Development of the capabilities and capacity of the national health services of the participating countries to undertake surveillance operations

WORLD HEALTH ORGANIZATION O}ICHOCMCIASIS IN UM VOTTA NA'I] O}TAL OI'{CEOCtrRCI,AS IS COI'I}4ITItrES Sixth meeting: &s--h4--r:#re-*19P-a x Document presentecl e.t the Corunittees, 3a,rnako, 24-26 ORGANISATION MONDIAL"E DE LA SANTE CO}]IIROL PROGRAI,II,IE RTUER SASII{ ASEA t{ I;': ' "'I Original: Engltsh thiral meetirrg of the National Onchocereiasis April 1979. DE\TJI,OPi,MNT O]] TIIE C^{PABIITTTE.S AIIID CAPACITY OI1 TTIE NAIICI{AL Ir-IITJI SH]VICES OF [F.M PAP.TICIP,^.TII'IG CCIUIXIH,IES TO I]].IDMTAJG SURVEIIIANCE OPEF"ATIONS * by nr E.G. Seausoleil Director of Med.ical Serrrices, Ghana IIE\TEI,OPT.ENI' CF' T}E CAPASITII]XS AI.ID CAPACTTY CE TTIE 1\IAT1OIIAT HEATTH SERVICLS OF 15iE PARTIC]PAT$G COUNM.IES TO Ii]IDIA.TAKE SUR\TEIITA}ICE OPM.ATIONS b0, nr. E.G. Beausoleil Direotor of Med.ical Servicos, Ghana fhe kogra,me for the Control of Onohocerciasis in the Yolta River Sasin has been d,esi€ned as a vertical progsanme outsicle the national hcalth serrioes of the Participating Countries for reasons that are so obnrious that they need. not be d.weIt upon here. Correequently, the wi-d.e a.:aeay c,f p:rogra'rr''{e activlties ranging flcm vector control to waluation are oamied. out solely by OCP staff. Hor*ever, like all mass campaigns, the plaruaing and irrpleuentation of, the progranroe should. be envisag;ed. within the framework of the g:eneral healtJe pqlicies of the Participati.:rrs Cqmt:ries. this {qplios involveuent of the general health serrices in a mass eaurpaign at alL the 5 trad.itional 1eve1s of adminisfration, ioer cel1tr411 inte:med.iate and. peripheral Ieve1s. It therefore follows that the national health serrrices of the Parti- cipating Countries should..be more actively involved. in the lro#a"mne than they have been up to d.ate. tr\rthermore, close collaboration and co-operation between the national health serrrices and. OCP needs to be prmoted and. fostered because it is not envisag'ed that OCP will continue to be responsible for all activities indefinitely. At the conclusion of the prograrrrmel the Participating Co:ntries will be erpected to take over the responsibilities for naintaining tire achieve- ments and. preverrt resrrrgenee of the vector and the cLisease ln the freed. atreaE. Ind.eed., it is inconce:Lvable that OCP will exist ln its present form ind.efinitely. ,2- Ttr:is is because although certain epid.eniological factors, economic, technical, operational and. administrative considerations d.ernand. that the control of a d.isease like onchocerciasis in a wid.e area should. be d.esigpred. as a vertical caa,pajgn outsid.e the national health se::vices, such a campaign carurot and. should. not be viewed. as a separate entity. Ind.eed., it must be vier.ued. as an integral component of the social a:rd. econorric goa1s. Consequently, the Prograrrne and the natj.onal health services must be viei,red. and. d.eveloped. a.s interd.epend.ent long*term prograJrnne with closely related objectives and activities that rnust be fused. in a national progrpi-rileo 1t1r1s implies effective co-operation and. collaboration betwecn OCP and. the national health seryices of the Participating Countries. This ind.eed. becomes increasingly important as the Programme progresso!. fron the active to the consol-id.ation and. maintenancc phase. Altirough 2O years sou-nd- a long ti-me, corner especially when one considers that has come to an end. that the Prograarme is second. phase. Fnrthermore, consid.eri-ng the success in general, it is not inconceivable that advance into the consolid"ation phase. it is in fact only round. the the first phase of the Progranme getting ready to move into the of tire vector control activities some a.rea.s ui.ill soon be read.y to Consequently, the ParLicipating Countries shoul-d. novr begin to give serious consid.eration to the d.evelopnent of tl:eir capabilities and. capacity to take over tire Progranmc activities and. ti:e implementation of measures to prevent resurgence of the vector and the disease at the appropriate time. It is however not proposed. to d.eaI rrrith the future sf,ructure d.r:ring the maintenarloe phase since this is a complex subject that requires spccial consid.eration. Ihis paper is therefore confined. to only those activities that can readily be r:nd.ertaken joiltly between OCP and. the jrrd.ivitLual national. health authorities without much effort. 7- fn this connection, it is true that the technical and. operational reguirements of the O:chocerciasis Control Prograrnme demand. a special org:anizational structure and mechanisms for field. activities particularly in rela.tion to the voctor control activities. It is therefore clear that for obvious reasrons and. for the success of the Programrae, certai.n activities 1ilce vector control should. continue to be the sole responsibility of OCP until such tj:ne that the transfer of appropriate technology makes it possible for the Participating Countries to assr:me ful1 or partial responsibiliff for the activity. Horvever, in the interest of econoqy and. other considerations, there are a m:mber of a.ctivities in which the national health so:vices at the inte:mediate and. peripheral leve1s can participa.te in and. therefore make very useful eontri-brrtion as the Prograrnine progresses tor,€rd.s the consoli- d.ation phase. fnitially, some on all the contributions may be slfuht or mod.est in te::ms of what the spocially trained and highly skilled OCP persorurel aro capable of prod.ucir:S but then even such slight and. nodest contributior:s srs important a;rd. helpful as far as the long>te:cn goals of the Prograrme are concer:red.r for it is only fron srna11 and. mod.est found.ations that one can hope r,rith peseyera.nce and d.etermination to build. a solid. superstTucture of highly shil1ed. personnel for the futr.:re. Depending on the leve1 of the d.eveloprnent of the health services and. the infrastructr:re in the Programme area, those activities in whioh the national health se:lrices of the J coru:.tries can usefully pa::ticipate may be summarised. und.er the following: broad. categories: - collection of clinical and. epid.emiological d.ata; - collection of information on breed.ing vector d.ensitics and.idection rates; - chemotherapy and. drurg administration as and when consid.ered. appropriate; - storage of supplies; - focal f,reatment of breeding sites as and. when the need. arises; - propagation of health info::nation and. education of the public; - rehabilitation of the blind; -4- - collection of specimens of cytotaxonomic and. other relevant stud.ies i - applied. fie1d. research aimed. at tire d.evelopment of simple lnerrpensive but effective method.s of vector control that can easily be r:nd.ertaken by the national health services; - other relevant applied. fie1d. research projects e.g. te$ting of epid.emiological criteria that transnission has been reduced. to a Ieve} that epid.eniological surretllanco should prevent resr:rgence of the cLisease. Certain pre-requisites are howevex necessa^:ry if the national health authorities are to assume these responsibilities effectively and. meaning- fully. Firstly, there ntlst be political conrmitrnent. This is very important becawe without it, the forrrulation and persuance of appropriate policies and- the allocation of ad.equate resourees a;re not Iike1y. Secoud.ly, due consid.eration sl:ould. be g:iven to the control of onche- cerciasis in ttre formulation of national health policies and the aIloca- tion of resources for health prograrnmes. Third.lyr d.epending on the local situation and. conditionsr the appropriate organization with responsibility for the planningr mgartization, implenentation and evaluation of onchocerciasis control activities should. be established. and developed.. fn this conneetion, it is d.esirable that an Oncirocerciasis Unit be established. or a sub-division of the Public ilealth Division, Epid.emiolo- gical Division or otirer appropriate Division wi-thin the national health gervices. fhe staff rnay consist of the following: I. An Epideuiologist riith special training in the epirleniology . and" cont:-'oI of onchocerciasis; 2. One or trvo entomologists with special traininS: in the entomo- logical aspects of si.nulium control; 1. A group of entomological technicians; 4, A group of entomologists trained. to perforn arrd. examine skin snips. l/l:ere necessarTr the technicians may be polyvalent so as to combine the entomological activities lrith the clinical and. epid.emiolog:ical activities. Hospital laboratory technicians and peripheral laboratory staff working in health centres, health posts and sinilar peri.pheral health institutions should. be trained. to perforrn and examj.ne skin snips and to perfortr other relevarrt tasks appropria.te to their general duties and. functions. irlhere it is d.ecid.ed. to use general health seryices staff to perform ad.d.itional tasks, it is very important that they should. be made arare and. comrinced. that their onchocerciasis d.uties fomr an integral part of ttreir general d.uties and not separate as special activities. Tleis is very fuopcnrtant because irir.Iess this principle is fi::m1y accepted. the chances are that they may not discharge their onchocerciasis duties properly bocarrse general health services personnel have from experience been found. to look upon such add.itional duties as an extra Ioad superintend.ent on their normal d.utj-es and titat they are only helping others who should be pcrforming the tasks as their normaL duties. It is therefore imperative that the active interest of all workers be pronoted. from the outset a.nd. rnaintained. at all tj-me. Til:is ca1ls for the d.evelopment of suitable f,raining prog?anmes for national health persoru:eI. In this connection, i-t is proposcd. that OCP should. initiate ci.ialogue with the national health authorities of tl:e Participating Corrntries to d.efine the role of each national health service ancl on that basis to id.entify the persorurel and. traini.:g requirarac'::te as r,e1I as the appropriate mechanisms for co-operation and. collaboration in the Programne activities und.er general supervision and. technj-cal gu-iclance of OCP. On this issue, one for obvious reasons carinot, arrd should not 1ay d.own any hard. and fast rules or r,roc1eI. Each cor::rf,r7 '*i11 have to d.evelop a mod.e1 that ls most ad.apted to loca1 conditions in general and. the 1eve1 of d.eveloprnent as well as the crgarulzational structr:re of the health services in particular. .6- Hor,rever, whatever thc 1oca1 sltuation, it is irnportant that serious consideration be given to the d.evelopr:ent of the general health services not only to ensr:re that they are able to accept and perform their proper role in the ISogramme but raore i-mportant still as an integral component of the general socio-econonic development of the Proganme area wleich is the ultinate goal of the Progranmre, In su:nrary, it is a.5,reed. that the d.esign of OCP as a vertical prog?arme outsicle the national healtil services of the Participating Corxrf,ries is jusi;ified. on tecirnical, operational, adninistrative and. economic grourrd.s. It is also a6recd. that sorre operational activities like the vector confrol activities sirould continue to be the responsibility of OCP for the sane rea.sons. However, attention should be focussed. on the d.evelopment of si:np1e, low-cost but effoctive tools tirat can easily be hand.Ied. by national peripheral staff. fhis is very important for t]re naintenance phase .,vhen the Participating Countries r+i11 be oxpected. to assunre fu1l resporrsibilifu for preventing resur€Ience of the vector and tire d.isease. It is hovrever recognized. tleat for a nureber of reasons there should. be increasing active j.nvolvemeirt of the Participating Cor:ntries in the Progranrne. Firstlyr since the goals of OCP and. the goals of soeial and. economic development progra,rimres of the Partrcipating Countri.es are sirnilar, it follows that there shoulcl he close collaboration and. co-opexation between OCP and the comtries. Second.ly', in anticipation of the resporrsibilities of the Countrles d.uring the rnaintcnance phase, it is consid.ered. that initiated now to develop the capability and capacities of the Participatirrg steps be corrntries to assumo the envlsa6:ed. responsibilities. The Prograr'ule activitieg ln which the countries can participate have been id.entified.. Tiris calls for the establishment and d.evelopment of suitable structures and. iaechanisms within the health se:srj-ces of tJte corurtries. OCP is ca11ed upon to initiate d.ialogue with the couatries to initiate and- pronote appropriate action uhich will includ.e the identification of the manpo\,rer reqr:-irenents and. the trainir:g of national personnel.