Meeting of representatives of national onchocerciasis task force of APOC countries

African Programme for Onchocerciasis Conhol Programme africain de lufte contre I'onchocercose JAF-FAC I JOINT ACTION FORUM Office of the Chairman JOINT ACTION FORUM Seventh session Washington. 12-14 December 2001 FORUM D'ACTION COMMUNE Bureau du Pr6sident JAFT/INF/DOC.1 ORIGINAL: ENGLISH October 2001 MEETING OF REPRESENTATIVES OF NATIONAL ONCHOCERCIASIS TASK FORCE OF APOC COT]NTRIES a aMeeting of Representatives of National Onchocerciasi s Task Forces of APOC Countries Ouagadougou, Burkina Faso Februa ry !9-22, 200L Ref: MTGI/NOTF/200l 28102t2001 ! I I\/':, F"-t\ -\ : .t ' ). it t' I, I , kn. 1,, .it / { JAF/INF/DOC.1 Page i TABLE OF'CONTENTS Group photographs of participants Abbreviations Executive gnmmary Preface Objectives and Expected Outcomes Narrative of the Meeting Review of the Extemal Mid-Term Evaluation 1. Purpose and Process 2. Prioritized and annotated Recommendations 3. Timeline for Implementation Review of Phase II Programme Document Outline 1. Purpose and Process 2. Phase II Programme Document Outline G. Review of Phase II Memorandum of Understanding Annexes Agenda List of Reference Documents Phase I and Phase II Objectives Chairperson's Address Calendar of Phase II Document Preparations List of Participants A. B. C. D. E. Page 2 3 4 5 6 7 9 9 9 25 27 27 28 40 4L 45 46 47 48 49 F 1. 2. 3. 4. 5. 6. JAF/INF/DOC.I Page ii Group photographs of the participants: 2l.Oz.zOOL Thank you all on behalf of the affected rural communities! fih l.--- i : t, i I It JAF/INF/DOC.1 Page iii Abbreviations AFRO APOC CAR CBM CBTI CDD CDTI ComDT CSA DRC ECOWAS EPI ICEP IEC JAF KAP LF MDP MoH MoU NGDO NID NLFTF NOCP NOTF OCP REA REMO SAE STP TCC TDR UNDP UNICEF wHo African Regional Offrce of WHO Africa Programme for Onchocerciasis Control Central African Republic Christofel Blinden Mission Community-Based Treatment with Ivermectin Community Directed Distributor Community Directed Treatment with Ivermectin Community Directed Treatment Committee of Sponsoring Agencies Democratic Republic of the Congo Economic Community of West African States Expanded Programme of Immunisation Inter-Country Exchange Programmes Information, Education, Communication Joint Action Forum of APOC Knowledge, Attitude, Practice Lymphatic Filariasis Mectizan@ Donation Programme Ministry of Health Memorandum of Understanding Non-Governmental Development Organisation National Immunisation Days National Lymphatic Filariasis Task Force National Onchocerciasis Control Programme National Onchocerciasis Task Force Onchocerciasis Control Programme in West Africa Rapid Epidemiological Assessment Rapid Epidemiological Mapping of Onchocerciasis Serious Adverse Effects Short-Term Professional Technical Consultative Committee of APOC Tropical Disease Research unit United Nations Development Programme United Nations Children's Fund World Health Organisation JAF/INF/DOC.1 Page iii Abbreviations AFRO APOC CAR CBM CBTI CDD CDTI ComDT CSA DRC ECOWAS EPI ICEP IEC JAF KAP LF MDP MoH MoU NGDO NID NLFTF NOCP NOTF OCP REA REMO SAE STP TCC TDR UNDP UNICEF wHo African Regional Office of WHO Africa Programme for Onchocerciasis Control Central African Republic Christofel Blinden Mission Community-Based Treatrnent with Ivermectin Community Directed Distributor Community Directed Treatment with lvermectin Community Directed Treatment Committee of Sponsoring Agencies Democratic Republic of the Congo Economic Community of West African States Expanded Programme of Immunisation Inter-Country Exchange Programmes Information, Education, Communication Joint Action Forum of APOC Knowledge, Attitude, Practice Lymphatic Filariasis Mectizan@ Donation Programme Ministry of Health Memorandum of Understanding Non-Governmental Development Organisation National lmmunisation Days National Lymphatic Filariasis Task Force National Onchocerciasis Control Programme National Onchocerciasis Task Force Onchocerciasis Control Programme in West Africa Rapid Epidemiological Assessment Rapid Epidemiological Mapping of Onchocerciasis Serious Adverse Effects Short-Term Professional Technical Consultative Committee of APOC Tropical Disease Research unit United Nations Development Programme United Nations Children's Fund World Health Organisation JAF/INF/DOC.I Page I A. EXECUTIVE SI.]MMARY The first phase of the African Programme for Onchocerciasis Control (1996-2001) has shown the successes of a unique international partnership in a disease control initiative involving donors, an international pharmaceutical company (Merck & Co.), the World Health Organisation, health services of participating countries, local communities and a variety of non-governmental development organizations. In the spirit of partnership, and following the recommendations of the 6fr meeting of the Joint Action Forum, representatives of ten participating National Onchocerciasis Task Forces met in Ouagadougou, Burkina Faso from l9-22n February 2001 at the offrces of the APOC to contribute to the preparation of essential programme documents for the second phase, 2W2-2007 . The main outputs of the meeting were: 1. A prioritization of the recommendations of the External Mid-Term Evaluation Report. 44 High Priority recommendations were highlighted and a timeline for implementation was develoPed. An annotated outline for the preparation of the Phase II Programme Document A detailed list of recommendations for the preparation of the Phase I[ Memorandum of Understanding. Secondary outputs of the meeting were: High acceptance and support of the extension of project periods from five to eight years. A decision to hold annual NOTF meetings around a focused subject. The circulation of the recent APOC internal audit to NOTFs. As APOC moves towards the signing of the new Memorandum of Understanding in Washington in December 2001, NOTFs witl have an opporunity to review the draft documents. 2 3 1 2 3 JAF/INFiDOC.I Page2 B. PREFACE This meeting of representatives of NOTFs was called to follow up on the recommendation of JAF 6 (paragraph 26) that APOC management should 'work closely with the TCC, participating countries, NGDOs and other partners" to study the recommendations of the External Mid-Term Evaluation Report. The overall goal of the meeting was for the representatives of the National Onchocerciasis Task Forces to contribute to the preparation of the Phase II Programme Document and Memorandum of Understanding. A copy of the External Mid-Term Evaluation Report had been circulated to all the NOTFs for study and comment. Those NOTFs that responded with specific recommendations and remarks as requested were then invited to a meeting at APOC Headquarters beginning February 19, 2001. Of the 14 countries with approved projects in the APOC partnership, ten responded to the task and were invited to attend the meeting. The countries present were: Cameroon, CAR, Chad, DRC, Liberia, Malawi, Nigeria, Sudan, Tanzania and Uganda. Joining the meeting were representatives of OCP, WHO/AFRO, NDGO Coordination Group and APOC staff. On Saturday and Sunday, before the opening of the meeting, participants came together as a steering committee to organize themselves. Nominations were made for officers, the provisional agenda was revised and the working groups were assigned. On Monday morning the meeting was opened by the APOC Director, Dr. Seketeli, and the nominated officers were ratified by acclamation. With the presentation of the objectives of the meeting and highlights of the Mid-Term Evaluation and outline for the Phase II document, the work of the delegates began. Following presentations by each country, participants went to their working groups to review the External Mid-Term Evaluation Report. Each group worked to combine the various NOTFs remarks in to a single recommendation and assign a priority level (high, medium, low). The groups' work was combined into a single document and then presented to plenary session where the recommendations were discussed and harmonized. After Dr. Seketeli and the APOC suff made presentations on the background, progress and major changes for Phase II, the delegates once again broke into groups. Each group was given a tentative outline of the Phase II Programme Document and were assigned different sections to consider. Using the Phase I Programme Document as a starting point each group considered the points on the outline and produced recommendations for a plenary session to consider. Finally, the Memorandum of Understanding was discussed in plenary session where remarks and recommendations were shared with APOC Management. This report contains the recommendations of the External Mid-Term Evaluation with the conference's remarks and prioritization; a timeline for implementation of high priority recommendations; an annotated outline for preparation of the Phase II Programme Document and suggestions on the preparation of the Memorandum of Understanding. At the end of the meeting the NOTFs expressed appreciation for having the opportunity to share their concerns and contribute to the development of the various documents essential to their prograrnmes. It was felt that the conference was particularly successful in that only those that had made prior JAF/INF/DOC.I Page 3 preparation were invited and that the work was focused. The participants agreed that annual meetings be held with a focused agenda. C. OBJECTIVES AND EXPECTED OUTCOMES The goal of this meeting is for the NOTFs to contribute to the preparation of the first draft Phase II Programme Document and Memorandtrm which will be presented to the l2th session of the TCC from Marchl2-17'h,2fi)1, as agreed by all participating countries in the 0*.lnf of December 2000. In order to achieve the goal, a number of specific objectives for this meeting have been agreed to as follows: 1. Consider the suggestions and recommendations which were submitted by participating countries concerning the Phase I evaluation. 2. Prioritize evaluation report recommendations with remarks by NOTFs added. 3. Develop an action plan to implement high priority recommendations for inclusion in the Phase II Programme Document. 4. Review and modify the tentative outline for the Phase II Programms f)6srrmsnt. 5. The last objective of the meeting is four-fold and concerns enlightenment on specific management issues: NOTF review of interim technical and financial reports, a briefing on the internal audit of APOC, monitoring findings on budgeting for IEC and advocacy strategies and materials and establishment and/or improvement of inter-country communication. The expected outcomes of this meeting are as follows: 1. A fuller appreciation on the part of the NOTF participants of the APOC desire to reach consensus among all partners before the draft programme documents are presented to the TCC. 2. Specific prioritized recommendations and implementation action plans concerning the Phase I evaluation. 3. Specific recommendations for possible inclusion in Phase II Programme Document and Memorandum which can be incorporated before presentation to the 12th TCC session in March. 4. Greater understanding of several vital management issues which will affect the NOTF management of all country prograrnmes in the future, including financial transparency, greater NOTF responsibility in the judicious vetting of financial and technical reports from projects, the necessary budgeting of IEC and advocacy materials and the vital issue of inter-country communication. JAF/INF/DOC.1 Page 4 D. NARRATIVE OF THE MEETING Dr. Seketeli, the APOC Director, formally opened the meeting. After a short discussion, the following persons were selected by acclamation: Chairperson Dr. Marcelline Ntep, National Onchocerciasis Control Programme Coordinator, Cameroon Co-Chairman Mr. Elvin Hilyer, Global2000 Representative, Sudan Reporters Mr. David Law, CBM Representative, Dem Repub of Congo Dr. Albert Eyamba, Global2000 Coordinator, Cameroon Dr. Justin Ndoyo, National Onchocerciasis Control Programme Coordinator, Central African Republic Dr. Ntep presented to the group the objective of the External Mid-Term Evaluation of Phase I of APOC which was completed in September 2000. This presentation included the process and expected outcome of the evaluation. A short discussion which helped to clarify some minor points followed. Dr. Seketeli then began the formal presentation of issues related to the preparation of the APOC Phase II Document. [t was explained that Phase I would end on December 31", 2001 and Phase II would run from January l"', 2C[l2 until December 31", 2007 , a period of six years. With this basic timeline in mind, Dr. Seketeli explained that a programme document would be prepared for the next phase and a new Memorandum would be signed at the next JAF meeting to be held in Washington in December 2001. Before that happens, donor countries will be visited by the World Bank and the APOC Director. Dr. Seketeli further briefed the assembly on guiding points gained from the CSA meeting in Washington in January 2001. One of the major points was whether the original objective of APOC should be maintained or amended in light of experiences from the first phase. The CSA agreed that the overall APOC objective should be amended. At this point, the APOC Director handed out a draft budget for 95 projects for Phase II of APOC. The delegates were pleased to see that management had prepared so well and with such forward thinking. Dr. Seketeli mentioned that ttre year 2Cf.3 should be considered the deadline for the last project proposals to be submitted to the TCC. Dr. Seketeli presented a calendar of events for the year 2001 which would culminate in the signing of the new Memorandum of Understanding at the JAF meeting in Washington in December. (see Annex ,. Mr. Charles Franz6n (Chairman of the NGDO Coalition in Tanzania) presented the proposed Objectives and Expected Outcomes of the meeting. The revised Agenda of the meeting was also adopted by acclamation. (see Annex 1). The participants divided into working groups and began their consideration of the recommendations of the evaluation report. Tuesday February 20h Delegates were asked to stand and observe a moment of silence for the passing away of the NOTF accountant in Cameroon. JAF/INF/DOC.I Page 5 The working groups continued analyzing the evaluation report and then met in plenary session to discuss the recommendations of section 2.9, Vector Elimination. A request was made for ltwara Focus to be reviewed for certification as vector-free. In addition, the group recognized that there were fly-nuisance areas with very high bite rates which should be considered for assistance. Item 2.9.7 in the report's recommendations was identified as High Priority and included in the timeline. Following the discussion on vector elimination, results of the three working groups were presented in plenary for harmonization and agreement. The APOC Director presented information concerning the preparations for the Phase I[ Programme Document. Some key points were: the Programme Document for Phase II has not yet been written; a draft budget for 95 projects was discussed for the 2N2-2010 period and it was noted with strong support that projecs were now budgeted for eight years rather than five; passive distribution has been included for all countries in the draft budget. Participans requested when ready that a copy of the Programme Document be circulated to all NOTFs. Dr. Amazigo presented the proposed APOC objective for Phase II. The group suggested that in light of the change of programme objective, a Vision Statement on the elimination of onchocerciasis as a disease of public health concern be added. It was further suggested that ttre objective should follow the Vision Statement in the Programme Document. A concern was also expressed that the objective be flexible enough to cater for CDTI in conflict areas. (see Annex 3). Wednesilay, February 21il A lengthy discussion took place clariffing points to be covered by the working groups which came together to consider the tentative outline of the Phase II Programme Document. The working groups presented the results of their deliberations in plenary session. Later, Dr. Seketeli led a discussion of the Memorandum of Understanding. Participants requested when ready that a copy of the draft Memorandum be circulated to all NOTFs. Thursday, February 22d The proposed timeline was presented for agreement. A long discussion ensued concerning the issue of signatures on the Memorandum of Understanding, whether the Minister of Health should sign alone or do so together with the Minister of Finance (for obvious financial reasons such as tax exemptions and other prograrnme benefits). Furttrer points were raised concerning financial and administrative issues and it was suggested that the OCP Protocol of Understanding could be reviewed in order to assist APOC in devising text to cover exigencies such as importation of Mectizan@, capital equipment, insecticides and other materials necessary for the effective running of the projects. Delegates voted to have NOTFs meet once per year. Some delegates emphasized that the meeting should have a focused agenda. Participants were briefed by Dr. Seketeli on the importance of inter-country dialogue, NOTF review of interim technical and financial reports and the internal audit of APOC. It was agreed that a summary of the internal audit will be sent to all NOTFs. Dr. Amazigo addressed the delegates on IEC budgeting as well as advocacy strategies and materials, and findings of monitoring. In addition, she reminded everyone of the importance of community self-monitoring and stakeholders meetings as keys to susuinability. Dr. Seketeli thanked the participants for their hard work and dedication and after a brief final address by the Chairperson, Dr. Ntep, ttre meeting was officially closed. (see Annex 4). JAF/TNF/DOC.I Page 6 E. REVIEW OF EXTERNAL MID-TERM EVALUATION REPORT l. Purpose for Review and Process (i) Purpose Provide oppornrniry for NOTFs to make input to the recommendations of the Mid-Term External Evaluation Report and to prioritize those recommendations with a timeline for implementation. (ii) Process o Delegates divide into working groups o Each group reviewed the report with all NOTFs' recommendations o Where remarks were felt required, they were added to the report o Prioriry level was assigned to each of the recommendations . The group reports were combined into a single document showing all groups' remarks and prioriry level . In plenary session the remarks and priority levels were reviewed and harmonized o Vector elimination recommendations were debated only in plenary o The high priority (HP) recommendations were assigned time periods for completion in a timeline 2. Prioritized and annotated external evaluation recommendations 1. Programme management 1.1 APOC Headquarters management Sug ge s tio ns and re c omm e ndation s 1.1.1 o The staffing plan for 2001 should be implemented and vacancies filled as soon as possible. Since however only three professionals are to be added to the staff complement, the sinration regarding Headquarters staff workload should continue to be monitored closely. In light of recommendation 1.3.7, it is absolutely essential that APOC staff be recruited and hired to assist the TCC in carrying out its duties of review, etc. HP r.t.2 In order for the increased staff to operate optimally, the Programme's Executive Director should consider delegating more final responsibility for operational work to his professional staff, thereby adopting a more strategic management style. o HP 1.1.3 o [n view of the increasing number of projects and the continually expanding workload, efforts should be made to streamline planning procedures and place as much responsibility as possible at country level; Needs to take into consi.deration country ability and available support to carry out this task- HP LP 1.t.4 a a 1.2.4 a JAF/INF/DOC.I Page 7 Headquarters should pay increased attention to the need to involve country programmes in decision making about ttre timing of visits, missions etc. Every transfer of funds by APOC Headquarters should be accompanied by letters to both the NOTF secretariat, the project itself and the WHO country office, stating exactly which funds are being transferred, and for what purpose. 1.1.5 o The APOC governance structure should be critically reviewed and rationalised for Phase 2 of APOC: to inculcate the principle of 'community directedness' at all levels; to reduce costs of administration; to avoid duplication of work; to reduce the administrative burden on both APOC staff and national and project staff; and to position the programme so that it links effectively with other emerging global or regional disease control prograrnmes. When this review takes place information should be gathered about the formas of governance of other externally supported prograrnmes in WHO, with a view to learning from their examples. Each country, with the support of APOC, should establish an appropriate way of strengthening linkages. LP 1.2 Financial management Sugge sttons and re commendations t.2.1 o In order to develop sustainability and accountability at country level the role of the NOTFs and the WHO country office in financial management should be strengthened progressively, through the necessary training and sensitisation. As projects move through their five-year cycle the responsibility should increasingly be left to the national level. NOTF and the WHO office should play an increased role in controlling project expenditure. The focus of this recommendation should be on strengthening the NOTFs with the assistance of wHo. HP t.2.2 . Setting budgeting standards should (with country adjustments if necessary) will make everyone's life easier. There should also be a clear policy in relation to topping-up of salaries. The evaluation team is of the opinion that, in the interests of sustainability of projects, the practice of topping-up has to be phased out as rapidly as possible. The inevitable consequences regarding staff motivation will have to be dealt with in other ways, so that solutions are in place by the time APOC funding ends. The following are suggested: * Administering a well-run programme, with clear objectives. * Good, supportive supervision, integrated with routine supervision of other activities at each level. NOTFs disagree thal top ups should be phased out rapidly. HP t.2.3 Projects should be made aware that some delay in providing receipts is acceptable, provided that they are supplied within a reasonable time frame (e.g. three months). LP LP JAF/INF/DOC.I Page 8 1.2.5 a The ceiling on the WHO country office imprest accounts must be raised, where this has been a problem. HP t.2.6 . To achieve a progressive hand-over of project management to national prograrnmes, APOC Management and TCC should identiff projects which perform well in terms of financial reporting. Projects should not be subject to continuous monthly review of expenditures - rather, random spot checks should be applied to them. Project financial reports continue to he submitted monthly and reviewed al NOTF level is not necessartly APOC. LP 1.3 TechnicalConsultativeCommittee Sugge stions and recommendations 1.3. 1 r The role of the TCC should urgently be re-defined, to align it with its technical mandate. Some of the work that it currently does should be taken over by NOTFs, particularly six monthly project reviews. Some of the work should be done by APOC Headquarters staff (which is about to be expanded). At the same time TCC should advise that decision-making be delegated as far as possible to other partners, including NGDOs and MoH at appropriate levels. TCC should review the degree of scrutiny needed to assess projects adequately, in order to streamline the process of review and to build capacity for review and decision- making at the national level. Concerned NOTFs should be financially supported tu perform these tasks. HP t.3.2 Phase 2 of APOC offers an opporunity for formal restructuring of TCC, as well as a reconfiguration of TCC membership to include members with skills in management and finance. The proposals developed by the TCC and APOC staff are a useful starting point to initiate a trial of new procedures. 1.4 The NGDO Co-ordination Group Sugge stions and recommendations t.4.t . The Group should consider nominating a national staff member of one of its member NGDOs, and a representative of a local NGDO undergoing mentoring, to serve on TCC. HP a HP JAF/INF/DOC.I Page 9 1.5 Synergies between APOC and OCP Suggestions and recommendations 1.5. I o The Programme Management should develop a plan (early in 2@1) which demonstrates how the technical and administrative support which they need can be provided in Ouagadougou, after 2002. This plan should of course take into account the fact that a subregional Centre for Multi- Disease Surveillance and Control may be in operation by that time, in the same Ouagadougou compound, which could continue to provide the support that OCP currently provides. If APOC Management cannot find this support in Ouagadougou then they should consider other locations and develop costed scenarios, so that a definite decision can be taken in the first half of 2001. The NOTFs suggest that APOC HQ should. be located in an APOC country. Additional points to be considered in costing are accessibility, communication and traveltor most APOC countries. HP 2. lnplementation 2.L Coverage Sugg e s tio ns and re c o mme ndatio n s 2.t.1 . Steps must urgently be taken to ensure the use of standard denominators and methods for estimating coverage at all levels. It is recommended that TCC immediately reaffirm its preferred options. In doing so it should consider the tried and trusted OCP formas: * Number of persons treated as a percentage of the total population of that area. * Number of communities/ vitlages treated in an area, as a percentage of the total number that has been indicated (by REMO) for treafrnent in that area. Deadline for complinnce should be circulaled to all countries. HP 2.1.2 . There is an urgent need for operational research in projects with low rates of coverage, to identify causes of low coverage and to identify strategies to address this. The evaluation team notes with appreciation that studies of this type are a current TDR priority. However projects and district level staff should also be encouraged and empowered to undertake research on this topic, as it pertains to their situations. There is a need to broaden the base of potential researchers. HP 2.r.3 When the process of negotiation with communities is underway, it is suggested that the advantages and disadvantages of conducting separate or simultaneous census and distribution be discussed with them. In this way communities can make a more informed choice of method. In either case it should be routine for the census to be updated with each distribution, which keeps the denominator accurate. o LP JAF/INF/DOC.I Page 10 2.r.4 r For each participating country with significant problems of securiry/ health service breakdown, very specific planning is needed to make provision for a continuation of onchocerciasis control after 2007. In ttmes of civil strile and insecurity, projects should be able to be placed on hold. Thts would permit tunding and project schedules to be resumed once normalcy is regained. HP 2.t.5 Operational research is needed which would build up a stronger evidence base on which to develop CDTI projects. The results of such research should also be used to modify the CDTI strategy where appropriate. a HP 2.r.6 a LP 2.2 Drug procurement and delivery Su gg e s tio ns and re co mme ndatio n s 2.2.r These studies should be conducted by projects, in consultation with the respective NOTF, and the TCC. The Programme needs to build operational research capability at the local level. a 2.2.2 a LP LP An important feature of Phase 2 should be the planning and establishment of a delivery system which is completely independent of APOC funding. Wherever feasible drug delivery should be integrated into MoH drug delivery systems., but where these are not functioning other channels will have to be used. In any plan the record keeping systems need to be firmly established and standardised. The possibility of dealing with the drug as a 'donation of no commercial value' should be explored, if this will save clearance and handling costs. 2.2.3 . Research should be carried out to establish whether alternative package sizes would reduce wastage and/ or increase coverage. Due to recent Merck repackaging, NOTFs cannot agree with this recommendation. 2.2.4 As always communities should be encouraged to identiff the most effective and sustainable way of ensuring distribution to community level. This means however that they need to be aware of the advantages and disadvantages of the different options. a LP JAF/INF/DOC.1 Page ll 2.3 The role of national structures in Programme implementation Sugg e s tions and re co mme ndatio n s Countries should be encouraged to integrate CDTI fully into the routine functioning of their health districts and regions. Clear indicators are needed to show progress in integration (see also section 3). Dedicated onchocerciasis personnel are probably only sustainable at national level, and at State or provincial level in large countries with many projects. The danger of using APOC funding to create temporary, unsustainable structures is real. Accordingly, a key activity at the start of Phase 2 should be to identiff which structures will be left to carry CDTI forward after Year 5, and to use APOC funding primarily to strengthen those. There is linle doubt that the district level will be a prominent player. Expertise should be developed in such a way that it is the districts which assume resporsibility and have the necessary capacity. 2.3.r a 2.3.2 O 2.3.3 a HP HP Further important recommendations concerning sustainability are made in section 2.8 Training and supervision Su g g e stio ns and re c o mme ndation s 2.3.4 o Each project or district should be encouraged to make a plan for sustainable training and supervision, as soon as possible - and to move into the implementation of that plan before the APOC subsidies dry up. Training must become 'leaner and meaner'. Innovative approaches should be encouraged and shared - for irstance, sharing transport between progralnmes (already being done); training school teachers or other members of the communiry to be involved in supervision (already being done); conducting training during routine supervisory visits for other purposes. NOTFs believe that training should include all levels in the progratnme. Personnel should be trained by those in the level immediotely above (e.g. rural health workers to train distributors). HP 2.3.5 o There is a need to ensure that each country has a reservoir of the technical expertise that onchocerciasis control needs, at senior management level - especially epidemiology/ disease control, biostatistics, medical entomology and medical sociology. Available expertise in the country should be investigated, and shortages that are identified should be remedied before 2007, by a carefully managed scholarship scheme. [t is recommended that APOC should budget yearly for this exercise during Phase 2. There should be emphasis also placed on management expertise and not iust medical or scientific qualtftcaions. HP JAF/INF/DOC.I Page 12 2.4 Community involvement CDDs: selection, and incentives Suggestions and recommendations 2.4.r a Operational research is needed on a number of topics. The phenomena of attrition, community involvement, CDD motivation and incentives need to be more thoroughly understood - as well as the interaction between these issues. This is needed if appropriate corrective measures are to be taken and sustainability achieved. For example, the most appropriate forms of incentives in different contexts need to be identified. Such operational research needs to be undertaken by the projects themselves. HP 2.4.2 . The existing example of cost recovery should be closely researched, and compared with the experience of cost recovery/ sharing in other community based health services, e.g. revolving drug funds, EPI and family planning. A major concern is the possible adverse effect of cost recovery programmes on coverage. HP Health education/ IEC Suggestions and recommendations 2.4.3 Continued and sustained sensitisation about the Programme is needed at all levels, both in the health service and also in political structures like provincial, district and local government. It should be a major priority for APOC and national programmes. a HP 2.4.4 . IEC materials are needed but they should be carefully developed (on the basis of a KAP study wherever possible) and pilot tested. APOC could draw on known expertise in this field - one NGDO is particularly skilled - to facilitate this process in national programmes which are lagging behind. IEC malerials should be pertodically made available tor use by the NOTFs in print media. MP 2.4.5 . Modules for inclusion in the curricula of health professionals should be developed by APOC for adaptation at country level (there is evidence that this would be welcomed). HKI would be better equipped to do this than APOC. However, this should be done together with NOTFs and taking into consideration the unique aspects of training facilities within each country. HP 2.4.6 JAF/INF/DOC.I Page 13 Serious side-effects S ug g e stio ns and re c omme ndation s a An urgent investigation is needed, to determine to what extent TCC policy is being applied in co-endemic areas. Projects in these areas must be very strongly advised to adhere to policy tully. 2.4.7 a Health centre nurses in affected areas urgently need some form of motorised transport, to enable them to carry out surveillance as recommended by the TCC directive. tf this is not yet available APOC will have to budget for it - it is unlikely that the MoHs in affected countries will be able to do so. 2.4.8 a A decision must be taken as soon as possible, to launch rapid epidemiological mapping for loiasis in suspected co-endemic areas. 2.4.9 a ln other countries where SSEs are likely but have not yet occurred, the lessons learnt and policies developed must be applied immediately. HP Involvement of women Sugge stions and re commendations 2.4.10 a Operational research could be carried out to determine whether it is important to collect gender distinct data about coverage, and to look at the relative performance of men and women as CDDs. HP HP HP LP 2.4.t\ . [t is certainly possible for the Programme to be more active in promoting the recruitment of women to management, as well as encouraging them to become CDDs. In light of the fact thal over 50Vo of the population are women, the goal Jor all projects wtll be 207o female CDDs the first year, 30Vo the second year, 40Vo the third year and 50Vo the fourth year. In addition, project management should actively recruit women for professional positions. HP JAF/INF/DOC.I Page 14 2.5 Monitoring Su gge stions and r e c o mme ndation s 2.5.r a Independent/joint monitoring is a key way of maintaining quality of project work and the motivation of those involved in them. APOC should evaluate the new in-country monitoring carefully, to see if it produces the same beneficial results. Funding for its continuation should be arranged before APOC's mandate expires. Several problems were repeatedly raised, as requiring elucidation through research. These particularly concerned issues at the coalface: causes of absences and refusals, cost recovery; incentives; the link between onchocerciasis, epilepsy and ivermectin treatment. Substantial research is also needed into questions surrounding the issue of integrating other interventions MP 2.5.2 o The NOTFs must work actively towards the integration of basic monitoring data into national and district health systems. The official health information system should include data on CDTI wherever appropriate. Reports on onchocerciasis control activities (health education, training, treatment) should be regularly included on agendas of district health management teams. NOTFs should begin arranging training for the different levels of the health service, in the utilisation of routine CDTI data for management purposes. Progress on CDTI inclusion in the national health information system could be a very good indicator for sustainability. HP 2.5.3 . Projects with high and low cosV treatment ratios should be inspected on site, to clarify the reasons for such situations. NOTFs see no rationale for this recommendation in light of the fact thal there is still no standardisation of a common denominator for determining coverage. 2.6 Operational research Suggestions and re comme ndations 2.6.t a Countries which have little capacity for operational research should be encouraged and enabled to develop this with the support of APOC staff and the TCC. Key staff at the national level could be identified and trained, and national institutes encouraged to participate (see also section 2.3 above). 2.6.2 There is a clear need for co-ordinating onchocerciasis related research in Participating Countries. At present the only body which could reasonably do so is the NOTF - perhaps through a suitably skilled subcommittee. [n the interests of sustainability, review of proposals could be delegated (or partially delegated) to such a body. Once the necessary capacity has been built, NOTFs should process proposals, based on operational problems encountered. MP a 2.6.3 HP a JAF/INF/DOC.I Page 15 into the CDTI prograrnme, or linking them to it Projects should be encouraged to bring forward their particular needs. NOTFs consider the link between oncho, epilepsy and ivermecttn treatment very imponant for study. It might also be important to research issues related to non-compliance. HP 2.7 lmpact assessment Su gge stio n s and re c o mme ndation s 2.7.t ln view of observed problems with the entomological aspects of study execution, it is recommended that a panel of experts be commissioned to review progress to date, and to suggest possible refinements for the next phase of the study. a 2.7.2 a LP LP MP A home must be found for the study, when APOC ceases to function aftet 2007. Although the studies did not set out to measure the impact that the Programme is having on the health seryices, it appears from data collected so far that such an effect is taking place in project areas. Since it is too late to conduct baseline studies in this regard, other studies of impact will have to be commissioned. (e.g. post hoc, case control studies). 2.7.3 a a 2.7.4 r A thorough review of the socio-economic impact studies done to date should be conducted to determine if appropriate and relevant data are available, without huge expense incurred in collecting it. NOTFs recommend that countries should be allowed to do impact assessment studies on microfilarial load and transmission wtth a budget provided by APOC. LP 2.8 Sustainability Suggestions and re commendations 2.8.1 The desired situation in which projects should find themselves at the end of APOC funding must be very clearly defined, at first in general terms. This should urgently be done by TCC, using inter alia the recommendations of this report, and the result given in the form of a checklist with timelines - a set of progressive indicators for each year of the project, which allow for a realistic appraisal of whether projects will achieve a level of sustainability by their fifth year of funding. The guiding principle of such a document should be intensified devolution of Headquarters functions to countries, by means of intensified advocacy, sensitisation and capacity building, leading to integration of these functions (see also section 4). HP MP JAF/INF/DOC.I Page 16 2.8.2 a 2.8.3 a a Following this general definition existing projects (especially those in their second 2t/z years of funding) must be enabled to make specific plans to comply with the requirements of such a checklist, taking into account the realities of their situation. A similar process is required for national prograrnmes and NOTFs - if the latter plan to disband they have to start building capacity elsewhere as soon as possible. Projecs and NOTFs will need to be supported and monitored as they implement such plans. [t is recommended that the responsibiliry for these processes be specifically given to one or more senior professional staff members at APOC Headquarters. To this end it will also be useful to develop a flow chart of projects which visually shows when projects started and when the five years of funding end. Some projects took an unexpectedly long time to take off, for a variety of reasons. These investments should not be destroyed for the sake of a relatively arbitrary cut-off point, when some additional support could reasonably lead to sustainability and success. In such cases it is aspects which are critical to the future of onchocerciasis control in that country that need to receive additional support, namely capacity building leading to full integration into the health service. MP 2.9 Vector Elimination Projects Suggestions and recommendations 2.9.7 o APOC is requested to convene a meeting in Tanzania in 2001, to determine APOC strategy in the field of vector elimination (as opposed to control) for Phase 2 of the Programme. Such a meeting should bring together all the available expertise in Participating Countries, APOC, OCP, TDR, TCC and elsewhere. In these deliberations due consideration must be paid to the measurable and predictable impact of CBTI and CDTI operations on the epidemiology and transmission of onchocerciasis. HP 2,10 The impact of current and future therapeutic developments Suggestions and recommendations 2.r0.1 o APOC should lend its full support to teams and centres which are monitoring possible non- response to ivermectin (e.g. in the Pru basin in Ghana). TCC should consider developing criteria for the need to conduct research into this phenomenon in a given situation. Priority for APOC in Phase II. HP 2.to.2 APOC should lend its fuIl support to the current trials for macrofilaricidal drugs, e.g. moxydectin (which is now at the human trial stage), and for the teams and centres which are performing this research. HP JAF/INF/DOC.I Page 17 2.t0.3 o TCC should also give serious consideration to implementing a system of monitoring the impact of CDTI on morbidity (through determining disease prevalence and incidence in selected sites), to complement and monitor coverage rates. NOTFs believe that it is important to know for how many years the tablets need to be taken (15 years, 20 years, longer?). MP 3. Integration 3.f Integration at Community Level Sugge stions and re comrnendations 3.1.1 CDTI has entered communities on a large scale, often for the first time, and very likely has the credibility to promote the inclusion of further activities. Care must be taken that CDTI takes place in harmony with other health and development related activities at community level (past and funrre). MoH and NGDO staff need to espouse the 'community empowennent' model when introducing other activities to communities. a LP 3.t.2 o On a practical level it is suggested that NOTFs initiate a dialogue with other disease control programmes in their countries, to clarify the situation regarding utilisation of community level workers, and the incentives given to them. Once the situation is clarified steps should be taken to harmonise and optimise the modus operandi of the different prograrnmes. Without compromising the bastc tenets of CDTI, progrommes should be open-minded in dialogue wilh other disease control initiatives in order to establish some common ground in creative ways to motivale community workcrs. HP 3.2 Integration at health district level Sug g e stio n s and re c o mme ndation s 3.2.r o APOC must spearhead advocacy for a specific plan at all levels, to lead to full integration of CDTI by at the end of Year 5 of APOC support. By this time district authorities must have been enabled to plan for, train for and supervise CDTI fully. In some countries such planning will have to include civil authorities at district level, who are responsible for health budgets. It is heartening to know that APOC has developed a checklist developed to monitor integration in its member countries; this may now be urgently and consistently used. The checklist should be made available to NOTFs as soon as possible. HP 3.2.2 . It must be clear where the activities that CDTI requires (training, supervision) are located in budgets (whether there is a separate line item or not). NOTFs interpret the above as follows: Wherever CDTI activities are being undertaken, budgets for all relevant activifies must be included al the implementotion (district) level. HP JAF/INF/DOC.I Page 18 3.2.3 a Since CDTI coverage data is periodic (once a year) it may well have to remain distinct from other continuously collected health information. Progress reports on CDTI activities should form a routine part of district planning meetings. Supervision schedules must include CDTI. HP 3.3 Integration at higher levels Sug g e stio ns / re c o mme ndation s 3.3.t a Again there must be progress towards planning, budgetary allocations, supervision and information gathering - by MoH - in support of activities that are now known to be essential for the smooth running of the prograrnme. Fresh ttrought must be given to advocacy, so that relevant groups inside and outside MoH are fully informed and, where relevant, involved. Again, the checklist that the Programme has developed to monitor integration in its member countries will be useful. MP 3.3.2 o The future of the NOTF needs to be worked out. In spite of its official position it still exists in parallel with the 'onchocerciasis desk' in some section of the Ministry. Its continued existence should depend on its usefulness, which may vary with time (e.g. NGDOS may change their priorities; other ministries like Education or Local Government may be included). In either case the body/ bodies which will drive CDTI after Year 5 have to be officially approved, strengthened, and funded. This is a task for the current NOTFs, with technical support from APOC. In countries where LF work is beginning, the NOTF should merge with the NLFTF to strengthen the national coordination body, In other countries, the NOTF can combine with other relevant bodies such as Prevention of Blindness Committee, etc. HP 3.4 Contribution to health systems and capacity building Su gg e stio ns and re co mme ndation s 3.4.1 A clear plan to empower national structures to handle major management issues must form part of APOC's planning for the second phase of its operations. This again highlights the need to plan systematically for the replacement of APOC funding by other, sustainable sources. a 3.4.2 a MP Urgent dialogue is needed at all levels, to explore the commitment of the national health services and NGDOs to the 'community empowerment' approach. The fact that the communiry directed approach was researched (by TDR) and found to lead to better coverage, should be a useful tool in this debate. Not everyone is convinced by the existing evidence. Additional evidence based studies should be undertaken to document ttle contribution of the community directed approach in integrated disease control initiatives. TDR's priorities in operations research may assist in funding some of these additional studies. LP JAF/INF/DOC.I Page 19 The inclusion of excellent, relevant material on onchocerciasis control in basic curricula must be negotiated. APOC should promote this activity through the NOTFs. HP 3.5 Future co-operation/ collaboration with other health related prograrnmes Sugge stions and re commendations 3.5.1 Policy at national and district level should safeguard and build on the 'community directed' approach, for all health prograrnme activities at village level - existing and new. An approach which allows the villagers themselves to handle new or additional activities as they see fit ru$t be promoted. At provincial/ State and district level the model of an activity integrated into existing procedures and budgets is clearly the most sustainable. At national level the 'NOTF' model as a support for specific disease control programme 'desks' in MoH should be considered - and, where prograrnmes have a lot in common, shared. 3.4.3 a a 3.5.2 a MP MP It goes without saying ttrat the lessons learnt about loiasis co-endemicity should be applied pro-actively in any future progranrme which intends to promote mass distribution of filaricides. This would involve rapid epidemiological mapping exercises, and providing training and resources for handling the side-effects. 3.s.3 o In order to avoid possible expensive duplication of structures and dissipation of resources berween different vertical prograrnmes, CSA should urgently review the APOC Prograrnme Document and the Memorandum of Understanding for Phase l. Modifications or amendments should be made that will allow APOC to explore and work towards a sensible integration of onchocerciasis control with other disease control and elimination programmes (including that for LF, which is about to be operationalised) at all levels: international, national, district and community. The NOTFs believe that APOC and the internationol LF or any other health control initiatives should be merged al all levels. HP 4. Partnership 4.1 Success of the present partnership formula Sugge stions and re commendations 4.T.1 It is clearly essential that when APOC ends there should be a mechanism which continues to promote partnership in planning, monitoring and research around onchocerciasis control. The nature of such an arrangement is however far from clear. There is therefore an urgent need for NOTFs to plan for the future of partnership. Since countries and NGDOs differ substantially, it is logical to expect different models to be developed in different situations. Each NOTF should be asked to develop a strategic five-year plan. This plan should indicate whether they see their role as phasing out and gradual integration with MoH, or whether they are going to continue to exist as a partnership, and to support onchocerciasis control activities. JAF/INF/DOC.I Page20 NOTFs feel strongly that the strategic plan should be for eight years instead of five and proviston should be made for the renewal of equipment in the latter years of Phase II in order to adequalely prepare for post-APOC function. LP 4.2 The contributions of the partners S ug g e s tions and re c omme ndations 4.2.1 o The overall aim of partnership must be the integration of CDTI into the routine functioning of the health service of each member country. Where there is no functional health system, CDTI should serve as the entry point for its development. In each project the spirit of partnership that has developed must now be put to use at each level, while APOC funding remains - a planned and orderly process of task allocation to each partner that will lead to sustainable CDTI. The overall aim o! partnership is the eliminalion of onchocerciasts as a public health problem wtth the integration of CDTI into the heakh system recognized, as the mechanism to achieve this. HP 4.2.2 The role of the donors is naturally crucial to ttre Programme - they have demonstrated commendable commitment. However their priorities are not static, and recent changes towards (for example) poverty alleviation have been noted. The Programme urgently needs to engage with donors in discussion about the future - if it fails to take a creative and forward thinking role in these discussions it will find it hard to maintain donor commitment. a HP 4.3 National and international NGDOs Su gg e stio n s and re c o mm e ndation s 4.3.r o The one successful example points the way: NOTFs should identify potential local NGDOs who are then to be trained and mentored by international ones until they are ready to be subconrracted to take on work within projects. Finally they will be able to function independently. Each international NGDO should in fact consider partnering with an appropriate national or local NGDO to build capacity and expertise in fund raising, progralnme implementation and financial management. The NOTFs, and not just the international NGDOs, should be responsible for contacts with potential local NGDO partners. MP 4.3.2 o [t may be useful for NOTFs and TCC to accept a broader concept of what a 'suitable NGDO' looks like, beyond vision/ blindness related NGDOs. For example the possibility of working with local NGDOs dealing with general community development, or even village associations, should be investigated. At the same time NOTFs and TCC should continue to be vigilant in screening applicatiors, ensuring that approved national NGDOs are able to deliver the goods. NOTFs leel tht this is not a vali.d interpretation of the TCC or NGDO posifion. Active local NGDOs need not be vision/blindness related. JAF/INF/DOC.I Page2l 4.3.3 o Where NGDOs cannot be found who are willing to take on new projects, the 'tried and trusted' OPC model of bipartite partnership (APOC and official health service) should be considered - again, working towards full integration within a five year period- HP HP High Priority MP Medium PriorityLP Low Priority o JAF/INF/DOC.I Page22 3. IMPLEMENTATION TIMELINE FOR NOTFs HP RECOMMENDATIONS - PTIASE II 2004 2005 2006 2007 2008 2009 2010 PROGRAMME MANAGEMENT APOC HQ Management I .l.l 1.1.2 1.1.3 Financial Management t.2.t 1.2.2 1.2.5 fechnical Consultative Committee 1.3.1 1.3.2 NGDO Coordination Group 1.4.1 Svnersies Between APOC & OCP 1.5.1 IMPLEMENTATION Coverage 2.1.1 2.1.2 2.t.4 2.1.5 Role of National Structures in Proqramme Implementation 2.3.1 2.3.2 2.3.3 2.3.4 2.3.5 Communitv Involvement 2.4.1 2.4.2 2.4.3 2.4.5 2.4.6 2..4.7 2.4.8 2.4.9 z.4.tt s 2002 2003 JAF/INF/DOC.I Page23 2002 2003 2005 7.OO6 2007 2008 2009 2010 Monitorine 2.5.2 Operational Research 2.6.2 2.6.3 Sustainabilitv 2.8.1 Vector Elimination Meetinq ln 2001 2.9.7 Impact of Current and Future Therapeutic Developments 2.10. I 2.10.2 TNTEGRATION lnteqration at Community Level t.1.2 lntegration at Health District Level t.2.1 1.2.2 t.2.3 lntegration at Hiqher Levels 3.3.2 Contribution to Health Systems and Capaci8 Building 3.4.3 Future Cooperation/Collaboration with Other Health-Related Programmes 3.s.3 PARTNERSHIP Contributions of the Partners +.2.1 +.2.2 National and International NGDOs 4.3.3 JAF/INF/DOC.1 Page24 F. REVIEW OF APOC PHASE II PROGRAMME DOCUMENT OUTLINE 1. Purpose: Provide oppornrnity for the NOTF representatives to have input to the preparation of the Phase II Programme Document. 2. Process: o Presentation by Dr. Seketeli and APOC o Delegates separated into working groups with the Phase I Programme Document and tentative outline of Phase II document o Groups were assigned different sections of the outline to study o Phase I document was read and remarks/suggestions were put into the Phase II outline . Groups reported in the plenary session for discussion and acceptance AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) PREPARATION FOR PHASE II ANNOTATED OATLINE OF THE PROGRAMME DOCAMENT FOR PHASE II OF APOC I GLOSSARY PREFACE EXECUTTVE SI]MMARY INTRODUCTION l.l The Past: the disease, its burden and control 1.2 The distribution of onchocerciasis in the area of APOC operations PROGRAMME ACHTEVEMENTS 2.1 Development of operations 2.1.1 Setting up Infrastructure JAF/INF/DOC.I Page25 VERSION NOTFs Meeting 22.02.01 o Ministries of Health: Buildings, Communication network, Waler, Electricily, Health system . APOC: Vehicles, capital equipment, IEC matertals o NGDOs: Vehicles, capital equipment . Communities: Community Structures 2.1.2 Program Management o Setting up of the management staff al the headquafters in Ouagadougou o Setting up of TCC o Setting up of the coalition of NGDOs . Setting up of financial management system 2.I.3 National Onchocerciasis Task Forces (NOTFs) and Projects a Setting up of NOTF and executive secretarial in Mintstry of Health Partnership2.2 I Where bullets do not appear in the text, information to be furnished by APOC JAF/INF/DOC.1 Page 26 2.3.1 2.3.2 2.3.3 2.2.I Partners involved . Donors . WHO o NGDOs o Mtnistry oJ Health . CommuniA (Define their role and contributions). 2.2.2 Strengthening the partnership model o Viewed at the organizttional structure c Harmonizption of methods and strategies among partners o Sharing of human and finance resources . FlexibiliU among partners 2.3 Focal Vector Eradication Operations (Describe feasibility and implementation steps in the foci - Refer to APOC management). Itwara Focus in Kabarole district, Uganda Tukuyu Focus in Morogoro Region, Tanzania The Bioko Island in Equatorial Guinea 2.4 Rapid Epidemioloeical Mappine of Onchocerciasis (REMO) o Traintng of naional teams on REMO methodology o NEMO results (refer to APOC Management) o Recall REA exercises. 2.5 Ivermectin distribution 2.5.1 Geographic and therapeutic coverages 2.5.2 Community participation and ownership . Community participation and ownership o Integration of trained distrtbutors into health systems . Community involvement in the choice of the drug distributors etc... . Community self monitoring 2.5.3 Monitoring and evaluation . Development of monitoring tools o external and internal monitoring exercises . Jotnt visits in the participating countries by APOC /HQ/TCC/NGDOS c Mid-term external evaluation o TCC repofis o JAF meetings o Partners meetings .4 Baseline data for impact assessment of Programme operations2.5 JAF/INF/DOC.I Page27 3 o Traintng and setting up of nattonal teams o Field studies (Refer to APOC Management for results) 2.6 Grass-root resource development CDTI 2.6.L Capacity-building in Health Care Systems a Training in epidemiology, REMO, Monitoring tools, imprest system' onchocerciasis control and CDTI philosophy 2.6.2 Community-based capacity building a Training of distributors on onchocercinsis control, CDTI philosophy and census exercises. 2.7 Prosramme in other Health care and activities o CDTI has been ased as entry point of other health activities (NID, Vitamtn A) . Community well organizedfrom CDTI activities. PROGRAMME OBJECTTVE AND STRATEGIES DI]RING PHASE II 3.1 Obiective 3.2 Strates.v 3.2.1 lvermectin Distribution a) CDTI in meso and hyper-endemic areas (i) Definition : Community Dtrected ivermectin distribution in the areas in which prevalence rate has been estimaled al least 207o and distribution has been performed by members of the Community. (it) Process of the strategy in hyper and meso- endemic areas . Epi.d.emiological surveys . Visits to eligible communities by supportive teams . Communitysensitisation . Choice of distributors . Census o Trealment CDTI in conflict areas o NGDOs and international organirutions for action . Potential use of church organisations CDTI in areas of co-existence of onchocerciasis and loasis In high risk zones: . kEA sun)eys (iii) (iv) JAF/INF/DOC.I Page28 a ComDT in meso or hyperendemic area followed by supemision conducted by drug distributors Jrom dny 2 to day 8 and by the nurse Jrom day j to day 5. In relaively low risk zones: . Training of drug distributors and nurses for early detection of serious adverse effects (SAE) c Districts Hospitals equipped (v) Monitoring and Evaluation o Strengthening oJ independent monitoring . Integration of CDTI reports into health system o Joint visits APOC HQ/NGDOS . Mid term external evaluaion for Phase II in 2006 (vr) Impact Assessment Studies . To carry out entomological, sociological, ophthalmological and dermalological surveys in 2004 and 2008. (vit) Sustainahility of CDTI Integration of CDTI into the Primary Health Care System o At communtty level : dialogue between CDTI and other health programmes o At district level: onchocerciasis control must be pan of minimal activitie s packnge o Att central level: advocacy for financial resources allocation for onchocerciasis control CDTI as entry point for other community-based health programs o Yes ! But dialogue to be developed Role of Women in CDTI activities o To be encouraged but decision must be taken by community Cost recovery and cost sharing o Operational research needed to identify advantages and disadvantages b) Clinic based treatment in hypo-endemic zones Definition of areas of concern : trealment in the areas in whtch prevalence rale is up to 19Vo Rationale and gains for Programme support to countries for clinic-b as e d tre at me nt . Higher chance for onchocerciasis elimination . Reduce morbidity (i) (ii) Provide treatment to people who have moved to hypoendemic areas from hyper and mesoendemic communities 3.2.2 Focal vector eradication activities Criteria for undertaking vector eradication activtties o Disturbances due to vector bites o Vector ecologyt, foci isolation . Technicalfeasibility (ii) Strategy to be applied . Depends on characteristics of the foci ORGANIZATIONAL AND MANAGERIAL FRAMEWORK DIJRING PHASE II 4.L Governance 4.1.1 Joint Action Forum (JAF) c The composition of JAF shoald. remain the same o In Phase II, the IAF should continue to meet annually, not once every two years after the first four years as indicaled in the Phase I document o Responsibilities of JAF shouW remain the same 4.1.2 Committee of Sponsoring Agencies (CSA) Nl sponsorc of the progromme should be members of the CSA (including one selected member of the NGDO Coordination Group and one Ministry of Health representative chosen by assembled delegates at the annaal JAF meeting) 4.1.3 Fiscal agent a This shouW remain the same 4.2 Programme Management JAF/INF/DOC.I Page 29 Executive Agency Programme HQs Note: NOTFs recommend that the APOC office shouA be re-located to an APOC participaing coun$ 4.2.3 Technical Consultative Committee (TCC) The TCC should be expanded to 12 members as follows: three independent scientists, three technical representatives of the NGDO Coordinotion Group, one representative of the Mectiznn@Expert Committee andfive independent members with an emphasis on public health management and finance with preference given to those from endemic countries a (i) 4. a 4.2.r 4.2.2 a a JAF/INF/DOC.I Page 30 4.3 NGDO Coordination Group 4.3.1 Membership . This is determined by the existing group . NGDOs wishing to join must meet existtng criteria 4.3.2 Role a a 4.3.4 a 4.4 4.4.r Fund raising, worldwtde programme promotion, foster and support APOC, work closely with other appropriale programmes (LF, etc.), encourage national and international NGDOs to become involved, participale as appropiate tn operational research 4.3.3 Guiding principles regarding NGDO involvement in APOC No changes Coordination of the Group's activities By Secretariat at WHO HQin Geneva National Onchocerciasis Task Forces (NOTFs) Membership . Full NOTF to meet twice per year . Working NOTF to meet regularly with the following suggested as members: Ministry of Health (dffirent departments), Institute of Medical Research, WHO, IINICEF, all representatives of the NGDO Coalition, notional LF director and any other relevant parties. All should be full voting members. 4.4.2 Role Agree with the document roles with the additional following points: . Develop and implement national eight-year stralegic plans . Review financial and six-month repofis devolved by TCC to the NOTFs . Programme promotion and fund raising . Coordinate with the NLFTF and explore merger of two task forces . Operational research 4.4.3 Responsibilities of the Governments of APOC countries . Create a favourable envtronment for all partners . Ensure onchocerciasis is included in national & district health budgets o Ensure ultimate responsibility for implementing national plans for onchocerciasis control 4.5 JAF/INF/DOC.I Page 3 I Affected communities Communities are emphasized as the key partners in the programme and every attempt should be made to encourage them to select the best health promotion choices Three additional paragraphs should be added emphasizing gender, empowerment and povefi alleviation Funds disbursement flow-chart APOC to provide Purchase of Equipment a a 4.6 Collaboration between APOC and other community-based programmes o Regular inter-agency meetings c NLFTF be merged y,ith NOTF and coordinate all activifies al all levels . As per recommendations, dialogue is necessary with other health control initiaives 7 Mectizan Donation Proeram and its policy of Mectizan delivery Responsibiltty oI the MDP 4. a 4.8 Disbursement of funds 4.8.1 Guiding principles o In countrtes with civil strife and other situations of tnsecurity, APOC may allow the project to suspend operations until normalcy is resumed o Agreement with APOC management before NGDOs pre-finance projects o APOC and WHO to improve communicate with NOTFI concerning funds transfers Qetters copied with all relevant data) 4.8.2 a 4.9 4.9.1 Capital equipment Renewal of capital equtpment in the latter stages of projects to ensure supemisory su stainability po st-AP O C Transport should be made available for health personnel in areas of co-endemicity 4.9.2 Other equipment For training and presentation purposes, programmes should budget for LCD projectors and digilal cameras 4.10 External evaluations of APOC . Leave as is a a a JAF/INF/DOC.1 Page32 5. PLAN OF OPERATIONS FOR THE SECOND PHASE (2002-2010) Introduction To be provided by APOC Programme targets The programme will have to aim at establishing community directed CDTI programmes where they do not exist already and continue with the process of strengthening them where they exist. The target for every CDTI programme is to achieve a therapeutic coverage of at least 65 Vo and a geographical coverage of 100 Vo. The ultimate trealment goal will have to be 100 Vo, at least 90 Vo. By the end of the programme in 2010 all restdual support activities will have to be integrated in the Nuional Health Semice. By the end of 2003 all the proiects of the programme have to be implemented. 5.1 5.2 a a a a a 5.3 Disease distribution 5.3.1 Rapid Epidemiological Mapping of Onchocerciasis (REMO) Within the first two years Phase II , REMO must have been completed in all APOC countries and a clear map4evelop on the GIS has to be perfurmed. 5.3.2 Mapping of Loasis Before the end of 2002 mapping of Loasts has to be complete and it should be known where it overlaps with Onchocerciasis 5.3.3 Rapid Epidemiological Assessment (REA) in areas of co-endemicity of onchocercias is/loasis . This task should be finalized within the first year of Phase II. 5.4 Community Directed Ivermectin proiects 5.4.I Duration of the Projects The duration of the project should be 8 years tn prtnciple with post extensions under special circumstances. (e.g. conJlict areas, polittcal unrest, restructured health delivery system ) 5.4.2 Estimated number of Projects to be implemented during Phase II The estimated number is 95 projects but it shall be open to new proiects until the end ofthe secondyear of Phase II o a o a JAF/INF/DOC.I Page 33 5.4.3 Management of severe adverse effects (SAE) All programmes will adhere to the guidelines of MDP in the management of severe effects. The guidelines should define SAE and procedures. 5.5 Vector Eradication Proiects 5.5.1 Duration of the Projects In phase II also the duration will be of 2 to 3 years i.e. a preliminary investigative lear, followed by one or two years control activity and post-control evaluation afier which all entomological activtty will cease. 5.5.2 Estimated number of Projects to be implemented during Phase II The existing projects will be continued and new areas which are suilable and feasible will be identified. Areas where flies are a nuisance or numbers of bites are exceptionally high wiV be investigated and considered accordingly 5.6 Trainins/capacity buildine 5.7 . Refer to NOTFs commenls on the Mid-Term Evaluation report, items 2.3.4-5 . o In addition to this, training should include an emphasis on analysis of data for pro gromme implications and actions Advocacy and Information. Education and Communication (IEC) . Refer to items 2.4.3-5 in NOTFs comments to Mid-Term evaluation repofi. o Inter-country exchange shall be facilitated by APOC management. 5.8 Biostatistics and Information Svstems o a a a a Personnel in the APOC countries will have to be given the opportunity to be trained in Biostatistics and Information Systems in Phase 2. New software will have to be investigaled like EPI-MAP and Health-Map as well as SPSS and similnr systems like SAS and traintng will have to be completed and progress be monitored. tn an continuous process before the end of the program. A training in qualitative and quantitative research methods should be added.a 5.9 Research 5.9.1 Operational research c Reter to items 2.7.2, 2.7.5 and 2.4.1 as well as 2.6.1- 3 in NOTFs comments to Mid-Term evaluation repofi . 5.9.2 Search for a macrofilaricide a Refer to item 2.10.2 in NOTFs comments to Mtd-Term evaluation repoft. JAFANF/DOC.I Page 34 5.10 Collaboration with other Health Programmes . Refer to item 3.5.1-3 in NOTFs comments to Mid-Term evaluation report 5.11 Monitoring and Evaluation . Refer tu item 2.5.1-3 in NOTFs comments to Mid-Term evaluation report 5.12 Impact assessment of APOC operations a Refer to item 2.7.14 in NOTFs comments to Mid-Term evaluation report 5.13 Manaqement. administration and support services 5. 13.1 Programme Headquarters 1) Personnel . Reler to item 1.1.1 in NOTFs comments to Mtd-Term evaluation report 2) Administrative support services, logistics and infrastructure APOC should establish its offices tn an APOC country by the end of 2003 where infrastructure and facilities are in place. a 5.13.2 Support from WHO/HQs, WHO/AFRO and the NGDO Coordinator's Office WHO will conttnue to play its role as the Executing Agency with suppon from the NGDO Coordinator whose office should be moved to the new APOC HQ by 2003. WHO/AFRO to improve its communtcation with each WHO country office and facililae without delay financial transfers, capital equipment requests and other important admtnistrativ e and financial matters. 5.14 Consultants'services o Expertise will have to be sought as much as possible within APOC countrtes as well as the existing structures of APOC management in Phase II . o Inter-country consultancy will have to be encouraged. . A unified system of provision of honorariums be introduced for all consultants. 5.15 OperationalTravel APOC shall be responsible for all operational travel by management staff and other implementers of the programme where other partners are not able to cover the costs. 5.16 Statutorv meetinqs . Clarill statutory bodies and times and purposes of meetings. a a a JAF/INF/DOC.I Page 35 5.17 Proqram Exchange Inter-Country Exchange Programmes (ICEP) will have to be supported annually throughout the programme BIJDGETARY FORECASTS FOR TIIE 2OO2.2O1O PERIOD FOR DONORS CONTRIBUTIONS 6.1 Budget justification . Supplied by APOC management . Templates lor budget submission wiA he designed by APOC by the end oJ 2001 and submitted to the countries by the start of Phase II. Summary list of Proiects with costs and neople to be treated 6.3 o Supplied by APOC management Summarv annual budgets per category of expenditures 1 SuWlied by APOC management Trend of APOC Budgets estimates from 1996 to 2010 . Supplied by APOC mnnagement Timeline of Budsets c A clear timeline for budget submisston , consideration , decision and allocation of Junds will be worked out and tncluded in the document RISKS AND SAFEGUARDS Civil unrest 6.4 7.1 Nsk: Ctvil unrest will adversely affec* operations of CDTI in certain countries o Solution: Flexibility with the CDTI model in areas of civil unrest and insecurity as well as finances and schedule of duties . Solution: Develop procedures for trealment during temporary armistices c Solutton: NGDOs and governments should be encouraged to take responsibility to expand CDTI into areas emerging trom civil strife afier the termination of APOC 7.2 Resistance to ivermectin Risk: Development of resistance to ivermectin . Solution: APOC is committed to operational research to find new micro and macro-filariacides a 6. 6.2 6.5 7 a Solution: Lookinto possibilities ofdrug treatrnent alternative in cases ofresistance to lvermectin JAFANF/DOC.I Page 36 7.3 Shortage of financial resources Risfts: Donors do not come up with funds and governments/NGDos do not fulfill their commitments . Solution: APOC reduction in resources to the entire programme . Solution: Advocacy with the governments and NGDOs o Solution: Community empowerment, communities assume responstbility for projects themselves, putting pressure on authortties 8. BENEFITS The group is happy with the text but suggests afew additional items: 8.L Health benefits . Prevention of blindness o Dermatologicalbenefits o Well-being . Positive impact on children o Secondary health benefits - overall decreased parasite lood 8.2 Social benefits . Empowerment o Enhanced procreative potential 8.3 Ecouslqls jeneE6 . Pover$ alleviation . Physical well-being improves productivity 9. POST-APOCINTER-COTINTRYCOLLABORATION 9.L Rationale Inter-country collaboration will encourage and permit the followtng: o Share experiences . Collaborale across borders o Share expertise and successes o Collaborale on operational research tncluding impact assessments 9.2 Framework . Post-APOC, Post-JAF biennial (every 2 years) meeting of NOTFs o Start two years before the close of APOC o Organised by NOTFs themselves Support to inter-country collaboration . NOTFs, governments and NGDOs to lookfor resources to support this initiative 9.3 JAFANF/DOC.1 Page 37 G. R-E,VIEW OF MEMORANDIJM OF I.INDERSTANDING l. Purpose: Provide NOTFs opportunity for input to preparation of the Phase II Memorandum of Understanding 2. Process: Using the Sudan NOTF's remarks as a guide (as they were the only country to submit comments), the delegates met in plenary session to discuss recommendations. 3. RECOMMENDATIONS: a Vision Statement to be added to the Programme Objective for Phase II to take into account the goal of eliminating onchocerciasis as a disease of public health importance Document should make reference to MDP Document should take into account the recommendations of the Mid-Term External Evaluation Report Recommended that APOC and the LF international initiative should be merged Recommended that the host country Chair the JAF and both the Chair and the Vice Chair be elected by the JAF Recommended that the composition of the CSA should be expanded to include only active donors, one representative of the NGDO Coalition and one representative of the participating countries' Ministries of Health Recommended that the policy of TCC three-year non-renewable membership be reviewed Recommended ttrat the TCC be increased from 10 to 12 members Recommended that the TCC should function in the way it was designed in the Programme Document Ensure that the MoU includes a clause protecting APOC and MDP from any legal action in the event of deaths resulting from Mectizan@ treatment in co- endemic areas Recommended that a clause be inserted on the importation of capital equipment (e.g. vehicles, computers, etc.) and insecticides by perhaps borrowing some language from the OCP agreement Recommended that the section on Mectizan@ needs to be more precise in order to avoid other taxes (e.g. computer taxes, new ECOWAS countries' taxes, etc.) Recommend that the Section 3.5 on NGDOs is to vague and needs to be strengthened. A suggestion is as follows: 'The national government signing their agreements recognize the legitimate role of collaborating NGDOs in execution of this agreement and recognize the valid agreement signed by their NGDO's government. Collaborating NGDOs will have the same exemption and rights that are allowed under this agreement for purposes of executing this progralnme.' Recommended that Part I of the MoU be developed by the World Bank. a a a a a a a o a a a a a JAF/INF/DOC.I Page 38 Annex I MORNING MEETING OF REPRESENTATIVES OF THE NOTFS OF APOC COUNTNES @aaGADOUGOa, 19 - 22 FEBRaARY, 2001) ADOPTED AGENDA 19/2/2001 MONpAY 1. 2. 3. 4. APPOTNTMENT OF RAPPORTEURS. APPOINTMENT OF MODERATORS ............... INTRODUCTORY PRESENTATIONS 4.1 Objective of the external mid-term evaluation......... 4.2 Process and expected outcome of the evaluation ...... 4.3 Preparation for Phase II of APOC (Direction APOC) 5. OBJECTIVE AND EXPECTED OUTCOME OF THE MEETING ...... 6. ADOPTION OF THE AGENDA 7. COMMENTS OF NOTFs ON MID TERM REPORT BY COUNTRIES 7.1 Cameroon 7.2 OPENING ...... Chad.. Uganda 10.1 10.2 Programme Management ) Programme Implementation ) 08H00-08H10 08H10-08H20 08H20-08H30 08H30-08H40 08H40-08Hss . 08H55-09H10 09H10-09rI2s 09H25-09H35 .... 09H35-09Hss . 09H55-10H10 .... 10H10-10H30 ..10rr30-10Hs5 7.3 TEA BREAK...... Sudan... Democratic Republic of Congo (DRC) Malawi. Nigeria Central African Republic.... Tanzania 7.4 7.5 7.6 7.7 7.8 7.9 10H55-11H15 11H15-11H30 11H30-11H45 11H45-12H00 r2H00-tzHl5 tz}jt5-12H30 8 9 DISCUSSIONS, QUESTIONS AND CLARIFICATIONS ON THE REPORT AND THE COMMENTS OF THE COT]NTRIES. . LI.INCH BREAK ..... 13HOO-15HOO 12H30-13H00 ORGANISATION OF PERSONS IN THE GROUPS AND FIRST MEETING OF THEGROUPS " 15Hoo-15H10 Constitution of working groups (3 groups) -REVIEW AND PRIORITIZATION OF RECOMMENDATIONS TN THE MID TERM REPORT FOR ADOPTION BY NOTFs .PROCESS OF IMPLEMENTATION OF RETAINED AND PRIORITIZED RECOMMENDATIONS (ACTION PLAI'D GROIJP WORKS MIXED GROUPS BY COLTNTRY) 10 15H10-18H00 JAFiINF/DOC.I Page 39 Annex I 16H30-r6lr5s 20t2t2001 TTIESDAY MORNING 10. (CONt'd).REVIEW AND PRIORITIZATION OF RECOMMENDATIONS IN TIIE MID TERM REPORT FOR ADOPTION By NOTFs -PROCESS OF IMPLEMENTATION OF RETAINED AND PRIORITIZED RECOMMENDATIONS (ACTTON PLArg GROItp WORKS (MTXED GROrrpS By coUNTRy)....10.3 Partnership 10.4 Integration & Sustainability TEA 8R8AK............ uH00_11rI30 10.5 Vector Elimination (Plenary session) ..... 11H30-12H00 11 PRFSENTATION OF PRIORITTZED RECOMMENDATIONS FOR ADOPTION BY NOTFs 08H00-11H00 t2H00-t2H20 t2t12{U-^L2H45 12H45-13H00 13H00-15H00 11.1 tt.2 I 1.3 Programme Management...... Programme Implementation .. Partnership....... LTJNCH BREAK LL.4 11.5 Integration & Sustainability.... Vector Elimination 15H00_15H30 15H30-16H00 16H35-16H45 16H45-17H05 17H05-17H25 TEA 8REAK............ r6H00-16H25 12. DRAFT DOCUMENT FOR PHASE II OF APOC l2.r Background : Update on progress made (DIRECTION Apoc) r6H2s-r6lr3s t2.2 e.g summary of areas of Major changes for phase Ir (DIRECTION Apoc)(D Programme Objective (ID (ID (IV) Programme Strategy and Targets Duration of Projects and new initiatives Programme Involvement in other Health and Development Activities .17H25-t7H40 JAF/INF/DOC.I Page 40 Annex I MORNING t2.3.2 Group I: Group II: 12.3 Contribution to Draft Document for Phase II: Review of the tentative outline GROT P WORK 08Ir00-10H00 12.3.t 2U2l2001 WEDNESDAY Programme Achievements Programme Objective and Strategy during Phase II Organizational and Managerial Framework Risks and Safeguards; Benefits; posr-APOC inrer- country Collaboration Plan of Action and Budgeary forecasts for Phase IlGroup III 12.4 Contribution to Draft Document For Phase II: Group Works (Cont'd).... 10H25-12H25 13. CONTRIBUTION TO DRAFT PROGRAMME DOCIIMENT FOR PHASE II: GROTJPS, PRESENTATIONS 12H25-13H00 CONTRIBUTION TO DRAFT PROGRAMME DOCUMENT FOR PHASE II: GROUPS' PRESENTATIONS (CONT'D). 15H00-16H25 12.3.3 14. APOC MEMORANDUM (PHASE rr) (DTRECTION APOC) T4.L Background. L4.2 Countries Presentations of areas in APOC Memorandum Requiring Changes during Phase II.... . ........ 2212/2001 THURSDAY MORNING 15. TEA 8REAK............ 10H00-10Ir25 LUNCH BREAK ...... 13H00-1sH00 TEA BREAK 16II25.16H50 .. 16H50-17H10 .. 17H10-18H10 PRESENTATIONS BY RAPPORTEURS: CONCLUSIONS AND RECOMMENDATIONS OF THE MEETING 15.1 Mid term review 08H00-09H30 15.2 APOC Programme Document for Phase II... .. 09H30-10H30 TEA BREAK 10H30-10H55 15.3 APOC Memorandum for Phase II 10H55-11H25 16. OTHER MATTERS t6.L t6.2 16.3 16.4 16.5 Institutionalization of the meeting of the NorFs representatives Inter-country dialogue NOTF Review of Interim Technical and Financial Reports Briefing on the Internal Audit of APOC Budgeting for IEC and Advocacy Strategies and materials: Monitoring findings JAF/INF/DOC.I Page 4l Annex I 11H25-13H-00 ) ) ) ) ) 17. cLosINc CEREMOI{Y BH00-13H30 t JAF/INF/DOC.I Page 42 Annex I LIST OF DOCTIMENTS 1. External Mid-Term Evaluation Report 2. Phase I Memorandum of Understanding 3. Tentative Phase [[ Programme Document Outline 4. Report of the May 2000 Partnership Meeting 5. Phase I Programme Document 6. country NorF comments on External Mid-Term Evaluation Report 7. JAF 6 Report 8. OCP Memorandum of Understanding JAF/INF/DOC.I Page 43 Annex I PHASE I PROGRAMME OBJECTTVE To establish, within a period of 12 years, effective and self-sustainable, community-based ivermectin treatment throughout the endemic areas in the geographic scope of the hogramme, and' if possible, to eliminate the vector and hence the disease by using environmentally safe methods in selected foci. The attainment of this objective will ultimately realize the goal of etimination of onchocerciasis as a rlisease of public health and socio-e+onomic importance throughout Africa and so contribute to improving the welfare of its people. PHASE TI PROGRAMME OEIECTTVE To establish through collaborative partnership, and within the frsmework of primary health care activities, effective and sustainable gspmtrnity-directed ivermectin treatment throughout the remaining endemic areas in Africa and, if possible, to eliminate the disease by vector eradication in selected foci. Auainment of this objective will ultimately strengthen health care sysrems while realizing the goal of elimination of onchocerciasis as a disease of public health importance and as an obstacle to socio - economic development throughout Africa, empowering communities to improve their own welfare and thus contribute to poverty alleviation. I JAF/INF/DOC.I Page 44 Annex I Original: in French MEETING OF REPRESENTATIVES OF THE NOTFS OF APOC COI.INTRIES oUAGADOUGOU, FEBRUARY t9-22, 2001 STATEMENT BY DR. MARCELLINE NTEP, CHAIRPERSON OF THE MEETING AT THE CLOSING CEREMOI{Y Thank you Mister Director of the APOC Programme for the honor which is made to me to pronounce the word of closing. This meeting of Representatives of the NOTFs of APOC countries was beneficial for us. I think that we did not drowse much, that we were not bored at all during these past four days. Together, we reviewed and adopted the priority recommendations of the Mid-term External Evaluation of Phase I of APOC. As regards the Programme and Memorandum of APOC documents for Phase II, they will no longer be foreign to us, as was the case for the same documents in Phase I of the Programme, since we contributed to the outline of their drafting. Once we are back in our countries, we are required to submit a report on this meeting to our respective hierarchies and to the other members of the NOTF. As soon as we are in possession of the report of this meeting, we will try to plan for ourselves the activities retained here in Ouagadougou according to the priority recommendations agreed upon and the implementation schedule adopted. To conclude, let me in the name of all the participants in this meeting of representatives of the NOTFs of APOC countries invited by the APOC Director, say thank you to the APOC Headquarters staff, the executive as well as suppoft staff, for this enriching experience. We hope that the next meetings of Representatives of the NOTFs of APOC countries will be as interesting and attractive as this one which is ending today. We wish the APOC Management all the best, and a safe journey back home to the various participants in their respective countries. I declare closed the deliberations of the first meeting of Representatives of the NOTFs of APOC countries. a Thank you calendar of events for submission of APoc Phase II programme document Dates JAF/INF/DOC.I Page 45 Annex 5 Events Dispatch of tentative outline to CSA members Deadline for feedback from CSA members Invitation of contributors to provide text Contribution of the NOTFs Representatives in Ouagadougou Incorporation of NOTFs Representatives' comments Deadline of submission of all contributors of texts Deadline for first preliminary draft First preliminary draft available for TCC members in ouagadougou but also dispatched to CSA members cSA to discuss contributions from the TCC and csA members in paris Incorporation of all available contributors to the draft document a I 0u02t0t r0l02t0r L5l02t0r 22t02tot 25t02tot 05t03t0t Lzt03t0L 13t03t0L 29-30t03t0r 1" week of April JAF/INF/DOC.I Page 46 Annex 5 LIST OF PARTICIPANTS CAMEROI.IN 21.02.2001 Dr. Marcelline NTEP Coordonnatrice Nationale du Progralnme de Lutte contre I'Onchocercose, Ministdre de la Sant6publique, B. P. 155 Yaound6, Cameroun - T6l/Fax: (237)22.69.10 Dr. Albert EYAMBA Repr6sentant, Carter Center, Pr6sident de la coalition des oNGD, 69g Rue Joseph Mballa Eloumdem, Bastos Charles Atangana, Yaound6, Cameroun - T6: (237) 21.73.26 - iax: (237) 20.50.12 - E-mail: grbp@camner.cm LIBERIA Ms. Verda TARPEH Administrator, sight Savers International (ssl), 10 Nortei Ababio St, Airport Residential, Accra,Ghana - Tel: (233) 2r.77.42.10 - Fax: (233) zr.77.4z.og - E-mail: vtameh@ssiwa. africaonline. com. gh MALAWI Mr. Phillimon TAMBALA National Coordinator, The National Onchocerciasis Task Force of Malawi (NOTF) , Ministry of Health and Population c/o P. O. Box 2273 Blantyre, Malawi - Tel: (265) 624-44g; (265) 620-535: Cell: (265) 835-612 - Fax: (265) 624-526 NIGERIA Dr. Jonathan Yisa JIYA Director PHC & DC (NOCP), National Onchocerciasis Control programme, Federal Ministry of Health, Federal secretariat, Ikoyi - Lagos, Nigeria - Tel/Fax: (234) l2696013 Dr. Elisabeth O. EL-HASSAN Country Representative, Sight Savers International (SSI), 1 Golf Course Road, Kaduna Nigeria - Tel:(234) 62248360 - Fax: (234) 62248973 - E-mait: ssing@infoweb.abs.net a t JAF/INF/DOC.I Page 47 Annex 5 REPT'BLIQTIE CENTRAFRICAINE Dr. Justin N'DOYO Directeur de la M6decine Pr6ventive et de lutte contre la Maladie, Coordonnateur National duProgramme de Luue contre I'Onchocercose (PNLO), Ministdre de la Sant6 et de la population, B. p.783 Bangui, R6publique centrafricaine - T6l: e36) 61.76.65 - Fax: (236) 6t.01.37 Mr. Helmut SCHRADER Country Representative, Christoffel-Blindenmission (CBM) and Project Administrator, prograrnme National de Lutte contre l'onchocercose et la c6cit6 (PNLoc), B. p. 1772 Bangui, neputtiqueCentrafricaine - Tel: (236) 50.67.59 - Fax: (236) 6t.44.50 REPUBLIQTJE DEMOCRATIQI'E DU CONGO Dr. Kupa MUKENGESHAYI Coordonnateur National du Programme de Lutte contre I'Onchocercose, Ministdre de la Sant6publique, Bld du 30 juin N'4310, B. P. 13342 Kinshasa 1, R6publique D6mocrarique du Congo -TEI: (243) 33247; (243) 9947t38 - Fax: s/c WR - (L) 407 953 9080 Mr. David LAW Program Administrator, christoffel-Blindenmission (cBM), Programme National de Lutte contreI'onchocercose, 36Avenue de Ia Justice, B. P. 13342 Kinshasa l, R6publique D6mocratique duCongo -Tel: Q43) 8801976 - E-mail: Dlaw@maf.org ST,IDAN Dr. Abdel Karim Ahmed EL FAKI Director General for Preventive Medicine, Federal Ministry of Health, p. o. Box 303 KhartoumSudan - Tel: (249) 1177.15.55 - Fax: (249) 1177.62.69 , a Mr. Elvin HILYER country Representative, Global 2000, The carter center, Chairperson of the NGDo coalition, c/oAcropole, P. o. Box 48 Khartoum, Sudan - Ter: (249) fi 77.17.45; eaD fi 79.26.5g - Fax: (249) 11 78.55.36 - E-mail: global@sudanmail.net TANZANIA Dr. Simon KATENGA National Coordinator, National onchocerciasis Task Force (NoTF) secretariat c/o Ministry ofHealth, P. o. Box 9083, Dar-es-salaam, Tanzania - Tel: (255) 2221130025; (255) 222ll2glg- Fax:(255) 2221130009; (255) 222118552 - E-mail: katensa@raha.com or imaz@maf.oig Mr. Charles FRANZEN country Representative, lnterchurch Medical Assistance, (IMA) Inc., National onchocerciasis TaskForce (NOTF) Secretariat clo Ministry of Health, P. O. Box 90g3, Dar-es-Salaam, Tanzania - Tel:(255) 2221130025; (255) 2221t2918- Fax: (25s) 222tt3n1g; (255) 2ZZttB552 - E-mail:imatz@maf.org t JAF/INF/DOC.I Page 48 Annex 5 TCHAD Dr. Kimingar NAMANGUE Coordonnateur National du Programme de Lutte contre I'Onchocercose, Ministdre de la Sant6 publique, B. P. 440 N'Djamena, Tchad - T6l/Fax: (235) 52.48.38 Dr. Ctuistian TOSI Repr6sentant, Organisation pour la Pr6vention de la C1cit€ (OPC), B. P. 898 N'Djamena, Tchad - T6llFax: (235) 52.43.89 - E-mail: sante.dmr@mail.rd UGANDA Dr. Richard NDYOMUGYENYI National Coordinator, National Onchocerciasis Control Programme Secetariat, 15 Bombo Road, p. o. Box 1661 Kampala, uganda - Tel: (256) 41 348-332 - Fax: (256) 4t 348-339 - E-mail: notf@imul.com Mr. Moses KATABAWA Country Representative, The Carter Center, Chairman of the NGDO Coalition, P. O. Box 1ZOZ7, Bombo Road, Plot 15, Vector Control Division Building, Ministry of Health, Kampala, Uganda - Tel: (256) 41251-025 - Fax: (256) 4t 250-376 - E-mail: rvbprg@starcom.co.ug SECRETARIAT Dr. Azodoga SEKETELI Director, African Programms for Onchocerciasis Control Progarmme (APOC), 0l B. P. 549 ouagadougou 01, Burkina Faso - Tel: (226) 34.22.77 - Fax: (226) 34.48.00 - E-mait: seketelia@oncho. oms. bf Mr. Fornrnd AGBOTON Administrative and Financial Officer, African Programme for Onchocerciasis Control (APOC), 01 B. P. 549 Ouagadougou 01, Burkina Faso - Tel: (226) 34.29.53 or (226) 34.29.59. - Fax: (226) 34.28.7 5- E-mail: aqbotonfa@oncho.oms.bf Dr. Uche AMAZIGO Acting Chief of the Sustainable Drug Distribution Unit, African Programme for Onchocerciasis Control (APOC), 0l B. P. 549 Ouagadougou 01, Burkina Faso - Tel: (226) 34.29.53 or (226) 34.29.59.- Fax: (226) 34.28.75 - E-mail: amazigouv@ocho.oms.bf Ms. Pamela DRAMEH NGDO Coordinator for Ivermectin Distribution, WHO, Prevention of Blindness and Deafness, world Health Organization (WHo), 20, Avenue Appia, cH-L211Geneva 27, Swizerland Tel: (+41 22) 791-3211 - Fax: (+4122) 791-4772 - E-mail: pdrameh@who.ch Dr. Mounkai'la NOMA Acting of Epidemiology and Vector Elimination Unit, African Programme for Onchocerciasis Control (APOC), 01 B. P. 549 Ouagadougou 01, Burkina Faso - Tel: (226) 34.29.53 or (226) 34.29.59. - Fax: (226) 34.28.75- E-mail: nomam@oncho.oms.bf Dr. Jean-Baptiste ROUNGOU Regional Advisor on Other Tropical Diseases (OTD), c/o WHO/Onchocerciasis Control Programme (OCP) B. P 549 Ouagadougou 01, Burkina Faso - Tel: (226) 34.38.18: (226) 34.29.53 or (226) 34.29.59. - Fax: (226) 34.28.75- E-mail: roungoujb@oncho.oms.bf I a a