REPORT OF THE FIFTEENTH SESSION OF THE TECHNTCAL CONSULTATTVE COMMTTTEE (TCC) I)IR/APOC/REP/TCCI5 03i01/200-l Ouagadougou, 16-20 Septemb er 2002 AFRICAN PROGRAMME FOR ONCHOGERCIASIS CONTROL (APOc) CONTENT OPENING (including agenda items 1,2,3,4,5,6,10 and 11) 1 REPORT ON THE REVTEW By THr APOC MANAGEMENT OF, 1.r, 2*r, 3m AND 4TH YEAR PRoGRESs REPoRTs AND SUBsEQUENT YEAR BTIDGBTS(APPLrcATroN oF THE NEw REw\TEw pRocESs) (agenda item 13)......................5 REvrEw, CONCLUSTONS AND RECOMMENDATTONS oF TCCI5 .........s KEVIEW OF ]ST, 2ND, 3M AND 4TH YEAR ANNUAL TECHNICAL KEPORTS (agenda item 14) .......................j CAMEROON, Page A. B. C. c.1 NOTF/HQ Support (3'dl4h Year Report) Adamaoua CDTI Project (3'd Year Report)....... Haute Sanaga./Belabo CDTI.Project (l't year Report) Littoral II CDTI Project (3'o Year Report) South West II CDTI Project (2'd Year Report)............ Cenhe I CDTI Project (1't Year Report)....... West Province CDTI Project (l't year Report) CENTRAL AFRICAN REPUBLIC. CAR CDTI Project (3'd Year Report)....... 6 6 6 7 7 8 8 8 9 9 9 9 CHAD Chad CDTI Project (4th Year Report) - Resubmission DEMOCRATIC REPABLIC OF CONGO..... NOTF/I{Q Support (2"d year Report) EQUATORIAL G(IINEA Bioko Island CDTI Project (3'd year) vector Elimination Project (Technical Report January 2000 - April2002) ETHIOPIA NOTF/HQ Support (2"d year Report) Kaffa-Shaka Zones Projects (2nd year Report). Thyolo, Mwanza & Extension CDTI project (4tr, year Report) NIGEKIA NOTFA{Q Support (4th year Report) ............... I 0 ............... 10 11 ....11 Kaduna State CDTI Project (4th year Report)....... Jigawa State CDTI Project (2_nd year Report) (re-submission) Cross River CDTI Project (4ft year Report) Kwara State CDTI Project (3'd year Report)....... Kebbi State CDTI Project (3'd year Report) Adamawa CDTI Project (3'd year Report)....... Borno CDTI Project (3'd Year Report) Plateau,/Nassarawa CDTI proj ect (4tr' year Report) ll Edo/Delta CDTI Project (3'd Year Report)..... Oyo State CDTI Project (3'd Year Report) ..... Ekiti CDTI Project (2nd Year Report)............. Gombe State CDTI Project (2nd Year Report) Nrger State CDTI Project (2nd Year Report)... Ondo CDTI Project (2nd Year Report)............ Bauchi State CDTI Project (2nd Year Report) t4 15 15 l5 t6 t6 t7 SUDAN..... Southem Sudan CDTI Project (4th Year Report)....... TANZANIA. Mahenge Focus CDTI Project (4th Year Report) Resubmission Ruvuma Focus CDTI Project (3'd Year Report) Tukuyu CDTI Project ( 2nd Year Report) Tukuyu Focus Vector Elimination Project (3'd Year Report).... Tanga CDTI Project (2nd Year Report)....... AGANDA.. Mpamba-Nkusi Focus Vector Elimination Proj ect........ C2 KEVIEW OF NEW NATIONAL PLANS AND PROJECT PROPOSALS (agenda item 15) ANGOLA National Plan for CDTI control... Angola CDTI Project....... BURUNDI National Plan for CDTI control... Burundi CDTI Project CAMEROON North-West CDTI Project DEMOCRATIC REPUBLIC OF CONGO.... Bas-Congo Kinshasa CDTI Project......... ..17 ..t7 .................18 .18 .18 .t9 .19 .19 20 ...........21 ...........21 ...........22 22 .22 20 20 25 .23 .23 SUDAN..... 24 24Mvolo County CDTI Project TANZANIA .............24 Morogoro Focus CDTI Project....... ......24 UGANDA........ ..25 Proposal for Focal Vector Elimination of Simulium neavei s./. in the Mpamba-Nkusi Focus ...25 D. ADDITIONAL SUBJECTS CONSIDERED BY TCCIs 25 Item 7 Items 8 and 9 Item 12 Item 16 Item 17 : Review Meeting of the Vector Elimination Projects. ........ : Evaluation of Sustainability of CDTI Projects and Second APOCAIOTF Representatives Meeting in Abuja. : Financial management of APOC funded projects. : Review of operational research proposals.... : Other matters 26 27 27 28 ul Training in Data Management and GIS Update on MACROFIL (Moxidectin).......... Update on country sfudies on cost per treatment estimates.. Report of the Scientific working Group on Serious Adverse Events following Mectiyan Treatment of onchocerciasis in Loa-loa endemic areas. (May z0oz). Date and place of the sixteenth session of the TCC Cconclusions and recommendations Closure of the session................. LIST OF PARTICIPANTS ................ Agenda....... ADD ON INTERVENTIONS': Other disease control efforts within the APOC projects supported in Phase II through the APOC Trust Fund ...... Conclusions and recommendations of the meeting on the review of onchocerciasis vector elimination projects in the APOC prografirme 06 - 10 May 2002 (Ouagadougou, Burkina Faso) .......... APOC support to projects after 5 years........... TCC 1 5 recommendation/endorsement/acceptance/approvals ... . . . . .. . . . .. . . . . . .28 .28 .29 29 Item 18 Item 19 Item 20 Annex 1 Annex 2 Annex 3 Annex 4 Annex 5 Annex 6 30 30 30 3l JJ 34 35 39 41 1THE APOC TECHNICAL CONSULTATIVE COMMITTEE Fifteenth session Ouagadougou, l6-20 September 2002 A. OPENING (including agenda items 1,2,3,4,5,6,10 and I I) 1. The fifteenth session of the Technical Consultative Committee was held at the OCp Headquarters in Ouagadougou chaired by Professor Mamoun Homeida (the list of participants is attached as Annex 1). 2. The Director of OCP, Dr Boakye Boatin welcomed the participants, stressed the importance of TCC in the life of APOC and underlined the importance oi th" experience of that Programme for the work of OCP: 3. Dr Azodoga S6k6t6li, Director of APOC, reiterated the welcome to the TCC session. He regretted that it had not been possible to arrange for simultaneous interpretation English/French due to a delay in contacting the interpreters; he assured the participints that appropriate affangements in this respect would be made for future sessions. He thanked Members of of the Committee for their valuable contribution to the work of APOC and their readiness to undertake field missions whenever required. 4. Dr Mohamed Hacen, WHO Representative to Burkina Faso, emphasized the importance of the two African onchocerciasis control programmes not only for health development but also for socioeconomic development. OCP would soon come to an end after having successfully attained its objective while APOC would continue its activities to rid Africa of riverblindness. He wished, on behalf of his Organization, success in the deliberations of the Committee during the coming week. 5. Professor Homeida then expressed his satisfaction that the Committee at the opening of the Second Phase would be able to concentrate more on scientific and technical matters than had been the case hitherto, given that financial and administrative issues were to be handled by the APOC Management. He was pleased that the Committee now had a "full house" membership and called on brevity in the presentations of project reviews. A series of important meetings, inside and outside APOC, had taken place since the previous session of TCC and would be reported to, and considered by, the Committee at its current session. Professor Homeida singled out sustainabllity, Loa loa and the coordination with the Llrnphatic Filariasis Elimination prograrnme as major challenges for ApOC. He finally suggested that the completion of the REMO process, with the exception of Southem Sudan, would result in modifications of the list of CDTI projects. . 6. Item 2ithe provisional agenda (attached as Annex 2) was approved. The Director informed the Committee that items until now listed under "Other matters" would in future appear independently. 7. Item 3: Dr Ole Worm Christensen, Secretary to the Committee of Sponsoring Agencies, highlighted the issues considered bv CSA at its March, July and Septetnber sessiotts. Much of the Committee's time was spent on matters related to the closure of OCp and the post-OCP onchocerciasis control activities. CSA supported, and had earmarked funds for, the intensified CDTI programme in the river basins of Pru (Ghana), Oti (Togo), Mafou 2(Guinea) and Tinkisso (Guinea) where CDTI programmes would be the principal means of control supported by a Special Intervention Team. Large scale CDTI in Sierra Leone, as the sole means of control in that country had now been added to the activities of the Special htervention Team. Aerial larviciding would be carried out in the Oti basin untit 2007. The Special Lrtervention Team would operate under the guidance of Director, APOC and report to him. As regards vector control, CSA recommended that aerial larviciding in the Oti area and in Bioko be combined under a common contract. 8. There would be a three months winding-down of those OCP matters which could not be closed before the end of 2002 to be carried out by a small team of former OCP staff, also under the administration of the Director of APOC. 9. CSA had organized the OCP External Evaluation exercise and considered its report during the September session. 10. The Committee decided to continue the inclusion of the hypo-endemic countries (Kenya, Mozambique and Rwanda) within the list of APOC countries leaving the door open for CDTI control should new or imported cases occur. 11. Dr Christensen finally referred to the Donors' Conference, organized by CSA, to be held in Luxembourg on 8-10 October. The agenda would include: OCP closure; wrap-up plan; post-OCP onchocerciasis control; the report of the OCP External Evaluation; socioeconomic development; APOC implementation report; financing of APOC (2003-2010); operational research; and ComDT approach to other health development programmes. 12. [n connection with the responsibility of APOC regarding the activities of the Special Intervention Team, the Director pointed out that this would be a WHO-executed activity for which the Regional Director had appointed him to take charge. He reassured TCC that these activities would not draw on APOC funds; the OCP Trust Fund Reserve would fully cover the costs. TCC would receive reports of the Special Intervention Team for information only. However, as and when required, Members of TCC might be requested to provide technical advise on special issues in an individual capacity or as members of independent ad hoc task forces, outside the TCC structure. 13. On the subject of applying the ComDT approach to other health development activities, the Director pointed out that the Phase II Memorandum had given him the mandate to support such activities "within the geographical scope of the Programme". He would ensure that onchocerciasis control would not be jeopardized and requested TCC to prepare guidelines for APOC involvement in other programmes applyng the ComDT approach. A set of guidelines is attached as Annex 3. 14. Item 4: Matters arisingfrom the Zdh WGOO meeting, which marked the 10 years of the existence of the Group, were presented by Ms Pamela Drameh, Coordinator of the NGDO Group. The meeting was held in line with the events to mark 15 years of the Mectizan Donation and the 250 millionth treatment with ivermectin. The Group was honoured by the presence at the meeting of the CEO and Senior Vice-President of Merck & Co., Mr Raymond Gilmartin, and Mr Ken Frazier. 15. She highlighted a number of conclusions and recommendations arrived at by the Group. She informed the TCC that the NGDO Group welcomed the planned study on cost per treatment to be undertaken by APOC and expected that this would provide more accurate assessment of this cost. J16. The Group affirmed the importance of assessing the sustainability of projects and the plans of APOC to do evaluations as projects progress. The Group recommended that projects that did not fare well in the initial evaluation should receive special attention from the Ministries Health, APOC Management and other partners to enable such projects to improve performance and to avoid intemrption of treatment. 17- The Group recommended that APOC and MDP support the development of appropriate training materials, and collaborate with NOTFs, to prepare all field staff to manage SAEs in areas co-endemic for onchocerciasis and Loa loa, in order to facilitate the implementation of the MEC/TCC guidelines during the first round of treatment. 18. The Group received a report of the combination of Vitamin A and ivermectin distribution in Nigeria by UNICEF and HKI and in view of the cessation of NIDs where Vitamin A is currently distributed, recommended that this should be carried out more widely where needed. 19' Item 5: The Chair, in reporting on the follow-up to the recommendations of the fourteenth session of TCC, mentioned that many of the recommendations in Annex 4 of the TCCI4 report were to be dealt with under separate agenda items during the current session. He referred specifically to the planned validation studies of RAPLOA and the combined mapping method, which had recently been discussed in Manchester. The examinatio n for Loa loa in Ethiopia had been completed showing absence of Loa loa inthe areas examined. 20. As regards assistance to Yemen, a communication from the Govemment was still awaited' It was pointed out that APOC would not have a mandate to finance onchocerciasis control in that country but that the government could call on the Programme to provide know- how in the form of technical assistance without drawing on APOC funds. lnsofar as the Yemen issue was raised by the Mectizan Expert Committee (MEC) in the context of worldwide onchocerciasis control, it was suggested that MEC/MDp woutd contact the yemen authorities for them to initiate action. 21. There was a need for TCC to prepare guidelines for granting ApOC-financing of projects after five years of implementation (see Annex 5. 22. TCC Members were provided with CDs containing Programme information and data. Updating could be arranged either by Members bringing their CDs to TCC sessions for updating by the Management or by the Management "-rnuiling updates to Members for theirown insert. 23. Item 6: ln introducing the item on updating of operational researcft, Dr Hans Remmeprovided an update on onchocerciasis implementation research, focusing on research on rapid mapping' Following the recommendation of the TCC13 to explore the development of u rupld mapping method that combines the environmental risk map and RAPLOA, a workshop was held in J]ddr,e 2002 in Manchester which brought together the researchers concerned, some members of TCC and two experts in spatial statistics. The workshop participants designed a combined mapping method and a plan for validation of the different methods in Central Africa. The meeting also introduced the concept of an Operational Contour Map, showing High Risk Zone, Low Risk Zone and. a Boundary of Uncertainty (BoU) where on statistical grounds it is uncertain whether the risk is high or low. 424. Following the meeting, researchers at the IRI and the University of Lancaster in the UK had significantly improved the environmental risk model, recalibrating it using additional environmental data and the parasitological data from the RAPLOA study of TDR. The model had also been enhanced with a new factor describing residual spatial variation and statistical approach which allows quantification of the statistical uncertainty in the model predictions and fine tuning of predicted Loa Loa nsk maps using local survey data for areas where such data are available. When this enhanced model was applied to the data of Cameroon, it resulted in greatly improved predictions. 25. Several studies on sustainable ivermectin delivery were underway. A multi-country study on advocacy for sustained CDTI will be completed early 2003 and the final analysis workshop for a multi-country on additional health tasks of CDDs was scheduled for October 2002. A new multi-country study on the use of the ComDT approach for delivery of other health interventions had been advertised and there has been an excellent response with 33 applications from multi-disciplinary African research teams, many of them of very high quality. 26. TCC noted that significant progress had been made with research on rapid mapping and the development of an improved environmental risk model (ERMr) that allows the estimation of confidence intervals for the risk predictions. The Committee endorsed the proposed activities for the near future, i.e. field validation of the ERMr, RAPLOA and the combined method, and development of an expanded ERMr model that allows the use of RAPLOA data for estimating the residual spatial surface. 27. TCC reviewed the proposed sites for the validation studies, and suggested some modifications of the location of the three selected sites. 28. The Committee recommended that the location of the reported cases of severe adverse events (SAEs) thought to be associated with Loa Loa, be plotted on the latest PCM as another way of validating the risk map. 29. TCC noted that the RAPlOA/parasitology exercises in Ethiopia resulted in that programme avoiding having to execute village by village REA, as Loa was not detected in a sample of 20 villages selected from the potential high-risk locations. 30. TCC recommended that this process be used in the interim, while mapping methods were being developed and RAPLOA was being validated, for projects where Loa loa was predicted by ERMr models in countries outside of Nigeria and Cameroon. 31. TCC also recommended that detailed recommendations be developed, in consultation with MEC, for the operationalization of RAPLOA and ERMr. These recommendations, based on RAPLOA assessments, would be envisioned to replace the current TCC/MEC guidelines, which require village by village REA in areas where the ERMr suggests Loa may be present. 32. Item 10: The Committee received an update on REMO/GIS in APOC countries with special reference to Angola, Burundi and DRC. It 2002, rapid epidemiological mapping of onchocerciasis (REMO) had been carried out in 8 of the 11 provinces of Democratic Republic of Congo, in Angola and Burundi. The data collected were integrated in the geographical information system (GIS) and CDTI areas were defined. B5 33. As at September 2002, REMO exercises had been implemented in the 19 APOC Participating Countries. 34. Item 11: As to the projected number of CDTI Projects during Phase lI and the Phasing-out Period, the Committee was informed that in the Programme Document for phase II and the Phasing out Period a total of 95 projects had been forecasted based on the available REMO and REA data. As the REMO would be completed in 2003 in all of the 19 Participating Countries, the total number of projects expected to be funded by ApOC Management had increased to 109. The Director reassured the Committee that the increase of 14 additional projects would not result in an increase of the estimated budget approved by JAF7. REPORT oN THE REvIEw BY THE APOC MANAGEMENT oF lsr, 2*o, 3*AND 4TH YEAR PROGRESS REPORTS AND SUBSEQUENT YEAR BUDGETS (APPLICATION oF THE NEw REVIEW PROCESS) (agenda item r3) the 2"dl't, rd th subsequent year budget. 35. During the period between TCC 14 and TCC 15, the Management of ApOC reviewed 121 project documents including the progress reports submitted or re-submitted; the technical reports to be reviewed by TCC; and the subsequent budgets of 32 ongoing APOC projects. 36. Of the 32 budgets submitted or re-submitted, only one had been rejected for re- submission to the Management of ApOC. C. REVIEW, CONCLUSIONS AND RECOMMENDATIONS OF TCC15 C.l Review of 1't, 2no, 3'o and 4th year annual technical reports (agenda item l4) 37- As an introduction to the review, Mr Fortune Agboton, APOC Budget and Finance Officer, informed the Committee that the total amount budgeted in the Plan of Action and Budget fot 2002 under the Budget Line Item "National Projects" (US$ 10 043 528) ApOC had already spent US$ 5 184 360 for 53 projects submitted by the NOTFs, including 6 newly approved CDTI project by TCC14 and 47 subsequent budgets for the previously app.ou"d projects in APOC countries. 38. He also informed the Committee that 6 new CDTI project proposals were submitted for review by the current TCC15 and that during the period between fbC t+ and TCC15, 32 subsequent budgets were received by the Management of APOC of which 31 were approved by the Management and the Letters of Agreement finalized. 39. In addition to those approved before March 2002 and, after TCC 14, the budget proposals for 54 projects had been reviewed by the Management and 53 approved for a total of US$ 5,184,360. on 6CAMEROON NOTF/FIO Support (3'd/4th Year Report) 40. TCC15 noted that the report clearly outlined the activity of the NOTF/HQ and described the support given to the field. The NOTF/HQ had continued to play a role in encouraging NGDOs already in Cameroon to take on new project areas so that all endemic regions could be covered. The National Programme was gradually gaining knowledge of the total population in the hlper and meso-endemic areas of Cameroon via census and REA exercises. The NOTFAIQ had taken an active role in assisting the field in working safely in Loa loa endemic area and in training for the identification and management of cases of SAEs. TCC noted that cost recovery had ceased for ivermectin distribution and CDDs would now be supported out of a Poverty Alleviation Fund. 4t The Committee recommended that the NOTF and all partners involved in CDTI: Develop a strategy for increasing treatment coverage in all project areas. As noted by TCC13, coverage in the area of 40o/, wlll have little impact on transmission of the disease. Determine the population in hyper and meso-endemic areas (i.e. obtain denominator) so that the progress of all programmes can be more accurately monitored. S ecure onchocerc iasis-sp eci fic funding from the Government Continue to improve upon the identification of those at risk for and those having developed SAEs rn Loa-endemic areas and continue to find the best means of managing those cases to assure the best possible outcomes. Continue to supply a summary table with treatment and training data for all programmes in the NOTF/HQ report. Inclusion of a narrative regarding the goals of the national programme as a whole for upcoming years would be informative. Assure, if possible, that the funds collected during all years when cost recovery was in effect are targeted for onchoc erciasis -related ac tiviti es. Share result of the workshop to create IEC materials in relation to SAE with others. (i) (iD (v) (iiD (iv) (vi) (vii) TCC accepted tlre report with the above recommendations to be addressed by the Project. Adamaoua CDTI Project (3'd Year Report) 42. The TCC noted the project provided 121,722 treatments in 488 communities, and expanded from 2 to 4 health areas. Treatments reached a therapeutic coverage of 57oh (total population 214,000). However the report did not clarify the UTG and geographic coverage. Training of 644 CDDs represented 196 treatments per CDD, an acceptable ratio. 43. The report provided a thorough description of the nine severe reactions identified through post treatment surveillance for subconjunctival haemorrhages. There were no deaths and all patients recovered. All patients with reactions occurred in the Bankim health area in December 2001. Seven were male, and none reported alcohol consumption; all had taken their first ivermectin treatment; and all were found to have Loa loa in blood examinations (ranging from 320-1780 mf/ml). One patient (with Loa count of 320 mf/mI) had CNS manifestations (lower extremity weakness, urinary incontinence, altered Glasgow score). The rate of hospitalizations in Bankim was 3 per 10,000 treatments, and the rate of CNS events was 0.6 7per 10,000. TCC commended the project and NOTF for rapid identification and management of these patients. TCC 15 accepted the 3'd Year annual technical report for the Adamaou project and requested information in the next report on the (ITG and geographic coverage. Haute Sanaea./Belabo CDTI Project (1't year Report) 44. TCC13 had reviewed the mid-term report and not the l't year report as stated in the report of TCCl3. TCC noted that this report was verypoor, both in substance and quality of writing e'g. the background information and implementation data were incomect and confusing. TCC recognized that the quality was unsatisfactory partly due to poor project performance on the ground, which was in fact worse than when the project started. The project attained the low therapeutic coverage of 29.7o/o and in some villag"r.u"n as low as10,/I /O. 45. TCC15 expressed serious concerns and requested clarification on a number of issues as follows: (i) conversion from GBIT to GDTI has not yet happened in this project. (ii) The project had not requested any ivermectin for 2 years. (iii) Important issues of SAEs and drug tablets used have not been reported at all.(iv) Although not clearly requested, there seemed to be a desire for REA exercise to be done in 75 villages, presumably among those previously receiving treatment, this needed clarification. The report was reiected to be resubmitted to TCC16. The project should present a neh) realistic plan of action and budget proposal. The NOTF Cameroon must taie urgent steps to ameliorate the extremely poor performance of the project execution, the low treatment coverage, and the quality of its report writing. NOTF should also intervene in the handing over process of this projectfrom the current NGDO to the new one earmarked. CDTI nd -,Y ear 46. The project had addressed the recommendation of TCC12. Endemicity of the communities had been clarified using REA, treatment data provided, census completed and training undertaken. The recommendation of TCC 14 (i and ii) had also been addressed. However, TCC noted that the report was verbose, repetitive and poorly written. The therapeutic coverage was still low (36%). 47. (i) (ii) (iii) (iv) TCC recommended that The project should intensify education and mobilization of communities and also explore the use of the media. The project should improve therapeutic coverage and complete 2002 treatment as planned. The link in transferring patients with SAEs should be strengthened (absence of health committee member who ensure transportation). The NOTF should conduct a report writing workshop for projects and review technical reports before submission to TCC. TCC accepted the 3'd Year Littoral II CDTI report. 48. This was a 2nd Year technical report covering the period April 2001 to March 2002. TCC was concemed that the report was written in a manner such that it was like a third party to it, indicating that issues that should have been taken seriously were not of concern to the report writer. The project reported that late justification and misuse of funds had delayed activities and that CDTI activities had also been suspended for a year due to 6 SAEs leading to 4 deaths related to Loa loa. Although reported training and mobilization appeared to have been adequate, with emphasis on SAE diagnoses, management and referral, the treatment coverage was only 31.8% and geographic coverage 85.7oh. No information was given on absentees, refusals, ivermectin usage, and on the SAEs and their management. 49. TCC requested information on: (i) (ii) (iii) (iv) The funds misappropriated and the vehicle stolen. SAEs, their diagnosis and management. Govemment provision of vehicle to move SAEs to treatment point. Details of ivermectin receipt and usage. TCC accepted the technical report with the information requested above to be provided by the Project. tt Year 50. TCC noted that this report was 91 pages in length and contained 12 Appendices, most of which were uninformative. Despite its length, the Centre 1 report did not follow APOC guidelines and was lacking important and required tables, such as the 'Implementation of CDTI' table showing key indices (choosing time of treatment, collecting ivermectin, providing CDD support, etc). There were numerous repetitive tables (for example pages 15, 26 and 30 have tables containing the same information). 51. The Centre 1 Project treated 123 786 persons (corresponding to only 690/o of the ATO, 460/o of the Total Population) during the reporting period. There were 1 158 CDDs trained (91% of the objective), which represented 106 treatments provided per CDD. The text reported that 13 severe adverse reactions occurred during the treatment period, and one death, but little information on these patients was provided. Ln Annex 4 (pages 35-37) a line listing of 26 SAEs is provided, and the Committee requests prompt clarification on this important issue. TCC 15 rejected the first year annual technical report for Centre I because it did not conform to guidelines for annual reports, its length was excessive, and the failure to provide details of the severe adverse reactions that occurred in 2001. TCC recommended the report to be resubmitted to TCC16. West Province CDTI Project (1't Year Report) 52. This was a 1" Year technical report covering the period January to December 2001. The project planned to phase its activities over 3 years starting with Loa loa hrgh risk districts in the 1" year and achieving full coverage in the 3'd Year. The Committee was pleased to note that the project was making good progress to conversion from CBIT to CDTI and achieved a 75%o therapeutic coverage and l}Ooh geographic coverage of the first seven districts in the I't 8 South West II CDTI Project (2nd Year Report) 9Year. However, the SAEs that occurred were not mentioned in the report, nor was the result of REA given. 53. TCC requested the project to provide: (D (ii) Detailed information regarding the REA carried out. Details of SAEs that occurred during the period under review with explanation on their management. Information on ivermectin supply and usage.(iii) TCC accepted the technical report. CENTRAL AFRICAN RBPUBLIC ect rd 54 TCC congratulated the project on the excellent work done despite the reported difficulties. To sustain the results, TCC hoped that the operational research undertaken on the support to CDDs would be taken into account and asked that the results of the study be communicated to the TCC 16. CHAD 4th The report tnas accepted and the Project was encouraged to address the issue of its Jinancial sustainabtlity and in particular the MOH taking over the payment of the salartes of its staff currently funded by the NGDO. 55. TCC15 noted that the project had taken into account concems of TCC14 in the resubmission, which was an improvement of the last submission. The report now consists of a part from the NOTF covering both areas and separate detailed reports from the two differentproject areas as requested by TCC14. Details were provided on ivermectin used and on the funds received by cost recovery. TCC however noted that: (i) In the section of the report concerning Moundou it appears that key indicators were not understood e.g. therapeutic coverage was calculated as u p.r."riuge of ATO and eligible population and not according to total population. TCC recomriended that the project refer to TCC14 report for the list and definition of the key indicators to be used. (ii) The report showed an increase in treatment in the Sahr Region, but no previous treatment figures were given for Moundou. TCC accepted the report with the condition that the coruect treatment figures with indices are provided to APOC Management. 10 DEMOCRATIC REPUBLIC OF CONGO NOTF/IIO Support (2nd Year Report) 56. TCC noted that the report did not provide details on the implementation of CDTI projects and results of supervision and the evaluation undertaken. TCC further noted that considerable activities were carried out which had not been reflected in this report. TCCLS accepted the technical report but asked that the missing information be sent to APOC management with clarification on REMO data, CDTI jigures and results of s up e rvi s io n an d ev alu atio n activitie s. EQUATORIAL GUINEA Bioko Island CDTI Project (3'd Year) 57. Total population in Bioko Island (including the town of Malabo) was 90,000 with the rural population according to census said to be 16,000. The project reports a l00o/o geographical coverage of the rural communities and a therapeutic coverage of 66.3%o. 58. (i) (iv) (ii) (iii) TCC expressed some concerns and made recommendations to the project as follows: The mobilization of communities seemed to have been done vertically, and the report stated that supervision had not been satisfactory due to lack of logistic means. The project should decentralize activities to the district level. The project should try as much as possible to ensure that the therapeutic coverage increases significantly in the rural communities. The project was approved with a budget to treat 90 000 people and TCC strongly urged the project to extend treatment as soon as possible in the urban area of Malabo. TCC accepted the 3'd Year technical report and asked that its concerns and recommendation,listed above, be given immediate attention by tlte project. Vector Elimination Project (Technical Reoort January 2000 - April 2002) 59. This project had been scrutinized by the Meeting on the Review of Onchocerciasis Vector Elimination Projects in May 2002 with the recommendation that arrangements be made for examining the "contractual conditions of the use of helicopters for an anti-simulium campaign in Bioko". 60. Field training had been completed and operational data were collected for compilation and analysis. Simulium yahense, Bioko form, had been found sensitive to temephos and the ground larviciding so far undertaken had had no harmful effect on the non-target fauna. TCC accepted the technical report. 11 ETHIOPIA 61. TCC congratulated the NOTF for the prompt action on the request by TCC to investigate the prevalence of Loa loa in the Bench-Maji and North Gondor CDTI areas. TCC recognized the important role the Carter Center Representative was playlng in the functioning of the Secretariat as the Secretary of the NOTF. N 62. (i) (ii) TCC recommended the following: A plan of action for 3'd Year be provided. That pertinent information found in the minutes of the NOTF meetings be included in the technical report. Clarification was required on the summary of finances, was it for the CDTI project or for the NOTF? (iii) (iv) Trend data, treatments, coverage, and cost per treatment for each CDTI projects should be provided. (v) Maps as referred to in the report should be included. TCC accepted the 2"d Year technical report. Kaffa-Shaka Zones proiects (2nd year Report) 63. TCC commended the project for an excellent performance for a 2"d yearproject. Theproject attained high geographic (100%) and therapeutic (77%) coverages. lntegrition into health and non-health structures was ongoing. TCC noted that the r"po.t *u. *ill written, although there was conflicting information on the total population of ihe treatment area and the report did not indicate the period being covered. 64. TCC requested the project to clarify the total population, provide information on absentees and refusals and improve on CDD per population to Z CDOs per 250 population. The project should advocate for funding from the Government and also provide information reported to MDP on severe adverse events in this treatment round. TCC accepted the 2"d Year technical report. MALAWI th -,Y ear 65. This is a Year 4 technical report for Thyolo and Mwan za and 3'd year for the extension area. The project still.had a low coverage (370 57g person) of 56.6% despite the fact that the project was in its 4th year. The g.og.uphi" coverage was not specific however, it was clears from the table that it was also not satisfactory especially in the extension area (e.g. Chikwawa)' CDTI was not strictly applied in the Tea Estates where health workers are distributing ivermectin. 66. TCC raised the concern that the activities on the ground did not match the age of the project when it should be sustainable in a year,s time. t2 TCC accepted the technical report and recommended that APOC/WHO organize a worksltop of key health staff to review the results of the sustainability evaluation and discuss a way forward and that a mid-term (year 3) review be undertaken in the extension dres. NIGERIA NOTF/HO Support (4th Year Report) 67. This report was well written, reflecting good activity in the field and a good example of how the HQ worked in a large country. The Committee remarked on the maturing of this HQ to an active HQ taking steps into streamlining activities and being involved in advocacy, with a very active NGDO Coalition. Different methods were being used to execute activities with the contribution of all partners, e.g. the celebration of the l0th year of the National Onchocerciasis Day and renewal of budgets and technical reports. 68. The HQ supervises zonal task forces, the National Task Force activities and review meetings, and is helped in the technical matters by a Technical Steering Committee. There are 27 projects (26 CDTI in 32 states and 1HQ). One project is in its l't Year, ten in their 2nd Year, eleven in the 3'd Year, and five in the 4th Year. 16.5 million people were treate d, (73%), in 471LGAs and in 3 148 communities. The Govemment had contributed US58, 000 out of $125 000 pledged. TCC recommended that the report summarize the contribution from States, LGAs and communities. The Committee accepted the 4'h Year technical report. Kaduna State CDTI ect (4th Year Report) 69. Kaduna State has 23 LGAs, with an estimated population of about 4.7 million and 16 LGAs are under CDTI, with 928 732 persons treated in the reporting period. This report was well written, with clearly presented tables of the indicators of the CDTI implementation process. The Project was doing well on the ground, reaching 82.6% therapeutic coverage and 100% geographic coverage. TCC asked that the project provide: (i) The number of ivermectin tablets used;(ii) A progressive treatment figure displayed as a histogram; and(iii) An action plan for the subsequent period. The Committee accepted the 4'h Year technical report. a 70. The report was an improvement on the previous report and made attempts to address TCC14's concerns, although TCC would have liked a separate section addressing its comments. The project had a good therapeutic coverage rate (80%). TCC noted that absentees and demand for incentives could be reduced if the ratio of CDD per community members was increased, information available to women was known; and their involvement enhanced within the appropriate structures. The monitoring tool could help the project identify and solve these challenges. 13 TCC accepted the 2od Year technical report Cross ver CDTI ect (4th Yqar Report) 71. This report is well written with a lot of background information and i*ovative ideas. The report goes into detail about community self-monitoring and stakeholders meetings with some results. TCC recommended continued (D Implementation of stakeholders meetings and community-self monitoring:(ii) Use of altemative mechanism for community participation in a weak pHC.(iiD Utilization of Town Development Unions u.ra otn". community-based organizations(CBos). The Committee accepted the 4'h year technicul report. rd., Y ear 72' Kwara neighbours on Benin, an OCP country which called for satisfactory activities on Kwara and across the boarder. However, the TCC felt that the activities of the project and the technical report were unsatisfactory. TCC reiected the report and asked that the Projecr address the following points:(, The report did not qddress TCCl4's concerns of rhe number treated to totalpopulation. (it) It was not clear if census was done and persons at risk are identified.(iit) Treatment figures are in contradiction to the figures given by the NGDL.(iv) There is no good explanation to the drop in treated persons from 700 000 last yearto 596 653 in the curuent year. Kebbi State CDTI project (3d year Report) 73' The report was short and concise but paragraphs showing the strengths and weaknesses were not included in the report. The Project has reach"a tOO % giographic coverage and 87o/o therapeutic coverage. The report did not make mention of the link with theprimary health care system. TCC asked that the Project report on sustainability in subsequent reports. TCC however, encouraged the Project to continue ulorg the line it was following. TCC accepted the 3'd Year technical report. rd -. Y ear 74' Distribution was done in 2 504 communities, with 776 Bl3 persons treated, out of atotal population of 958,031. The project reported that the State Government had released 3 million Naira and 150 000 Naira was released by some LGAs but some are still to support theproject financially. 75' TCC noted that the report had some discrepancies in treatment figures, tables used andthe number of communities covered during the prqect year. The TCC commented that the counter part funding at State level and LGAs was not yet satisfactory, and recommended that efforts should be put into advocacy and soliciting of funOs from all concerned. TCC requested that: (iD (iii) (i) (ii) (iii) t4 The number of previous treatments should be presented in graphical form, to show progressive increase in treatment coverage and tablets used. Correct number of LGA under CDTI funded by APOC should be provided. The project provides clarification for the treatment figures of communities, in tables 1 and2 as well as the number of persons treated and tablets used. The 3'd year technicsl report was accepted. Borno CDTI Proiect (3'd Year Report) 76. The report was well written, containing most of the necessary information. A plan of action was provided for the next project year. TCC noted that the Project was moving along smoothly and that TCCI2 and TCC13 concerns had been addressed. There was however need to move rapidly towards achieving a l00o/o geographic coverage in this mature project. The Committee requested that subsequent annual reports should include and provide information on: (i) Yearly ivermectin treatment for previous years since inception, to demonstrate progress of the Project; Ivermectin inventory, including number of tablets received, used and missing; Refusals and absentees. TCC accepted the technical report. The use of CDTI as a vehicle for vitamin A distribution and the contribution /support from the State and LGAs were commended. Plateau/Nassarawa CDTI Project (4th Year Report) 77. The CDTI Project area covers 21 LGA and 935 villages with a revised estimated population of 1 134 477 . A therapeutic coverage of 83o/o and 100% geographic coverage were achieved. The project reported on the LFE activities in 2002. TCC commended the project for plans to prepare a 3'd year post APOC plan of action. TCC was concemed that: (i) Issues raised at TCC13 were not really addressed; (ii) There were issues of sustainability due to no counterpart funding from LGA and States. (iii) There was no evidence of integration. TCC accepted the technical report but the above issues should be addressed specially those already mentioned by TCC13. Edo/Delta CDTI Project (3'd Year Report) 78. This was a model report, containing all the information requested in a format that is very easy, interesting to read and concise. Data were presented for each LGA in each State followed by a summary table prepared for the total project. Treatment data was presented from 1993-2002, with trends in refining census as well as trends in treatment. Sustainability information included amounts contributed from LGA and village level. Data presented in summary table in US dollars (page 17) is off by one decimal point. Plan of action with responsible personnel and timeline was included in the report for each State. 15 TCC accepted the report and encouraged the project to submit proposals on: (t) The issue of incentives for CDDs.(ir) The rate of refusals ancl absenteetsm over time and an exploration of the statement that this may be due to people getting tired and the ,post-honuy*rri effect'. 3'd Y, 79. The Committee noted that TCCI3's concerns had not been addressed by this report. TCC raised additional concerns as follows: (i) As recommended by TCC13, the project should increase the number of CDDs. The project should strive to have at least one CDD per village and at least 2 CDDs per 250 population. (ii) The project should explain how a geographic coverage of 660/o was calculated. According to table 5-2,treatment occurredin2 450 communities of the 2 497 targeted. This would give a geographic coverage of more than 66%o. (iii) The report gives no information on monitoring and supervision. (i") The project should revise their ultimate treatment goal. In the introduction, it was stated that 1.3 million need to be treated in the project area, yet the report states that already in2002 they had treated over 1.4 million people. (v) More narrative in future reports. The 3'd Year report was rejected and it h,as requested that it be resubmitted tu rtte TCC addressing the concerns of TCCI3 and those raised above. 80. The second year technical report from Ekiti State showed that 456,907 persons were treated during the 10 months period May 2001 to February 2OOZ. This is an 8o/o decrease over treatments provided in 2000 (498,127) and TCC requested clarification to Management on whether this decrease was due to a 10 months period of reporting or if treatment activities had actually decreased. The report uses interchangeably the terminology 'target population, and 'ATO' for the denominator of 663,356 (69% coverage), and TCClequeJed^clarification on the UTG for the project. TCC notes that this ru-" r"qu"st was made in its last review of theproject (TCC13 report). 214 of 334 communities were reached (geographic coverag e of 640/o), and the project is encouraged to reach full geographical coverug. i., ihe coming-year. TCC noted the low rate of CDD training (the 1508 CDDs trained represented only 57yo of the training objective) and that the ratio of persons treated to CDD trained was high (302:1) and suggested more CDDs be trained in 2003. The TCC also noted the efforts being made to improve the situation in Ekiti South West by traditional and civil leadership. TCCL5 accepted the 2"d Year annual technical report for Ekiti State, with rhe request that these clarifications be made in the next report. CDTI Year 81. Ten out of eleven LGAs in the State are either hyper or meso-endemic with onchocerciasis. The population at risk was 786 221 person.. iirl. is the 2"d year technical t6 report showing an increase in persons treated from 450 440 rn 2000 to 515 823 in the current year. This represents 650/o therapeutic coverage. The geographical coverage was low (66%). 82. TCC raised the following concern The Committee accepted the 2"d Year technical reportfor Gombe State. NiBer State CDTI Project (2nd Year Report) 83. This report was satisfactory and TCC commended the project for making significant progress. TCC recommended that APOC Management write to commend Nigeria NOTF for effectively following up on the TCC Mission recommendations which had resulted in impressive performance by the project. (D (iD 84. (i) (ii) (iii) (iv) (v) There should be an effort to increase the geographic coverage. Effort should be made to increase the therapeutic coverage in some LGAs which have low coverage rates e.g., Nafada, Kaltungo, etc. More effort should be done to fully integrated the programme into PHC. TCC encouraged: The project to make efforts to obtain the US$ 50,000 allocated by the State; The project to involve more people outside the traditional health services in supervising CDDs, health education, etc. The project to continue encouraging communities to select more CDDS. The NOTF to clarify REMO status in Niger State. The National Onchocerciasis Control Teams of Benin and Nigeria to meet as soon as possible to develop a plan of action to address the common cross boarder issues. ATO figures. Detailed figure on the total population. ClariJication on why it had not reached 100% geographical coverage, while CDDs were trained in all villages. The Committee accepted the 2"d Year technical reportfor Niger Stute. Ondo CDTI Proiect (2"d Year Report) 85. TCC noted that this report was clearly written but lacked information on the following: - Detailed figure for total population. - Whlle I 322 communities had trained CDDs, only 1 242 received training. No clarification about this had been given. - Release of counter part funding by the NGDO. - The project was still not providing ATO data as requested by TCC13. - Treatment figures in 3'd year report should be given covering the project year, broken by calendar year and not combined. TCC accepted the report with the caveat that the project provide to APOC Management: (,(i, (iii) I7 Bauchi State CDTI ect (2"d Year Report) 86. TCC noted that the report contained most of the required tables with data but lacked text that would have made the report more informative. The project was encouraged to elaborate more on specifics of CDTI implementation, training, mobilization, supervision, etc, in future reports to TCC. Additional CDDs should be chosen in each community to reduce theCDD per population ratio that now stands at approximately 1 CDD to 470 population. Advocacy should be increased at the State level as an attempt to assure the release of counterpart funds from the Government. 87. TCC raised further issues of concern and made recommendations as follows:(i) The report was lacking comments on the projects monitoring and supervision. Details on this aspect of the project should be submitted to APOC Managemint for review.(iD As commented by TCCI3, therapeutic coverage was low and continued to be so for a project in its 2"o year of treatment. The project is asked once again (as it was during TCC 13) to provided an explanation and to propose strategies for increasing coverage.(iiD The project should explain how ivermectin was made available to communities where CDDs did not collect them. The Committee accepted the 2"d year technical report. SUDAN th 88. TCC recognized the peculiar situation of the project area and was pleased with the improvement of the political situation in the area. This-had enabled devoiution of project management and coordination with the newly constituted Southern Sector Onchocerciasis Taskforce (SSOTF). The project had addressed the demand for detailed annual and cumulative treatment data, but the definition of community is still problematic. TCC commended HealthNet for its role in coordinating the project over the years. 89. (i) (ii) (iii) (iv) TCC recommended that: Definition of community for treatment takes account of REA/REMO data and disease endemicity. SAEs should be promptly reported and mechanisms put in place to implement MEC/TCC guidelines in case of SAEs. The report of investigations of the reported SAEs in the reporting period should be provided to TCC. APOC Management request from WHO the report of investigation of epileptiform of the disease in children. 90. TCC further recommended that the nationals who have just taken over the management of the project should be supported in their new role to enhance performance of the project. TCCL5 accepted the 4t' Year technical report for southern sudan. 18 TANZANIA Mahenge Focus CDTI Project (4th Year Report) Resubmission 91. This report was a resubmission of the Year 4 technical report reviewed by TCC14. The report responded satisfactorily to the concerns of TCC 14 with the exception of an explanation of the high level of refusals (23% in 2000; 20o/o in 2001) and the high level of absenteeism (ll% - not sure whether this is year 3 or 4 data). The revised report states that the project was interested in conducting operational research on this issue and has turned to the National lnstitute for Medical Research (NIMR) to assist the Project Coordinator in preparation of a proposal for review by the NOTF and APOC. The TCC looks forward to this proposal but encourages the project to address the high level of refusals and absenteeism with a more proactive strategy. The report admits that there is a problem with the distribution occurring at a time when the communities do not want it, i.e. during the rainy season. This undoubtedly contributes to the high level of absenteeism and refusals. The TCC recommended that the project adhere to the decisions of communities for the time when the distribution should take place. 92, The report made a strong case for the need for improved transportation options. The report was still weak regarding specific plans to increase coverage, such as intensified mobilization and education and monitoring and supervision. The proposal did not include a work plan for year 5. Before the 5th Year funding can be released the plan of action must be provided to APOC Management. 93. The report was still poorly written and would benefit from a thorough review by the NOTF before it is submitted to ensure that it follows the required format for CDTI project proposals. The TCC accepted the 4h year revised report. R 94. The report is fairly well written and informative but the executive sunmary was not comprehensive. The numbers of refusals, absentees and defaulters should not be as high as 37 879 if all communities had been mobilized and had selected periods and method of distribution. There is no indication that IEC materials were used. The report showed that supervision was poor and no information was given on frequency and procedure. TCC noted that most of TCC14's concerns had been addressed. Therapeutic and geographical coverage rates had improved and training had been integrated into district plans. However, the CDTI team in Ludewa District had not been revived following the transfer of the District Project Coordinator and the departure of the Assistant DPC for further studies. 95. (i) (ii) TCC recommended that the project: Intensify individual and group health education at community level. Improve on supervision by identifying and training more supervisors, using supervisory checklist and initiating CSM and SHMs in all districts. Adopt improved strategies (including IEC materials) for health education and community mobilization and retrain implementers on community mobilization and health education skills. (iii) 19 (iv) Arrange for district onchocerciasis coordinators to visit and train in other projects doing well in community mobilization and health education. The Committee accepted the 3'd Year technical report. 2"d 96- TCC noted that this report, though badly written, contained most of the required information. However, information on population was confusing particularly as "community,, and "population" was used interchangeably. The report had provided comprehensive treatment data. The project had made a good progress at integrating CDTI into pHC system. 97. (D (ii) (iii) (iv) (v) TCC recommended that the project: Provide clarification on absentees and refusals. Re-present the table titled "total number of communities in hyper and meso-endemic areas" in order to resolve the mix up between "population" and ,,communities,,. work out strategy to improve supervision and quality of training. Initiate CSM and SHM. NOTF should conduct report writing training for CDTI coordinators and vet reports before submission to APOC/TCC. The Committee accepted the 2'd Year technical report. Tuku Focus Vector Elimination Proiect (3'd Year Report) 98. This project was scrutinized at the Meeting on the Review of Onchocerciasis Vector Elimination Projects in May 2002 which recommended that a first elimination campaign byground larviciding be carried out during the dry season of 2003 and that a second and last treatment be undertakenin2004, if necessary. 99. The following activities had been carried out: - The prospection of larval breeding sites inside and outside the focus - The identification of new insecticide dosing points in the focus - The determination of the discharge rates using a floater - The collection of baseline entomological data 100. The results indicated that: entomological baseline data exist for Lufilyo-rrater, Tapio bridge, Lwango Masako and Kambasegela. 73 breeding sites were prospected and 25 of these were positive for S neavei pre-imaginal stages. The discharge rates varied between 2.4 and, 12.6 m3ls. Trained field personnel were available The Committee accepted the report and requested that data collection should be critically monitored and TCC supervised. T 101. TCC commended the project on its satisfactory progress. Geographical and therapeutic coverages are good although the latter is slightly loweifor 2001 (Ay s.+rl"1.rn" integration into regional and community health *unug"-"nt plans was commended. d 20 102. (1) The Committee noted and recommended the following: The project should improve health worker/population ration, improve health education and duration of treatment to take care of absentees and refusals. Clariff the conflicting information on "l00yo of communities agreed on period of distribution" vis a vis distribution in farming and food shortage periods; recalculate the coverage in Table 6; and clariff conflicting information on knowledge of disease vis a vis 100% of communities having received health education. The project needs to discuss management of reactions as one way of improving coverage. (iD (iii) The Committee accepted the 2nd Year technical report. UGANDA Mpamba-Nkusi Focus Vector Elimination Proj ect 103. After consideration of the feasibility study in the Mpamba-Nkusi focus, the Meeting on the Review of Onchocerciasis Vector Elimination Projects noted that information and data in sufficient quality and quantity had been collected to allow for a large-scale campaign by ground larviciding. 104. Human, material and financial resources were available for the implementation of the project. TCC accepted the report. CZ Review of new national plans and project proposals (agenda item 15) ANGOLA National Plan for CDTI control 105. TCC was pleased to receive and review for the first time the National Plan and a CDTI project from Angola. TCC commended Angola for its proactive role and the work put into developing these documents and undertaking the REMO exercise. REMO however, remains to be completed in the 5 other provinces of the North. TCC noted that the NOTF had already been created by MOH although it was not yet functioning as not all members had been appointed. TCC also noted that a cost recovery law was being decided in parliament; however, cost recovery would be implemented in the 2 CDTI projects to be launched. 106. (i) (ii) TCC raised concems on the following issues: The plan did not contain information on the estimate number of people to be treated in Angola. The potential problem with Loa loa was not addressed given that the Northern Province might be a Loa-endemic area. Information on the inputs of the NGDOs involved was not provided.(ii i) 2T TCC recommended that the plan be approved as a preliminary national plan and that APOC Management organips a workshop to assist in the further development of the plan. Aneola Proiect 107. The project intends to cover two provinces located to the extreme north-east of Anogla, Lunda Norte (9 municipalities) and Lunda Sul (4 municipalities), with an estimated at risk population of 458 241. TCC noted the challenge in implementing a CDTI project in a country with a poor primary health care system, inadequate health staff, destroyed roads, etc. 108. (i) (ii) (iii) The Committee brought up the following concerns: The timetable of activities did not show when the distribution would take place. No information was provided on the NGDO and its letter endorsing the proposal was not attached as stated in the proposal. The figures proposed for treatment do not relate to the REMO figures. This needs to be rectified. Govemment structures should be encouraged to make financial contributions to the project. The budget justification was scanty and did not reflect APOC's philosophy to show a reduction over the years. The budget was excessive in some line items e.g. feeding, travel and supplies. The potential problem with Loa /oa should be addressed. TCC also recommended that: REMO be completed for the whole of the country when security allows National level should be alerted that Loa loa may exist in onchocerciasis endemic areas and be informed of the TCCA4EC recommendations for treatment with ivermectin in areas of co-endemicity. (iv) (v) (vi) TCC requested that the proposal and hudget be rewritten with technical assistance fromAPOC and resubmitted to APOC Mansgemen4 addressing the concerns raised above and a suitable NGDO partner identtfied. BURUNDI National Plan for CDTI control 109. TCC was also pleased to receive and review for the first time the National plan and a CDTI project from Burundi. The plan was well written with a great deal of detail. TCC noted with satisfaction the vector control activities in the plan and suggests that the programme may wish to seek technical advice from APOC on proposed activities as ApOC "outa not fund vector control. 110. (D (ii) The committee recommended the approval of the national plan from Burundi. 22 Burundi CDTI Project 111. The CDTI project is situated in the extreme north-west of Burundi at the boarder with DRC (West) and Rwanda (North). Ivermectin was distributed annually for 12 years in hyper/meso endemic foci by mobile teams and the project plans to move to CDTI within a year. TCC commended the authorities on their commitment and readiness to start the project. TCC noted the plans to involve the Ministry of Interior in the implementation of the project. The proposal clearly outlines the plans to introduce cost recovery, demonstrating some experience in that respect. TCC noted that, in the spirit of CDTI, charges would be agreed with the communities. ll2. TCC acknowledged the letter by the supporting NGDO, CBM and recognizedthat planning was still ongoing. TCC recommended the approval of the CDTI project and that the budget be revised by APOC Management following the resubmission of the budget in line with the proposed changes curuently being undertaken with the CBM. CAMEROON North-West CDTI Project 113. The North-West province CDTI project will cover all 7 divisions in the province, 14 health districts and 163 health areas. The entire area was hyper-endemic according to REMO. The project plans to treat 542,433 people by the 5th Year. ll4. TCC noted that the proposal was well written and comprehensive, and that the proposal: - Showed a good time plan of action with all CDTI activities listed in their proper order. - Made a deliberate effort to plan to integrate CDTI into PHC from the onset of the project. - Provided good plan for training, mobilization and health education. - Showed a good knowledge of cross-border activities and will take over treatment of part of the area presently being treated by Cross River and Taraba projects in Nigeria. - Has details missing on the number of health facilities and health personnel in the area, plans for the implementation of the MEC/TCC recommendations for treatment in Loa- endemic areas, affangement for storage of Mectizan@ and procedure for supervision. - Planned to treat a very high population in the first year. - Provided an extremely excessive budget (US$3.4 million for the 5 years) and high cost per treatment (US3.2 over the 5 years). The budget was very heavy on capital equipment - (3 cars, 150 motorbikes and 3 computers), with an exorbitant amount requested (US$168,000) by the NGDO partner from APOC. TCC recommended that the proposal be accepted on condition thut the issues below are addressed by the project and that APOC Management drastically reduces the budget in line with the revised number to be treated in the first year. (i) (ii) (iii) (iv) (") 23 Provide missing details listed above. Select appropriate sustainability indicators for monitoring and evaluation. Reconcile contradictions on cost recovery. Obtain RAPLOA data from study team and conduct RAPLOA in communities for which no data exists. Reduce the number to be treated in Year 1 and change the year for the first round treatment to 2003. DEMOCRATIC REPUBLIC OF CONGO Bas-Congo Kinshasa CDTI project 115. The project covers the rural part of Kinshasa and three further districts, Bas-Fleuve, Cataractes, Lukaya. This area included the Mayumba Region, from which large numbers of Loa-related SAEs had been reported years ago, after DEC treatment. REMO surveys were done in 200L-2003 in27 of the 31 health zones. The project plans to cover 6 hyper-endemic health zones' then extend to all meso-endemic areas. The lroject plans to treat a population of2.97 million in 6,72T communities. The NGDO partners are quoted as FOMETRO, CRS andIMA/SANRU. The possibility to re-implement vector control activities was considered in theproposal. 116. TCC noted that: - The proposal made no mention of SAEs from treatment by DEC or ivermectin previously undertaken. - The proposal made no mention of the MEC/TCC guidelines for treatment in Loa loa co-endemic areas and recognized. that technical assistance in the management of SAEs was required by the project. - The issue of trylpanosomiasis was not addressed in the proposal. - The treatment objective of the first year (880,000) was over ambitious. ll7' The budget requested from APOC did not decrease very much over the 5 yearsfollowing the APOC guidelines. TCC particularly noted the high amount requested for technical assistance; fuel and drugs in relation to SAEs was under budgeted; training wasplanned for just the first 2 years; training of trainers was only planned foi tfre first yeai; and there was no justification for a video camera. 118. TCC recommended that the project: (i) Implement (at least) the first treatment round using an intensive surveillance system. (ii) Organise, at all levels, a specific haining on the Loa loa issue (focusing on the MDP/TCC guidelines and recommendations). (iii) Organize the distribution during a fairly short period. (iv) RAPLOA and parasitological surveys be performed to validate the Liverpool-IRD map. 24 TCC recommended the approval of the proposal, and that no treutment be done until all precauttons had been taken to ensure that the issue of Loa loa was addressed. TCC further recommended that technical assistance be built into the national team to deal with Loa loa issues. APOC Management was requested to reduce the budget in line with the number of people to be treated. SUDAN Mvolo County CDTI Pro_iect 119. The project proposes to start a CDTI project in the Western Equatorial in the South Western Region of South Sudan. The project intended to treat 75 000 to 100 000 persons, living in 51 communities in Mvolo County. 120. TCC expressed concern that: (i) The present proposal did not have any valid data, REMO or parasitological. (ii) The current Southern Sector CDTI project was supported to cover Mvolo County. (iii) The proposal did not look at the issue ofZoa loa andhow SAEs will be managed. (iv) REMO needs to be completed in this area. TCC rejected the proposal and requested that funds already allocated to the Southern Sector CDTI project be used to expand CDTI activities to Mvolo County. TCC recommended that available skin snip data be integrated into the GIS by APOC Management. TCC further recommended thatfuture proposals from the Southern Sector of Sudan must involve all partners particularly the nationals in the southern part of the country. TCC urged that the exercise of the planned REMO be completed and be the basis for determining further CDTI areas. TANZANIA Moroeoro Focus CDTlProiect l2l. The Morogoro District CDTI project was proposed for a region of eastem Tanzania that had two other CDTI projects, the Mahenge CDTI and the Kilosa CDTI projects. The partner NGO was SSI. No maps are provided of the prqect area, and no REMO. The project proposes to reach full geographic coverage and treat283,911 persons in the first year (total population 333,856). TCC noted an inconsistency in targeted villages: 137 (page 5) and 146 villages (page 53), and requested clarification from Management. The implementation plan was well described. The numbers of CDDs to be trained in the first year (1752) meets ratio guidelines of 1 CDD per 250 persons to be treated. Since REMO had been completed in this area, TCC requested further clarification on why the proposal included a request for funds to carry out additional REA. 122. The proposal was well written, and provided a thorough budget and justification. However, the budget was high for the first two years, and requested two terrain vehicles, yet only 5 motorcycles. High training costs are proposed in the second year that are inconsistent with the plan to reach full geographic coverage in Year 1. Cost (APOC financing) per treatment calculations are not provided and should be requested from the project in the usual 25 graphic format to assure the proposal follows APOC guidelines. Management is requested to scrutinize the budget. 123. TCC noted the statement (page 9) that a devolution plan to transfer responsibility to communities would be executed in the third year of the program. TCC emphasized that CDTI strategy calls for full community involvement from the very beginning of the project. TCC recommended the approval of the proposal, with above clariJicattons and adjustment in the budget by management. UGANDA Prooosal Focal Vector Elim ination of Simulium eavei s.l. in the Mn Focus 124. Following the conclusion of the feasibility study, a project on the implementation of vector eradication in the Mpamba-Nkusi focus was now considered by the Committee. 125. Ground larviciding would be carried out during one year followed by 2 years monitoring in this highly isolated focus. TCC recommended approval of the project after downward revision of the budget. D. ADDITIONAL SUBJECTS CONSIDERED BY TCC15 126. Item 7: Review Meeting of the Vector Elimination Projects. This agenda item was introduced by Prof. Soungalo Traord and Dr Peter Enyong who provided the Lommittee with details regarding the four vector elimination foci financed by apOC (Tukuyu, Bioko, Itwara and Mpamba-Nkusi). This information included the vector species involved; the history of vector control; the epidemiological situation; ivermectin control; and accessibility to the breeding sites. 127. The follows: conclusions and recommendations of the Review Meeting can be summarized as - Tukuyufocus: elimination of the vector populations within the limits of the focus and measurement of the risk of recontamination by immigrant Sintulium flies. - Bioko focus; aeial larviciding as from the dry season of 2003 - Itwara and Mpamba-Nkusi foci.' elimination of S. neavei in the Itwari focus and continuation of ground larviciding in the Mpamba-Nkusi focus.(For further information see Annex 4 attached). 128. The Committee was informed that Professor Garms had been on mission to Itwara in July and his report was awaited. The vector control programme in the Mpamba-Nkusi focus for 2002 had so far not been implemented. Negotiations were underway with the OCp aerial company for a contract combining larviciding in Bioko with that in the OCp Special Intervention Zone if Oti (Togo). Larviciding in the Bioko focus would possibly need to be carried out during two years at a cost between US$ 600 000 and US$ 800 000. Good baseline data were available. 26 129. A core-group had been established on the Bioko Island to follow up on the recommendations and former OCP vector control staff would assist and support the larviciding programme. 130 Expertise regarding vector control was available in Tanzania in particular at the higher scientific and technical level but less at the field operational level. 131. Regarding measuring the impact of CDTI programmes on transmission in relation to vector control, it was suggested that incidence of infection would be a more reliable indicator. 132. Items I and 9: A summary was provided by some members of the sustainability evaluation team on the progress made in developing instruments for the Evaluation of Sustainability of CDTI Projects and of the report of the Second APOC/NOTF Representatives Meeting in Abuja at which the sustainability issue had been the main topic. Reports of the evaluation of the nine projects for which sustainability evaluation had been conducted were made available. Seven had shown satisfactory progress toward sustainability and two were classified as not making satisfactory progress towards sustainability. 133. Regarding the report of the Second Meeting of the National Onchocerciasis Task Forces Representatives, the Director emphasized that it expressed the views of all the partners represented at the Meeting as well as the findings of the experts involved in developing a methodology for evaluation of projects for their potential sustainability. He would welcome the views of the Committee with specific recommendations to the Management for the actual implementation of the "directives" contained in the report. The manual and guidelines to be prepared would reflect the views and recommendations of TCC. 134. The Committee concentrated its consideration of the Abuja report on the Executive Summary with particular attention to Annex A: "Criteria for Further APOC Support" (pages xi and xii of the report). The attached Annex 5 reflects the view of the Committee regarding the presentation of the criteria. To facilitate the reading of Annex A it was also suggested that it would have been preferable to list the conditions for considering a project "fully sustainable" under that heading. 135. TCC emphasized that the programmatic support activities (page xii) would not be provided to any projects after their fifth year implementation, irrespective of the category to which they belonged (fully sustainable, making satisfactory progress towards sustainability and not making satisfactory progress towards sustainability). It was stressed that the Management should have a certain amount of flexibily in the interpretation of the indicator values for a three year extension of APOC financing of "projects making satisfactory progress towards sustainability". 136. The Programme Director stressed that there was no question of "abandoning" any projects. For those "fully sustainable", Management would continue monitoring the progress, support training and operational research and would consider providing whichever equipment was required by the government/NOTF for that purpose. 137. TCC expressed great concem that the reports of the nine evaluated projects indicated that all the projects were heavily dependent on APOC financing which would run counter to sustainability. 138. It was strongly recommended that the same indicators be used in monitoring and evaluation exercises and also reflected in technical project reports. 27 139. It was pointed out that unlike previous monitoring exercises that had only dealt with the operational level, the current sustainability evaluation also included the levels ;,high.. up,,.It was expected that such evaluation would strengthen the structure at the ro-*r,rrity l.u"l and put pressure on the supporting levels. 140. In all, 35 projects (I7 in their third year and 18 in their fifth year) were to be evaluatedfor sustainability during 2003 and the Committee received the timeline and plan for the implementation. It was stressed that NOTF headquarters would also be submittedto fifth year sustainability evaluation with the understanding that many of them would continue functioning well beyond that year. TCC endorsed the findings and conclusions of the sustainability evaluation of the nineprojects sofar carried out. rtem 12: Finuncial management of ApoCfundedprojects. l4l. The Budget and Finance officer of APOC updated the TCC members on the progress made in the transfer of funds to the freld. It was noted that there were no longer delays in the transfer of funds to the field with the exception of transfer to projects that coitinued delaying their submission of the monthly imprest returns. 142. TCC was informed of the comments made by the External Auditors on the audit ofAPOC's accounts forthe fiscal year 2001. The auditors highlighted once againthe delays in the submission of monthly imprest retums despite the efiortLade by thJ Management of APOC. 143. Projects were requesting from APOC substantial funds for field activities as demonstrated by the low percentage of consumption during the period covered by the Letters of Agreement of the approved budgets after the reductions of tt " brdgets as submitted. Item 16 (Review of operationql research proposals). Relation between attriti rates of Distributors ( s) and in Ko 144. TCC considered that this proposal dealt with an important research issue but the methodology was weak and the budget was imprecise. The Committee recommended the approval of the funding of the research on the condition that comments of the reviewer were appropriately addressed. TCC requested that guidance of the reviewers be communicated to the researchers. of at or 145. It was considered an important subject. However the problem was not stated in sufhciently clear terms and the sub-objectives did not "lead" into the main-objective. TCC recommended the approval of the proposal after the objective and design had been improved with guidance from the reviewer. 28 which determine treatment- proerammes (Uganda) 146. A subject highly relevant to the CDTI approach. The proposal was well documented but the household investigation appeared excessive and no plan of action was included. TCC approved the proposal pending submission of a revised budget. of success and failure of the 147. This was a resubmission, which had taken full account of the recommendations made regarding the original proposal. The budget amount was still not clearly stated. TCC recommended the approval of the proposal pending submission of a firm budget estimate. of the of the implementation 148. This proposal was re-submitted after having taken into account the observations made by the reviewer. 149. It was considered an interesting proposal. The Committee recommended that a fourth objective: evaluation of the impact on programme function be added to replace the fourth objective listed in the proposal ("to design appropriate intervention strategies") TCC recommended the approval of the proposal. Community Directed Treatment with ivermectin for the control of Onchocerciasis in Ueanda in Ateas where Simulium ueqvei is the only Vector: Comparison of thq 3 monthly and annual Treatment Regimen 150. The proposal had three aspects: the comparison of the two regimen: the feasibility of 3 monthly treatment; and the assessment of the cost per treatment under the two regiments. It was intended to apply entomological, epidemiological and parasitological examinations. TCC did not recommend the approval of the proposal. Item 17 (Other matters): Training in Data Management and GIS 151. As stated in the APOC Programme Document for Phase II and the Phasing-out Period, the Management of APOC initiated training sessions in integrated data management and mapping systems. The objective of the training was to promote the creation and the use of databases and the geographical information for planning, management, and monitoring/evaluation of APOC funded proj ects. 152. Update on MACROFIL (Moxtdectizl.' a summary was provided of the process of bringing moxidectin to its large-scale use to control onchocerciasis. It may be available in 2006-2008. The three phases in this process were outlined and a number of issues concerniug 29 the eventual application of the drug in the field were given (see also the section on Macrofil in the report of the Second Meeting of the NorFs Representatives in Abuja) 153. The Programme Director informed the Committee about his participation in meetings arranged by the Company to the drug regulation boards in London and paris. His impressiJn was that there would be a good collaboration between Merck and Meyrs. update on country studies on cost per treatment estimates; 154' Dr. McFarland gave an update on the status of the TCC request for a study of the costper treatment with ivermectin. She discussed the plan of action to complete the protocol and select study sites before the end of 2002, anticipating data collection and analysis in early 2003 - As part of her presentation she provided a short outline of the complexity of conducting a cost study. She then enumerated a set of questions on which TCC guidance is needed. These included: o clear statement of the purpose and audience for the study o Costs do not vary randomly so need to select a stratified sample by relevant variables - maturity of CDTI programme - coverage rates - geographic characteristics of endemic areas - population density, distances, difficult terrain - NGDO partner? - Conflict situation - State of PHC system o - How many countries and projects? o 'ltmtng - coordinate with other field visits such as sustainability evaluations. 155' The TCC members had a lively discussion about the scope of the proposed cost study.Should it be a study of the entire costs of the APOC 'machineryi o1. "or""rrtrate on the critical costs that must be sustained in the CDTI areas in future? The decision was taken that the latterquestion is the key one for the sustainability of CDTI. It is particularly important to concentrate on those costs that must be sustained by governments and communities in future. The TCC suggested that the core CDTI function as provided as an Annex in TCC13, wouldprovided a list of priority CDTI programmatic functions that can be used in the cost study todefine the appropriate range of functions for investigation. 156' Dr. McFarland will develop a budget for the cost study and collaborate with ApOC management regarding timing and selection of countries for the study. Report of the S-cientific Working Group on Serious Adverse Events following MectiyanTreatment of onchocerciasis in Loa-loa endemic areas. (May 200i) 157' The Chair summarized the proceedings, issues and recommendations of the WorkingGroup. Among the items discussed were the mapping of Loa loa; a review of all cases ofSerious Adverse Effects (SAEs) reported from Loa- loa endemic areas and their clinicalpresentations; the pathogenesis of Loa encephalopathy; risk factors for developing Lou encephalopathy; and health education issues in areas wheie SAEs had occurred. 30 158. The Working Group recommended that a "Loasis Technical Advisor" position should be created in Cameroon. This Advisor would assist the Ministry, NOTF and other partners in onchocerciasis control with gathering epidemiological and clinical information on cases of Loa encephalophaty and with the implementation of guidelines for treatment with ivermectin in Loa loa endemic areas. 159. The Programme Director emphasized the strong support provided by APOC, which he considered an important contribution to the post and the work of the Technical Advisor. DATE AND PLACE OF THE SIXTEENTH SESSION OF THE TCC (agenda item 18/ TCCl6 Ouagadougou. 17-21 March 2003 in Ouagadougou. TCCIT: 15-19 September 2003 in CONCLUSIONS AND RECOMMENDATIONS (agenda item 19) 160. A draft report was approved with the understanding that modifications suggested by TCC Members during its consideration, and approved by the Committee, would be included in the final report. CLOSURE OF THE SESSION (agenda item 20) 161. The Programme Director paid a deepfelt tribute to Professor Mamoun Homeida and Dr Frank Richards, who would cease their TCC membership at the end of he current session, for their devoted and constructive contribution to the deliberations of the Committee and to the African Onchocerciasis Control Programme. The participants joined the Director in his expression of gratitude to Mamoun and Frank. 162. Dr S6k6t6li finally proposed the name of Professor Eka Braide as the successor to Professor Homeida as Chair of TCC as from the forthcoming session in March 2003. The proposal was approved by acclamation. Prof. Braide would accompany Prof. Homeida to the Donors's Conference in Luxembourg (8-10 October) and to the December JAF and Joint JPC/JAF sessions in December as Chair designate. The Chair then closed the fifteenth session of TCC 31 LIST OF PARTICIPANTS s.net ANNEX 1 I 2 J 4. 5 Professor (Mrs) Adenike Abiose, Medical Director, The National Eye Center, p.M.B. 2267, Kaduna, Nigeria, Tel: (234) 62 41 73 73,Fax: (234) 62 41 0g73, E-mail: ab io s e(€Dinfoweb. ab s. net Professor Mamoun M.A. Homeida, Chairman of TCC, National Onchocerciasis Task Force CNorF), P.o. Box 12810, Khartoum, Sudan, Tel: (249 11) 23 55 04 I 22 67 gg, Fax: (249 ll) 22 47 99 I 23 55 03, E-mail: amst33@hotmail.com Dr Frank O. Richards Jr. Deputy Director, Global 2000 River Blindness program The carter center, one copenhill, Atlanta, Georgia 30307,Fax: (770) agg a51r; Tel:(770) 488 4511, E-mail: fxrt@cdc.gov Dr Mary Alleman, Associate Director, Mectizan Donation Program, 750, Commerce Drive Suite 400, Decatur, GA 30030, Atlanta, usA, Fax: 1 404 371 113g; Tel: | 404 37 I | 460; E-mail malleman@taskforce.org Dr Bertha Maegga, Tukuyu Research Station, NIMR-He, p.o. Box 53g, Tukuyu, Dar-es-Salaam, Tanzania, Fax: (255) 65 55 22 50; Tel: (255) 65 552250, E_mail: mae ggabta @affic aonline. co. tz Dr Michel Boussinesq, s/c val6rie Delphanque, DRI, IRD, 213 rue La Fayette, 754g0 Paris Cedex 10, France Prof Eka Braide, Dept. of Biological Sciences, University of Calabar, p.O. Box 3679, calabar, Nigeria, Tet: (234) 87 230 452,Fax: (234) 087 ito gt+ I 087 230 grt, E-mail : ekanem b@hotmail. com : onchocal@skan net.com 8. Dr Elizabeth Elhassan, Country Representative of Sight Savers lnternational, 1 Golf Road, P.O. Box 55, Kaduna, Nigeria, Tel (234) 62 24 83 60 or 62 24 89 73, Fax 62 24 89 73, E-mail: ssln TCC MEMBERS (234\ 10. 11 6 7 9 Dr Deborah McFarland, Associate Professor, Department of lnternational Health,Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta,Georgia 30312, Tel: 404 727 7949, Fax: 404 727 4590, E-mail: dmc farl@sph. ernory. edu Dr Peter Enyong, Tropical Medicine Research Station, p.o. Box 55, Kumba, cameroon, Tel: (237) 35 42 31, Fax: (237) 35 42 3l,E-mail: penvong@canmet.cm Dr Danny Haddad, Director, Onchocerciasis Department, Helen Kelen International, 352Park Avenue south, Suite 1200, New york, wy, tooto, Tel: 1 2r2 5320544 ext: 805; Fax: I 212 532 60L4, e-mail: Dhaddad(dhetnet.nl 12. Mr Moses Katabarwa, Country Representative, The Carter Center, P.O. Box 12027, I 025, Fax: (256) 41 250Bombo Road, Plot 15, Kampala, Uganda, Tel:376,B-mall: "Glo (2s6) 4t 2s 32 OBSERvERS t3 t4 WHO/OCP Prof. Soungalo Traor6, OCCGE, InstitutPierre Richet,01 B.P. 1500 Bouakd 01, COte d'Ivoire, T6l. : (225) 31 63 37 46,Fax: (225) 31 63 27 38 Dr Christine Godin Benhai'm, 33 rue Brun Larochette, 26220 Dieulefit, T6l. : 33 6 08 91 7l 93 or 33 4 75 46 40 59, Fax : 33 4 75 46 39 34, E-mail : c.godin@maeic.fr 15 T6 t7 18 19 Dr Boakye A. Boatin, Director, OCP/Ouagadougou, Burkina Faso Dr Laurent Yam6ogo, CVCU, OCP/Ouagadougou, Burkina Faso Dr Komla Siam6vi, CPET, OCP/Ouagadougou, Burkina Faso Dr Laurent To6, RLA/VCU, OcP/Ouagadougou, Burkina Faso Dr Assimawd Pana, PET, OcP/Ouagadougou, Burkina Faso WHO/APOC 20 2l 22 23 24 Dr Azodoga S6k6t6li, Director, APOC/Ouagadougou, Burkina Faso Mr Mounkaila Noma, CEV, APOC/Ouagadougou, Burkina Faso Dr Uche Amazigo, CSD, APOC/Ouagadougou, Burkina Faso Ms Victoria Matovu, COP, APOC/Ouagadougou, Burkina Faso Mr Fortun6 Agboton, BFO, APOC/Ouagadougou, Burkina Faso a JJ 1 ANNEX 2 AGENDA Opening Adoption of the Agenda Matters arising fiom the 97th, 98th and 99th sessions of the CSA Matters arising from the 20th NGDO meeting Follow-up of the recommendations of the fourteenth session of the TCC Update on Operational Research Report on the Review meeting of the vector Elimination projects Report on the Evaluation of Self-sustainability of CDTI projects Report on second APOCA{OTFs representatives meeting in Abuja and on follow up actions Update on REMO/GIS in APOC countries with special reference to Angola, Burundi and DRC Status of the forecasted number of CDTI projects during Phase II and Phasing out period Report on the financial management of ApOC funded projects Report on the review by the APoc Management of 1't 2n0,3'o and 4th year progress reports and subsequent year budgets (application ofthe new review process) Review of 1" 2'd, 3'd and 4'h year annual technical reports from the following countries: 2. J. 4. 5. 6. 7. 8. 9. 10 1l t2 13 14. (i) (ii)(iii)(i") (v)("i) (vii)(viii) (ix)(*) 9?-:I9ol (6) G\fOTF/HQ Support, Adamaoua, Haute Sanaga, Littoral II, SouthWest II, Centre I) CAR CDTI Project (1) Chad CDTI Project (l) PRC (2) (NOTF/HQ, Kasai CDTI project) p gqa toria] p_u1ngl(2) ^(B ioko Island cDti, vector Eliminati on proj ect)Ethiopia (l) NOTF/HQ lllalayi (1) (Tl,yqtg,Mwanza & extension CDTI project)Nig-eria^(9) (NorF/HQ,S_upport, Adamawa, Borno,"cross River, Edo/Delta, Ekiti, 9l{or_ov9 and Plateaua.{aiiarawa, Kaduna, Jigawa, Gombe, Niger, Bauchi'stut"tCDTI Projects) Sudan (1) (Southern Sudan CDTI project Tanzania (3) (Kilosa ,Tanga Tukuyu- CDTI projects & Tukuyu Vector eliminationproject) 15. t6. 17. Review of new National Plans and projects proposals Review of operational research proposals Other matters(i) Training in Data Management and GIS(iD Update on MACROFIL (Moxidectin)(iii) Update on country studies on cost per treatment estimates(iv) Report of the Scientific working group on loa loa Date and place of the sixteenth session of the TCC Conclusions and recommendations Closure of the session 18 t9 20 34 ANNEX 3 ADD oN INTERVENTIONS': other disease control efforts within the APOC projects supported in Phase II through the APOC Trust Fund TCC15, recognizing that in the phase 2 memorandum document that 1) the Programme Director shall be authorized to approve funding for projects combining community-directed treatment activities for other diseases with those for onchocerciasis within the geographic scope of the Programme' (2.3.v); and 2)'TCC shall advise the Programme Director of such projects involving other disease control activities as envisaged in paragraph'2.3.v. (Memorandum for APOC Phase II and Phasing out Period, pages IIl4-5), recommends to the APOC Director that: I-CDTI Projects from their second year of operations and shown in their monitoring and evaluation to be making acceptable progress will be eligible to apply for new and additional support from the APOC trust fund to implement 'add on interventions' (AOIs). A project can propose more than one AOI. TCC will review these proposals and make recommendations to the Director pertaining to their funding. 2-AOIs may be other community directed mass tablet distribution activities (eg, Vitamin A, praziquantel for schistosomiasis, ivermectin and albendazole for lymphatic Filariasis, azitbromycin for trachoma), although other community interventions (such as impregnated bednets for malaria and cataract case finding) that may be implemented in a 'community directed' fashion can be included as well. 3-The AOIs shall follow the priorities, policies, directives, and standards of the Ministry of Health in the country for such interventions. 4-Applications for support for AOIs will be made by the NOTF to TCC endorsing the proposed AOI. The applications should be of sufficient detail to satisfy TCC that the new intervention will not hamper the function and sustainability of the ongoing CDTI effort against river blindness. 5-A budget should be included with the proposal. The APOC standard of l5:25 cost sharing with the MOH and NGDO partner shall apply. The CDTI program may apply to receive support for new programmatic activities related to the AOI, including funds for training, monitoring and supervision, consumables, transportation, and procurement and transport of interventions (eg. Vitamin A, praziquantel, albendazole, impregnated bednets, etc). 6-Projects in their fifth year of APOC funding that have achieved at least a 'progress toward sustainability' rating shall be eligible to receive additional APOC support via application for AOIs. TCC noted that TDR, with support of APOC, had launched a multi-country study on using ComDT for other health interventions was ongoing and it was important to take into consideration the outcomes of this research as soon as they become available. 35 ANNEX 4 CONCLUSIONS AND RECOMMENDATIONS OF THE MEETING ON THE REVIEW OF ONCHOCERCIASIS VECTOR ELIMINATION PROJECTS IN THE APoc PROGRAMME 06 - 10 MAY 2002 (ouagadougou, Burkina Faso) I. TUKUYU FOCUS - The insecticide treatment, 2001-2002 was not able to be carried out in the period of low water volume as foreseen initially by the plan of operations (delay in the clearance for the introduction of temephos, the preliminary operations of sensitization of Authorities and population). It did not therefore provide all the expected information but it gave us basic elements to enable us realize the first large scale campaign (complete coverage of all the known breeding sites). Considering: The advantages for the populations and for the health services of a complete elimination of the vector; The impact of an elimination of the vector on the duration of the distribution of Ivermectin; The human, material and financial resources already invested; The fact that in spite of shortcomings (management, supervision, quality of the baseline data) the experiences of the first treatment allow us to envisage an optimum larvicide coverage. The Meeting recommends a) The execution of the first vector elimination campaign by ground larviciding in the Tukuyu focus. The objectives will be: - To eliminate the vector populations within the limits of the focus ; - To measure the risk of recontamination by immigrant Simulium flies. b) That this campaign be executed in the dry season 2003 taking into account the delays in the preparation of the campaign and the constraints of the time frame of the Phase II of APOC; c) That after the analysis of the results by an Ad Hoc committee and according to APOC's initial guidelines, a second and last treatment round be carried out in 2004, if necessary; d) That the cytotaxonomic studies be re-activated within the focus (examination of fixed and fresh materials) and in the adjacent foci; 36 e) That right away and by the mid 2003, the following activities be realized: o Strengthen and improve the performances of the entomological teams (fly collections, dissections, larviciding); o Elaborate an action plan and a budget which integrates the recommendations of the meeting and which will be the subject of a proposal to be sent to APOC Management before the 15th of July 2002 in view olformulating a Letter of Agreement by the Management of APOC for the fifth year vector elimination activities; o Avail themselves of the services of a hydrobiological team specialized in the follow-up of the impact of the insecticide treatments on the non-target fauna; o Recruit and train additional technicians; o Improve on the quality and efficiency of the management of the project; o Get the project team to provide their reports (technical and financial) as required by the contract, within the time limit that will allow APOC to carry out an effective follow up; o Strengthen the supervision capacity at the level of the APoc programme; o Continue the data collection activities (fly collections, dissections, prospections); take advantage of the next dry season to locate access roads to breeding sites which were identified during the previous operation; o Complete the putting together of the necessary materials for the next larviciding campaign. U. BIOKO FOCUS The meeting observed shortcomings in the recent REA survey and census in the island of Bioko. Besides, the CDTI coverage in the rural area remains well below the threshold of 650/o recommended for CDTI projects and this, without considering the city of Malabo which is partially under passive treatment with ivermectin. Although the ground larviciding which took place in 2001,was quite effective on the developing stages, it was incomplete because of the inaccessibility of some of the rivers especially in the south of the island. The group was informed of the possibility that a small fleet of helicopters equipped for the application of larvicides be retained in the OCP zone by the aerial larviciding company partner of the Programme beyond December 3t,2002, closing date of the ocp. Thanks to the work of consultants recruited by APOC, sufficient data both in quality and in quantity is available, to enable to plan and to begin vector control operations. However, because almost all ground access to the vector breeding sites in the southern part of the island is inexistent, it is not possible within the time frame of the operations, to eliminate the vector by ground larviciding. A detailed aerial treatment strategy has been designed. It will necessarily require a highly qualified staff and the use of a special helicopter equipped with the spraying system currently used by OCP. 37 The Meeting recommends: a) The refining, as soon as possible, of the REA and census data for Bioko, notably in Malabo city; b) The intensification, by all means, of the community directed treatment with ivermectin; c) Contacting the OCP subcontracting company if applicable, to find out the possibility and contractual conditions of the use of its helicopters for an anti- simulium campaign in Bioko; d) ln case of agreement with the company, that the campaign should be conducted during the dry season 2003 (January to April); e) That the campaign's objectives should be to demonstrate that it is possible to obtain full coverage of all breeding sites of the island; 0 That after analysis of the results by an Ad Hoc committee, a second and last campaign is carried out in 2004, if necessary; g) That in the absence of any agreement with the aerial spraying company, ApOC Management should forward the project to the Authorities of Equatorial Guinea for a possible execution with other Partners. In that case, the financing of activities could no more be assured by APOC. However, APOC will provide Equatorial Guinea with technical support as well as helping to look for other sources of funding if necessary. This technical assistance would be also desirable in case the project of vector elimination would be transformed into a national vector control Programme to be financed by the national Authorities; h) That from now on, the following activities be carried out: ' The NOTF should submit immediately to APOC Management, a proposal for the fourth year vector elimination activities for the elaboration of the letter of agreement; o Maintainentomologicalsurveillance; ' Improve on the quality and efficiency of the management of the project; o Strengthen the supervision capacities at the level of the ApOC Programme; o Get the project team to submit their reports (technical and financial ) as required by the contract, within the time limit that will allow ApOC to carry out an effective follow up; o To strengthen the nefwork of detection of very low residual populations of blackflies; o To put in place an operational base in Ureca to organize a fly collection network in the south of the island. UI. ITWARA AND MPAMBA-NKUSI FOCI The vector in the focus of Itwara and Mpamba-Nkusi is S. neavei. This species, due its bio-ecological peculiarities (relatively reduced flight range, long duration of larval development, sensitivity to ecological changes, phoretic life) is more vulnerable to vector elimination operations. I t 38 In spite of the persistence of some larvae and adults of S. neavei on the Siisa and Asrva rivers up to 2001 at the latest, the group noted that since 1997, no female of S. neavei has been collected in the Itwara main focus. A volume of information and data, sufficient in quantity and quality, has been collected in Mpamba-Nkusi. It could allow us to begin and to evaluate alarge scale campaign by ground larviciding in the focus. Besides this, human, material and financial resources are available. The meeting recommends: a) That a think tank be put in place aiming at formulating an official recognition of the elimination of S. neavei in the Itwara main focus as well as the modalities of that recognition; b) That entomological surveillance be reduced in the Itwara main focus and to a lesser degree in the sub-foci of Siisa and Aswa; c) That the distribution of ivermectin be continued, at least, at the present level of coverage in all the foci; d) That in the Itwara main focus, the reduction of the Onchocerca (macro and microfilariae) populations be followed up until the extinction of the parasite in man; e) That the NOTF submits immediately, to APOC Management a proposal for the fourth year vector elimination activities for the elaboration of the letter of agreement; 0 That the National Coordinator, after signature of the letter of agreement, takes administrative steps to release the funds already available in the country for the initiation of the vector elimination activities by ground larviciding in Mpamba- Nkusi in June, 2002; g) That Professor Garms, who has planned and steered with his Ugandan team, the Programme to control S. neavei which culminated in 1997 in the elimination of the vector, should pay a site visit to the two foci (Itwara, Mpamba-Nkusi) to supervise entomological activities on the spot. That Professor Garms shall make suggestions to APOC Management on the frequency of fly collections especially in the Itwara main focus. h) That the following activities should begin immediately: o The famihaization of the technicians with the methods of calculating entomological indices; . Improve on the quality and efficiency of the management of the project; o Get the project team to forward their reports (technical and financial) as required by the contract, within the time limit that will allow APOC to carry out an effective follow up; o To strengthen the supervision capacity at the level of the APOC Programme. , a39 ANNEX 5 APOC support to projects after 5 years After the fifth projectyear, APOC should not support programmatic activities. This includes: Salary top ups Routine CDTI activities such as CDD training, monitoring and supervision and distribution of M ectizan Running cost for motor vehicles Cost of consumables lntemal procurement and transport of Mectizan. APOC may consider providing technical assistance and advocacy support after the fifth year, for the years 6-8, only if certain criteria are meet (see below). Such allowed support for projects after their fifth year includes: - Cupital equipment replacement - Capacity building to strengthen project sustainability especially regarding effective management of scarce resources, advocacy and local resource mobilization. Leadership development, and data / information management - Advocacy for commitment of government to continue to support CDTI - Technical assistance, external monitoring and evaluation - Mapping (REMO) - Operational research to improve implementation of sustainability of CDTI. The process for application of a CDTI project for additional support after its fifth year requires the successful completion of several evaluation steps: - External monitoring at end of the first year and implementation of recommendations ensuing from that evaluation - A mid-term review during the third year of CDTI implementation, and evidence of use of the results to guide the project towards sustainability. - A Fifth year evaluation with grading of the project (using impartial reviewers who will apply the detailed nine point sustainability instrument) into one of three categories: i) Fully sustainable, ii) Making satisfactory progress towards sustainability; and iii) Not making satisfactory progress towards sustainability. For projects that are FULLY SUSTAINABLE, there will be evidence in the fifth year evaluation that: - All of previous year's budget was released by government. - Evidence that resources have been used for planned activities - Evidence that CDTI is in place and functioning - Evidence that the project has achieved 100% geographic coverage and ac cep tab le (hi gher than 6 5 oh) therapeutic coverage. I 5, I 40 APOC should cease further programmatic support and continue to monitor its sustainability. APOC may consider providing advocacy support, training and new capital equipment after the fifth year, upon request from the project through the NoTF. For projects that are MAKING SATISFACTORY PROGRESS TOWARDS SUSTAINABILITY, the fifth year review will show that: - Some of previous year's budget was released by government. - Evidence that an effort has been made to address the issues raised during the mid-term evaluation - Evidence that most elements of CDTI are in place - Evidence that resources have been used for planned activities - Evidence that progress is being made to achievingl00% geographic coverage and acceptable (higher than 65oh) therapeutic coverage has been attained. APOC should cease further programmatic support to these projects, but could consider providing advocacy support, training and new capital equipment after the fifth year, in accord with a 3 year, post APOC planfor sustainability For projects that are NOT MAKING SATISFACTORY PROGRESS TOWARDS SUSTAINABILITY, APOC funding should be suspended until the project submits a detailed 3-year, post APOC plan that satisfactorily addresses: - Critical issues raised in the evaluation report and how they will be addressed by the goverrment at all levels - Written agreement that the three year MOH contribution to the CDTI budget will be released by government. - Evidence that an effort has been made to address the issues raised during the mid-term evaluation - In some cases changes made in project leadership. I J ,. t 4t ANNEX 6 TCCl 5 recommendation/endorsement/acceptance/approvals TCC 1' approval of new 5 CDTI project and 1 vector elimination proposal out of 7 proposals reviewed (para I 05-125). 2. that the location of the reported cases of severe adverse events (SAEs) thought to be associated with Loa Loa,be plotted on the latest PCM as another way of validating the risk map (para 28). 3' that RAPlOA/parasitology be used in the interim,while mapping methods were being developed and RAPLOA was being validated, for project, -*h"r. Loa loa waspredicted by ERMr models in countries outside of Nigeria and Cameroon (para 30). 4. that detailed recommendations be developed, in consultation with MEC, for the operationalization of RAPLOA and ERMr. These recommendations, based onRAPLOA assessments, would be envisioned to replace the current TCC/MECguidelines, which require village by village REA in areas where the ERMr suggests Loa may be present (para31). 5' that the same indicators be used in monitoring and evaluation exercises and also reflected in technical project reports (para 13g). TCC endorsement/acceptance/approval 6' TCC endorsed the findings and conclusions of the sustainability evaluation of the nineprojects so far carried out (para 140). 7 ' TCC approved the proposal by acclamation of Professor Eka Braid as the successor toProfessor Homeida as Chair of TCC (ptara 162). 8' TCC accepted 33 out of 37 annual technical reports reviewed (para 40-104). L ,t t
Organisation mondiale de la santé (OMS) · Technical Documents
Report of the fifteenth session of the Technical Consultative Committee (TCC): Ouagadougou, 16-20 September 2002
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