contribution for 1983 received or to be received after 30 Septernber 1983 UNDP previous contributions through projects directly executed by wHo - us $z.o m. (1973-1978)