oCP lft4.4a ONCHOCERCIASIS CONTROL PROGRAI.IME IN THE VOLTA RIVER BASIN Long-tem Strategy : Information Docr.uuent. ocP/Lrs 29.06.84 a ocPf 84.4a NoEe: Ttris document is rnade available together with the Long-Term Strategy(LTs)proposal (JPC.5.7(OCPf84.4)) to allow readers of chat proposal wtro wishto acquaint themselves with the programe in some detail, to do so ln a convenient mFnner (see paragraph 5.2 of the LTS document. a IoCPl84.4a ONCHOCERCIASIS CONTROL PROGRAI'IME IN THE VOLTA RIVER BASIN AREA 1. Historical perspective of events leadins to the start of the Progrme 1.1 Since the mid-1950s several attempts at controlling the transmission of onchocerciasis were made in circuoecribed arees in Equatorial end ldest Africa with varying degrees of success. These localized operations aimed at blackfly control through the application of larvicides at breeding sitee in rivers, except for one or two areaa where DDT sas used as an adulticide.Larviciding was mainly carried out from the ground until L975 r'tren the Onchocerciasis Control Prograrmne (OCP) introduced the use of fixed-wing aircraft and helicopters for t^his purpose. During the 1960's ORSTOMI ent.omologists, assigned to OCCGEZ, carried out a series of experiments on larviciding techniques and their effectiveness in areas covering parts of Upper Volta, Mali and the Ivory Coast with the financial support of the European Development Fund (fOf) and of the French Aid and Cooperation Fund(FAC). This work led to the start in L962 of en onchocerciasis control operation in the same areaa including the Farako zone which, excepting brief interruptions, continued, Lrith EDF support, until L975 at wtrich time control operations were taken over by OCP. The work of the UK Medical Research Council team in Cameroon on epideniological survey methods and strain differences in Onchocerca volvulus also he1 ped to 1ay the foundation for the technical approach of OCP. Furthermore, WHO supported onchocerciasis control projects in West Africa provided useful field experience for the conduct of the Programne. L.2 With the growing concern about the serious adverse effect of onchocerciasis on human health and on socioeconomic development in extensive Parts of West Africa and the recognition that control of traneuission of the diseaqe was a distinct possibility, it rdas decided to convene a Joint USAID3/occcE/wno Technicai Meeting on the Feasibility of onchocerciasisControl wtrich was held in Tunis, Tunisia froo I to 8 July 1968. The meeting concluded that tta large-sca1e Simulium control scheme for the purpose of reducing the prevalence and ir6@ of onchocerciasis among ihe- peopleliving in the savanna zone of tlest Africatt vras feasible, forloving uhich 1 Offi"" de la Recherche Scientifique et Technique Outre-Mer. 2 Otgaaization de Coordination et de Coop€ration pour la lutte contre les Grandes End6nies. 3 Ag"n"y for rnternat,ional Development of the united states of America. ocP /84.4a 2 2 the government,s of seven countriesl in that geographical area submittedrequests to a number of intergovernmental and bilater;l agencies (includingLNDP, FAo, ffio, rBRD, EDF and usArD) for support in the prepa..tion of astrategy for an onchocerciasis control Prograume in the volta River Basin areaand for eventual assistance to the inpremeritation of this prograrune. 1'3 subsequently, a rnission rras aet up to prepare an overalr strateev forthe Onchocerciasi^s_^Control Progranrme. The report of the pAG Mis"io"Z ;;"subnitted late 1973 to. r".ii.g of r"pr"""rrt.tives of the participatingcountrie' in west Africa, of potentiar donor countries and of theintergovernmentar agencies concerned. The proposed strategy, covering aperiod of 2O years, and the technical reconmenhations were approved and fundsco*itted for the initial phase of operations of the onchocerciasis controlPrograme in the volta River Basin area f or which I.lHo rras appointed theExecuting Agency. I 2'L The overall direction of the operationel and budgetary policies ofocP rests with the JoinE Prograrnme comittee (Jpc) which noilarli.L"t" once ayear and is composed of rePresentatives of the Participating Countries, ofDonor Countries and Donor Agencies, and of the four sponsorinfAgencies ('FAo,LNDP' l,Ho and the llorld Bank). JPc exercises general suplrvision of theplanning and execution of _the-Progra'me, examines the annuai progress reportof t-h" executing agency (wHo) 8s well as other reports subnitted to it,considers the plan of action proposed for the following year and approves thecorresponding budget. 2'2 In each one of the Participating Countries a National onchocerciasisComittee (Noc) tras been established nitf, a view to ensuring liaison betweenthe Progreme and the national authorities concerned and in -order to promote,within their respective countrieo, activities nhich ere supportive of OCp. Ameeting of rePresentatives of all National onchocerciasis Comlittees isnormally held once yearly. 2.3 An Expert Advisory Conrmittee (EAC) sith a membership of L2ecientiets, coming from disciplines of direct relevance to ocp operations,carries out technical audit of ocP and furnishes technical and scientific advice to the Director of the programe, as and when required, and to theJoint Progr:me Comittee. EAC convenes at least once a year. The EcologicalGroup (five members) although having an independent status is a sub-group ofEAC through which it reports to JpC. of the Progranrne 1 Benirr, Ghana, Ivory Coast, Mali, Niger, 2 The Preparatory Assistance Miesion to CountrieB. Togo and Upper Volta. the Governments of the Participating oCP/ 84 .4a 3 2.4 Representatives of the four Agencies involved in the Onchocerciasis Control Programe meet f our or f ive times a year es the Conrmittee of Sponsoring Agencies (CSA). The role of CSA is, documentation of issues faced by OCP, assessing to resolve these issues, and Eo make recomendat that Comittee in its decision-making process. inter alia one of preparing of the Prograrunethe capac ty ions to JPC in order to assist, 2.5 The Programe DirecEor is responsible for all OCP operationsi for the preparation of plans of action and corresponding work progremes; for the reporting on Programe activities i for the preparation of the Progranrme budget docrment; and for maintaining a continuing contact and dialogue with the governnents , and agencies concerned, as well as with the scientific cormunity. To accomplish these tasks the Director is supported at the OCP Headquarters in Ouagadougou, Upper Volta, by four technical units (Vector Control, Epideniological Evaluation, Socioeconomic Development Support and Adninistration and llanagemenE) each headed by a chief assisted by operational/scientific and general service staff. The najor part of vector surveillance and control operations is carried out through a network of six OCP sectors and 24 sub-sect,ors wtrile the epideniological evaluaEion is conducted by two mobile tearns based in Ouagadougou. In 1983 there were 56 professional and 750 general service posts within the Programe. 2.6 The EanagemenE strucEure described in the preceding paragraphs(organigra*e attached as Annex 1) has remained essentially unchanged since the start of Programe operaEions, except that before 1980, the functions of the Joint Programe Comittee rrere carried out by the Joint Coordinating Cmittee (JCC) having the same membership as t.hat of JPC and presided over by an independent chairman; the duties of EAC were perforned by a Scientific and Technical Advisory Conmit.tee (STAC) whose members sere appointed frou a Scientific Advisory Panel, now disbanded; a Steering Comittee, set up by the Executive Heads of the four Sponsoring Agencies, rras concerned with those issues now being dealt with by csA. 3. Geographical coveragq 3.1 The definition by the PAG Mission of che area in which OCP operations nould be conducted was originally (1973) arrived at from ttlo considerations, namely that the disease vector, the blackfly, rras able to travel long dietances, i.e.150 kn or Eore (now known to be considerably in excess thereof ) and that t.he Programe would be conf ined to the control of aavanna-onchocerciasie. Ttre latter determining factor was based on the assumption Ehat the presumed Itforest straint'of Onchocerca vo1vulus, wtrich gave riee Eo clinically less serious disease manifeitations (in particular eye lesions) than the t'savanna strainrr, could not establish itself outside forest areas and there ect as an agent of the savanna-type of onchocerciasis. AIso, it was taken for granted that the trsavanna strain" of the parasite could not survive in forest zones. 3.2 The original OCP area covered 640 000kn2 of sudan and guinea savanna in Benin, Ghana, Ivory Coast, I.lati, Niger, Togo and Upper Volta. The boundaries of the OCP aree coincided in the north and north-eest nith the linits of the distribution of the disease vector; to the south gith the beginning of the forest zor.ei and to the rrest and east essentially with national borders. It was expected that by conducting Prograuune operations in such a large area, the risk of serious adverse effects of reinvasion would be virtually obviated. OCPl84.4a 4 3.3 The launching of Programe operations waa staggered within the area as follows: Phase r (geographical) sterted in February L975, Phaee rr in March L976, and Phase III in March L977. (fte Eap in Annex 2 shoss the geographical Phases of the Prograuae.) As early aa L976 it became apparentthat the problem of external reinvasion of infective blackfliee night pose athreat to the successful outcome of OGP operetions. In order, therefore, to combat the reinvasion of blackflies from breeding sites located outside the OCP area and also, at the request of the Ivory Coast, to control sme foci of severe onchocerciasis, the Programers southern border was redefined with the result th^at operations were started 'in L978/79 within an additional 110 000 kmz, situated in the south of the rvory coast (see geographical Phase IV on map in Annex 2) thus bringing the total OCp area ro 764 000 knz. 4 Vector control: entomological surveillance and 1 arviciding 4.1 Savanna blackflies exclusive cytoepecies in all of the country wtrere forest that part of Mali which is included Sinuliun damrosum s.s./sirbanun) of Upper ta except e Eouth-rres sPeC res (-!.:__sofuse) are found); in the Prograrnne area; in ate tern p in most the northern receive days a wtrich night flies. The the art of half of Ghana; in the ocP sector on Niger; and in the north of Togo andBenin. The forest species, S. soubrense/sanctipauli, are found together withS. damnosum s.s. in those ar@olta wtrich boider on the rvory coast; Ehroughout the rvory coast; in the eouth-east of Ghana; and inthe north of Togo. The najority of the blackflies caught in the Extension area of Benin and Togo cannot be routinely identified as belonging to one or another species. 4.2 The area in strich the savanna species are the only vectors is today characterized by very low ASR/ATPI levels and, indeed, at several catchinlpoints by the total absence of blackflies for a number of years. In the remaining Perts of the OCP area, i.e. in the western and eastern border zones,in Parts of the south of the Ivory Coast and Ghana, and in the Southern Extension area, the blackflies are present in numbers wtrich frequently give rise to ABR/ATP values exceeding the levels of tolerability I Annual Biting Rate:itffisit yeer. The leve1 of tolerability has been set at an ABR of 1000. Annual Transmission Potential :The number of infective larva e have been transmitted to the person under I above by the biting level of tolerability has been set at an ATp of 100. The number of blackfly bites a person would at the river bank for eleven hours a day, 365 aCPl84.4a 5 report, the Preparacory Assistance U-iss 20 yearst "very high ievel control"l o necessery as t'the cumulaLive lifespan 4.3 The technical approach to onchocerciasis control in the Programe erea, as deternined by the PAG Mission and inplemented by 6P, is based on vector control and the subsequent interruption of disease Eransmission'. This control consists of aerial application of insecticides in order to ki11 the blackfly in its larval stages at breeding sites in fast flowing rivers and in large iEr""r". The frequency and intensity of larviciding are determined ,""kly on the basis of findings reported through the entomological r.rrr"illa.rce system. Ttre applicaEion of larvicides from the ground has so far been carried out on a limited scale only. 4.4 As the prospect of effective mass-Ereatment of c linical of the PAGonchocerciesis cases was rather remote at the time of submiseionion felt at that time that a period of f S. dannosum in the OCP area would be oE-a7iTEli?hocerca volvulus filariae and of the last microfilariae produced by these adults (was) in Ehe region of 16 to 18 yearstt .1 4.5 The phenomenon of ttexogenousrt reinvasion of blackflies (frorn sourcea outside the OCP area) has tended to follow a fairly uniform pattern during the past. few years. In the west, reinvasion starts gradually during the months of April and May/June (moving in an east north-easterly direction), while it "or"r later in the east. On both sides the peak falls in June/July before thedisappearance sometime during the month of August. 4.6 The annually reinvaded areas are located in Ehe western Part of the l.tali section of the present OCP area; in the north-lrestern Ivory Coast; and in the northern parts of Benin and Togo. The external sources of migration are found in Guinea in the west and in the Southern Extension area in the eaet reith a possible influx in Benin fron Nigeria. The invading blackflies all belong to the group of savanna species (S. dq*qqgff* g.q./sirbanuu) excePt in Togo where the nigrating blackflies also include the There was no reinfestation ( from sources within the during 1983. S. squamosurn 1e8. Programe boundaries 4.7 The problem of blackfly resistance to organophosphorous larvicides is ) geographically limited to Ehe Atlantic basins reduction in susceptibility of forest species in the Ivory Coast, although a(S. soubrense/sanctipauli) has spread into southern Ghana wtrere the rivers are left untreated. 4.8 WiEh a fairly localised exception, resistance has been confined to the fore^st species and it has thus been possible to continue the uoe of temephosz in more than 757. of the OCP erea. The above mentioned exception was in the lower Bandama river basin where in 1983 the savanna species pair S. damnosum s.s./sirbanun exhibited a six to seven times reduction of temephos susceptibility. The problem was overcome by the use of Bacillus thuringeniensis H-14 (Teknar)J. 4.9 The use of chlorphoxim as a replacement for temephos in the control of Abate resistant forest species has led Eo cross-resist.ance as both compounds belong to the group of organophosphorous larvicides. However, after a season of non-treatment by Chlorphoxim, thaE particular insecticide reassumes its effectiveness as a larvicide against forest species until, after about three months, resistance re-emerges. This is in contrast to resistance to temephos which is very stable. I Pac report, page 43. 2 Temephos = Abate. 3 T"krr., = one of the formulations of B.t. H-14. OcP/84.4a 6 4.10 B.t. H-14 is used during the rainy season in resistancffi organophosphorous laivicides ." lo.rg as the not exceed 50 cu.m./sec. which is Ehe upper operational Above that limit Chlorophoxin is substituted for Teknar. rI-vers affected by discharge Limit for rate does its use. 4.11 A special measure, introduced in 1983, has been the attempt to neutralize the Sirnulium reservoirs at the lower Bandama river (Ivory Coast) by the application-offi dosee of Teknar during Ehe dry season (weeks lZ to 27iin order to inpede the population explosion and the spread of blackfliesbefore the wet season. The result of this experiment (ttoperation clean-up") turned out to be quite encouraging. An inport.ant additional justification forthe operation was the fact that resistance to Abate had been detected in aavanna species prevalent along that particular sect.ion of the river. 4.12 The information and data required for directing aerial operations nonitoring the situation as regards vector control are provided by entomological surveillance netrrork. The total Programe area is divided six sectors made up of 24 sub-sectors. and the into 4.13 During the rainy season, somewhere around 24,000 km of river, including the Southern Extension erea, are under OCP entomological surveillance. The ntrmber of river kilometres actually treated by larvicides obviously varies appreciably from the rret to the dry season, during the latter reaching a level of only a fes hundred km. Eight Hughes 500 helicopters, one large BeIl 204 helicopter and two fixed-wing aircraft operate during the wet 8ea80n. 4.L4 The control of the effect of aerial operations is carried out at 230 capture points used for ABR"/ATP calculations within the treated Progra'rne area to wtrich should be added 46 points in the Southern Extension area. During the wet seeson 286 sites were visited once a month by entomological surveillance staff in order to check for the absence/presence of blackfly aquatic stages in rivers treated; to capture blackflies wtren present; and to read weter gauges, all with a view to providing the data necessary for directing aerial oPerations. 4.15 Vector control from the ground is carried out in the Bandiagara area near the Niger river in MaIi. Regular blackfly control and weekly searches for larvae are made by tlro OCP teams with the support of village health workers who have been trained for t,hat purpose by the Progranme. A11 breeding places found to be "posiEivet' are treated nanually with larvicide. 5. Epidemiological evaluation and disease control 5.1 Data pertaining to the incidence, prevalence and comnunity load of infection concerning onchocerciasis are obtained by repeated examination of populations in preselected indicator/evaluation villages. Such examinations are either simple evaluatione (microecopial examinations of skin-snips, cLinical and sinple visual testing) or detailed evaluations (opthalmological examination added). In addition, onchocercal nodules and adult worms are exiced and examined Eo determine the longevity of the female as well as its imunological properties. 5.2 The overall geographical distribution of onchocerciasis by endemicity in the Progra'n'ne erea at the time irmediately preceding of OCP operations showed extensive hyperendemic areas (prevalence levels of the 6tart rates Inore oCPl84.4a 7 than 502) between the Red and White Vo1ta Rivers above and below the border betneen Ghana and Upper Volta; along the Sissili River and its tributariee in Ghana; in the north-eastern regions of the Ivory Coast adjacent to Ehe Black Volta; and around the tltrite Bandama and Bou Rivers in the north-central parts of the Ivory Coast. Towards the more arid regions in the north of Upper Volta, the prevalence leveIs decreased gradually. A similar, but less pronounced tendency of declining infection rates prevailed when moving towards the east and west from the heartlands of the Volta River basin. The southern border of the savanna-type of onchocerciasis merged gradually with the endemic foci of the ttforest-typettof the disease. On the whole, epideniological findings played an important role in determining target areas for OCP activities.Ttre PAG mission estimated ,that out of a total population of 10 rni11. in the original Progrnme "r..1 .o." than one million suf fered fromonchocerciasis including up to 100 000 cases of severe eye lesions of which at least 35 000 were blind. 5.3 The distribution and prevalence of blindness corresponded relatively well with the endeoicity levels of onchocerciasis. In areas wtrere the disease was hyperendemic, the blindness rates reached 47 or Eore, in mesoendemic zones(35-602 infection rates) they oscilliated between 2Z and 4X, wtrile in hypoendemic cmunities (belos a prevalence rate ot 357) the rates dropped to the level of 0.5 to 27. 5.4 The st,atistical unit at OCP HQ (see paragraph 6.1 below) has recently introduced the concept of the mean microfilarial load of a cohort of adults(cormunity load of infection) as an indicator of Ehe intensity of infection. This indicator is considerably more sensitive than the prevalence rate when it cones to detecting a decrease in the number of adult uorms in a previously hyper-endenic population having been exposed to the effect of vector control for some time. The difference bet.ween the sensitivity of the two indicators is less marked in meso- and hypo-endemic areas. 5.5 The downward t.rend in the prevalence of onchocerciasis within the Programe area, which is now apparent, ri11 become increasingly discernible over the next five years. While epidemiological findings have so far had lirnited impact on day-to-day decisions regarding the direction of Programte control activities, there can be little doubt that such findings will come to play an ever increasing role in the operational decision-making Process. .6 Somewhere around 75 villages (ab. 300 inhabitants each) are visited ach year (60 for simple and 15 for detailed examination). 5.7 The control efforts of the Programe have been almost entirely concentrated on larviciding. Until the Present time there is no drug available which is sufficiently effective and safe to be used for large-scale selective population chemotherapy. Diethylcarbamazine (pnC-C ) is a microfilaricide with a rather short-1ived effect and causing intense reactions as a result of killing rnicrofilariae. DEC-C is, therefore, not suitable for mras-treatment which is elso the case for Suramin, a -acro-filaricide, wtrich gives riee to aevere side-effects essentially due to a high level of toxicity. 1 Th" total populaEion of the present (1984) Programe southern part of Ivory Coast) is estimated at 15 million. area (including the 5 e oCP I 84.4a 8 6. Statistical Angls:!r 6.1 An important aspect of the monitoring of control activities and of the field research progra"rme is the sEatistical analysis of operational data and statistical support to the planning and implementation of the various research activities. The OCP biostatistician thus plays a major role in ensuring that individual research proposals are planned and executed in a coordinated manner, according to priority needs of the Programme, and that the analysis of research/operational data and the conclusions drawn therefrom become available as early as possible, a task nhich is facilitated by the recenE installation of a computer in oCP/HQ. 7. Ecological monitoring 7.L The surveillance of the hydrobiological environment in terms of detecting any possible adverse effects of new or currently ueed larvicides ernployed in the control of onchocerciasis has already for some years been the operetional responsibility of three Participating Countries, i.e. Ghana, Upper VoIta and the Ivory Coast. Sinilar activities are carried out by the governments of Benin and Togo in their respective sections of the Southern Extension area. Each country has established its orrn team for the purpose of ecological monitoring within iEs national boundaries. 7.2 The role of OCP in this field is one of coordination and the initial detection of possible adverse effects of nes larvicides being tested. The Progranme also enters into contract6 with national institutes responeible for hydrobiological data collection and analysis. 8. Socioeconomic development 8.1 The adverse effect of onchocerciasis on socioeconomic development is implicitly referred to in the overall Prograrnne objective defined by the Expert Advisory Comittee (EAC). The monitoring of any population movements r*rich could be ascribed to the successful operations of OCP and the impact of such movenents on the populations concerned have therefore received due consideration by the Programme. OCP HQ receives regular reports from Ehe Participating Countries on their socioeconomic development, with particular emphasis on that occurring in ttoncho-controlledt' arees, which are presented to the constituent bodies of the Prograrnne. 8.2 As a corollary to the reduction in onchocerciasis transmission brought about by the control of blackflies, the Programe has been instrumental in enhancing socioeconomic development among populations of the OCP area through the "liberationttof fertile land, which had previously been deserted due to a high endemicity of the disease. 8.3 Obviously, the planning for and inplementation of progrermtres for repopulation of "oncho-controlledtr areas is the prerogative of the Participating Countries concerned. The role and activitiee of the OCP Socioeconomic Development Unit have consequently been oriented towards the collection, analysis and dissemination of information on developnnents in this sphere within the Programe area, the conduct of special studies for the benefit of OCP countries, and support to governments in their efforts to improve the social and economic conditions of populations moving into previously rroncho-infectedtt areas. cEP/84.4a 9 9. Training 9.1 In the early days of the Programe, the main emphasis as regards training was on the preparation of naEionals, essentially from the Participating Countries, to assume operational responsibilities as OCP Staff Members. This, however, did not preclude the training in onchocerciasis control and related fields of nationals employed in their own countries. The orientat,ion has been towerds t.he st.rengthening of countriest support to the Prograrune and of their capability to eventually support the devolution Process and to carry out former OCP activities. A linited number of fellowships have also been awarded to OCP staff meubers to study and faniliarise Ehemeelves with certain special Eechniques and procedures of particular interest to the Prograrune. The training has increasingly been carried out within OCP itself or in institutions located in West Africa. Only in highly specialized fields are fellowships being anarded for studies outside the Programe area. In a few cases have fellows from other, non-OCP, countries been admitted as trainees and assigned for shorter or longer periods to Progranrme operations of particular interest to them. 9.2 The OCP training programe has addressed itself to three cetegorieg of health- and health-related manporrer froo Participating Countries (and in a fen cases from within the Programe staff itself), namely professionale(physicians, entomologists, hydrobiologists, economists, etc.); technicians; and adrninistrators. 9.3 The najority of fetlowships and in-house training has been given in the field of entomology and vector control with particular emphasis on hydrobiology. Physicians and nurses have received post-graduate training in such fields as ophthalurology, parasitology, biostatistics, economics and highly specialized examination and study techniques. Annex 3 presents in a tabular forn the number of fellowships granted since the inception of the Programne by subjects studied and by fellowsr count.ries of origin. 10. Research 10.1 It was understood from the stert of the Progrrnme that continuing research would be required in respect to the identification, lifecycle, reproduction and transmission of Onchocerca volvulus; the pathology, diagnosis, treatment and epideniology of the disease; and the identification, reproductive behaviour, flying/resting patterns, vector capacity and control of the various Sjggl-ig cytospecies. Furthermore, as the Progra e has developed it has Uee.r.s"pported by ongoing operational research concerned rrith such issues as treatnent schedules, aerial and ground transport, improvement of spraying equipnent, blackfly trapping and organisation of entomological surveillance. 10.2 A great deal of the research is carried out. in the OCP area by the Progrrnmers scientific and operational staff, with or without the assistance of consultants, but use is also made of collaborating institutions andlaboratories, within or outside the Prograrnme are8, which undertake to investigate specified problerns under contract with OCP. A special case is the Onchocerciasis Chemotherppy Project which is being irnplemented in close collaboration with TDRr and the pharmaceutical industry. A fruitful collaboration has also been established with the chemical industry in the search for new larvicides and improved formulations of those currenlly in use. Itt WHO/UNDP/IBRD Special Programme for Research and Training in Tropical Diseases. OCP 184.4a -10- 11. Budeetary and financial espects of the Prograrnrne 11.1 The financing of the Onchocerciasis Control Prograrmae is borne by a number of governments of countries situated outside the OCP area, by certaininternational development banks, and by organisations/specialised agencies belonging to the United Nations system. A11 contributions are paid into an Onchocerciasis Fund which is administered by the World Bank. A separate aource of financing is provided by the Participating Countries at the level of LZ of the annual budget estimates. LL.2 A Plan of Action and Budget is presented annually to the Joint Programe Cormittee for approval on the basis of which funds are secured for the subsequent year. Every quarter the Progranme Director draws from the Fund the amounts required to support Ehe operations. The @P expenditure is subject to the same internal and external audit as LIIIO while the OCP Funditself is audited by the World Bankrs external auditors. I1.3 In L973 the PAG Mission estimagsd that the Prograrrne would require funding at a level of tfZO million over 20 years (1974-1993). of rhis sum,$fA nillion would be required for the first financial Phase (o974-lg7g). Thereafter expenditure rraa estinated on an annual basis, that is $5.8 rnillionper annum for the period 1980-1983 ana $5.6 nillion per annr.m for the period 1984-1993. 11.4 It is interestilg-to conpare the }lissionrs estinate of expenditure with actual expenditure during the first ten years of EEZ-Ei[rame. Measuredin terms of 1980 US do11ars, Ehe Mission estimated an expenditure of $119.2 nillion for the period L974-L983. Act.ual expenditure for this same period was $134.7 ni1lion. Thus, for a Een year period, actual expenditure hae exceeded estimated expenditure by only 132. 11.5 In 1974 the Progranrme was financed by only six Donor Countries, LrNDP and the World Bank. Now, there are 13 Donor Countries, plus development banks, foundations and international organizations. (Annex 4 lists the current (1984) donors). 11.6 The total budget. approved for 1984 asount,s to US$ 24 202 000 Annex 5 shows the distribution of the budget by Programe activities. ocPl84.4a 11 - 12. Srmary of results and achievements 12.1 Ttre changes in the entomological situat.ion due to OCP operations have been impressive. Measured by the Annual Biting Rate (ABn) and the Annual Transmission PoEential (ATP) there has been a remarkable regression in the deneity of onchocerciasis throughout the original OGP are8, excePt in those peripheral zonea wtrich are subject to reinvasion of Simulium s.1. (Annex 6 illustrates ATPs at catching poirrt": before Program,ne ifl-atiotrs and in 1983.) L2.2 The findings of longitudinal ophthalmological investigations over 7-8 years, and in particular the nou very low-Ieve1 of invasion of the eye of microfilaria (nf,), confirm the reduction in transmission of Ehe disease. Of those r*ro initially showed ocular microfilariasis, 702 have nold improved/recovered while there was no change in 157, and deterioration in 10-302 of the cases (depending on the invasion load). In virtually all those suffering from punctate keratitis the lesions have healed spontaneously; two-thirde of early stage ocular lesions have stabilized /inproved, nith 57 of the subjects having proceeded to blindness, as did 77, of the advanced lesions. L2.3 A particularly reliable indicator for measuring the epideniological impact of the Prograrnne is the incidence of infection and disease aoong children born since the stert of cont.rol operatione. Recent investigations have demonstrated that in 9O7 of che original OCP area, this group of children has been sithout risk of contracEing onchocerciasis. The prevalence trends observed during the tine incerval betneen the pre-control era and 1983, by different age-groups, are illuotrated in Annexes 7 to 9 L2.4 The uae of the mean nicrofilarial load index in the gEatietical analyeis of epidemiological evalua!ion data has made it poseible to drarc regression lines in respect to the levels of intensity of infection over deiined periods of time, both for initially hypo/oeso-endemic and hyper-endemic populations. Practically all such regression lines converge at zero aE a point of time situeted around 11 years after the interruption of transmission. Ttre inplied assumption, that th" -ry longevity of the adult worm is in the neighbourhood of 11 years has received support by the findings of laboratory studies on the mortality of macrofilariae. 12.5 As long as onchocerciaeis persisted in highly exposed, hyperendemic conmunities, it would give rise to blindness at an early age (nean: 39 years) when the victios would normally be at Ehe peak of their productive livee. The blind persons became an economic liability to the co-unity and would, themselvee, suffer a 13 to 15 years reduction in life expectency. It has been eetinsted that as a result of Programe operations,27 000 people have been eaved froo going blind in Upper Volta alone.
Annex 1 OCP Orgqligramme PROGRAM}.IE DIRECTOR ADHINISTRATION AND I.IANAGE}lENT EPIDEMIOLOGICAI EVAIUATION VECTOR CONTROL APPLIED RESEARCH ECONOMIC DEVELOP}'ENT PERSONNEL TEA}1 TEA}I 2 AERIAL OPERATIONS BUDGET rND FINANCE ADMIN. SERVICES OPHTHALMO TEAM ENTOMOLOGICAL EVALUATION SUPPL I ES TRANSPORT MANAGEMENT ZONE IiEST 3 SECTORS 11 suBsEcroRs ZONE EAST 3 SECTOITS 1 GROUP 13 SUBSECTORS I Annex 2 Start of Pro Operatlons by Geoeraphical Phases \4: boundary of present (1984) OCP area boundary of Geographical Phases boundary of Southern Extenelon area o ar-a- : rrrr - 1 ! I II t I I 'l I \ \ \\ IJ I 0. v Mrr ti at altt r. ol ! I ., Annex 3 Annexe 3 Distribution of OCp Fel lowships bv iects studied and by Fellows' Countries of Origin(cumulative until end of 1983 R€partit ion des bourses OCP class6es par suiet 6 6 et par pavs d'origi ne des boursiers(cumulative jusqu'a la fin de 1983) a Type of trainine Type de f,ormation En tomologie Hydrobiolo gY Hvd robio- logie Parasi Eology Epidemiology Parasi t.o 1 . Epidemiol. Economics Ophtalmologie Sciences econom Others Divers Trainine of technicians Formation de techniciens (4-6 months 4-6 mois) BN7 ML 7 CT7 NG 3 GII 1 SN 2 GB2 1r{ 2 GC5 TG14 HV8 UG 1 GII GC BV I 2 I cc1 EV1 total (65) 59 4 I t l*.rr""n.r ...rr,r* L-..""*." lTl?"r srarr | - ""d."" total (14) - technicians - techniciens total (13) ML1 SU 1 NRl sL1 BN GC Itv 1 1 I ML TG !H 1 2 1 HV1 I.Jlt 2 4 7 3 BN1 GH 4 MLl HV4 HV3 5 1 4 3 BN CI GH 2 1 1. HV TG 2 1 GP.2 GH HV 2 2 BN GH TG I 2 t BN CI G',n I I 2 HV ML SN 1 1 1 HVl 7 2 4 4 7 I versi tr t. univers. (2-3 yrs .f ans) total (25) @., page 2) Entomology Oph chalmologv Annex 3 Annexe 3 -2- fype of trainins lype de fo rmaEion tomo logieEn Hydrobio Hydrobio- logie logv Parasitology Parasi to 1 . Epidemiol. E emlo Ophthalmologv talmo e Economics Divers Others universitaire aduate orma t- GC ML NG TN 1 1 2 1 BN CI HV12 1 GH GC 1 I slHl GC NG 1 1 E{ GTI NG I 1 1 total (17) 5 4 3 2 3 1 (134) 8o L4, 18 lo 7 5 BN: Benin GB: Guinde Bissau ML: MaIi SN: Senegal TN: Ianzanie L'H: oMs/vftto CI: GC: NG: SL: C6te- d'-Ivoire Ivory Coast Guin6e (Conakry) Guinea Niger Sierra Leone GH Gtrana HV: Haute Volta Upper Volta NR: Nigeria SU: Soudan Sudan UG: Ouganda Uganda TG: Togo Entornology Sciences econom. university trs. I Annex 4 Annexe 4 a List of Donors to the Onchocerciasis Control Prosramme Liste des donateurs au Progranme relgiuy'aelgique Canada France Germany, Federal Republic otfltt"^rgne, Republique Federale d' ratyf tt"tie ;apay'.lapon Kuwaiy'Koweit Nether lands/fays-ras Norway/Norv6ge Saudi Arabia/arabie Saoudite Switzerland/S,ri r.. United Kingdom of Great Britain and Northern lrelandr/Royaume-Uni de Grande-Bretagne united states of Americar/Etats-unis d'Amerique et d'r'rlande du Nord African Development f.rrty'f.rrque africaine de D6veloppement A1 Sabah Foundatioy'Fondation A1 Sabah Organization of Petroleum Exporting Countries/Organisation des Pays Exportateurs du Petrole United Nations Development Programn"/P.og.rr*r. des Nati.ons Unies pour 1e D6veloppement Itre World nanly'U Banque Mondiale World Health Organizatioy'Organisation Mondiale de la Sant6 1984 , I Annex 5 Dis tri bution of the Budget by Progranune Activities 1984 - $ ooo Epidemiological Eveluetion $ aso Economic Development(3.5%l Vctor Control 3136(xl \(56.2St $ 3o4(1.3%) Applied Rcsearch,Environmental Monitoring, Oata Processing and Training t 2666 fi 1.0%) Chcmothcrapy $2 500 -/ 0o.3xl Officc of thc Programme Oir?ctor t 865 Adminirtrativc Suppon, Ouagodougou 3 1624 (6.7%) Liaison AF RO Brazzavillc 370 (0.3%) Adm i n istrativc Support, Geneva W6t?rn cxtcntion|t 282 (s.3%t Meetirgs $ 178 3 260 10.7%l fl.r*l I I , Annual Transmisslon Potential 1. Before Proeramme operatlons I \ a., t I 2. L982 - 1983 Annex 5 O o-. Q ro-rr O a-r e o-n Oo' o .'-\'ll,- O 'roo o t00- 199 Q zoo-rss Q r,oo-zes(9 -ooo o I ') -t -J- ''l I I ! ! i I ! I a Annex 7 Prevalence of erciasls: O-4 Years 1. Before Progranme Operations ! O Prcwtcncc >O O Prcvutcncc ' O O Prcvolcnce incr.qsiqt o 6 dt /_t-- )I a aj \ 1 t ,i a 2, L983 Prcvohmr o 0 I t , 't ! a -O. I( t I .--r,. I{* - .\ I I I I ! I I IAnnex 8 1. Before Progranme Operat.ions O Prrvolcnce > 0 O Prrvoloncc = 0 6 I r!. -l ,--.-. I t ! I ( I I 2. 1983 OPreyolcncc incrcosing O Pranolcncc dGcr"o3ing O Prcvolcncc . 0 o I I I I I I aa I t Prevals.nce of Onchocerciasis: 5-9 Years I I I I 't i\ Annex 9 Prevalence of Onchocerclasls: 10-14 Years 2. 1?83 ! O Prcvolcncc >0 O Prrvolme: 0 o ItPravol.nc" inct"o3ing OPrcvolcnca dacrroring OPrrvohncr r 0 o t, t I I ( o I ,-..-.j I t .: II I I I I I I ."..-.1 I L 1 i t6, I o (' o -l T oo-o ,)ii' 1. Before Programe Operatlgns t ( ..) o-.