Joint Coordinating Committee, second session, Paris, 2 and 3 December 1975: independent chairman's report of proceedings

JOINT COORDINATING COM},IITTEE ONCHOCERCIASIS CONTROL PROGRAI'{ME IN THE VOLTA RIVER BASIN AREA Second session Paris 2 and 3 December 1975 INDEPENDENT CHAIRMANIS REPORT OF PROCEEDINGS 1. The second session of the Joint Coordinating Conrnittee for the Orchocerciasis ConErol Programme in the Volta River Basin area, was held aE. the European Office of the Vlor1d Bank, Paris on 2 and 3 December 1975. The session was attended by representatives of the Governments of Belgium, the Peoplers Republic of Benin, Canada, France, the Federal Republic of Germany, Ghana, Ivory Coast, Japan, Kuwait, Mali, the Netherlands, Niger, Togo, the United Kingdom of Great Britain and Northern Ireland, Ehe United States of America, Upper Volta, the African DevelopmenE Bank, the United Nations Development Programe (uNop), the Food and Agriculture Organization of the United Nations (FAO), the World Bank (IBitD) and the World Health Organi- zatLon (WIIO). The session was also attended by the Chairmen of the Economic Development Advisory Panel (EDAP) and of the Scientific and Technical Advisory ConEnitree (STAC), and observers from the Organisation de Coordination et de Coop6ration pour Ia Lut.te contre 1es Grandes End6mies (OCCGE) and the Office pour Ia Recherche scientifique et technique outre-mer(ORSIOM) of the French Governmenr. (tist of participanrs Annex I). 2. In opening the session the Independent Chairman welcomed Ehe participants and reviewed events which had taken place since the first session of the Conrnittee, in Abidjan, on lI and 12 February 1975. In particular, Dr Candau recalled the signature of the Onchocerciasis Fund Agreement on 7 May L975 at the World Bank Headquarters, Washington, which assured the financing of the first six years of the Progranrne (L974-L97r. Speaking of his recent visit to the seven Participating Countries, the Independent Chairman informed the JCC that he had had occasion to aEtend meetings of the National Onchocerciasis Connnittees and to noEe the interest and importauce attached to the Programme by the Governments concerned; he had also witnessed the efforts made to assist the Prograrmne during the first year of operaE.ions. The Independent Chairman stressed that this had been an experimental year which had yielded valuable knowledge for the subsequent operations. ELECTION OF THE VICE-CHAIRMAN OF THE SESSIOT{ H.E for Recalling the procedure adopted at Abidjan, the Independent Chairman proposed I"Ir l"Iamadi Keita, Minister of Pubtic Health and Social Affairs of Mali, as Vice-Chairman the duration of the session. This proposal was unanimously approved by the JCC. ADOPTION OF THE AGENDA The agenda was adopted by consensus (Annex II). PROGRESS REPORT OF TIiE WORLD HEALTH ORGANIZATION FOR 1975 Ihe report by the World Health OrganLzation covering the activities of the OnchocerciasisControl Progrannne during the period January-September 1975 was presented by the progrannne Director who gave a detailed account of developments since September 1975. The Cormnittee 1,ras informed of the PreParation of the remaining Country Protocols covering the contributions Eo the Progranune from Benin, Niger and Togo, and mention was made of the services and personnel already being provided under similar Protocols by Ghana, Ivory Coast, Mali and Upper Volta. The build up of logistical support to the control operations was descri-bed, including the establishment of a radioconrnunications network, the setting up of additional hydrological stations and the installation of vehicle maintenance workshops. The work of the epidemiological evaluati-on unit, which had examined L4 76L persons in 67 villages in Upper Volta, Ivory Coast and Ghana between February and November L975, hTas reported on. The JCC was also informed of IINDP financed-training activities, in particular in the field of entomology. Since thebeginning of the Progranrne twenty-one entomological personnel had received training under an agreement established between WHO and OCCGE, and executed with the assistance of ORSTOMpersonnel, and three fellowships had been awarded. a Page 2 The Chief of the Simulium control operations informed the Conrnittee that 41 larviciding circuits had be6ii.o.rdffiEEtween February and the end of November 1975, and samples from about 350 breeding sites checked each monEh by the entomological surveillance teams. The control of the larvae had been found to be generally effective and no harmful side-effects from the insecticide treatments had been detected by the hydrobiologists working on the aquatic monitoring prograrrEne. In spite of the reinfestation of adult blackflies which had occurred during the rainy season in certain areas of the control zone, the results of the first 10 months of treatment showed a generally satisfactory reduction in the transmission of onchocerciasis. Erom preliminary studies which had been conducted on the reinfestation problem it appeared that the adult female flies which had been caught emanated from outside the treated area. In this regard a special operational research programne, integrated with the entomological surveillance activities, was being prepared so that a fuI1 investigation could be made and appropriate countermeasures developed should the phenomenon recur. This programrne would be carried out with the assistance of members of the Scientific Advisory Panel and in cooperation with research institutes. The JCC was informed that control operations would be extended into Phase II in January 1976 and preparations for Phase III - extension of the surveillance network, training and recruitment of personnel, had already begun. ANNUAL REPORT OF THE SCIENTIFIC AND TECHNICAL ADVISORY COMMITTEE The Chairman of the Scientific and Technical Advisory Conrnittee (STAC) introduced the annual rePort. He said that SIAC considered an extremely promising start had been made to vector control operations, but emphasized that the human aspects of the problem should noE be neglected, particularly as regards the movement of population. Conrnenting on the visits of STAC members to the Progranrne area, che Chairman said that due to the absence of key personnel in the entomological field the first group had been some- what critical of these activities. On the other hand the opinion of the second group, whose visit had coincided with the reinfestation problem, had been more favourable. In the field of epidemiological evaluation, initially t-he clinical and parasitological examinations had beenjudged as rather superficial but had improved as the meEhods were refined and the evallration teams gained experience. The group had, however, expressed conc.ern at tl're lack of suitable treatment for the high proportion of heavily infected inhabitants t.hreatened with blindness in the villages visited. Iurning to research, the Chairman noted the progress thaE had been made in the establish- ment of laboratory colonies of S. dannrosum, and stressed the need to find a labor atory animal for studies on E.he parasite itself, irr connexion wiEh chemotherapeutic research, and Eo develop a mathematical model for future progranrning. Attention had been pai"d to inununological problems and, although with regard to diagnosis the outlook was favourable, greater efforts were required in clinical research on onchocerciasis and in the identification of microfilariae. The Chairman said that considerable basic research was required and urged Ehat the highest priority be given to chemotherapy and new insecticide formulations. In the field of training, the lack of candidates for the fellowships available in epidemiology and parasitology was regretted. REPORT OF THE ECOLOGICAL PAI{EL In the absence of the Convener of the Ecological Panel, who was unable to attend the session, the group was represented by the Chairman of the Scientific and Technical Advisory Conrnittee who is also a member of the Panel. Introducing the report, the representative informed the JCC that one of the Panelrs main concerns was the need for more refined methods of measuring the considerable variations in r^rater flow in rivers under E.reaEmenE, which deter- mined the insecticide dosage required. With regard to human ecology, the Panel emphasized the problems arising from resettlemenE, particularly the risk of spreading other diseases. Page 3 Other matters which had received the Panelrs attention included larvicide particle size, and the collect.ion, recording and analysis of data. In the field of aquatic monitoring the Panel had noted with satisfaction that so far analysis of data had given no evidence of harmful effects on the non-target fauna. The attention of the JCC was drawn to the duplication between certain functions of the Panel and the Scientific and Technical Advisory ConrniEtee. Ihe Panel anticipated that a clearer definition of the roles of each body would be achieved at a joint meeting of both groups to take place in early l{r;ch 1976. DISCUSSION OF AGENDA ITEMS 5, 6 AND 7 In expressing their satisfaction with the results of the first year of operations and the Progress made since the firsE session of the JCC, delegates paid tribute to the work of Prograrmne staff, particularly in the field, and to the cooperation of the participatingCountries. Appreciation was shornm of the contributions made by the Governments concerned in terms of personnel, buildings, funds and services. Certain delegates from the Participating Countries indicated their concern at the reinfestation of adult blackflies in parts of the treated zone, and their desire for an extension or modification of the Progranrne area. In some countries important developmentprojects l^7ere at risk either from reinfestation, or because they were in areas iurnediately outside the boundaries of the Progrannne. While sympathizing with the concern of theParticiPating Governments, other delegates stressed that until the causes and the effects of reinfestati-on were more clearly understood it was premature to consi-der expansion as a solution.It was recalled that the boundaries of the Progranrne had been defined on the basis of technicat analysis and since initially the Progranrne was experimental in character, any modification atthis stage would be inapproPriate. When more information had become available the situation would be reviewed, taking into account the financial implications involved. In the meantime, research on reinfestation in the Progranrne area and studies on all aspects of the vector shouldbe intensified. WHO informed t.he Conunittee that the question of the extension of the progranrne area had already been considered by the Steering Conrnittee. It had been agreed that when al1 phases ofthe Prograrmne had been implemented, an evaluation would be undertaken by WI{o, together with the various advisory bodies, on the basis of which a decision could be taken at the JCC regarding any possible modification to the progranrne area. Noting that due to a temPorary shortage of insecticide treatment intervals had been extended from 7 to 10 days, a question was raised regarding the effects of the longer interval and the possibility of its adoption generally. wHo assured delegates thaE the appearance of adult flies in the treated area could not have been caused by this nrodification. It was explained that although during the rainy season it was possible to extend treatment intervals,it was preferable in general to maintain the present rhythm. The weekly schedule was relatedto Ehe duration of larval development which is dependent on aquatic factors such as $ratertemperature and food. Referring to the concern expressed about the possible devetopmenE of resistance toinsecticides in S. dannosum, WHO said that the problem was being carefr.,lly studied with the assistance of consultants and oRSToM. So far s. danrrosum had maintained a constant degree of susceptibility to AbaEe. rrials were beingtmiElilE-oi a range of orher promising insecti- cides to ascertain their suitabirity for use in the programme. With regard to the biodegradability of Abate in water, mud and fish, delegates wereinformed that studies were being carried out in this field by the Center for Disease ControI,AElanta, United States of America. The JCC stressed the importance of an adequate health infrastructure in areas alreadybeing repopulated due to a reduction in the blackfly density. It was suggested that, as \^7asalready the case in some countries, this should form part of the overall iEvelopment, and should be taken into account in planning the economic development of the freed areas. 14Ho, reminding delegates that the development of the health infrastructure was the responsibility Page 4 of the Governments concerned, indicated its willingness to assist, should the Governments so desire, and explained that the WHO representatives in each country were already lending their support in this field. In view of the urgent need to find suitable drugs for mass treatment of the affected populations, the JCC strongly supported the reconrnendation of the Scientific and Technical Advisory Corunittee for greater emphasis on research on chemotherapy. It recognized, however, the difficulties faced in trying to promote research on drugs, and suggested that WHO seek guidance from STAC in npbilizing the private and public resources available in many countries. WHO outlined the developments in research on epidemiology and chemotherapy since the last meeting of STAC. These included the conclusion of agreements for studies on the dynamics of the transmission and pathogenesis of onchocerciasis, and for field trials of available drugs. Mention was made of irmnunological studies on the developmen t of an 0. volvulus ant igen, and on the standardization of a specific indirect irmnunofluorescence antibody test. The establishment of a chemotherapeutical research centre in the Prograrmne area was conunended by the JCC. In reply to a query regarding data collection and analysis WHO confirmed that both entomological and epidemiological information was being transmitted to WHO Headquarters where analytical studies would shortly cortrnence. Referring to the coordination of research activities, delegates expressed the hope that liaison would be maintained between the Onchocerciasis Control Prograrmne and the WHO Progra.urne for Research on Tropical Diseases, and that Ehe responsibilities of each group would be clearly defined in order to ensure the best use of available human and financial resources. I,IHO pointed out that an Onchocerciasis Research Coordinating Conrnittee (composed of representatives of other divisions concerned mainly with tropical diseases) had been set up in WIIO Headquarters In fact research sponsored by OCP on certain aspects of onchocerciasis was already quite advanced. Delegates emphasized the need for a strong and consolidated research prograrmne with sufficient flexibility to meet inevitable changes. It \^ras suggested that STAC might play a useful role in coordinating research inputs. With regard to the duplication between the interests of STAC and the Ecological Pane1, the view was expressed that both groups should be retained as separate entities. The JCC considered thaE the independent evaluation carried out by these two bodies was valuable and noted with satisfaction that their recormnendations had been recognized and taken into account by WHO. The desirability of a larger training provision under the Programme and broader training activities to enable nationals of the countries concerned to play a greater role was mentioned. It r^ras suggested that the assistance of the National Onchocerciasis Conunittee in finding suitable candidates in adequate numbers should be sought. Members of the Conrnittee informed the Independent Chairman of their satisfaction with the quantity and quality of the information provided for the session. Certain delegates expressed the wish to receive more information about the Progrannne in addition to the quarterly progress rePorts. The possibility of subsequent progress reports including information about the contribution made by the Participating Countries was raised and it was suggested that reports on the Prograrmne be expressed in quantitative rather than qualitative terms with annual numerical targets concerning which an evaluation would be made. WHO was also requested to provide copies of ONCHO FLASH, a monthly news bulletin issued by the Progranrne. irIHO indicated its willingness to provide additional information but pointed out that ONCHO FLASH was a strictly non-technical publication intended rnainly for the National Onchocerciasis Conrnittees and information media in the Participating Countries. ECONOMIC DEVELOPMENT ASPECTS OF THE PROGRAMME The representative of the United Nations Development Programne (UNDP) presented a report on the action which had been taken since the first session of the Joint Coordinating Conrnittee at which, he recalled, there had been general acceptance by the Participating Governments of the concept of the planning methodology jointly proposed by FAO, IBRD and UNDP. Page 5 The ConrnitEee was informed that missions had been undertaken by FAO and the World Bank in five of the sevr:n countries namely Benin, Ghana, l"Iali, Togo and Upper Volta. The purpose of the first missi<>ns had been to discuss the preparation of requests for IINDP assisEance in comPleting the resource inventory and development planning parts of the methodology; the second, I'fact f:Lndingttmissions, had been concerned with the data bank and pre-investment studies. A report had been prepared by the agencies concerned and submitted both to the Steering Conrnittee and ttre Participating Governments. It was stressed that the $5OO OOO made available to each country by UNDP was intended to serve only to launch the economic development planning activities. The total cost of these activities would be considerably larger. The other nrain points emerging from the findings of the missions were that firstly, use should be made c,f expertise available in the countries concerned, or national planning institutes shoul.d be strengthened through training of personnel to create a national resource for this and other planning purposes; secondlY, in view of the important role played by agriculture in the economies of the seven countries, the repopulation of fertile valleys would be an important factor in developmenE provided such repopulation was planned and organized; thirdly, already existing data on soil utilization, climatology and hydrology should be assembled. In this respect it was proposed to train local personnel to carry out field surveys. Finally, in some countries where several planning offices existed, it. was proposed to set up an independent Development Planning Group attached to the national Ministry of Plan. Ihe main function of this group would be the preparation of a 1O-year development plan for the onchocer- ciasis freed zones; it would also assist the C,overnment in negotiations with interested aid agencies. Surmnarizing the developments which had taken place in relation to each country, the llNDp representative informed the JCC that UNDP had provided or had been requested to provide assis- tance i-n a number of fields including the preparation of draft project documents (Benin, Ghana, Mali); aerial protographic coverage (Benin, Ivory Coast, Niger, Togo and Upper volta); the collection of daEa on tsetse affected areas (Ivory Coast) the preparation of a master plan and collection of dernographic data for the district of Say (ttiger), the collection of hydro and hydrogeological,lata for the formulation of a water resources development plan (Niger), extension of the contract for the resource inventory and development planning (Togo); carto- graphy and land capacityfland use studies (Togo); Lxtension of the post of pLanning economist to the Autorit6 drAm6nagement des Va116es des Voltas and the provision of a sociologist (Upper Volra). With regard to the additional funds that would be required for planning activities, the JCC was informed that, while 1JNDP would be willing to consider requests for financing under national or regional IPFs, in view of the present financial situation it would be unable to meet the ful1 recluirements. UNDP suggesEed that other sources of finance be explored. In reply to a query raised concerning the joint FAO/IBRD mission report, the represen- tatives of the ag;encies concerned explained that this was a technical document intended to serve as a basi-s for government planning, and hTas not intended for circulation to the JCC, although copies were available for information on request. Stressing the need for development to keep abreast of the vector control operations, cert-ain delegates expressed the view that effective action on economic development in treated zones should not be delayed through the use of over-sophisticated methodologies. The UNDp rePresentative Pointed out that it was not necessary to wait until planning had been completed for all freed areas; development could corrunence in certain areas while planning proceecled in others. There r^7as general agreement that assistance to development \^/as of equal importance as assistance to the health operations and, if not forthcoming, in 20 or 3O years when the enormous efforts made to eliminate the disease might have been forgotten, the impoverishment resulting from inadequate planning would remain. Page 6 Reviewing the FAO/IBRD mission report for economic and social development, theParticipating Countries reminded the JCC that planning structures already existed in their countries, and endorsed the UNDP suggestion thaE the financial aid envisaged be used to reln-force these national structures, particularly through the training of personnel. The wish was also expressed for specific identified projects to benefit as rapidly as possible fromfinancing independent of the bilateral or multilateral assistance sought for the nationaldevelopment projects, and without prejudice to existing projects. Finally, the JCC wasinformed that as a result of infl-ation, drought and the energy crisis the participating Countries were facing enormous budgetary difficulties, and requested assurance that the additional funds required would be forthcoming without a contribution on their part. Replying to the Participating Governments, the llorld Bank assured delegates that thetechnical assistance provided under the Progranrne was intended to support existing planning structures, unless the Governments concerned indicated otherwise. Once a decision had beentaken by the Governments concerning their requirements, the Bank would take steps to assist them in seeking external financing for specific projects. It was emphasized that prioritiesin externally financed national development programmes would have to be determined by the Governments themselves. The Bank Group \,ras not in a position to guarantee all the funds that might be requested and its own future participation would inevitably depend on the next reptenishment of IDA funds. EAO pointed out that the contribution of the Participating Governments had been includedin the FAO/World Bank report in order to give an indication of the services and facilities tobe provided by those Governments in kind. The contributions indicated represented buildings, manpower and other resources already available. I'lhile agreeing with the importance of integrating planning for onchocerciasis freed areas with overall national planning, some delegates considered that within the national prograrnmespriority should be given to the economic development of the freed areas. Delegates were reminded that the main justification for the heavy expenditure on oncllocerciasis control layin the prospects for development. the rAo/rrRD report had devoted 1itt1e space to ongoing prograrrEnes as the report dealt mainly with Ehe framework of fuEure planning. In any case, it is neither possible nordesirable to modify planning and implementation of already identified projects which would continue to develop until such time as the first data bank would be established and it wouldbe possible to tailor projects to meet count.ry priorities in a systematic manner rather than allowing the continued spontaneous resettlement of some areas under vector control, which has already begun. In reply to a query concerning which development projects \^/ere specifically onchocerciasis related, the mission believed that Governments regarded those projects in the freed valleys asbeing most closely related, but the OCP area generally would benefit from the relief of populaEion pressure through resettlement of these va11eys. The proposal to train national personnel was strongly supported by delegates, although it was felt that in certain fields where information could be rapidly obtained, such as the utilization of satellite pictures, it would be preferable to use experienced staff while training nationals to assist at other levels. The Participating Governments rr/ere assured by certain delegates that financing for identified projects would be forthcoming and were invited to submit proposals at an early date A\INUAL REPORT OF THE CHAIRMAN OF THE ECONOMIC DEVELOPMENT ADVISORY PANEL Referring to the role of the Panel, the Chairman said that it should be concerned with national but not supranational planning activities and should ensure the integration and utilization of the different types of data collected. He considered the creation of a data bank to be a definite step forward as inadequate information and its non-systematic utilization had always been a serious shortcoming to development activities, and one that he himself had encountered in the preparation of his report. In this respect, the Chairman stressed the value of associating different types of daEa in order to arrive at a sound judgement. Page 7 With regard to the composition of the Panel, the Chairman envisaged a smal1 multi-disciplinary grouP of 6-10 persons selected on the basis of their technical experience in the area, it being understood that members from other consultative groups should participate in its work. The JCC noted with satisfaction that the Chairmanrs views as expressed in hisparticularly in regard t.o planning, coincided with the observations of Governments and his realistic approach was conunended. rePort, in Ehe region, Delegates expressed regret that the Panel had not yet been formed. While supporting rheChairmanrs view that its composition should not be based solely on nationality, certain members stressed the danger of a high-level group with a too-theoretical approach. A sound knowledge of the region and its problems was considered a prerequisite. However, it was pointed outthat not only should the economic interdependence of the region be taken into consideration,but develoPment should be viewed in the context of a world of inEer-related economies. sincethe objective of such economic development \^ras to increase and develop the potential of thesecountries in an interdePendent and dynamic world, a wide understanding of political and economic problems l^7as necessary on the part of those who would advise the technicians workingin the field. In selecting members a balance should be achieved to create a group with abroad vision, which, while containing practical details within their proper prospective, wouldmaintain a realistic impartial approach. The LINDP representative supported this view and said that he would welcome the earJ.yestablishment of such a 8rouP. The representative of the world Bank indicated his agreementwith the views expressed regarding the membership of the panel. rt was noEed that in accordance with the Memorandum of understanding members of EDAP would be appointed by the worldBank, taking into account the views of the JCC and in consultation with the other sponsoringagencies' rhe rePresentative of the world Bank requested members of the JCC to suggest namesby the end of January 1976. rt was hoped that a meeting of the panel could take place duringthe sunrner of L976 so that it could report to the JCC aE. its third session. AIl Governments and sponsoring agencies were requested to keep the panel well informed of development activities. The desirability of including on the panel a physician with experience of the healthproblems of development v/as emphasized and it r.. g".r"."1ly agreed that the forlowing disciplinesshould be represented: economy, sociology, geography, agricultural development, development ofwater resources and public health. rt was also agreed that alternative members r^zould beappointed. rn this connexion the chairman referred to the wHo Expert Advisory panels, notingtheir value to that organization in enabling it to confer with internaEionally recogni.zedspecialists on al1 imPortant subjects, and suggested rhat the panel might well fo11ow thisexample. A certain flexibility would be maintained which would allow the panel to call uponexternal consultants if required. The chairman of EDAP said that a new phase in the general conception of development hadbegun, breaking away from traditional approaches through alternaEive technologies, the creationof maximum employment, decentralization and accelerated training. In his view it would be therole of the Panel to study all these aspects with the maximum of creativity and imagination. REVIEW OF TIIE PLAN OF ACTION AND BUDGET OF THE PROGRA},IME FOR 1976 wHo presented the budget f.or L976. The JCC was informed rhar obligarions f.or L974-L975were expected to amounE to some $9 million and for 1976 chese were esEi-mated at $1o 726 goo.rt was pointed out thaE, although the uncertainty of the financial and monetary situation madeprojection for future years more difficult, inflationary trends had been taken into account inthe 1976 figures. The total budget submitted for the first three years of operation (L974-1976) amounted to some $20 miIlion, approximately the same figure as presented to the firstsession of the JCC in February 1975. wHo explained that to maintain this level and toaccomodate additional helicopter flying hours essential for intensified surveillance, and anincrease in the quantity of insecticides, a series of cuts had been made. rn particular, theconstruction of the Prograrmne Headquarters building had been postponed. of the budget proposed Page 8 for l976r lL.4% was devoted to the vector control operations and epidemiological evaluation, LO,3% to research and training, and the remainder to ProgranEne Headquarters in Ouagadougou and the technical administrati-ve support in WIIO Headquarters in Geneva, the WHO Regional Office in Brazzaville and FAO Headquarters in Rome. Substantial technical and administrative services would continue to be provided by WHO. The JCC noted with gratification that the estimates for the first Ehree years had been kept within the figures presented at the first session, but expressed concern at the increase in expenditure in WHO Headquarters services which represented about LO% of the total cost for the first three years of the PrograrEne. Referring to the decision to postpone construction of Programme Headquarters, it was noted that costs might become prohibitive as a result of inflation. The presentation of the 1976 budget was found to be an improvement over the previous year but it was felt that a number of points required clarification and greater detail should have been incorporated. For example, the budget estimates presented at the first session might have been included for easy reference, and the rearrangement of individual items which had been necessary to maintain the present level could have been highlighted in the text. Wi.th respect to financial control, a request was made to clarify who has the authority to make adjustments among items within the approved budget. It was pointed out that the agenda for the JCC included a review of the Plan of Action for 1976 and WHO was requested to provide a separate document on this in future which would take into account not only budgetary asPects, but also a presentation of the proposed plan of operations for the succeeding year. A request was also made for the financial documents to be circulated to JCC members aE least a month in advance of the session. WHO assured the Connnittee that all the points that had been raised would be taken into account in the preparation of fuEure documents. The budget under consideration was the result of discussions with the Steering Conrnittee; every effort wouid be made to further reduce the expenses related to the WHO Headquarters support unit necessary for the coordination of operations. With regard to financial controls, trrlHO informed delegates that the services of I,fiIOrs internal and exEernal auditors were employed; furthermore special management studies were being carried out in order to ensure the efficiency of operations in the Progranrne area. As far as the aerial operations \^7ere concerned, I^IHO explained that two additional heli- copters were necessary in order to ensure continuity in the oPeraLiorts. Replying to a question concerning the j-ncrease in the allocation for salaries in 1976 as compared to that for L975, WHO explained that apart from annual increases and statutory allowances a 7-8% rate of inflation had been incorporated. Moreover, in 1975 a number of Posts had not been created until July whereas the allocation for 1976 covered 12 fu11 months for all posts and additional support personnel in the field. The contingency provisions which had been included the previous year to provide the necessary flexibility to the control oPerations had now been absorbed into the different allocations. }'INANCING OF THE ONCHOCERCIASIS CONTROL PROGRAMME Introducing the subject of financing of the Programme, the World Bank representative reminded the Conrnittee that, when the Onchocerciasis Fund Agreement was siSned in May 1975' the pledges received were in various forms. As a result a number of questions remained open relating to the financing for that year. Referring to the income and disbursements uP to November 1975, the representative of the Bank explained that the accounts were based on Pledges for both L974 and 1975 which amounted to some US$ 13 million. At the end of November the balance in the Fund was about US$ 5 million, from which an advance of US$ 2 million would be made to WHO in December leaving US$ 3 million to be carried over into 1976. Drawings on the Onchocerciasis Fund it 1976 \,rere expected to amount to about US$ 10 million. The Unired Kingdom representative recalled that his countryrs pledge to meet IO% of the Programme requirements ran until March 1977. It was based on current estimates for 1976 and \,ias established on the basis of the annual review of the Progranrne. The United Kingdom Page 9 representative reminded t.hose responsible for the Programe thaE his Government would be receptive to further calIs upon the substantlal resource of expertise available in that country. During the discussions Ehe following contributions for 1976 were indicated by the various governments: Canada - Can$ 5OO OOO (subject to Parliamentary approval); Federal Republic of Germany- DIl3million; France- FF4millionl Kuwait - $ lurillion (in addition to the g lmi1lion pledged for 1975); the Netherlands US9 I million (subject to Parliamentary approval); the United States of America $ 1 million (against the planned toLal coumitment of $ 6 million for the first phase of the Prograuune (subject to availabiliEy of funds)); the African Development Bank U.A. 15O OOO (equivalenr ro US$ 18O OO0). The representative of Belgium informed the Corurittee of the Governmentrs intention to increase its contribution from BF 5 million in 1975 to BF 15 million Ln L976. The Prograrmne would also benefit indirecEly from the BF 10 million which the Government had decided to contribute to the WHO Special Prograurne for Research and Training in Tropical Diseases. Referring to the need for additional development aid in areas freed from onchocerciasis, the representative of Kuwait indicated that the Kuwait Fund for Arab Economic Development was now entitled to extend its assistance to non Arab developing countri.es and would welcome requests from the Prograrmne. The Fund could also help to finance feasibility studies when neces sary. The representative from Japan stated that a contribution of $ 5OO OOO had been made in November 1975. A further contribution would be forthcoming in 1976, subject to Diet approval. Thereafter, the question would be reviewed each year in the light of the resulEs of the Prograrune. The representative of Ivory Coast informed the JCC that his Government would continue to contribute the salaries of the five national staff attached to the Prc.grannne, as well as to bear the costs of office rent, water, electricity and other services. The JCC was reminded that the World Bank Group had agreed to contribuEe up to l0% of the total Progranrne requirements, subject to the approval of its Executive Director. The Bank representative pointed ouE that the offer of a grant rather than loans was unusual and, in fact, OCP was one of only two Programes to receive such grants. That departure from normal pracEice had been specially authorized under a resolution by the Board of Governors which had agreed t.o a grant of up toUS$ 1million for L976 to be made from the transfer of the Bankrs net income to IDA. Reviewing the financial resources of the Fund f.or L976 it was noted Ehat the total funds available amounted to US$ 12.26 ni]-Lion from which some US$ 10 million would be advanced to I4IHO during that year leaving a cash balance of US$ 2 million to carry over to 1977. A number of delegates urged that efforts be made Eo seek additional sources of financing, in particular from the Scandinavian countries and the United Nations Environment Prograrmne. In reply the World Bank representative informed the JCC that so far efforts to enlist the support of the Scandinavian countries had not been successful. However, as enough funds were available for the current financing of the Progrannne, and as it was not desirable to accumulate a large reserve, it might be premature to seek additional funds at t.his point. Costs arising from any possible expansion of the Prograrmne, and the pressure of inflation, would be felt at a later date, and every effort would then be made to secure such additional financing as might be required. OTHER MATTERS Arrangements for the third session of the JCC At the invitation of the Government of Upper Volta, it was agreed to hold the third session of the JCC in Ouagadougou at the beginning of December L976, on dates to be mutually agreed between the Government and the IndependenE Chairman. Page IO An invitation was extended by the C,overnment of Togo for the fifth session to be held in Iom6 in 1978. Channels of cournunication Ihe Independent Chairman informed the Connrittee that he proposed to write to all members to clarify the channels of conrnunication to be followed for all matters related to the JCC. Report of the meet lng The Independent Chairman informed the Conmittee that he proposed to issue a Chairmanrs report of proceedings as had been done for the previous session. It was agreed that this procedure would be adopted for all future sessions. CLOSURE OF THE SESSION I'lr S. Kpognon, Alternate ExecuEive Director of the World Bank expressed his satisfaction with the proceedings of the JCC and informed the Conrnittee that his participation in the sessi-on had enabled him to familiarize himself with the problems connected with onchocerciasis control; he would thus be in a position to stimulate the interest of other Governments, and with his colleagues of the African Group on the Board of Administration he would approach, in Particular, the Scandinavian countries. Mr Kpognon informed delegates of the special inE.erest the President of the World Bank had for the Onchocerciasis Control Progranrne and assured the Conrnittee of his support. In conclusion IIr Kpognon congratulated all concerned in the Prograrmne for the progress made so far. Dr C. Sow (OCCGE) rhanked for the fruitful collaboration contributing in various fields importance attached by the JCC readiness to assist further. the sponsoring agencies as well as the Independent Chairman which had been established with his Organization which was of research and in the training of personnel. NoEing the to chemotherapy, Dr Sow informed the Conrnittee of OCCGETs Ihe Independent Chairman expressed his gratitude to all participants for the help which they had afforded him in the accomplishment of his functions. Recalling Ehe concern of the Chairman of the Scientific and Technical Advisory Conrnittee, Dr Candau emphasized the necessi-ty of giving sPecial attention to Ehe search for suitable chemotherapy for the treatment of those affected by onchocerci-asis, whose suffering would persist even after inEerruption of the trans- mission of the disease. In closing the session, the IndependenE. Chairman informed delegates that iE. was hoped the JCC would be able to undertake a closer analysis of the Prograrrrne at the end of 1976 and to study the problems associated with the possible exEension of the area covered by the operations. A\INEX I JOINT COORDINATING COMMITTEE Pari s 2 and 3 December 1975 LIST OF PARTICIPANTS Dr M. G. Candau Independent Chairman Joint Coordinating Couunittee (JCC) PARTICIPAT ING GOVERNMENT S Pegple's Rep"blic of B H.E. I'Ir Issifou Bouraima I'tinistre de la Sant6 publique et des Affaires sociales Mr Nicolas Ahouansou Membre du ComiE6 nat.ional de Lutte contre lrOnchocercose MinistEre de lrlnt6rieur et de la S6curit6 Mr B. Nestor Lawson Secr6taire d I Ambassade Ghana Colonel J. B. B. Asafu-Adjaye Executive Director National- Onchocerciasis Secretariat Ministry of Economic Planning Dr E. G. Beausoleil Deputy Director, Medical Services, (Public Health) t4inistry of Health lfr Belo-Giwa Project Officer, Socio-Economic Development I"linistry of Economic Planning Ivory Coast Dr F. S6ri6 Directeur g6n6ra1 de la Sant6 MinistEre de la Sant6 publique et de la Population Mr Kouam6 Ndri Kpatchibo Directeur BSIE Secr6tariat Etat Budget MinistEre de lrEconomie et des Finances Mr Georges Bureau Consei 11er Direction de lrAm€nagement du Territoire MinistEre du Plan Mali H.E. Mr l,Iaroadi KeiEa I"linistre de la Sant6 publique et des Affaires sociales ANNEX I page 2 Dr Souleymane Sow M6decin-Chef de Ia Division de la M6decine socio-pr6ventive MinistEre de la Sant6 publique et des Affaires sociales Niger Dr Ibrahim Alfa Directeur du Service national de lrHygiEne et de la M6decine mobile Ministdre de la Sant6 publique et des Affaires sociales Togo Dr Christophe Quadjovie Directeur g6n6ra1 de la Sant6 publique IvlinistEre de la Sant6 Dr Adj6t6 Prince-Agbodjan M6decin-Chef du Service des Grandes End6mies IulinistEre de la Sant6 publique et des Affaires sociales Itlr Roger Viwal€ Adigo Ing6nieur Agro- Economist Membre du Comit6 nationa la Direction g6n6rale du Plan e Lutte contre lrOnchocercose eb 1d Mr Robert DotE Mensah Adminstrateur civil Charg6 de Mission au M.inistEre des Finances et de lrEconomie Membre du Comit6 national de Lutte contre lrOnchocercose Upper Volta H.E. Mr E. H. R. Sawadogo I{inisEre de la Sant6 publique et des Affaires sociales H.E. Mr L€onard Kalmogo Secr6taire dtEtat au Plan auprEs du Ministre du Plan, du D6veloppement, de lrEnvironnement eE du Tourisme I{r Simeon Sorgho Secr6taire permanent du Comit6 national de Lutte contre lrOnchocercose CONTRIBUTING PARTIES African Development fank ( I"Ir I. Y. Kande Aid Coordinator Belgium Mrs Suzanne Vervalcke Directeur drAdministration, Direction de la Coop6ration multilat6rale MinistEre des Affaires 6trangEres, du Connnerce ext6rieur et de 1a Coop6raEion au D6veloppement ANNEX I Page 3 Canada I'Ir Paul Ladouceur Progranrne Manager Canadian International Development Agency Mr Frank I'les Prograrrne Officer Canadian International Development Agency Mr Ian Lindsay Technical Adviser Research Establishment Dr C. W. L. Jeanes Special Adviser - Health and population Canadian International Development Agency France Mr Jean Audibert Directeur des Progranrnes Sous-Direction des Prograurnes conjoints IulinistEre de 1a Coop6ration Dr Henri H61iEs Charg6 de Mission - Direction de MinistEre de la Coop6ration la Sant6 publique et de la Coop6ration l'1r Christian Madec Charg6 de Mlssion - Direction des progranrnes ItinistEre de la Coop6ration Federal Republic of Germany Hr Holger Tantz Federal M:inistry for Economic Cooperation Dr Karl-Hans Eter Counsellor, Department of International Relations Federal Ministry for Youth, Fanrily Affairs and Health Japan l'1r Teruo Okada First Secretary Embassy of Japan Paris Kuwait I'1r Galal Amin Economic Adviser Kuwait Fund for Arab Economic Development ANNEX I Page 4 The Netherlands I4r W. J. Kakebeeke Deputy Chief, Division of International Affairs Ministry of Public Health and Environmental Hygiene United Kingdom l,Ir John E. Whitelegg Head, West Africa Department I,tinistry of Overseas Development Dr John Lowell Kilgour Chief l,ledical Adviser Ministry of Overseas Development Dr Peter Haskell Director, Centre for Overseas Pest Research Ministry of Overseas Developmen! United States of America l"1r Donald S. Brown Deputy Assistant Administrator Bureau for Africa Department of State Agency for International Development (AID) l'1r John D. Pielemeier Office of Development Services Department of State Agency for International Development (AID) Mr Herman O. l"larshall Health Specialist Office of Central and West Africa Regional Affairs Department of State Agency for International Development (AID) SPONSORING AGENCIES Un ited Nations Development Progranrne TJNDP I,1r },lichel Doo Kingu6 Assistant Administrator and DirecEor Regional Bureau for Africa l'1r Gian Pennacchio Chief, Division for West Africa Food and Agriculture Organization of the United Nations l,1r Cyril G. Groom Senior Officer, Policy and Planning Unit Agricultural Services Division I,1r David Carney Consultant ( FAo) AI.INEX I PaEe 5 InternaEional Bank for Reconstruct.ion and Deve loomen IBRDt a I,1r E. PeEer Wright Program Director Western Africa Region I,1r Marc L. Bazin Division Chief Western Africa Region Mr Dennis R. Garff Loan Officer Western Africa Region I,1r Abdallah El I'taaroufi IBRD Resident RepresenEative in Upper Volta I I{r Iulaurice Burer Agronomist Projects Department Western Africa Region World Hea Ith Orsanization (WHo ) a Dr A. Belleri-ve Director-Consultant, OCP Dr P. Ziegler Programme Director OCP, Ouagadougou Dr J. Mahoney Assistant Director, Health Services Regional Office for Africa Dr R. Le Berre Chief, Vector ConErol Unit, OCP Dr E. Onori Epidemiologist, OCP l.{r J. D. Marr EnEomc 10 gi s t/Bio lo gis t, o3P l,lr A. Imbruglia Chief, Budget, BFI Miss R. Villars Adminis trative Of f icer EX OFFICIO PARTICIPAI{TS Professor P. G. Janssens chairman of the scientific and Technical Advisory conmittee and also represenEinB the Ecological Panel- Institut M6decine troPicale Prince L6opold Ant$rerp, Belgium ANNEX I page 6 I'1r Paul-Marc Henry Chairman of the Economic Development Advisory Panel (EDAP) President of the Development Centre Organization for Economic Cooperation and Development I,1r Stanislas Kpognon Alternate Execut.ive Director InternaEional Bank for Reconstruction and Development OBSERVERS Oreanisation de Coordination et de Coop6ration pour la Lutte contre les I Grandes End6mies (OCCGE) Dr Gheick Sow Secr etar y-Genera 1 Office de Ia Recherche scientifique et Eechnique Outre-Mer (ORSIOM) Dr Jean llcuchet Pr6sident du Comit6 technique drEntomologie m6dicale Parasito logie et l'licrobiologie t I ONCHOCERCIASIS CONTROL PROGRAMME IN THE VOLTA RIVER BASIN AREA JOINT COORDINATING COMMITTEE Second session Paris 2 and,3 December 1975 AGENDA Opening of the session Statement by the Independent Chairman Election of the Vice-Chairman of the session Adoption of the agenda Progress Report of the World Health Organization for L975 Annual Report of the scientific and rechnical Advisory conrnittee Report of the Ecological panel Annual Report of the Chairman of the Economic Development Advisory panel Economic development aspects of the progranrne Review of the Plan of Action and Budget of the prograrrne for 1976 Financing of the Onchocerciasis Control prograrrane Other matters Closure of the second session ANNEX II page 7 JCC2.1 I 1. ) 3. 4. 5. 6. 7. 8. 9. 10. 11. L2, 13. I I a