! II i I a JOINT COORDINATING COMMITTEE ONCHOCERCIASIS CONIR.OL PROGRA}'IME IN THE VOLTA RIVER BASIN AREA Third session, Ouagadougou, 1-2 December 1976 INDEPENDENT CITATRMAN'S REPORT OF PROCEEDINGS The Ehird session of the Joint Coordinating Cormrittee for the Onchocerciasis Control prograrme in the Volta River Basin area was held at the Pa1ais du Conseil consultatif national pour le Renouveau (CCm), Ouagadougou, on 1 and 2 December 1976. Itre session was aEtended by representatives of the Governments of Belgitrm, Benin, Canada, France, Federal Republic of Gemany, Ghana, Ivory Coast, Japan, Kuruait, Mali, Netherlands, Niger, Togo, United Kingdom of Great Britain and Northern Ireland, United States of America, Upper Volta, the African Development Bank (ADB), the United Nations Development Prograrmre (UllOp), the Food and Agriculrure Organization of the United Nations (feO), the World Bank (IBRD) and the World Health organization (mro). The session was also attended by the Chairuan of the Scientific and Technical Advisory Corunittee (SfeC), the Secretary of the Economic Development Advisory panel (nOgp), Mr S. Kpognon, Alternate Executive Director, World Bank, and observers fro'm the Conmission of the European Comnunities (CfC), the Organisation de Coordination et de Coop6ration pour 1a Lutte contre les Grandes End6mies (OCCGE), and the Office pour Ia Recherche scientifique et technique outre-mer (ORSTOM) of the French Government.. A list of participants is attached as Annex 2. The session was opened by His Excellency General El Haj Aboubakar Sangoul6 Lamizana, president of the Republic of Upper Volta, in the Presence of high authorities of the Republic and members of the diplomatic corPs. 1,he Independent Chairman, Dr M. G. Candau, thanked the President of the Republic for honouring the Comittee with his presence and welcomed the guests and participants. In his introductory staterrEnt (attached as Annex 4), Dr Candau observed that the results of OCPrs first two years of control activities bore witness to the satisfactory Progress being made ,towards the hr-man, social and economic development of the areas freed from transmission of onchocerciasj.s. A recent visit to the seven Participating Countries had convinced him of the Governmentsr general satisfaction with the Programe. However, the preoccuPati-on of certain Governments with the possible extension of the Programe area suggested that the question merited careful examination in the near future. Another subject of concern was the reinvasion of part of the Programe area. The Independent Chairnan concluded by enphasizing the need to make ful1 use of the international scientific conrnunity to intensify research. His Excellency the presidenE of the Republic of Upper Volta delivered an address (attached as Annex 3) in which he described the Progranrme as a fine example of a concerted international effort unique in its concern with both health and economic development. The difficulties overcome and results achieved gave grounds for optimism that transmission could be checked; he therefore called for research to focus on chemotherapy in the hope of curing those already stricken by the disease. Paying tribute to the Contributing Parties and Sponsoring Agencies for their support, he pointed out thaE the Participating Countries would each have their own approach to the economic and social developuent of the reclaimed areas, and that the Comitteers session provided theo with an opportunity for supervision of the Progreme and for concerted action. At the conclusion of his address, the meeting was susPended to permit His Excellency the President and other guests to withdraw. After the resrmption, the Independent Chairman read out a cable received from Norway in which the Governoent confirmed a Norwegian contribution to the Onchocerciasis Fund, subject to parliamentary approval, of 2.75 rrLlrlLon iVorwegian Kroner in each of the years 1978 and L979 (a iot"l of some US$ 1 niLlion). fhe Norwegian Government wenE on to exPress its great interest in the programe, attaching particular importance to the asPects of economic development and social justice in the areas freed from onchocerciasis. The rndependent Chairman was authorized to express the Cmitteers gratitude to the Norwegian Government. Page 2 ELECTION OF NIE VICE.CHAIRMAN OF THE SESSION Recalling the procedure adopted at the Corrnitteers first and second sessions, theIndependent Chairman proposed His Excellency Mr Salia Sanon, Minister for Rural Development and Chairman of the National onchocerciasis Corunittee of Upper Volta, as the Vice-Chairman forthe duration of the session. This proposal was approved by acclamation. ADOPTION OF THE AGENDA The provisional agenda (docr:ment JCC3.1) was adopted without amendment (see Annex 1). PROGRESS REPORT OF THE WORLD HEAIIH ORGANIZATION FOR 1976 ffiIOrs progress report for the year to September 1976 (document JCC3.2) was introduced bythe Programre Director, who also descrlbed developments since that date. The programme had maintained and developed all its activities. Larviciding operations had continued throughoutthe Phase r area, where 93 weekly ci-rcuits had now been completed, and since 15 January 1976in Phase II (46 weekly circuits). Transmi.ssion had been considerably reduced or interruptedin the treated area, enabling spraying to be halted for much of 1976 in large sections of theBlack Voita, Como6 and upper Leraba basins. After 22 months of larviciding, and although theorigin of the adult blackflies reinfesting a sma1l part of phase r had not yet been determined,the Prograrmne Di-rector felt that reasonable optimism was justified. Preparations for the start of larviciding in phase III in February 1977 had, been under way since eatly 1976. The three new sectors and to subsectors had been made operati.onal, andcollection of the necessary entomological, hydrological and flight survey data was being completed. A new air company would assume responsibility for all aerial operations inJanuary 1977. The work of the two parasitological evaluation teams and the ophthalmological team was ontarget; simple examinations had covered 156 villages and 38 52t people, detailed examinations31 villages and 8201 people. By the end of 1977, ary1e baseline medical data would be stored on comPuter at WHO headquarters to assess the effects of vector control. The Economic Development UniE had been established in February 1976 with the recrui.tment of its chief. Following visits to the Partlcipating countries, the unit had begun a detailedinventory of all economic and social development projects in progress or planned in the area, and had prepared a questionnaire for use in updating Ehe inventory. The work of the Administrative Services Unit had included the reorganization of thetransPort system, including a neEwork for the maintenance and repair of over 2Oo vehicles.The Progranrne now had 35 professional and 57o general service staff of 20 nationalities; 95.6%of the staff in the Programne area were nationals of the seven participating CountrLes, o.7%from other African countries, and 3.7% from outside Africa. The JCC heard details of training activities, which continued to be a major preoccupation of the Prograumre. A11 the 1O entomologi.cal technicians trained under contract with OCCGE in1975'1976 had been recruiEed and were now the Phase III subsector heads. oRSToM had continuedto play a valuable role in the training of entomologists and entomological technicians fromthe Participating Countries. Inforur'ation on the Prograrmne was di.sseminated through a quarterly report and the monthly newsletter oNcIlo-FLASH, which had a circulation of over a thousand. A number of journalists and two television Eeams had reported on ocp activities during the year. The Chief of the Vector Control Unit provided details of the various entomological activities. Describing the different treatment circuits carried ouE in the rainy and dry seasons, he reported that, throughout the Phase I and Phase II areas, the results weregenerally encouraging and in some sections of river it had proved possible to interrupttreatment for a period. Page 3 By use of wa1l 11aps, he shosed first the general epideoiological situation before Ehe start of control operations in Phases I and II and then the Present potential transmission recorded in these areas by the evaluation teams. In 1976, over the major Part of the controlled area, transmission had been either interruPted cmpletely or reduced to a frhypoendemicrr level. Only in the reinvasion zone (oap attached as Annex 7) and the Bui stretch of the Black Volta had a I'mesoendemictt level been recorded. In the norEhern part of the phase II area results had been excellent to the end of November. Throughout August, for example, no more than three Simulirm per week had been caught at over 50 catching Points. The progress of studies on reinvasion was outlined. Full use had been made of consul- tants and collaborating laboratories. Daily catching points had been established in the suspect area in order to provide regular information. To establish Ehe identity of the migrant females r eggs had been obtained from theo and l-arvae hatched out for cytoEaxonoEic examinaEion. Use had subsequently been made of recently discovered morphological characteristics to differentiate the adults. Larvae, PuPae and adults had been collected for chemlcal analysis to assist in identifying the possible source of the invading flies. Areas outside the Prograurme area had been surveyed. Using an aircraft equiPPed with a trapping device and Doppler radar, an expert on lnsect flight had studied local meteorological conditions influencing fly Eovement. The lower Bandama had been treated for a period but, while remarkable results were obtained locally, this did not affect the reinvasion problem. However, it did show what could be achieved at minimal cost against a differenE species of the S. damnosum complex. As the invading flies were shown to be of the 'rsavannail species some p"i"Er "f .rigin could be ruled out. It was concluded from the studies that they probably came from the west or north-west - from north-r,rest lvory Coast or Mali in the Phase III areat or from outside the Programe area in Mali or even Guinea. In Phase III the sectors had been operational since June 1976 and treatment Idas schedul-ed to begin in the western Part and on the gti/Pendjari river basin in the east in February 1977. The Progra"tmers network of hydrologi- cal stations had been extended through contracts with naEional deParEnents or ORSIOM to obEain data for Phase III and improve coverage in Phases I and II. The new air coryany lras nol tackling the considerable logistic problems of establishing oPerations and training its staff. ANNUAL REPORT OF TIIE SCIENTIFIC A].ID TECHNICAI ADVISORY COM}'IITTEE The Chairman of the Scientific and Technical Advisory Comittee (STAC), Professor Janssens, reported to the JCC on the STACTs third and fourth sessions, and introduced the report (docgment JCC3.3) of the third session, during which a joint meeting had been held with the Ecological Panel to clarify the functions of the two grouPs. It was felt that this contact $ras so valuable as to warrant similar joint meetings each year. Several STAC members had visited the Progranrme area and in general had been impressed by the progress made. Discussing their reports, the STAC had reconmended greaEer participation in research by the technical staff, especially the younger workers, and suggested the holding of regular interdisciplinary meetings of senior Prograrme staff to discuss research and control activities. Clinical examinations conducted by the Epidemiological Evaluation Unit were considered satisfactory, though the detection of light infections should be refined and more sensitive parasitological techniques could be used in certain studies. The ophthalmological examinations were of high quality, and regret had been expressed that the Programe had only one ophthalmologist. The mobile eye clinics had proved a success. The unitrs sociologists were felt to have a valuable contribution to make. Reviewing research in progress at centres both within and outside the Programoe area, the STAC had stressed that a l0ajor effort was needed to find drugs suitable for mass therapy. Close coordination was recomended with WHOrs Special Progranrne for Research and Training in Tropical Diseases (fOR), of which UNDP was a co-sponsor, and with the WIfO/feO/fffrOP trpano- somiasis research proiect. Though by no means so serious as to compromise the Programers success, reinvasion remained the outsEanding entomological problem. In October t976 a Scientific Advisory Panel (SAP) working group on this topic, chaired by Dr Haskell, had drawn attention to the need for methods of maintaining laboratory populatlons of Simulir-m, cytotaxonomic and age determination Page 4 studies, and better caPt.ure techniques, and had proposed the establishment of a small agro-meteorological station on the affected Leraba. The STAC had also expressed interest instudies to find the formulation of Abate best adapted to sirnulir-m larvae, noting at the sa,etime that investigations had shown this insecticide to t.ffife effect on non-target aquaticlife in the formulation used; it had again pointed to the need for back-up larvicides in caseresistance to Abate developed. The STAC had welcomed the progress made in the computer storage and analysis of progrannredata, and underlined the importance of adequate funding for researctr ana the training ofnational counterPart staff in general. The Participating countries recognized that a propercareer structure was necessary if workers were to be attracted into research. DISCUSSION OF AGENDA ITEMS 5 AND 6 The JCC congratulated the ocP staff, the Executing Agency, Governments and researchworkers cooPerating in the Progranure on the Prograomet, "rr"o,r.aging progress. The nextessential, iE now considered, was to ensure that operations were extended to phase III onschedule while treaEnent of Phases r and rr continued, and it warned against any relaxing ofvector control activities. Representatives expressed concern regarding the reinvasion of tFeated areas. Furtherstudy was needed to determine the origin of the incoming blackflies and to define the geogra-phical limits of the phenomenon. otherwise, they mlght be thought to come from inside thetreated area' giving the impression that the control methods were not effective. ii-r"ight benecessary to extend the Programme area for entomological reasons, even to additional countries.other representatives warned against exaggerating the problem. rt was suggested that the JCCshould wait before reaching a firm conclusion; the 1975 reinvasion had been considered unusuar,but the extent and pattern of reinvasion La 1976 might equally be unusual. The comittee welcomed the studies in progress on the S-imulium species complex, the rearing of laboratorycolonies in continuous culture, alternative'in.secticides and formulations, and growth controlhormones, and drew attention to studies elsewhere on chemical sterilization and biologicalcontrol. rt referred to the need for monitoring of adult and larvaI popurations and forlong-term studies on the effects of treatment on non-target organisms. The Participating countries atttached great importance to the question of extending theProgramte area, and caLled for sEudies as soon as possible to determine how i-nfested zonesoutside the area could be included. rdeally, the area would be extended to all the infectedterritories of the Participating countries, and then to all possible sources of reinvadingflies. However, the connexion between reinvasi-on and extension should not be overstressed.Extensj'ons should be judged on their own merits, whether entomological or economic. rfextension to the whole of the Participating Countries was impracticable, at least all areas scheduled for develoPment projects should be included. Representatives cited the Manantali Dam project in Mali and a proposed sugar refinery just south of the oCp area at Boroutou,Ivory Coast' as examples of projects that would be seriously affected by onchocerciasis.' other rePresentatives, while supporting extensions in principle, pointed out that the programne was in the preliminary stages of its 2o-year life; it would be advisable to advance prudently, ensuring success in the Present areas first, and carrying out thorough studies on possible extensions. Referring to the economic asPects of the Prograrmre, representatives stressed the need forcollaboration with other prograrmes in the area. The iurportance of the time factor was obvious; countries could not wait for perfect control of onchocerciasis any more than theyhad been able to wait for control of other diseases. Indeed, perfectionism should be avoided;the Participating Countries had progra'rmes waiting, often extensi.ons of existlng projects, and wanted action, not lengthy studies. A representative reminded the JCC that the Programefs medical aspects were the firstpriority; the importance of health as a precondition for development was sometimes forgotten.It would be particularly useful if supplies of equipment such as syringes and nursesrkits, antibiotics, spraying gear, etc., could be provided. Some 20 rouLine items would give reasonable coverage of the resettled areas. Ihe need for WHO and the STAC to deveiop formal Page 5 criteria for declaring an area free of transmission, and therefore safe for development, tas eaphasized. Ttre JCC considered the STAC report much more informative than in the past, so that a clear picture of the objectives of research emerged. It considered that OCP research should be coordinated lrith the work of other parts of WHO, especially the Special Programme for Research and Training in Tropical Diseases, and warned that onchocerciasis should noE be forgotten by WIIO just because there was a separate OCP. It was suggested that the Programe should help in equipping national centres and laboraEories for research work. Doubt was expressed as to the need for a new central OCP laboratory, which could well be based on an existing centre in the area; local institutions, it was felt, might carry out mrny of the studies described in the STAC report that were entrusted to outside laboratories. SEressing the importance of both medical and drug research, the JCC expressed interest in the results of the field trials with suramin and diethylcarbazine, and caIled for further work on rDore effective drugs. Also, because the Progrenrme relied soIely on Larviciding as a control measure, the need for a back-up chemical in case resistance to Abate developed was eqhasized. The JCC agreed with the Programers emphasis on training, but felt thaE more should be done. It was suggested, in view of the size of OCP, the nuober of Participating Countriest and the future demands of the maintenance phase, that the Programe might run its own training scheme. Regarding relations between the Progrenme and the Special. Prograrme for Research and Training in Tropical Diseases, the WHO Regional Director for Africa pointed out that filariasis, including onchocerciasis, was one of the six di.seases seLected for priority study under the Special Programe. The African Regional Advisory Cormittee on Medical Research hadjust put the disease on its list of priorities. OCP was in close touch with TDR and that coordi.nation would continue. On the transfer of responsibility for the Programe to the IIHO African Regional Office, the Headquarters Support Unit in Geneva would be reduced to a minimum by transfers to Ouagadougou and a smal1 nucleus would be established in BrazzavLlLe. WHO was fu1ly aware of the i.mportance of training of both nationals of Participating Countries and of outside countries where onchocerciasis was a serious problem. The Programers objective was to assist countries to achieve self-sufficiency. Unfortunately, the work of many units left little opportunity for the staff to take part in training, and an attemPt would be made to find the best way to expand this aspecE of the Programe. Replying to representatives I questions, the Programe Director noted that quarterly reports on operations had been circulated since the start of L975. In future the rePorts would be prepared in Ouagadougou, and so should appear more promlptly. He informed the Comittee that copies of television films on the Programe had always been requested, so far without successi a form:1 request had been addressed to the British Broadcasting Coryany television tean now in Ouagadougou. As to the change in the air services contract, on the expiry of the present Coqanyrs contract at end 1976, tenders had been called for and WHO had accepted the best bid taking all factors inEo account. Vlith regard to the nature of relations wi.th research bodies, contracts rrere artarded by a research comittee. A11 research bodies were required to produce reports, which were then circulated, especially to the STAC. He noted that the centre for studies on chemotherapy at Tarnale, Ghana, would open in 1977; centres in the Programrne area were rnrking a valuable contributi.on to research, and a number had been provided with research equipment. The STACTs reco@endation for a mobile ophthaloological clinic would be studied. A representaEive had expressed concern at the delay, for budgetary reasons, in the construction of a Headquaters building in Ouagadougoul the Progranrme Director explained that after a revj.ew of the situation, it was now planned to Put uP a more modest building than originally proposed, at about half the cost. The necessary funds were provided for in tJ.;.e L977 budget. estirnates; if these were adopted, tenders could be calLed for irrmediately. It rras also explained that though an air operations base at Banako had been menti.oned in the 1973 PAG misslon report, it had since become clear thaE there was no need for a large nrmber of air bases. However, the construction of a base at Bamako or some other site could be justified if the Prograrnme area was extended Eo the west of Mali. Page 6 The WHO rePresentative considered that the problem of reinvasion wouLd not compromise the Prograrune. In the first 11 months of L976, of the 65O0 km of ri.ver treated, only 2OO km had been reinvaded in Phase I, and there had been no reinvasion in Phase II. Studies with larvae and adult females indicated Lhat the reinvasi.on c:me from outside the treated zone, ei.ther in Phase III or from outside the OCP area. Ihe females came from untreated savanna areas,probably from the rrorth-west and west of the reinfested area. The results of treatment in Phase III west would be fol-lowed carefully. Work was in hand to demercate the southern limit of the savanna cytotype, and trapping and marking studies would continue, together with studies of the blackfly populations in parts of Ghana, Ivory Coast and Mali outside the OCp area. Ifthe zones of origin could be determined, the possibillty would be studied of including them r4,ithin the Programme area. The Prograuure recognized the need for a buffer zone, and this could be.investigated when the area was under control. Frorn an operational point of view, before the Prograrrne area could be extended, studies through a fu1l yearly cycle would be needed to obtain the necessary entomological, transmission, medical and hydrological data. This would permit a seri.ous study of the necessary staffing,flying conditions, cost, etc. The necessary information on which to base a decision might be obtained in 18 months, although for areas where many of the necessary studi.es had already beendone a year might be saved. In any case, any extension would have to be adjacent to thepresent area. Replying to technical questions, the WHO representative referred to surveys made to testthe quality of river lvater suitable for breeding Simulir-tm in the laboratory. As to theinterval between release and capture, adult utactGitad travelled 90 km in 36 hours inCameroon. He noted that oCPrs close contacts with Ehe Comit6 Inter-Etats pour la Lutte contre1a S6cheresse dans le Sahel (CILSS) included the exchange of meteorological and hydrologicaldata. Following collaboration with occcE, oRSToM and Canadars International Development 'Research Centre since 1972, atEempts at biological control of Simulirrn would start in L977. ' He recall-ed no evidence of resistance to malathion. Tests n"IEEf,I'ted no difference in susceptibility of larvae to Abate between treated and untreated areas. A growth inhibitor I47as to be studied in addition to further insecticides. With regard to chemical monitoring,tests in the Como6 and Leraba experimental zone indicated that Abate persisted for only a shorttime in lsater. The Chairman of the SAP working group on reinvasion, Dr Haskell, said that he preferred theterm rrredistributionrr to rrreinvasionrr to describe this quite usual phenouenon. The eradica-tion of Simulirmr r^7as not possible; the object was to reduce the population in order tointerrupFE6Gission. Much had already been learnt, and other prorising techniques had beendescribed at the sAP roorking group. once Phase Irr operati-ons were under way in i9ll, tn" redistribution problem would have a different cmplexion, and he felt that it would be wrong todisturb Present activities by acting too hastily. It might be useful to associate the authorities of suspect areas in adjoining countries with OCprs work in order to obtain data.A special meeting could be held in a year or so to re-examine the problem. The representative of WIIO noted that no technical criteria existed for declaring an area safe for development. In general, areas reaching therrhypoendemicrrlevel of transmission could be resettl-ed. [fHO would try to work out criteria by which to judge when an area rdas eiEher free of the vector or had a sufficiently low leve1 of transmissi.on to permit resettle- ment and development. As to the health asPects of resettlement, [,IHO was working on protection against both try?anosomiasis and schistosomiasis. It had embarked on a field research p.o!.rn-" with FAO and UNDP, including 19 countries, to develop simple tr)ryanosomiasis control techniques, and had a project in Ghana on the control of schistosomiasis in man-mnde lakes. In mass chemotherapy, research was being done to discover if suramin was successful at low dosages without seri.ous side-effects, and IrIHO was trying to stimulate the pharmaceutical industry to cooperate in thedevelopment of antiparasitic drugs. Page 7 REPORT OF TTIE ECOLOGICAI PANEL In the absence of the Convenor of the Ecological Panel, the rePort (document JCC3.4) was introduced by professor Janssens, who [rad represented che STAC in the Panel. Ihe Panelrs most recent meeting had been considerably affected by the replacement of two members; it might in future be better either to have a briefing for new meobers beforehandr or Eo prolong the meeti-ng by a daY. The panel interpreted its field in the broadest sense, to include, besides biological and environmental rnonitoring, questions of nutrition, population, land reseEtlement and health care coverage. Water managenent and control had been stressed. Reporting on his field trip to the programe area, Dr Smith had underlined the urgency of planning for economic development and had raised a nuober of questions, including the relaEive fertility of plateau and riverain soi1s, resettlement strategy, the use of fertilizers, possible agro-industries, and the introduction of trypanosouiasis-toleranE cattle. A review of operational activities and reinvasion studies had been presented to the Pane1, which had conrmented on the need for further study of the vectorrs migratory habits. The panel had given its approval to a large-scale trial of the operational suitability of the larvicide ChLorphoxim, subject to the necessary precautions. It had also suggested Z4-hout sampl-ing of an untreated river Eo refute charges that Abate was daoaging aquatic life, and Ehe formulation of an insecticide, preferably as a stomach poison, with a parEicle size and density suited to the feeding habits of Simulir.m larvae. No ill-effects of spraying oPeraEions on fish had been noted. Professor Janssens pointed out thaE the Panelrs next meeting, in March 1977, would be held in Ouagadougou, and not in Geneva as the rePort stated- In answer to a questioo on the suggestion in Dr Smithrs report to the Panel that uPland soils are more fertile than ill-drained valley soils, Professor Janssens said that the findings of earlier ORSTOM studies did not bear out that view. The FAO representative observed that few systematic studies had been carried out; Dr Smith had wanted to avoid exaSSeration of the difference in fertility betereen the two soil tlipes. He also inforoed the Comittee thaE the Ecological Panel and STAC shared his preoccupaEion with chemical monitoring, which should be extended on site. A representative stressed the importance of the social asPects of resettle- Ioent, and suggested that the inslghts gained from social studies on populations now returning to areas not yet freed from onchocerciasis could be applied to planned Eovements Iater. Ile was informed that the sociologist attached to the OCP Economic DeveloPoent Unit was carrying out precisely that tyPe of studY. ANNUAL REPORT OF TIIE ECONOMIC DEVELOPMENT ADVISORY PANEL In the absence of the Chairoan of the Economic Development Advisory Panel (fOaf), its first annual report (docrment JCC3.5) was introduced by the Panelrs Secretary, Mr I{. de Souza. The report contained the Panelrs prelioinary reflections on the main subjects discussed at its trro meetings in 1975. In the areas freed from onchocerciasis, the problem of health and the organization of health services was accorded high priority by the EDAP, which reco,mended a siryle and practical health infrastructure specifically adapted to the rural environment, in which the populationjoined in the process of improving health conditions as Part of an overall Process of comunity development. 1,he Panel had discussed the relationship between food and health. To increase the present inadequate mean food intake in the region and Eo correct inequalities, a thorough sEudy of food requirements should be made. Countries would want the nel develoPnent areas not only to suppLy their loca1 populations but to produce a surplus for less favoured areas. fhe solutions to the delicate problems of land tenure and farming system were largely political. The Panel stressed, however, that farmers settling the freed areas should be guaranEeed sooe stability. The relative advantages of large- and small-scale farmlng had been discussed in some detail. Subject to technical studies, a judicious combination of the two systems would probably satisfy both social and political considerations and the need to increase Page 8 production rapidly'. The Panel had suggested cooperation with the office du Niger in MaIi,which had 40 years of experience in related problens. Migrants would need to be persuaded to repopulate the disinfested areas, thoughsPontaneous migration and unregulated occupation of the land night compromise developmentprojects and cause ecological deterioration. once settled, farmers would have to be inducedto stay' through provision of a mini.mr.m infrastructure, favourable producersr prices, and alowesE income at least equal to the lowest urban wages. Relations between planning for the development of areas freed from onchocerciasis and theprograuning of 10ng-term economic devel0pment in the sahel had been examined, together withpossibilities for cooperation between Participating Countries within the context of nationaldevelopment priorities, for example in cattle breeding and the exploitation of water resources.Pending the evaluation of mineral resources, development projects in disinfested areas hrerebased primarily on agriculture and agro-industries in which a second, more industrialized revelwould have to be added to the present artisanal level of foodstuff pioduction. The EDAP had ca1led for closer links with other bodies concerned with the prograrmre. rthad weLcomed the collection and storage of ful1 data on the regions to be disinfested and hadnoted that the findings of earller research were often still valid. Although thoroughstudies were necessary before projects rdere launched, panel members had warned agalnstinsisting on agreement on every detail before action was taken. The support of the popula-tion Las vital; development ProgramDes should therefore be preceded by patient campaigns ofinformation, training and consultation. Fina1Iy, the panel asked the corrnittee to 1et itknow what priority ro give to the study of the prort"r" it had raised. ECONOMIC DEVELOPMENT ASPECTS OF THE PROGRA},IME The representative of the United Nations Development programme (UUOp) presented a statusrePort on the planning of economic development in the areas freed from onchocerciasis, whichwas circulated to the JCC. The report included details of the utilization so far of UNDprscontribution of uP to us$ 5oo ooo to each of the seven participating countries to assist inprograrming the development of the freed areas, and a country-by-country review of developmentplans and progr:nmes in these areas. Apart from UNDPTs contribution, a number of other bil-ateral and multilateral sources offinancing were cooPerating with the Participating Countries. The growing number ofactivities called for strong coordination by.."h Go.r.rnment through appropriate planningmachinery' UNDP had emphasized that a planning unit identifiable with the prograune shouldexist in each country, preferably in the Ministry of planning, to ensure the integration andcoordination of efforts at the national level. The ocp Economic Development unit should bein contact not only with national onchocerciasis comittees, but also with Ministries ofPlanning or other ministries responsible for the coordination of international development aidin the countries. He suggested that at future sessions the JCC should base its discussion of this agendaitem on the register of economic development progratrmes in the freed areas being prepared bythe Economic Development unit, which would be ciiculated to countries for checking and updatedperiodical l-y. A fundamental question facing the Jcc was whether a coherent overall approach to thedevelopment of the disinfested areas would be possible, as in the case of controt operations.clearly such problems as water resources management, the development of stockbreeding, and landresettlement models went beyond national fronti.ers. Links with, for exaople, CrLS i., tt.sahel, the regi""il-l:9-8:11r: .f Eeteorology and hydrology financed by UNDp and orher sources,the 19-country WHO/FAO/ITNDP trypanosomiasis programme, the ,., p.og."r*. for the developmentof the river Niger, and the activities developed nithln the framework of the "C1ub des Amisdu Saheltr could all prove val_uabl_e. Page 9 The Chief of the OGP Economic Development Unit inforoed the Cotmittee that his unitrs initial activities had been to collect baseline data on the areas to be cleared of onchocer- ciasis, keep an up-Eo-date record of planned development activiEies, assist in arrangexoents and briefings for missions, and maintain close contact wiEh representatives of United Nations agencies, banks and technical assistance missions. The information gathered would provlde the basis for development projects in the freed areas. Three main approaches had been followed: visits to participating countries to discuss and observe OCP-related activities; the quarEerly collection of standardized informaEion, by means of questionnaires and personal visits, for st,orage in FAOts data bank on the econo,mic development of the Prograome area; and special studies on particular problems. One such study proposed rsas a survey of nutritional status oriented to household consr,rytion and expenditure, the object being to help in the preparation of agricultural development projects with an import substitution componenE. He noted that each ParticipaEing Country had its own approach to development of the freed areas, and that socioeconsmic studies financed from lIMPrs special contribution to each country were moving forward. DISCUSSION OF AGENDA ITETS 8 AI{D 9 Welcoming the report on Ehe EDAPTs first year of activity, rePresentatives agreed that contacts and consultation between the Panel and Participating Countries should be expanded. To avoid working in a vacur:m, all the Progrenrmers advisory bodies should be more closely linked. The Comittee expressed satisfaction thaE aaong priority topics the EDAP rePort dealt first with health and food, and hoped that its recognition of the need to move promptly from the study to the acti.on stage without undue insistence on detail was not merely a pious wish. It was suggested that an inventory of exisEing health structures in the Programe area should be prepared; it would be better to remodel the old systeo, which had long been aimed at the rural population, than to build completely anew. Health and nutrition education would be needed before, during and after the resettlement of disinfested areas. A representative questioned the role of the EDAP and Ehe Programe as a whole in economic development, for which responsibility l-ay with the Participating Governments, each with its own approach. Informati-on on all development programes in the countries, perhaps collected by IINDP, could help in stimulating aid. A ngmber of representatives raised problems relating to the resettlement and development of areas cleared of onchocerciasis. It was pointed out that it would be difficult to devise a standardized approach, because each country followed its dwn Pattern. Present land tenure systems were not necessarily favourable. Moreover, it would be wrong to assuse that the disinfested areas rrere empty; Eany were overpopulated. A representaEive observed Ehat migration towards the cleared l-and would.run counter to the general exodus froo rural areas, especially of young people. Io avoid Eoo o1d an age structure, acti.on must be t,aken to attract the young through such measures as the establishment of agro-industries, primary education with the stress on agriculture, and local technical eoLleges. Because it would b'e inequitable to discriminate in favour of the migrants, this implied the decentralization of educatj.on throughout the country. Similarly, apart from special protection measures against the disease, the heaLth system should be that adopted throughout the counEry, decentralized to health posts and soalL hospitals. Cormenting on the IINDP report, a representative suS8esEed Ehat in future the information should be circulated to countries in advance so that it could be supplemented by Ministries of Planning and disseminated to national onchocerciasis cor-ittees. In general, it would be useful if the various sources of aid could assist countries in coordinaEing aid Progratrilnes. Citing the examples of animal disease control and waEer resources development, rePresenta- tives pointed to the value of intercountry cooPerati.on in appropriaEe fields. It was considered that it would be useful to associate such bodies as CILSS, the Liptako-Gourma Authority, the Comit6 inter-africain drEtudes hydraullques (CIEH) and the rrAutorit6 des Aoenagements des Va116es des Voltas" (AW) with the work of the JCC and iEs advisory bodies. Page 10 rt was noted that crEH, which was located at ouagadougou, had what amounted virtually to a databank on the hydrology and other aspects of the region; instead of starting from scratch, itwould be preferable to build on what already existed. Mr S. Kpognon, Alternate Executive Director of Ehe trrrorld Bank, expressed satisfaction withthe results achieved so far. He suggested that a flexible "pp.o""h should be adopted topossible extensions of the Prograrme area, which mlght u" """ept.d when justified. Responsi-bility for the development of freed areas 1ay wittr the participatlng Governnents, whi.ch mustestablish priorities and coordinate p1ans, pieferably within tire reliorral framework increasinglyfavoured by the world Bank Group. countries needed to develop the capacity to identify,evaluate, Prepare and manage land development projects; UNDp and the Bank might envisage pre-investment assistance ln that phase. Because of the limitations on concessionary rDAassistance, all possibilities of co-financing should be explored. Referring to the request for distribution of a report on economic development in advanceof each session, the uNDP rePresentative suggested that the Economic Deveropment unit shouldcirculate an updated rePort every three rortil", the most recent being distributed as a JCCdocurnent' He confirmed that LINDP would assist in the strengthening of national planning. cormnenting on the question of the scope of economic development projects, the FAorePresentative pointed out that the steering cormrittee had concluded lhat most of them wourdbe national, but that a regional approach would be feasible in some cases, for example farmcrop research' He felt that the presence of a physici.an in the EDAP had been justified,since the chairmanrs report accorded due priority Lo health. rhe hlorld Bank representative recalled that the EDAprs role was defined in section E.2 ofthe Memorandum of understanding. rn its two meetings so far, the panel had succeeded inidentifying a number of areas and priorities. rn response to its request for suggestions for'further study, he-proposed the subiect of planning for resettlement of creared areas, and morespecifically the design of two projects in which ltre gant was assisting upper volta; theGovernment could then take the Panelrs views j-nto account and initiate an exchange of viewswith the Panel on development strategy. rn reply to a request for information, he confirmed that a project for cotton and cerearproduction in the Phase rrr area in south Mali would be financed by the worrd Bank Group to theextent of US$ 15.5 mi11ion, of which usg 5oo ooO was for studies in freed areas. Answering a query on drawings on LJNDPTs special contribution in Ma1i, the FAO representa-tive said that after initial surveys by three experts (a sociologi"i,-.., agricultural plannerand a pedologist), the Ministry of Pl-anning now proposed to go forward with a plan of actionprepared by FAo and rBRD. The plan, costed at usg 1.7 million, would be financed in partfrom the balance of us$ 477 ooo remaining from the uNDp contribution, rogether with usg 5oo ooofrom the ttrorld Bankrs South Mali programre. REVIEW OI' TTIE PLAN oF AcTIoN AND BI]DGET oF THE PROGRAII,IME FoR 1977 rntroducing the Plan of Action and Budget Estimates (docurnent Jcc3.6), the progrr,',meDirector designate, Mr M. L. Bazin, observed xhat Lg77 would see the transfer of responsibllityfor the Prograruners execution from tIHo headquarters to the African Regional office. secondly,the whole of the Prograrme area would be covered by spraying with the start of phase rrroperations in February L977. Thirdly, the air coupany rdas being changed. rnevitably, theresources received from contributors remained the upper limit to. .*p"Iaitures that can beincurred. For 1977, total ProSrarme requirements were estimated at us$ L3 L37 2oo; of the increaseof some 22% over 1976, L8% was imputable to i.ncreases i.n vector control operations a,'d.4% toinflation' The personnel would lnclude 44 professional and 65g generar service staff.Expenditure on hours of flight, training and research would remain at about the 1976 leveI. Ttre Director designate assured representatives that he would do everything he could toueet their Preoccupations - the strengthening of training, the strengthening of coordination Page 11 betrseen vector control and econooic development, intensified research on cheaoEheraPy, iryroved health service structures, the probleu of extending the Progrrme area, and the effective maintenance of vector control operations. He paid tribute to the work of the outgoing Programe Director, Dr ZiegLer, and expressed his appreciation of the ski1l and dedicatlon of the technical term he was inheriting. fhe Conrm'lttee welcooed the improved presentation of the Plan of Action and Budget Estinates; the docr.nent was clearer and more corylete than in the Previous yeat , and the budget rilas clearly related to the planned activities. The increase in the toEal estimrte f.or 1977 was considered to be justified. It was suggested that adjusted figures for L976 might have been shown next to the esEimFtes presented to the JCC in 1975, and that large, folded maps should be provided to supplement the not very legi-ble ones attached to the document. It was suggested that at a time when the Vector Control Unit was embarking on a large increase in operations and had been urged by the STAC and the Ecological Panel to play a larger part in research and training, its professional staff should be increased. IE was also suggested that in future the STAC could be used for programe evaluation. The urgent need for research on chemotherapy was eryhasized. It was suggested Ehat the funds devoted to this subject should be increased. After the interruption of Eransmission, adult rrorms in the body would continue to produce oicrofilariae for rnany years, and a suitable macrofilaricide was required. fhe IIHO representaEive said that the WIt0 Special Prograrme for Training and Research in Tropical Diseases accorded priority to onchocerciasis, and that WHO working groups on the innnunology and the chemotherapy of the disease erere to be convened shortly. There was sorDe hope of furEher cooperation with the pharmaceutical industry. fhe development of new antiparasitic drugs rras an extremely difficult, costly and lengEhy process; meanwhile, work would continue on known drugs. Particular importance rilas attached to the training of national personnel, particularly at the professional 1evel, not sinply for the Programe, but to meeE the broader needs of the Participating Countries. The Comittee recognized that an adequate career structure was vital; for example, some African countries were providing careers in research at the sane Ievel as academic careers. The shortage of cadres in all fields was conpounded by the failure of trained specialists to return to their countries after completing their studies, even when they had undertaken to do so. In certain fields, specialist training r{as available in Africa, but the Cournittee doubted if Africans were sufficienEly encouraged to study subjects needed by the Progranrme. It considered that information on the proportion of nationals working in OCP at each level and on the prospects for future self-reliance on the part of Participating Countries would be useful. If not all the training fellowships available were taken up, delegates asked for Governments to be informed so that candidates could be put forward. fhe representative of one Contributing Goverrment favoured a large increase in training activities if the Participating Countries could find qualified candidates and ldentify posts for them. A fuller presentation of the training progrrme was requested in the docrment for the fourth session. In reply, the WHO representative emphasized t.hat Ehe training of national personnel was an important part of OCP, and that the present trainees would be used in the Programe. Special machinery for training rras envisaged in the future. The Cormittee was struck by the proposed increases in the OCP vehicle fleet and Eaintenance structure, and suggested that national mrintenance services should be used, or built up if non- existent. If that was not possible, the Progremme should Erain its own maintenance staff, and not attract scarce personnel from other services. It was noted that logo already had a central garage for all UNICEF and WIiO vehicles, so that to set up another just for OCP would be inadvisable. In addition, WIIO had established a maintenance and repair training centre at Lorn6 which received trainees from other countri.es. fhe WIIO representative inforoed the Comittee Ehat the Programe had found that existing vehicle repair facilities were already overloaded and wai.ts were Iong. It had therefore set up its own network of garages and service stations. It trained its orrn staff, who took courses at the central garage in ouagadougou and worked under supervision on their return t.o other bases. In reply to a question on construction in Benin, the WHO represenEative explained that OCP had not had to build at Kandi because it had been able to hire a building and that the need for a base at Porga had not yet been definitely established. Page 12 During the discussion, participants pointed out that economic deveropment progranmesshould be related to the status of vector control and health care. once the treated areasbecame safe for developurent' the problem of coordination with a number of different ministrieswould arise' rt was fert that rePorts, prepared by the Economic Development unit, on economicdevelopment in relation to planning in each iarticipating country and to aid from all sourceswould help in that process. rn reply to further questions, the wIIo representative explained that the estimatedexpenditure on insecticides it 1977 was lower ihan in 1976 because it had been possible tobuy at a lower price; there was no reduction in quantity. As Lo epidemiological studies,incidence had always been studied in addition to prevalence by Beans of examinations ofchildren born since control operations started. rn view of the long discussions under other agenda items on the extension of the programnearea, the rndependent chairman considered that the time had come to move towards a decision.Ile suggested that a rePort on needs, possibilities and costs should be prepared for the JCCrsnext session' rn reply, the wHo representative said that the necessary steps would be taken. The comnittee recorded its appreciation to Dr ziegler for his rnagnificent pioneer work asfirst Director of the Progranme, and extended a warm welcome to his successor. The Plan of Action and Budget of the Programre for lgll were accepted by consensus. FINANCING OF IIIE ONCHOCERCIASIS CONIB.OL PROGRA}4ME The vice-chairman, H. E. Mr salia sanon, took the chair during the first part of thediscussion on this item. The cosmittee had before it a tabular siatement of receipts anddisbursements from the Programners inception to 31 october 1g76, distributed by the worldBank as administrator of the Onchocerciasis Fund. The representative of Belgium said that her Government intended to maintaln its L977contribution at the 1976 1eve1 of BF 15 million. Belgir:mrs contribution for 1g76 did noraPpear in the statement to 31 october as it had not yet reached the world Bank. she consideredthat such a statement was useful to representatives in reporting back to Governments; a methodshould therefore be found of showing all contributions, whether in cash or kind. At presentthe substantial contribution of IINDP did not appear at all. Ttle united Kingdon rePresentative said that since the date of the Bank statement hisGovernmentrs total Pa)ment had risen from us$ 1.4 million to us$ 2.1 million. He suggestedthat in future the budget document should contain a breakdown of donor contributions. I,Iithinthe limit quoted in that docrrtent of us$ 13 million, subject to parliamentary approvar, hisGovernment would continue to contribute 1o% of expenditure in 19i7; that represented anincrease to sone US$ 1.2 nillion. The representative of Kuwait said that of the us$ 6 million pledged by his Government forthe Programmers first stage, us$ 2 million had been paid in L975 atd,7glo. A request by theworld Bank to the Kuwait Fund for Arab Economic Development to contribute usg 2 rnillion in Lg77,within its total pledge, rdas expected to be approved shortly. Kuwaitrs continuing supportfor the Progrannne reflected its satisfaction with the progress made so far. The manyquestions raised aL the session regarding the possibility of extending the programre ".". r"."an indication of how successful operations had proved within the present boundaries; if thePrograrrrne had not been a success, no one would have asked for an extension. The Japanese rePresentative announced that his Government had decided to contribute atotal of us$ 5 nillion for the period L974-1979. usg 5oo ooo had been given in 1975 andUS$ 750 oo0 in 1976, Leaving a bi.ance of USg 3.75 nillion for the followi.ng three years. TheL977 contribution had not yet been fixed, but clearly it would be higher than in the pasr. The United states representative announced that his Goverrmrent would contribute US$ 1 million Ln L977, Itrithin its overall pledge of USg 6 million for the progranmers first s tage. Page 13 Ihe Netherlands representative asked for regular tnformation on all aid to the Progranrme area, because a concerted approach to its development was essential. Of his countryrs first- stage pledge of US$ 6 mitlion, US$ 2.5 million had been spent so far. Regarding rhe remaining US$ 3.5 nillion, his Government was in touch with the World Bank, and would have a positive attitude to requests for 1977. The representative of France said that his Government had so far contributed FF 13 rnillion of its total pledge of FF 26 nlllion; it intended to give FF 4 million in 1977 wirhin thar overall figure. Ttre Canadian representative said that his Governuent proposed to contribute CAI{$ 3 million over the si-x-year period. He announced a contribution of GAI{$ 5OO 0OO for L977, subject.to parliamentary approval. Furthermore, his delegation was prepared to recomend Eo the appropriate authorities in Ottalta a possible j-ncrease in Canadars contribution. The represenEative of the Federal Republic of Germany said that of his Governmentts pledge of DM 13 million for the period L974-1977, N 9 nillion had already been contributed and the balance of DM 4 million would be paid in 1977. The representative of the African Development Bank announced that, in addition to maintaining its contribution at U.A. 150 OOO (about US$ 18O OOO), ADB had decided to give priority in financing to development progra@es in areas freed from onchocerci.asis. The World Bank representative informed the Conrnittee that the World Bank Groupts Executive Directors had recently approved the provision of US$ 6 roillion - about 10% of Prograrme costs - over the first six years. I^Iithin that total, grants of US$ 1 nillion would be made in each of the years 1976 and L977, to be funded from the transfer of the Bankts net income to IDA. Pledges for the first stage as a who1e, subject j.n some cases to annual parliamentary approval, and including the US$ 6 million pledged by the l-Iorld Bank and the US$ 1 million pledged by Norway, now totalled some US$ 40 million. Support provided by other countries on a year-to-year basis could be expected to reach another US$ 13 nillion. Adding this to the US$ 40 nillion already mentioned and taking into account UNDPTs contribution to the financing of research and training, and esti-mated investment income of some US$ 600 OOO, total- resourcesfor the six years slightly exceeded the original financial target of US$ 54 million. However, the revised estimate of costs for the period rras now US$ 6f million. To bridge the gap, the Bank had initiated talks with possible new donors, and a nuober of Participating Countries had addressed a request for assistance to the European Development Fund. No firm conrmituents had yet been obtained, but the auguries were good. Further, Ghana had contributed y' Zn OOO towards 1ocal costs of the Programe, in addition to support in kind, and it was being assrmed, with the help of other Participating Countries, that at least US$ 5OO O0O of requirements would be financed fron 1ocal contributions. For L977, the Executing Agencyrs cash requirements were US$ 11.9 nillion. After allowing for contributions due, but noE yet paid, cash and investments in the Onchocerciasis Fund totalled sme US$ 4.7 million, against which a further quarterly advance of US$ 2.7 nillion would be oade to WHO before er.d L976, leaving US$ 2 million to be carried over to L977, Contributions for L977 ad.d.ed up to sooe US$ 11 nillion. Thus receipts shouLd be sufficient to meet cash requirements and to leave a balance of rather over US$ 1 miLlion to be carried forward. Nevertheless, the cash position was becoming increasingly tight, so that expenditure must be kePt within the budget linits and strict econony exercised in the Progranmers execution. The World Bank representative emphasized that lhe Programe had to be tailored to thebudget. New financlng conrmi.tments beyond 1979 would be called for at the JCCrs fifth session at the latest. Itrat night be the time to consider major expansi.ons of the OCP area, though snaller extensions might be m:de before then if funds became available or economies proved possible. Governments might consider providing technicat assistance outside Eheir normnl contributions for the expensive studies such extensi-ons would entail. Ttre World Bank would conti.nue to assist in mobilizing finance for the Progra"rme, which was planned to last 20 years; at the same time, the Bank was only one agency in a broad cooperative venture. Page L4 A table (attached as Annex 6) showing contributions pledged or indicated for L977 was circulated at the end of the session. OTIIER MATTERS Arrangements for the fourth session of the JCC At the invitation of the Government of Kuwait, it was agreed to hold the fourth session of the JCC in Kuwait in early Deceaber L977, on dates to be agreed betldeen the Government and ) the Independent Chairnan. The representative of Kuwait explained that the invitation was intended not only to show his countryrs interest in and support for OCP, but also to meke the Programre better known in the Arab world as an excellent exanple of international cooperation in the cause of all-eviating human hardship. The Comrittee expressed its thanks to the Kuwaiti Government. The representative of Togo reminded the Couaittee of his Governmentrs invitation to hold the JCCrs fifth sessi.on in Lom6 in 1978. Expression of thanks to the outgoing Programsne Director Recording its adniration and appreciation for the remerkably effective pioneer work of the outgoing Prograrrme Director, Dr P. ZiegLer, in establishing the Prograrme, organizing operations and building up an excellent staff, the Connnittee asked the Independent Chairman to express its thanks to Dr Ziegler, and wished him all success in his future work. The text of a letter from the Independent Chairman xo Dr ZLegler is attached as Annex 5. CLOSURE OF TIIE THIRD SESSION The Independent Chairman expressed his gratitude to the Vice-Chairman for his support during the session and to the Government of Upper Volta for its magnificent hospitality and the excellent facilities it had provided. He thanked all the participants and the conference staff for their cooperation in the exercise of his functions. Wishing ali. representatives a safe return home, the Independent Chairman declared the third session of the JCC closed. EXCURSION ARRANGED BY THE GOVERNMENT OF T'PPER VOLTA On Fridayr 3 December, at the invitation of the host Government, a group of some 35 participants visited part of the area being developed by the Autorit6 des Am6nagements des Va116es des Voltas (AW) and had an opportunity to observe the progress made. ONCHOCERCIASIS CON]3.OL PROGRAI'IME IN I'ITE VOLTA RIVER BASIN AREA JOINT COORDINATING COMMITTEE Third session, Ouagadougou, 1-2 December 1976 AGENDA 1. @ening of the session 2. Statement by the IndependenE Chairman 3. Election of the Vice-Chairman of the session 4. Adoption of the agenda 5. Progress Report of the world Health organization for 1976 6. Annual Report of the Scientific and Technical Advisory C@ittee 7. Report of the Ecological panel 8. Annual Report of the Chairman of the Economic Development Advisory panel 9. Economic development aspects of the progrsme 10. Review of the Plan of Action and Budget of the progranrne tor L977 11. Financing of the Onchocerciasis Control programe L2. Other matters 13. Closure of the third session Ar.lMx 1 JCC3.1 ANNEX 2 Page 2 JOINT COORDINATING COMMITTEE Ouagadougou, 1-2 December 1976 LIST OF PARTICIPAI{TS \r,,ll. G. Candau Ihdependent Chalrman Jbi.nt Coordinating Comittee (.fCC)\ PARTICIPATING GOVERNMENTS Peoplers Republic ,of Benin r- Son Excellence Monsieur Issifou Bouratma ' l,tinistre de la Sant6 publique \.,iNico1as AhouansouSifr6taire permrnent du Comit6 national de Lutte contre lrOnchocercose Ghana .lCol.orfl J. B. B. Asafu-Adjaye Executive Director WatJonal Onchocerciasis Secretariat Mir{istry of Economic Planning Dr S. K. Prah r] Officer-in-charge fl Institute of Aquatic Blology Mr N. S. Belo-Giwa Principal Economic Planning Officer A National Onchocerciasis Secretariat ' \ Ministry of Economic Planning Ivorv Coast \ L: Son Excellqnte Monsieur J. B. Mockeyi Ministrp de La Sant6 publique et de 1-a Population Dr I. Kone r- Directeur de 1a M6decine socialef- MinistEre de Ia Sant6 publique et de la Population Mali Son Excellence Monsieur Mamadi Keita f Ministre de 1a Sant6 publique et des Affaires soci-al-es Dr Souleymane Sow .. M6decin Chef de la Division h la M6decine socio-pr6ventive et des Maladies transmi.ssiblesi- MinistEre de la Sant6 pubLique et des Affaires soci'ales Dr Garame Traore f- Directeur, Conseiller techniquei' MinistEre du D6veloPPeoent rural ,i I ANNEX page 3 Niger Son Excellence Monsieur Ie Chef de Bataillon Moussa Salatf Ministre de La Sant6 pubLique et des Affaires sociales ,_ Dr Ibrahim Alfa Ciss6 J Directeur des Grandes End6mies Togo f: Professeur Kqgtso Kokougan Nathanlels Directeur g6n6ra1 de la Sant6 Dr A. Prince Agbodjan M6decin Chef du Service des Grandes End6mies MinistEre de la Sant6 publique et des Affaires sociales Dr Mensah Robert Dot6 Adninistrateur civi1, Conseiller technique MinistEre des Finances et de lrEconomie Upper Volta Son ExceNqgp,zd,Ionsieur Salia Sanon Minis tre;b{\ loppement rural Son Excellence Monsieur 1e Docteur Tinga Douaoba Ministre de la Sant6 publique et"des Affaires sociales Son Excel)Encq-Monsieur Boubacar Souoana Ministre dtrrflIin/ M. \8in6on Sorgho Secr6taire permenent du Cornit6 national de Lutte contre lrOnchocercose I Dr Jeaq-Marie Kyelem Secr6ta\e permanent adjoint du Comit6 national de Lutte contre lrOnchocercose CONTRIBUTTNG PARTIES African Development Bank (ADB) Mr M. Bouzid Engineer Operations Department Belgiro I'1rs Suzaflile Vervalcke Directeur drAdministration, Direction de Ia Coop6ration multilat6rale MinistErq.des Affaires 6trangEres, du Comerce ext6rieur et de la Coop6ration au D6veloppement Canada uis uxVfency Mr Michel de Goumois amUas,efd\ of Canada to Ivory Coast, Mali, Niger and Upper Volta ',,. \ "./Mr I. ti.gdsayEarth Sgt\ces Division Defens/ ReJearch Es tablishment t'" i I ,t T {- I r,-1 r' ,r, t"i Fr t" r tr ANNEX 2 page 4 Mr P. Racicot Councellor at the Canadian Embassy in Abidjan Mr E. Gauvreau First Secretary' Representation of Canada in Upper Volta France(re*. 5cu-r*o - 567' ff' q o 'iL- Mr Henri H61iEs Charg6 de Mission i la Sous-Direction MinistEre de 1a Coop6ration Federal Republic of Germany Dr Winfried Pulst Federal Ministry Japan Mr Takateru Ohse Medical Expert of Consultant at the Ethiopia Kuwait de la Sant6 publique eE de lrAction sociale for Economic Cooperation the Japan International Cooperation Agency United Nations Economic Conrnission for Afriea j\ Dr Galal E. Ahmed Amin Economic Adviser Kuwait Fund for Arab Economic Development Ihe Netherlands Mr I,{. Th. Six .ij Second Secretaryr Represent4tion of the Netherlands in Upper Volta United Kingdom Mr w. D. Maniece {')i ,-iL 2\ } } Y }l ,I" Head of hlest and Central Africa Department 'i Ministry of Overseas Development Dr A. M. Baker r'l Medical Adviser f 1., Uirri"tty of Overseas Development or e. rt\e<drr Directol , \entre for Overseas PestMinffiry of\erseas Development ,\ United States of America Research { A Mr Dennis Conroy Director, African Regional Affairs Office Agency for Interrnational Devel-opment Dr Joe L. Stockard Tropical Medicine Adviser Health Office bf the Bureau for Technical Assistance Agency for. International Development AT.INEX 2 Page 5 SPONSORING AGENCIES Food and AgriculEure 0r zatLon of the United Nations FAO \- ,/Mr T. S. \"rAribisalaDirector;' '\, Agricg/tural \ervices Division Mr C. G. L# Senior pdr\"t, Policy Agricy{twa\services llorld Bank (IBRD) A *t' Mr E. Peter WrighL ; Programliirectorfl Western Africa Region u'pJt". M"L/ UwoP acli;rd Representative Ur Alan Oo"p.rt/ \Mr Step\n Denning Divisio.n \ief Westerh Afr\ca Region Mr M. J. Sharpston Economist Western Africa Region Mr Adrian Otten Agricultural Economist Western Africa Region Mr Abdallah" Et Maaroufi World Bant Rd'bident RePresentative in Upper Volta United Nations Development Programe (IINDP) I'tr Michel Doo Kingu6 Assistant Administrator and Director' Regional Bureau for Africa in New York '!-tMr Gian Pennacchio ghd,of ., I oicrisi"@n'-$or"*fles.&**fsi"crtat'-tfiglr"ttrk" _/Mr Gregorigrtreliciano UNDP Reoz6sentative in Ghana "/ Mr Jean-Claude Petitpierre UNDP Repfesentative in Ivory Coast l"Mr Jean-Pierrg"6chellenberg IINDP Repres"€ntative in Mali , ,rrMr Jens Hp3.d1- UNDP Re"pdbsenEative in Upper Volta 'and Planning Unit Division in Togo (" ? aLnrrg.**" *.3 c*'o.*t te"'ra"*(/ UNDP Depurft' Representative in Niger AI{MX 2 Page 6 t1r Herbert A.. "BehrstockAssistant Representative 0f f ice of. the LINDF" Representati.ve I ur .rean)qd',rsse UNDAT,fI \rector in Niger ,,/ \ World Health Or8anization (WHO) Dr Comlan A., A. Quenr:m Regional Eirector for Africa Ur a. Crl'eqendijk Director.l Division of Budget and Finance Dr T. LbpCs Direct-pt, ,pivision of MaLaria and Other parasitic Diseases{ l= Dt P. ziegler, EFr /neI Fri-r€€+.-r.r--Oncheeereieb*e- gorrgrdi- -t ogra[[e r Mr M.\1. gazin Di-rector Designate Onchocerciasis Control Progranrme Dr R. 'I,e Berre Chief Vector Control Unit Onchop'erctasis Control programe{ Mr J.\q. Ml-'Marr Entongld"gis t/Biologi s r Onch6cercias,is Control Prograrme EX OFFICIO PARTICIPAI{TS Mr Wilfrid de Souza Secretary of the Economic Development Advisory panel (EDAp) Professor -P.. c. Janssens chairman. of the scientific and rechnical Advisory comittee (srAC) Mr Stanislas Kpognon Alterqate Executive Director World Bank OBSERVERS jj i' in the Peoplets Republic of Benin r' Organisation de Coordination et de Dr Cheick Sow Secretary- General ation pour la Lutte contre Grandes End6mies (occcE) Office de Ia Recherche scientifique et Professor G. Camus Directelrr g6n6ra1 Dr Jean Mouchet Directeuf 'des Services scientifiques centraux t ue outre-Mer (ORSIOM) AT.INEX 2 PaBe 7 Mr B. Philippon y' Chet de la Mission ORSIOM auprEs de I'OCCGE i Bouak6 J Directeur, Institut de Recherches sur lrOnchocercose d Bouak6 Cormission of European Comunities ,. Miss GabriEle von Br{chowskif' Delegate of the comiision of European comuniEies in upper volta ANNEX 3 Page 8 ONCHOCERCIASIS CONTROL PROGRA},IME IN TIIE VOLTA RIVER BASIN JOINT COORDINATING COMMITTEE Third session, Ouagadougou,, 1-2 December 1976 ADDRESS BY TI1E HEAD OF STATE Mr Chalrman, Members of the Conrmittee, Presidents, Ministers, Ladies and gentlemen, My country is happy to be acting as host to the third session of the JoinE Coordinating Couunittee for the Onchocerciasis Control Progranrme in the Volta River Basin area. Mr Chairman, ladies and gentlemen, coming here to Upper Volta, where the Onchocerciasis Prograrnrne has its headquarters, you have come to a country where hospitality in the African sense of the term is not an empty word. Consider yourselves at home and feel welcome among us. Onchocerciasis control is for us West African countries a fine exarnple of concerted and disinterested international action to make possible the implementation of a prograrmre unique of its kind if we take into account both the health and the economic aspects. Since December L974 we have been closely following, through our ministerial departments, the progress of the health work in the field. We are therefore aware of the successes achieved and the difficulties encountered. The successes have already come ful1y up to our expectations. As for the difficulties, when we Look at the nr:ober of institutes, of scientists and of well--wishers involved, we are inclined to feel some degree of optimism. hlhen phase III of the Programne is eventually launched, the area defined as the onchocerci.asis region will be covered and the high cormand of the Onchocerciasis Progranme will thus contain or reduce the transmission of the illness that makes human beings, our kith and kin, flee fro,nr their native soil. But does that mean that apicture reproduced in a rather widely distributed document, showing a blind father led by his child, wil-1 be seen no more? We have no guarantee of this, and that is why, following the example of one of our sister countri.es participating in the Onchocerciasis Prograrmre and rePresented on this Comlittee, Upper Volta ventures, on behalf of all six I.Iest African countries, to ask that a big effort be made in the field of chemotherapy, so that those of our brethrenwho are already infected can have some hope of cure. Thus, Mr Chairman, some alleviation will be brought to that hr:man misery which r^re see about us and which cannot but accord very iIl with the economic and soci-a1 development of our countries. Our unreserved suppogt goes to this Prograrmne, and all those who are or will be concerned in its promotion wiLl always receive due encouragement and assistance from Upper Volta. ' Mr Chairman, Dr Candau, Upper Volta r^7as gratified in 1974 when the members of the Joint Coordinating Conmittee, on our proposal, approved your appointment as its chief officer. IhaE action l^7as a recognition of your outstanding merits. You accepted this appointment and it is heart-warming to see a m:n thus sacrifice himself to the cause of mankind. your presence at the head of this Conrtittee is an earnest of success for the Prograrmre. I join those who have already done so i.n wishing you every success in your task. ANI{EX 3 Page 9 In the Presence of this Comittee I have pleasure in also paying tribute to another man who, ln the difficult Post he occupies, is always mindful of thl prout"r" of the emergingcountries: r am referring to the president of the world Bank, Mr McNamsra, who has piayed akey role in the PreParati.on and implementation of the onchocerciasis control programe, whichis the continuation on a larger scale of the cerTaign undertaken by OCCGE, thanks to Ewo bodies which are very well known to us: the FED and the FAC. Nor must I omit to mention the workof those who served on the PAG mission and thus supplied essential baserine data for thePrograme. I should notr like to address their Excellencies the Ambassadors of the countri.es that areassisting with the financing of the Onchocerciasis progrFrme _ the representatives of thecontributing parties - and ask them Eo be kind enough Eo convey to their governnents and tothe agencies they rePresent our sincere thanks for their contribuEion. At a tiEe when thereis talk of a dialogue between north and south and when we are all preoccupied by Ehe state ofthe worldrs econooy, hard hit by an infLation which is putEing most countries in difficulty, we have here a fine exaurple of solidarity between developed and emerging countries. I,Ie hopeto see your number increase so that the burden will be less heavy and the successful outcomeof the Prograume better ensured. rt is the task of the sponsoring agencies and of the working groups that have been set upto be vigilant in ensuring the-success of this Programme, whose final objective is the reclamation of some 700 oo0 krn2. r have already spoken to you of the health picture. Asregards economi-c and social development, the contacts established between some of these agenciesand our technical departments will enable the future course to be mapped out, wiEh the provisothat the way in which each African country envisages its development must be understood. Addressing now the Participating counEries, r should like, Right Honourable Dlinisters andrePresentatives, to say to you that we were united in desiring this progr:nrme and that wePossess, in Ehis conrmiEtee where joint planning is possible, an instrument for supervising thisPrograme, and that is what should determine our action. Such, Mr President, ladies and gentlemen, were the points I felt it would be useful torDention to you at the opening of your third sessi.on. r am sure that the rePorts which will be presented by certain working groups of your cornmittee in the course of this session will demonstrate the urgency of the .r""d to plt i.rtoeffect the economic and social development of the onchocerciasis zones. I wish your session every success. ANNEX 4 Page 10 ONCHOCERCIASIS CONTROL PROGRA},IME IN TIIE VOLTA RIVER BASIN AREA JOINT COORDINATING COMT{ITTEE Third session, Ouagadougou, 1-2 December 1976 ADDRESS BY THE INDEPEMENT CHAIRMAN Mr President of the Republic of Upper Volta, Presi.dents, Members of the Government and Diplomatic Corps, I'lembers of the Joint Coordinating Cormrittee, Your Excellencies, Ladies and gentlemen, Al1ow me, Mr President, in my capacity as Independent Chairman of the Joint Coordinating Comnittee, to acclaim your presence arDong us this morning and express our appreciation of the honour you are doing us by presiding over this inaugural meeting of the third session of the Joint Coordinating Comitee for the Onchocerciasis Control Prograune in the Volta River Basin area. This manifestation of the interest that you personally, Mr President, and your Government take in the progranme we have jointly undertaken is an invaluable encouragement to all of us. It is thanks to the invitation issued by your Government that we are today holding this third session in your countryts capital and I iutr expressing the feelings of all present when I teII you how grateful we are for your generous hospitatity. Ihe year 1976 was one of major progress in the development of our Onchocerci-asis Control Programe in the Volta River Basin area. The extension, beginning in January of this year, of the vector control operations to zone II, together with the initiation of epidemiological surveys, the establishment of the necessary structures, and the launching of exploratory operations in connexion with the vector control plan in zone 1II, all show that the Prograrme is following the course napped out in the plan of action. When, in the early months of 1977, insecticide spraying begins in zone I1I, the vector control operations will- cover the entire Pro8ra[me area. The experience of the first trdo yearsr operations, and the results obtained in zones I and I1, together with the knowledge aquired concerning the vector and the disease, give us reason to believe that the Programre is progressing satisfactorily, and that the social and economic development of the regions freed from onchocerciasis - the real objective of our efforEs - will acquire ever greater momentum in the years to come. I recently visited the seven participacing countries for discussions with S! go.r".nment about problems connected with the Programre and for an exchange of views on the agenda for our present session. 1 also ca11ed at the Programe Headquarters Lo obtain information about the progress of the work and visited several sectors and subsectors where vector control oPerations are proceeding. In several- countries I took part in meetings of the national Onchocerciasis Control Comittees and I should like in that connexion to stress the ioportant role of these comittees in the coordination of the Progranme at governxoent level' It became evident to rae from the various discussions and meetings I attended that the participating countries are saEisfied, on the whole, with the develoPment of the Programe and the results achieved so far. A}INEX 4 Page 11 Nevertheless, there remain problems to be solved and there is one in particular whichseems to be comon to several countries: that of the boundaries of Ehe prograrnne area. The sound argunents that have been advanced in favour of a reconsideration of thoseboundaries - from both the vector control and the economic points of view - seem to constitutegood grounds for reopening the question before long. Thus, the reinvasion - albeit liEited - of the south-western part of the progrenmre areais a Eatter of serious concern to the countries concerned. seconily, from the econo,micvieqpoint, several governnents regret that certain districts for which agricultural develop-ment projects have been planned but where onchocerciasis i.s rife have not been included withinthe boundaries of the area. The progress achieved in research on the taxonomy and biology of the species which make "P tl". Simulir-m damnosun cmplex, and on the possibility of establishing vector colonies inthe laboratory, show how important it is to intensify our efforts in order to obtain ever moreprecise knorledge of the biology of the various species and their role i.n the transmission ofonchocerciasis. Moreover, the establishment of such laboratory colonies erirl contribute tofacilitating and expanding international cooperation in research on the vector. While it must be stressed that our progrrrnme has constantly benefited frog the generousand invaluable cooperation of the international scientific comlnity, a stirl greater efforthas to be called for fro'm investigators. For, in order to try and alleviate the sufferingsand destitution of a large ProPortion of the populations, there is a pressing need also tointensify research on the biology of the parasiie and on the epidemiology, chemotherapy andimmunology of onchocerclasis. rtrat bad hygiene and ill-health are obstacles to social and economic development is nolra-days an acknowledged fact. rt is difficult to imagine how the hr:man, social and economicdevelopment of a region can proceed when nutri.tional deficiencies and diseases are rife there. Mr McNamara, President of the World Bank, recently wrote: rrBeyond the specifics of theBankrs project work . . . lies our central concern with the fundanental issue of all humandevelopment: improving the opportunity for individuals to achieve more furly their inherentpotential. Developoent is Deaningless if it does not in the end enhance the lives ofindividual human beings, parti.cularly those individuals whose circumstances . . . constitutean i.ntolerable insult to hr.man dignity itself". The onchocerciasis Control Progranme in the volta River Basin area is an excellent exampleof concerted international action to alleviate hr:oan misery and -ake possible the developmentof the regions concerned. The land utilization projects set on foot by onchocerciasis controlwill provide in turn the substructure for the establishment of social slrvices such as thosefor health, nutrition and education. Mr President, aI1ow me again to thank you on behalf of alL of us for having consented topreside over this inaugural meeting and to assure you that your presence is a great encourage- ment to us to continue our efforts. Finally, allow rne to thank the authorities and honour this meeting with their presence, and to tel1display stimulates us to give the best that is in us the guests who have been kind enough Eo them how greatly the interest they for the success of this progranrme. ANNEX 5 Page 12 10 December 1976 Dear Dr Ziegler, ) The JoinE Coordinating Committee for Ehe Onchocerciasis Control Programme in the Volta River Basin area was informed durlng its third session, held last week in Ouagadougou, that, Ihaving been asslgned to new responsibilities in the World Health Organization, you were going to relinquish the directorship of the Prograrmne. Ihe Comnittee has asked me to act as its spokesman in telling you how grateful we all are to you for the \dork you have accomplished in launching this Progrannne and directing it for three years, and for all the trouble and effort you have devoted to it. Your task has been a particularly difficult and delicate one and you can be proud of what you have accomplished. Your dedication and your active partlcipation in the meetings of the JCC have been much appreciated by the members of the Corunittee, who hereby express to you their gratitude and satis faction. On behalf of the JCC I wish you every success in your nel^, post and I Present to you and to Mrs Ziegler my kindest regards. Yours sincerelY' . Dr M. G. Candau Independent Chairman Dr P. Ziegler Onchocerciasis Control Prograumre P.O. Box 549 0uagadougou Upper Volta I t A}INEX 6 Page 13 ONCHOCERCIASIS CONlts.OL PROGRAI.IME IN TIIE VOLTA RIVER BASIN ARXA I t JOINT COORDINAITNG COMMITTEE Third session, Ouagadougou, L-2 December 1976 ESTTMATEp FINANCING 0{ oNCIIOCERCIASTS PROGRA}.I,IE rN 1977(us$ niltion) Iotal requirement for advances to tfllOglg expendi.tures on research and training to be financed by IINDp Total programme requirements Ln L977 Contributions pledged or indicated: African Development Bank (UA 15O OOO) Belgium (gf tS million) Canada (Can I 5OO OOO) France (ff 4 roillion) Germany (DM 4 nillion) Japan ($ 1 nillion) Krnuait ($ 2 mlllion) Netherlands ($ 1.5 nillion) United Kingdom (1O% of Fund requirements) unired stares (g 1 nilLion) hlorld Bank Group (g 1 million) United Nations Development programe Total contributions plus expected carry-over from 1976 Total finance available l-ess progr:me requirerDents in 'J,977 Expected carry-over to 1978 11. 90 o.57 L2.47 o.18 o.42 0.50 o.80 1.60 1. OO 2.oo 1.50 1. 19 1. oo 1. OO o.57 tI.7 6 2.oo 1l:1! L2.47 L.29 Note: rhe contribuEions indicated for Japan, Kuwait and the Netherlands are still subject to official confirmation. Rates of exchange used in converting non-dollar contributions are approximage only and rnay yaa, significantly in the course of the year. il A.n.* 7 ":i li Ann.xe 7 'C t II * I l z 9o =UJE UJ o vt ulz oN I' z o o z EE r o U' U E, N t q ,I !: ) ! \ '6 : l/\ -t6\ ."t i' ,. \r..'''-') ..i E\slEr\,"8 I\.t i\Ud ( \ .Et \l " -' -'' I I a g z6 d 9<z EZb -39 < 6-H -<5 s2J 5 q-, l, 12co U =o6E5d E H6 +0F2! o =6 = E;g P -<E=Jaee;E3AY 6 o - zo .'''7) _iJ i Dl( 7-.-rl ' r'' - o o .L ts\ i g-E - I -.JE' -- t { -- i) ,r \ \1.' ^l- -'- rz'r.l l 9s. : rsf,PLl,'nL \\ EI
Organisation mondiale de la santé (OMS) · Technical Documents
Joint Coordinating Committee: third session, Ouagadougou, 1 - 2 December 1976; independent chairman's report proceedings
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