Report of the sixteenth session of the Technical Consultative Committee (TCC): Ouagadougou, 17 - 21 March 2003

AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) REPORT OF THE SIXTEENTH SESSION OF THE TECHNICAL CONSULTATIVE COMMITTEE (TCC) Ouagadougou, 17-21 March 2003 DIR/APOC/REP/TCC16 10/06/2003

i CONTENT Page A. OPENING (including agenda items 1, 2, 3, 4, 5, 6, 7, 8, 9 et 10 de l’ordre du jour)............... 1 B. REPORT ON THE REVIEW BY THE APOC MANAGEMENT OF 1ST, 2ND, 3RD, 4TH AND 5TH YEAR PROGRESS REPORTS AND SUBSEQUENT YEAR BUDGETS (AGENDA ITEM 17) ....................................................... 6 C. REVIEW, CONCLUSIONS AND RECOMMANDATIONS DU TCC16 .............................. 6 C.1 REVIEW OF 1ST , 2ND, 3RD, 4TH AND 5TH ANNUAL TECHNICAL REPORTS (AGENDA ITEM 19).................................................................................................................... 6 CAMEROON ................................................................................................................................. 6 Sanaga/Belabo CDTI Project (1st year report) ...................................................................... 6 South West I CDTI Project (4th year report) ......................................................................... 6 Littoral II CDTI Project (3rd year report) .............................................................................. 7 Centre 3 CDTI Project (4th year report) ................................................................................ 7 Centre I CDTI Project (1st year report) ................................................................................. 8 North Province CDTI Project (4th year report) ..................................................................... 8 West Province CDTI Project (2nd year report) ..................................................................... 8 CONGO ......................................................................................................................................... 9 CDTI Project (2nd year report) .............................................................................................. 9 DEMOCRATIC REPUBLIC OF CONGO ..................................................................................... 9 Kasaï CDTI Project (2nd year report) .................................................................................... 9 Uélé CDTI Project (1st year report) .................................................................................... 10 Bandundu CDTI Project (1st year report) ........................................................................... 10 LIBERIA ...................................................................................................................................... 11 Lofa, Bong, Nimba and Montserrado Countries CDTI Project (3rd year report) ................ 11 NIGERIA ..................................................................................................................................... 11 Kogi CDTI Project (5th year report) .................................................................................... 11 Enugu/Anambra/Ebonyi States CDTI Project (4th year report) .......................................... 11 Imo-Abia State CDTI Project (4th year report) ................................................................... 12 Zamfara State CDTI Project (4rd year report) ..................................................................... 12 Oyo State CDTI Project (3th year report) ........................................................................... 13 Benue State CDTI Project (3rd year report) ........................................................................ 13 Kwara State CDTI Project (3th year report) ........................................................................ 14 Ogun State CDTI Project (1st year report) .......................................................................... 14 Yobe State CDTI Project (4th year report) .......................................................................... 15 Kaduna State CDTI Project (5th year report) ...................................................................... 15 TANZANIA ................................................................................................................................... 15 Kilosa Focus CDTI Project (1st year report) ....................................................................... 15 Tukuyu Focus Vector Elimination Project (4th year report) ............................................... 16 UGANDA ................................................................................................................................. 16 Phase I CDTI Project (5th year report) ............................................................................... 16 Phase II CDTI Project (5th year report) ............................................................................... 17 Itwara Focus Vector Elimination Project (3rd year report) ................................................. 17 Mpamba-Nkusi Vector Elimination Project ....................................................................... 18 ii C.2 REVIEW OF THE NEW NATIONAL PLANS AND PROJECT PROPOSALS (AGENDA ITEM 18).................................................................................................................. 18 CAMEROON ............................................................................................................................... 18 Adamaoua I Province CDTI Project ................................................................................... 18 South Province CDTI Project ............................................................................................. 19 DEMOCRATIC REPUBLIC OF CONGO ................................................................................... 19 Preamble on issues common to new projects proposals from DRC ................................... 19 Equateur-Kiri CDTI Project ................................................................................................ 20 Katenga-Nord CDTI Project ............................................................................................... 21 Katenga-Sud CDTI Project ................................................................................................. 21 Lualaba CDTI Project ......................................................................................................... 22 Mongala CDTI Project........................................................................................................ 22 Nord-Ubangi CDTI Project ................................................................................................ 23 Sud-Ubangi CDTI Project .................................................................................................. 23 Tshuapa CDTI Project ........................................................................................................ 23 ETHIOPIA .................................................................................................................................... 24 Preamble on issues common to new project proposals from Ethiopia ............................... 24 East Wellega CDTI Project................................................................................................. 25 West Wellega CDTI Project ............................................................................................... 25 Illubabor CDTI Project ....................................................................................................... 26 Jimma CDTI Project ........................................................................................................... 26 Metekel CDTI Project ......................................................................................................... 27 Gambella CDTI Project ...................................................................................................... 27 TANZANIA ................................................................................................................................... 28 Tunduru Focus CDTI Project ............................................................................................. 28 D. ADDITIONAL SUBJECTS CONSIDERED BY TCC16 ....................................................... 28 Item 11 : RAPLOA and the environmental risk mapping and its consequence on the implementation of the approved CDTI projects ........................................................ 28 Item 12 : Update on the evaluation of sustainability of CDTI and country plans .................... 29 Item 13 : Independent monitoring of CDTI projects in 2002 in Tanzania and Liberia ............ 30 Item 14 : Update on vector elimination activities : Bioko (Equatorial Guinea); Tukuyu Focus (Tanzania) ; Itwara and Mpamba-Nkusi Foci (Uganda) ................... 30 Item 16 : Report on the financial management of APOC funded projects ............................... 30 Item 20 : Review of operational research proposals................................................................. 31 Item 21 : Other matters ............................................................................................................. 31 Item 22 : Date and place of the seventeenth session of TCC ................................................... 32 Item 23 : Conclusion and recommendations of TCC16 ........................................................... 32 Item 24 : Closure of the session ............................................................................................... 32 ANNEX 1 : LIST OF PARTICIPANTS ................................................................................ 33 ANNEX 2 : PROVISIONAL AGENDA ................................................................................ 35 ANNEX 3 : TCC16 RECOMMANDATIONS/ENDORSEMENT/APPROVAL ................. 36 1THE APOC TECHNICAL CONSULTATIVE COMMITTEE Sixteenth session Ouagadougou, 17-21 March 2003 A. OPENING (including agenda items 1,2.3.4,5,6,7,8,9,10 and 15) 1. The sixteenth session of the Technical Consultative Committee was held at the APOC Headquarters in Ouagadougou from 17 to 21 March 2003 with Professor Eka Braide in the Chair (the list of participants is attached as Annex 1). 2. Dr Azodoga Sékétéli, Director of APOC, welcomed the participants to Ouagadougou of whom Dr Christine Godin Benhaim and Prof. Soungalo Traoré attended the session as full Members for the first time. He referred them to the relevant section of the Memorandum of Understanding for Phase II of APOC operations which will help them to familiarise themselves with their role as TCC members. Dr Sékétéli also welcomed Dr T. Ukety of the Democratic Republic of Congo as an observer of the session. 3. Then, the Director of APOC noted that TCC had a heavy agenda to deal with which included important technical and strategic issues such as the control of onchocerciasis in Loa loa areas and continued APOC-funding of projects based on approved sustainability plans. He also drew TCC's attention to the support and managerial role of some designated senior staff of WHO implementing APOC in the activities of the WHO/AFRO Special Intervention Team (SIT) which had been set up to continue residual activities in the Special Intervention Zones (SIZ) of the ex- OCP. Dr Sékétéli finally welcomed Prof . Braide in her new capacity as Chair of TCC. 4. Dr Sam Bugri, Chief of the AFRO Multidisease Surveillance Centre (MDSC), then conveyed the regrets of Dr Mohamed Hacen, WHO Representative to Burkina Faso, of being unavailable to attend the TCC session due to his absence on duty travel. Dr Bugri looked forward to the guidance of the Committee on a number of issues of direct relevance to the MDSC. 5. Dr Boakye Boatin, Director of OCP stressed that OCP had come to a successful end in December last year after 29 years of operations although, as already mentioned by the Director of APOC, control activities would continue for another five years in the SIZ by a Special Teams also responsible for “risk management”. He also informed the committee about the OCP closure activities which are going on (data entry, regularisation of outstanding claims, finalisation of the training of the last batch of staff not yet reemployed, completion of financial statements, transfer of equipment, materials, vehicles and buildings to SIZ, APOC, MDSC, WHO Representative in Burkina, and the former OCP countries, preparation for a final financial audit in June 2003, etc.), under the responsibility of a small team of former OCP staff members. 6. The Chair reiterated the welcome of the Programme Director. She recounted the several field visits undertaken by TCC members to assist projects in their implementation. She also referred to the heavy workload to be carried by the current TCC session which would deal with several new project proposals and other important issues, and appealed to the Members to be as brief as possible in their presentations. 7. Item 2: The provisional agenda (Rev. 1) attached as Annex 2, and the provisional annotated agenda were both approved after modifications to the latter. 28. Item 3: the Committee was informed by Dr Sékétéli about the new managerial and administrative developments in APOC since JAF8. He referred to the past when APOC had benefited from the support of OCP, in particular in the administrative fields, and presented the Committee with a new organisational chart for his Programme which would also provide support to the SIZ and AFRO Multidisease Surveillance Centre (MDSC), the latter also located in the former OCP headquarters building. 9. Item 4: as regards the role of the APOC Management Staff in the implementation of the activities in the Special Intervention Zones (SIZ), Dr Sékétéli enlightened TCC on the role of the APOC management in the implementation of the activities in the SIZ. He indicated that Dr Ebrahim M. Samba, WHO Regional Director for Africa, had given him the responsibility to centrally support, manage and supervise the Special Intervention Team (SIT) for which a Team leader had been appointed who also assumes the function of Coordinator of the Office of the APOC Director. Copies of the SIT organisational chart were distributed to the TCC participants. 10. Dr Sékétéli pointed out that the Team was not merged with APOC and that the Team and SIZ activities were financed by the remainder of the OCP Trust Fund available at the end of December 2002. TCC would have an indirect role to play in the implementation of the SIZ activities, in particular through its work on the development of the CDTI methodology the result of which would be equally important for APOC and ivermectin control in the Special Intervention Zones. Although SIT progress reports would not be formally submitted to TCC, the Committee would be continuously informed about the progress of the SIZ programme. A technical committee was being set up to oversee SIT operations. 11. Item 5: Dr Ole Worm Christensen, Secretary to the Committee of Sponsoring Agencies (CSA) in referring to matters arising from the 100th and 101st sessions of CSA, informed the Committee that the two sessions had been exclusively concerned with the organization of, and preparation for, the Donors' Conference held in Luxembourg from 8-10 October 2002 and the JAF, JPC and the Joint JAF/JPC sessions in Ouagadougou which took place from 1-5 December 2002. 12. At the Donors’ Conference participants endorsed the report of the OCP External Evaluation Team; agreed on the use of the remaining funds in the OCP Trust Fund for OCP closing-down activities and for the financing of the SIZ operations; and expressed full support for the further development of the AFRO Multidisease Surveillance Centre. The Donors congratulated APOC on its impressive progress; welcomed the efforts underway for establishing sustainability evaluation of CDTI projects; and expressed concern regarding inconsistent policies of different health programmes within the same area in respect to incentives for field workers. Finally, the Donors pledged US$ 59 million against the US$ 79 million needed to complete APOC operations. 13. Item 6: the Programme Director briefly summarized the outcome of the eighth session of the Joint Action Forum (JAF8). He reported that JAF8 commended the Programme for its progress over the past year. The issue of sustainability of CDTI projects was extensively discussed and it was confirmed that no project would be abandoned and that all efforts would be made to ensure sustainability with the possibility to extend APOC funding for a maximum of an additional three years with emphasis on the countries concerned assuming responsibility for sustainability by their own resources. The Forum approved the 2003 proposed Plan of Action and Budget for APOC. Dr Sékétéli indicated that at the close of JAF8 the date and venue of the ninth session were unknown but had now been confirmed to be held in Canada from 3-5 December 2003. 314. Item 7: Dr Mary Alleman of the Mectizan Donation Program informed the Committee about matters considered and recommendations made by the Mectizan Expert Committee (MEC) at its March 2003 meeting. The following were of particular interest to the Committee, as summarized below: 15. The MEC decided to postpone any revision to the current MEC/TCC guidelines for treatment with Mectizan in Loa loa endemic areas until the validation of RAPLOA was completed and a sampling framework for its application made available (see also paragraph 149). 16. The results of the survey on SAE reporting in 27 countries in Africa plus Yemen were presented to the MEC. It was noted that there was an overall poor response rate of 52%, but the information received indicated a good awareness and preparedness to report SAEs in almost all the responding countries. Taking available information into consideration, the MEC recommended that this survey of SAE reporting be considered completed as it had given the needed overview of the situation in a majority of the countries concerned. 17. Recent scientific data on the effect of multiple treatments/year (i.e. 4/year) with Mectizan on the survival and fertility of adult female worms and skin microfilarial densities were presented to the MEC. The operational experience and achievements of OEPA and OCP in bi-annual treatments with Mectizan were also considered. It was recognized that multiple treatments/year might offer the advantage of defining a shorter end point for oncho-control and that repeated treatments might be beneficial for skin disease. However, considering the operational aspects at present and for the foreseeable future in Africa, with APOC still striving to reach optimal geographic and therapeutic coverage, the MEC realized that it would not be possible at present to change the frequency of treatment in African programmes overall. It was noted however, that OEPA might implement different multiple treatment schemes, and OCP might have some available data from twice-yearly treatment, which could yield much valuable experience and encourage further research, including in the Special Intervention Zones. The MEC requested to be informed of future developments in this area and would come back to the issue in the future. 18. The MEC considered that treatment with Mectizan in communities hypo-endemic for onchocerciasis would reduce disease burden and contribute to decreasing transmission. Therefore, the MEC recommended:  further mapping of hypo-endemic areas and determination of numbers of people requiring treatment  the continuation of Merck’s donation of Mectizan for these communities  the further development and evaluation of strategies for treatment in hypo- endemic communities 19. Albendazole was being administered to 2 -year old children for the treatment of Lymphatic Filariasis. There were reports that in some cases, children below five years contributed to transmission of infection. TCC was therefore wondering why MEC would not lower their treatment criteria for ivermectin to facilitate co-administration of ivermectin and albendazole to children in the same communities. 20. Item 8: regarding matters arising from the 21st NGDO meeting held in Ouagadougou on 14 and 15 March 2003, Ms Pamela Drameh Avognon, Coordinator of the NGDO Group, informed the TCC that reports received from the field by the Group indicated that over 33 million people had been treated in APOC, OCP and OEPA countries in 2002, an increase of 3 million 4over the previous year. She highlighted a number of conclusions and recommendations arrived at by the Group. 21. The Group was concerned with the poor data management as reflected in the reports received from the field. These reports also indicated inadequate understanding of indicators, and data collection being perceived purely for reporting back to NGDOs and APOC Management. The Group recommended that the definitions adopted by TCC14 be included in any request made for reports to projects and that a taskforce comprised of MDP, APOC Management and the NGDO Group look at ways in which assistance could be provided to projects to improve data management, ensure backup of data and feedback to all levels. 22. The Group encouraged projects to use the revised APOC tools for participatory monitoring, as well as those for sustainability evaluation, as they incorporate sustainability issues and provide guidance on addressing operational problems. Projects should also emphasize sustainability issues in training and IEC materials. 23. Many projects did not yet have NGDO partners, a matter of extreme urgency for the APOC partnership. The Group welcomed the commitment made by CBM, IEF, the Carter Center and OPC to support new projects in DRC, Burundi, Cameroon and Ethiopia. 24. The Group discussed at length the concerns related to determining an “end point” of interventions in onchocerciasis areas and longer-term sustainability of projects. The Group recognized the urgency to define an end point if the various members were to have the capacity to support new programmes. In reality, due to phased geographical coverage in many projects, some communities would only have benefited from one or two years of treatment (see also paragraph 175 below). These communities would need continuing support for additional years to ensure full CDTI implementation. The Group recognized that NGDOs would need to discuss their continuing support post-APOC with individual countries. 25. As regards the increasing need for NGDO support with several new projects being implemented, the Programme Director stated that NGDOs were perhaps at their present limit for support and that efforts should be made to strengthen the NGDO Group and help in its search for additional funds. It was suggested in this connection that Director APOC might assist in soliciting support from additional NGDOs and that the promotion of national NGDOs could help in solving the problem. 26. After a thorough review of the issue concerning new projects for which NGDO partners had not yet been identified, TCC arrived at a series of conclusions and recommendations. It was pointed out that the Programme Document for Phase II and the Phasing-out Period did not prescribe the participation of NGDOs within the APOC partnership, thus leaving it to the governments to decide themselves on the inclusion of NGDOs in this partnership – a decision which had so far been favourable in practically all cases. However, the opinion of TCC was that NGDO participation in the APOC-conducted projects was highly desirable in the spirit of effective partnership. 27. Nevertheless, for a new project where, regrettably, it had not been possible to attract NGDO participation, TCC was of the opinion that the absence of an NGDO partner should not hinder the launching of the project if it was felt that the project fulfilled certain criteria regarding the Plan of Action both from the point of view of satisfactory implementation, resource requirements and good prospects for eventual sustainability. 28. TCC agreed on the following policy statement covering the above issues: 5"TCC notes that there were 3 proposals from Ethiopia and 5 from DRC in which there were no NGDO partners. Recognizing that the life-span of APOC is limited (closure in 2010), that NGDO resources are reaching the limit, and that there are still large populations (approximately 30 million) in need of mass treatment with ivermectin, TCC recommends that absence of a partner NGDO should not be an absolute contraindication to approval of a new proposal for APOC support: - The proposal should be technically sound. - There is evidence that efforts to attract an NGDO have occurred but have not been successful. - There is an understanding that a search for an NGDO partner, local or international will continue. - The national government commits itself to providing 25% non-APOC funds in the first year and sufficient funds in subsequent years, where no NGDO is eventually found. - The national government provides evidence that the 25% non-APOC funding requirements (usually provided by the NGDO partners) are available, and - The project environment and level of PHC development is adequate to support CDTI. Where no NGDO is eventually found for the project, TCC recommends that other NGDOs supporting other projects or WHO and UN agencies in the country provide technical support in the context of the NOTF and in collaboration between projects". 29. Item 9: the Programme Director reported on the follow-up of the recommendations of the fifteenth session of the TCC. He referred in this connection to Annex 6 to the TCC15 report in which recommendations of that session were listed. Practically all of them had been implemented by the APOC Management while some were the subject of further consideration during the current session of TCC. 30. Item 10: Mr Honorat Zouré from the Epidemiology and Vector Elimination Unit provided an update on the REMO/GIS in APOC countries (DRC, Burundi, Angola, Sudan, Cameroon, Nigeria, Equatorial Guinea and Congo Brazzaville). In order to ensure that CDTI programmes be instituted without delay also in the yellow REMO zones (REMO results to be refined) it would be important to undertake REA in such zones as early as possible after the overall REMO exercise so as to arrive at the final delineation of CDTI areas. 31. Item 15: the Committee was provided with an update on operational research by Dr Uche Amazigo who referred first to the TDR Multicountry Study on Additional Health and Development Activities of CDDs which had now been concluded and the report would soon be available. She then informed the Committee about the Progress of the TDR Multicentre Study on the Use of the CDTI approach for Other Diseases. A workshop had been held in Cameroon to develop a draft protocol for the study which was considered by the Standing Committee of TDR. Given the expected high cost of the study, only five of the planned nine teams would be funded unless additional funds were forthcoming. TDR was expected to update TCC17 in September 2003. 6B. REPORT ON THE REVIEW BY THE APOC MANAGEMENT OF 1ST, 2ND, 3RD,4TH AND 5th YEAR PROGRESS REPORTS AND SUBSEQUENT YEAR BUDGETS (agenda item 17) 32. The Management of APOC informed the Committee that 33 subsequent year budget proposals had been submitted during the period between TCC 15 and TCC 16. Of these budget proposals, 16 were reviewed for the preparation of Letters of Agreement giving priority to the projects for which the launching dates were between 1st January, 2003 and 1st April, 2003. The budgets reviewed included one 6th year (1st year sustainability plan) funding for a CDTI project and two 6th year funding for strengthening NOTF Secretariat Headquarters. C. REVIEW, CONCLUSIONS AND RECOMMENDATIONS OF TCC16 C.1 Review of 1st, 2nd, 3rd, 4th and 5th annual technical reports (agenda item 19) 33. Mr Fortune Agboton, APOC Budget and Finance Officer, informed the Committee that of the total amount budgeted for 2003, under the Budget Line Item “National Projects” (US$ 8 969 083) in the Plan of Action and Budget for that year, APOC had already spent US$ 2 030 836 for 23 projects submitted by NOTFs, including 6 CDTI projects newly approved by TCC15 (one CDTI project approved in 2001 by TCC13 not implemented due to long delays in conducting the RAPLOA; one sustainability plan for two districts under the Mahenge CDTI project which has received 5 years funding by APOC; two year 6 projects for NOTF secretariats in Nigeria and Tanzania) and 13 subsequent budgets for the previously approved projects. CAMEROON Haute Sanaga/Belabo CDTI Project (1st year report) 34. TCC noted that the present report seemed to respond to most of the concerns it express at TCC15. However there were still a need for consistency in the treatment figures. TCC also hoped to see included in the report data on usage of tablets including loss, number of persons who refused treatment and the number of absentees. TCC further noted that the transfer of the project from SSI to HKI had now been completed and the project is now called "Centre 2 CDTI project". 35. TCC therefore recommended that NOTF should specifically address the concerns of TCC15 namely taking urgent steps to improve the very poor performance of project execution and the low treatment coverage. TCC accepted the 1st year annual technical report for the Haute Sanaga/Belabo project with the above recommendations to be addressed. South West 1 CDTI Project (4th year report) 36. The TCC was concerned with the lack of progress made since the last report. Therapeutic coverage was still only at 31%, with high numbers of absentees (32,575) and refusals (113,846). Treatment was again undertaken during the farming season, a period not preferred by the communities which resulted in low coverage in the previous year. 37. TCC requested the project to elaborate on how the campaign approach that was suggested in the report would fit within the CDTI strategy. The project was also asked for more 7information on how many CDDs had received funds from the cost recovery scheme before it was suspended and how many were receiving funds from the new system. 38. The Committee recommended that the project take the following into account for the next year: (i) Distribution should be undertaken during the period preferred by the community and the project should work with other health programmes to make this possible. (ii) The project needs to increase health education and community mobilization. TCC accepted the 4th Year technical report. TCC also suggested that members of the Committee should work with the project to look at the problems during the sustainability evaluation exercise. Littoral II CDTI Project (3rd year report) 39. TCC commended the project for adequately addressing the concerns of TCC14 and for using the new reporting format. The project had: (i) intensified health education and mobilization of communities (ii) started using local media outlets in local languages (iii) conducted two treatment rounds and had increased therapeutic coverage (iv) conducted a second round of training on SAEs for health centres and hospital staff. 40. The project however failed to provide information on the outcome of the 4 cases of SAE that were referred to the health post or hospital. There still seemed to be some rumours about SAE which resulted in treatment refusals. TCC was also of the impression that NOTF was still not reviewing projects submitted to APOC in spite of the recommendation of TCC15 in that regard. TCC accepted the 3rd year annual technical report for the Littoral II project with the understanding that the above concerns will be addressed. Centre 3 CDTI Project (4th year report) 41. The project responded to TCC14’s request. TCC noted the funds released by the MOH for CDTI activities which amounted to US$ 79 834. The project reported that good progress was made in achieving and maintaining a geographical coverage of 100% and improving therapeutic coverage (from 46.8% during 2001 to 64.2% during 2002). The project puts this success to good mobilization and cancellation of cost recovery. TCC commended the project for a very comprehensive report. TCC accepted the report and recommended that: (i) Onchocerciasis activities should be integrated into district plans. (ii) The project reinforce capacity of programme staff. (iii) The project should integrate CDTI budgets into state budgets. 8Centre 1 CDTI Project (1st year report) 42. TCC noted with satisfaction that the project had adequately addressed all the recommendations of TCC15. The report highlighted the structures put in place for the management of SAEs and the use of IEC materials for the sensitization of the communities. TCC also congratulated the project on its efforts to build capacity at all levels. 43. TCC however recommended that the project should improve and sustain health education and mobilization of the communities with a view to attaining at least 65% therapeutic coverage and motivating them to take ownership of the project TCC accepted the 1st year annual technical report for the Centre 1 project with the understanding that the above recommendation will be addressed. North Province CDTI Project (4th year report) 44. TCC noted that the report was comprehensive and the project was encouraged to continue such reporting. The project was also commended for reaching 100% geographic coverage and 76% therapeutic coverage and was encouraged to maintain these levels and to reach its Ultimate Treatment Goal (UTG). It was noted that the project had responded to a number of TCC recommendations made regarding its 3rd year report (TCC 14). Specifically, the project provided details on cost recovery, what supervision entails and explained statistics provided in its 3rd year report regarding CDDs. 45. TCC made a number of recommendations: (i) The project should correct Tables 2 and 5 of the report to reflect revised numbers of endemic communities. (ii) The project should provide more information regarding the integration of migrants into CDTI. (iii) Text in the report mimics text found in West Province report and previous North Province reports. Where appropriate, new information should be infused into the text of technical reports. (iv) The project should provide clarifications on its remark, namely “heavy APOC administrative burden on NGDOs and MOH personnel due to reporting requirements and on ongoing unplanned activities”. TCC accepted the 4th Year technical report. West Province CDTI Project (2nd year report) 46. TCC commended the project for overall good programme implementation at all levels, in rural and urban communities, and particularly for obtaining 100% geographical coverage and 82.5% therapeutic coverage. It's hoped that this achievement will be maintained for the subsequent years. The project should strive to obtain Annual Objectives of CDDs involved. It was noted that the project had responded to the recommendation of TCC15 requesting that information on REAs conducted and details of SAEs occurring in 2001 be provided. 47. Although it is a well written, comprehensive report, it mimics previous reports of West Province as well as reports of North Province. As the project matures, it is encouraged to infuse 9new information into its future reports. The project should also be consistent with data from table to table. 48. TCC requested clarification on the following: (i) the 1.5 adjustment of the REA results in the hypo-endemic communities as used in tables 5 and 6 of the report. (ii) the remark: "the worrisome laborious early CDTI implementation process with subsequent administrative burden and increase workload for NGDO and MOH personnel". TCC accepted the 2nd year annual technical report for the West Province project CONGO CDTI Project (2nd year report) 49. The TCC congratulated the project for the progress made despite the difficult conditions. The Committee noted with satisfaction the involvement of local NGDOs in mobilization of communities and the involvement of communities in the assistance to CDDs. 50. The TCC recommended that the project in its next report: (i) be explicit on training activities undertaken, clearly indicating the health staff trained in the district and in health centres; (ii) clarify the contradictions and ambiguity given in the section covering the strengths and weaknesses as a number of issues appear in both sections, an example being the involvement of NGDOs stated both as a weakness and strength in the report; (ii) be consistent in the use of the terminology “villages” instead of communities, to avoid the confusion created with the use of both. This would facilitate the understanding of the figures regarding coverage. TCC accepted the 2nd Year technical report. DEMOCRATIC REPUBLIC OF CONGO Kasaï CDTI Project (2nd year report) 51. TCC commended the project for its good results in training and its performance in spite of the difficult operational conditions. TCC noted the poor support given to CDDs by the communities and that the involvement of some health staff (DMO, etc ) at the district and peripheral levels is weak. TCC also noted with satisfaction the involvement of medical officers and politico-administrative authorities and the excellent work of the CDDs who now took on other health activities. This was an indication that the APOC philosophy could lead to broader public health developments. 10 52. TCC encouraged the project to: (i) Ensure that ivermectin tablets were delivered more rapidly from the central level to the communities by sensitizing the DMO and the other district health workers. (ii) Use the common method for the calculation of the therapeutic coverage i.e. the total population at risk as denominator. (iii) Continue its advocacy activities, particularly with the ecclesiastic committees, which seemed to have a beneficial impact. (iv) Try to increase the proportion of women CDDs. (v) Continue its technical assistance to other projects in the country. TCC accepted the 2nd year annual technical report for the Kasaï project. However the Committee also strongly requested that the project cover the whole geographical area by the 3rd year. This could be facilitated by the creation of an antenna site in Kasai Oriental, if necessary additional resources could be made available for this purpose following consultation with APOC Management. Uélé CDTI Project (1st year report) 53. The committee noted that the report submitted, which did not follow the format of annual technical reporting, was not very well organized and details had to be prised from the report that consisted mainly of tables with scattered information. The project wrongly stated that it had achieved 72% geographical coverage, whereas it only achieved 23.71%. The number of health zones covered by the project was not clearly stated. The report provides no background information on the communities that decided on the mode of treatment, ivermectin usage, monitoring and supervision undertaken, integration in the primary health care system and measures taken to improve activities and the therapeutic coverage. 54. The committee was however pleased to note the involvement of CDDs in identifying epilepsy and cataract cases. TCC requested information on the following: (i) Clarification on treatment data, with accurate calculations on therapeutic and geographical coverage. (ii) Information on background, ivermectin usage, SAEs, monitoring and supervision undertaken and the indicators for integration and sustainability. TCC rejected the report and asked that it be resubmitted to TCC17 addressing the issues stated above. TCC also strongly requested that the project cover the whole geographical area by the 3rd year. This could be facilitated by the creation of an antenna site in Haut Uele if the necessary additional resources could be made available for this purpose following consultation with APOC Management. Bandundu CDTI Project (1st year report) 55. TCC congratulated the project on a report covering one out of four health districts. The report stated that financial resources for the project were guaranteed and the stakeholders were well committed at all levels of the implementation of CDTI activities. However the Committee expressed concern about the number of absentees and the lack of motivation and enthusiasm of some CDDs which could have a negative impact on coverage. TCC also noted that treatment forms were badly recorded, therefore not giving the coverage figures. 11 TCC accepted the 1st year annual technical report for the Bandundu project and recommended that: (i) clarification be given on the nature of absenteeism. (ii) CDDs be sensitized and ways be sought to improve their enthusiasm and performance. (iii) the project find ways of improving the record-keeping, collection and transmission of treatment forms. LIBERIA Lofa, Bong, Nimba and Montserrado Counties CDTI Project (3rd year report) 56. This is a well written report using the new template for reporting. The project reported that treatment was undertaken in 16 out of the 26 districts. 10 districts could not be treated due to civil unrest. Some people from the 10 districts received treatment in the displaced camps in Bong and Montserrado. The project reports a therapeutic coverage using the wrong denominator (1378 communities instead of 1622). Coverage is still low but is a significant improvement over the previous year. The Committee was pleased to note that the project had implemented community self monitoring. TCC accepted the report and asked that the project: (i) implement community self monitoring in the whole project area; (ii) use TCC14 definitions of key indicators to correct calculation of treatment coverage figures used in the report. NIGERIA Kogi CDTI Project (5th year report) 57. This is a mature project which had consistently achieved high therapeutic and geographical coverage (70% and 100% respectively for this 5th year). The project had recently been evaluated and was declared as making satisfactory progress towards sustainability. TCC commended the project for its achievement and hoped that many other projects would follow this example. TCC accepted the 5th year annual technical report for the Kogi project Enugu/Anambra/Ebonyi States CDTI Project (4th year report) 58. This is a good report containing all information required, reflecting a mature project. Thoughts had been given on a post APOC plan. Unfortunately, little attention had been given to TCC14 recommendations . TCC14 required additional information on what activities funds released by the State were used on, and who determining how these funds were used. TCC14 had also requested information on the number of ivermectin tablets used. 12 59. TCC requested that the project: (i) scale up community self monitoring which was only being implemented in a small number of communities; (ii) provide clarification on the reduction of total population by almost half a million from last year; (iii) provide the information requested by TCC14. The Committee accepted the 4th Year technical report. Imo/Abia State CDTI Project (4th year report) 60. TCC commended the project on a concise and well written report. The project had addressed most of the recommendations of TCC14 although there remained some inconsistencies in treatment figures presented in the histogram and those in the text. No data had been reported by LGA. 61. TCC was concerned about the long delay of the project in sending its financial report to APOC as only timely reporting would enable timely disbursement of funds by APOC to the project. The Committee was worried that at this stage of implementation of the project it still solely depended on external support. TCC accepted the 4th year annual technical report for the Imo/Abia project with the following recommendations - the project should: (i) re-do the histogram in the report and reconcile the data; (ii) clearly indicate the expansion of the programme to LGAs and exact number of treatment rounds by community; (iii) finalize post-APOC sustainability plan and ensure commitment of the government; and (iv) institute community self monitoring (CSM) as done by other projects taking into account the 2002 training workshop. TCC also recommended that in view of the five months of delay in financial reporting, APOC should not release any funds to this project until it had received a satisfactory financial report. Zamfara State CDTI Project (4th year report) 62. TCC noted with satisfaction the increased efforts to use culturally appropriate ways to reach women in Purdah with health education regarding CDTI and prevention of blindness. TCC also commended the project for its new efforts in training the LOCTs and CDDs on primary eye care. This was an important contribution to sustainability of the project both by adding services that are important to the community and by continuing attention to onchocerciasis as its more visible manifestations diminish in CDTI communities. 63. The cost per treatment reported was quite high, $1.01. This was because the LGA contribution was high: $104,347 for the number of people treated. TCC requested information on how the LGA contribution was calculated. Did the amount represent in-kind amounts from 13 the LGAs or actually cash provided? It was very impressive to see this level of contribution from the LGA. TCC accepted the report and asked that the project: (i) provide information on the method used in calculating the LGA cost contribution in future reports. (ii) describe the results of advocacy visits to the LGAs. (iii) reconcile seemingly contradictory statements: the project notes low response on release of counterpart funds but the LGA amount cited in Table 5 is very impressive. Oyo State CDTI project (3rd year report) 64. The project had responded to most of the concerns expressed by TCC13 and TCC15. Two recommendations still remained unanswered, namely the need for projects to have more than 2 CDDs where the village population is more than 250 people; and to be more narrative in future reports. TCC felt that overall the project's performance was good with treatment figures of 98% geographic coverage and 65% therapeutic coverage but which could still be improved. There was concern about the number of absentees and refusals of treatment. TCC accepted the 3rd year annual technical report for the Oyo State project with the above concerns to be addressed. Benue State CDTI Project (3rd year report) 65. This is an old project which started onchocerciasis control activities in 1991 and is in its third year of CDTI implementation. The project shows very little evidence of integration into PHC system. Several indicators which could be used to estimate this were not provided in the report. There was weak evidence for sustainability as a result of slow implementation of CDTI. There was inadequate commitment from the State, from the State Onchocerciasis Control Team and LGAs. The Committee recognized that if the communities were to benefit from control activities the status of the project needed to be reviewed. 66. The language of the technical report showed a high degree of complacency on the part of the State and NOTF. TCC noted that this report should have been returned to the State by the NOTF for revision. 67. TCC recommended that the project: (i) clarify contradiction in funding; the report stated that “The project had N3,560,000 in its account which was the balance of the second year funds” against “the project had no money to carry out other training and we could not carry out other CDTI activities …”. (ii) turns its weaknesses into opportunities. (iii) should show evidence of implementation of the recommendations of the Independent Monitoring undertaken in August 2001. (iv) provide evidence of implementation of the recommendations of NOCP Coordinator’s mission to the State. 14 (v) be evaluated for progress made toward sustainability by APOC as soon as possible. (vi) receive technical support from the NOCP, Zonal Coordinator and UNICEF for CDTI implementation in the State. (vii) provide the UTG. (viii) collate outstanding treatment data and complete and provide UTG. (ix) submit a 2 Year technical report. 68. TCC agreed with the suggestion by the State Coordinator that ”It may be necessary to change the Coordinator of the state team just so that we will see if things could move ahead for the benefit of the masses at the end of the line in the communities.” TCC rejected the report for resubmission to TCC17 and asked that funding to this project be stopped until remedial actions have been taken by the State and NOTF on the various recommendations. Kwara State CDTI project (3rd year report) 69. TCC reviewed this report which is a resubmission from TCC15. Inexplicably, TCC noted that the present report is exactly the same as that submitted to TCC15. TCC requested that TCC14 and TCC15 recommendations be re-sent to the project requesting it to comply with those recommendations. TCC therefore recommended that the present report be rejected and a revised report for its year 3 activities be resubmitted along with its 4th year report. TCC also recommend that funding for this project should be suspended until a satisfactory 3rd year report is received. Ogun State CDTI Project (1st year report) 70. The discussion on the registration of the population was confusing in the report. TCC was unclear whether the registration was still ongoing. The report computed coverage rates using the registered population of the communities treated as the denominator rather than the correct denominator of 895,585, the total population in the endemic communities. It was unclear whether treating only the registered communities and population represented a phased-in strategy for this project. TCC highlighted that the therapeutic coverage was 17.6% rather than the 67% reported in the report. 71. TCC recommended that the project: (i) clarify the issue of registration and how this relates to the census of the endemic population. (ii) given the low therapeutic coverage rate in the first year, provide a plan of action to increase therapeutic coverage particularly since the geographic coverage was 83%. (iii) provide data on ivermectin utilization. The Committee accepted the 1st Year technical report. 15 Yobe State CDTI project (4th year report) 72. TCC commended the project for a succinct report. The consistent contribution of the Yobe State government was noted as well as the "back seat" contribution of NGDOs and the NOCP. TCC was also pleased to note that the State and local governments were well mobilized and always ready to take up full responsibility of their partnership contributions although it was unclear in what form this contribution would take. The commitment of the various partners in this project was seen as an important indicator of sustainability. 73. TCC was however concerned that the high number of persons treated per CDD could suggest that attrition of CDDs may adversely affect the continued achievement of high levels of coverage of the project. TCC accepted the 4th year annual technical report for the Yobe State project and recommended that: (i) historical data on coverage rates and ATOs be provided to the Committee in order to provide the context for progress made in this project. (ii) the project should clarify the contribution of the LGAs. (iii) the project should provide information on CDD attribution and strategies to increase the number of CDDs per community. Kaduna State CDTI project (5th year report) 74. TCC noted that the main indicators such as the geographical coverage, therapeutic coverage, the UTG, total endemic communities, etc. were not given in the report and the conflicting treatment figures from the tables made it difficult to assess these indicators. TCC noted that the project had responded to TCC15’s request to indicate the number of ivermectin tablets used. 75. TCC was pleased to note that all 16 LGAs were fully implementing CDTI and commended the degree of involvement of communities, health staff and local authorities in the project. The project being in its final year and moving towards sustainability, it was considered important for the project to have counterpart funding readily made available. TCC accepted the 5th year annual technical report for the Kaduna project and requested that: (i) the indicators such as geographical coverage, therapeutic coverage and UTG be clearly given in subsequent reports. (ii) the project ensure that figures used in tables and the text are the same throughout the report. TANZANIA Kilosa Focus CDTI Project (1st year report) 76. The project had achieved the commendable therapeutic coverage of 63% during the first year of the project. TCC noted the good cooperation of multiple partners to support start up of the project. However, there was inconsistent data presented on total endemic population and communities. Data on the numbers of meso and hyper-endemic villages/sub-villages, population 16 by zone, ATO, UTG and geographic coverage were not reported. The report was not clear on the community level in Tanzania at which the distribution occurs. Is it at village or sub-village level? The Committee accepted the 1st Year report and asked the project to: (i) Clarify total endemic population and village/sub-village figures by level of endemicity. (ii) Provide a brief description of the level of Mectizan® distribution in the project area as background. (iii) Include ATO and UTG in report. (iv) Report geographic and therapeutic coverage. Tukuyu Focus Vector Elimination Project (4th year report) 77. The project had implemented part of the recommendations made by the Meeting on the Review of Onchocerciasis Vector Elimination Projects in the APOC Programme (May 2002). Preparations had been made for ground larviciding in the Tukuyu focus to be carried out in the dry season of 2003 followed by an analysis of the results to decide on the necessity of a second, and last, treatment round. Preparations were also being made for cytotaxonomic studies to be re- activated within the focus. 78. Furthermore, arrangements were underway for the strengthening of the entomological teams; for the institution of hydrobiological surveys; for strengthening the supervisory capacity; and for the continuation of the data collection activities i.e. fly collections, dissections and river prospections. 79. Conclusions - part of the TCC15 recommendations had been implemented. - larval stages and adult flies are being collected. - cytotaxonomical materials (larvae in Carnoy) are being collected inside and outside the main focus. - insecticide is in place and larviciding will start in July 2003. - a new vehicle and boat have been purchased for the project. - an enforced supervision team has been put in place. The report was accepted with the following adjustments: - the project to increase the number of catching days to at least 7 days per month. - future reports to follow the usual lay-out (Introduction, Activities, Results, Discussion, Conclusions) UGANDA Phase I CDTI Project (5th year report) 80. This is a well written report using the new reporting format and providing comprehensive information. The project had responded to TCC14 concerns. Definite steps were being taken for post APOC sustainability of the CDTI project using country resources from MOH and district health services, as well as APOC funds, while also looking for additional secure funding support 17 and local partners. However, 76% of funding for the 1st year of the 3-Year post-APOC period is still to be provided by APOC. TCC congratulated the project on the report and development of a post-APOC plan and requested APOC to encourage and support implementation of the Plan of Action. 81. TCC recommended that: (i) Non financial contribution of communities should be acknowledged by the project. (ii) The project provide reasons for high refusal rate among women in Kisoro. (iii) The project encourage more CSM in other communities and the use of stakeholders’ meetings. (iv) In view of budgeting but non-release of funds by MOH in the past, and no financial provision by districts in the past, there was the need to monitor for commitment given to financing post APOC plans. The TCC accepted the 5th Year technical report. Phase II CDTI Project (5th year report) 82. TCC noted that the project had responded to TCC15’s recommendations. The project had achieved 70% therapeutic coverage (369 174 persons treated) and 100% geographical coverage. Given that 100% geographical coverage had been achieved, the project was requested to check the figure for the UTG which was lower than the ATO. The TCC accepted the 5th Year technical report. Itwara focus Vector Elimination Project (3rd year report) 83. The project had implemented most of the recommendations made by the Meeting of the Review of Onchocerciasis Vector Elimination Projects in the APOC Programme (May, 2002). TCC commended the team for the good progress made. 84. TCC concluded that: - S. neavei is absent from the principal Itwara focus. - The sub-foci of Siisa and Aswa present still positive S. neavei breeding sites. - Part of the TCC15 recommendations were implemented. - Prof. Garms visited the project sites. - River prospections have been carried out. - Fly catches and dissections are on-going. TCC accepted the report and recommended that the project: - Continue river prospections. - Continue fly catches and dissections. - Implement larviciding in the positive breeding sites. 18 MpambaNkusi Vector Elimination Project 85. The project has implemented part of the TCC 15 recommendations. Prof. Garms paid a visit to this project and gave advice on the vector elimination. The field activities (crab collections, fly catching and dissections) are being carried out and should continue. The project should also envisage another round of ground larviciding to be sure to attain the ultimate goal of S. neavei elimination. TCC commended the team for the good progress made. 86. Furthermore, in view of the good progress the project is making, funds should be disbursed in time. 87. Conclusions: - Implementation of part of the TCC15 recommendations - Prof. Garms visited the project sites - River prospections have been carried out - Fly catches and dissections are on-going - River treatment has been done - Mapping of breeding sites completed - Increase in staff strength TCC accepted the report and recommended that the project: - Continue river prospection. - Continue fly catches and dissections. - Continue ground larviciding. C.2 Review of new national plans and project proposals (agenda item 18) CAMEROON Adamaoua I Province CDTI Project 88. This proposal was a resubmission of the proposal reviewed by TCC14. The project plans to include 3 additional districts (Djohong, Ngaoundere and Tibati) to the existing Adamaoua 2 CDTI project already supported by APOC, covering 4 districts (Tignere, Banyo, Bankim and Meiganga). The 3 new districts have been under treatment with Mectizan since 1997-8 with funding from Lions SightFirst and the International Eye Foundation. TCC noted that the proposal seems to request additional support from APOC for the initial four districts funded by APOC in 1999. The Committee noted that the project had already implemented the MEC/TCC guidelines for treatment in Loa loa endemic areas in the appropriate health districts. 89. The Committee maintained its recommendation made during TCC14 that this project area should stand alone and not be considered an extension of the ongoing APOC supported Adamaoua 2 project and further recommended that: 19 (i) APOC review the epidemiological data in the proposal to ensure that the results of the recent REMO refinement were used to determine the communities appropriate for mass treatment. (ii) Project provide the REMO summary and map for the treatment area as requested in the recommendations of TCC 14. (iii) The budget should only request support for the treatment area that will be covered by this CDTI project and should clearly indicate all partners providing financial support. TCC rejected the proposal and requested that the proposal and budget be revised and resubmitted through APOC Management for review by the TCC reviewers. Assistance with preparing the revision could be sought from the NOTF Coordinator and/or APOC. South Province CDTI Project 90. This project is located in two small isolated areas with a estimated population of 80 000 inhabitants (to be verified from the country), geographically distant and almost opposite (south and east) in locations from each other. Although technically, a well written proposal, it would seem that it was entirely conceived on the basis of data from 1992 parasitological data. TCC noted that they did not use the REMO map in preparing the proposal, giving rise to different geographical delimitation and interpretations of the exact project area. 91. TCC was concerned that the area could be a Loa loa endemic area but the proposal did not give any indication of the presence of Loa loa in the area . Given their geographical locations, TCC felt that, if operationally possible the Bengbis "arrondissement" could be attached to the Eastern Province project, and Olamze "arrondissement" be submitted as a separate proposal also including clinic-based treatment in the hypo-endemic communities in the Province. TCC however acknowledged that problems of supervision could arise when projects ran across/into other administrative provinces. 92. Considering that the project would be operating in an area suspected of being endemic for Loa loa, the MEC/TCC guidelines for treatment with ivermectin in Loa loa endemic areas should be implemented unless the project could provide evidence for the absence of Loa loa in the project area. TCC rejected the proposal and requested that the budget be revised based on the REMO map and resubmitted through APOC Management for review by the TCC reviewers DEMOCRATIC REPUBLIC OF CONGO Preamble on issues common to new projects proposals from DRC 93. The Democratic Republic of Congo has submitted 8 new CDTI project proposals, Equateur, North Katanga, South Katanga, Lualaba, Mongala, North Ubangi, South Ubangi, and Tshuapa projects. In reviewing these new proposals, TCC noted that many paragraphs were common to all proposals while a few were specific to individual projects. To assist the NOTF in addressing the common issues, they are summarized below: 20 Loa loa: 94. Surveys should be conducted to determine which project areas are endemic for Loa loa prior to the implementation of mass treatment for onchocerciasis. The MEC/TCC guidelines for the treatment of onchocerciasis with Mectizan in Loa loa endemic areas should be applied where appropriate. Descriptions of projects’ plans for the implementation of these guidelines should be fully described, and project budgets should be adjusted accordingly. REMO: 95. The REMO should be refined where necessary so that populations eligible for mass treatment can be identified. Treatment objective for Year 1: 96. The treatment objective for the first year of activities should be reduced to approximately 200,000 people in project areas where Loa loa is endemic. Budgeting: 97. Justification should be provided for each line item. Data describing populations in treatment areas: 98. The data describing the total populations and the populations eligible for mass treatment in the project areas should be consistent throughout each respective proposal. Specifics of project areas: 99. The proposals were found to be similar with regard to plans for implementation of the CDTI strategy. Each project is requested to submit a 2-3 page description of its unique plans for implementation and potential constraints and challenges (civil unrest, etc). KAP studies: 100. If KAP studies have been conducted in the project areas, a brief description of their results should be included in the descriptions requested above. If they are planned, the projects should indicate when they will be conducted relative to the first distribution and who will conduct them. 101. More detailed information is requested regarding the following:  Social aspects of community activities;  Prior community experience in development and health projects;  Community supervisors ;  the difference between the solidarity system to support CDDs and the cost recovery system for ivermectin distribution;  the activities and services provided by the SSP. Technical Assistance: 102. A mission of TCC members and other experts should be sent to DRC to provide technical assistance to the NOTF and project coordinators in planning the implementation of these new CDTI projects. Equateur-Kiri CDTI Project 103. REMO undertaken in this area revealed five hyper/meso-endemic health zones in the district of Equateur to which will be added the definite CDTI area of the health zone of Kiri in the district of Mai-Ndombe (Bandundu Province). The project plans to treat 969 communities in its first year of implementation and will treat 1 029 295 people living in 1 940 communities by its 21 fifth year. Christoffel-Blindenmission (CBM) is the NGDO partner in this project. TCC noted that Loa Loa is co-endemic in the project area. 104. TCC recommended that: (i) The project carry out a survey to determine Loa Loa endemicity in this zone. (ii) Realistic ATO be developed, given that the project would have great difficult reaching its UTG within 2 years. (iii) The project should provide the correct total population and treatment should be organized to take into account the migrant population. (iv) The NOTF play a stronger role in the project. (v) The budget be reduced with particular attention on capital equipment. TCC recommended the approval of the project following the revision of the proposal to address the concerns raised by the TCC and the revision of the budget. TCC further recommended that a TCC mission be undertaken to DRC to provide technical assistance to the project in line with the preamble stated above. Katanga-Nord CDTI Project 105. This is a new proposal covering two districts (Haut Lomami with 11 Health Districts and Tanganyika with 9 Health Districts) with a total population at risk of 941 871. REMO was done in April 2002 but still required refinement in some areas. With the exception of one hyper- endemic and two meso-endemic zones, the rest of the zones are hypo-endemic. Although there was no indication of Loa loa endemicity, surveys should be done in this regard. No NGDO partner has been identified for the project. 106. TCC noted with concern that CDDs would be carrying out activities such as treatment of SAE. The Committee requested that the health authorities ensure that such activities are actually undertaken by health staff. 107. The overall budget seemed reasonable although the cost of equipment reflected therein appeared inappropriate and the partner contributions rather small. TCC recommended the approval of the project following the revision of the proposal to address the concerns raised by the TCC and the revision of the budget. TCC further recommended that a TCC mission be undertaken to DRC to provide technical assistance to the project in line with the preamble stated above. Katanga-Sud CDTI Project 108. REMO was undertaken in Katanga-Sud Zone in early 2002. The project covers 3 endemic health zones in the province, Mufunga-Sampwe, Kansenya and Kampemba. The project plans to treat 546,000 in the first year and reach its UTG in the second year, treating over 700,000 people in 1,447 communities. TCC noted that this was a possible area co-endemic for loiasis. 109. TCC recommended : (i) The project identify an NGDO partner. (ii) Reduce the budget. 22 TCC recommended the approval of the project following the revision of the proposal to address the concerns raised by the TCC and the revision of the budget. TCC further recommended that a TCC mission be undertaken to DRC to provide technical assistance to the project in line with the preamble stated above. Lualaba CDTI Project 110. Lualaba is situated in the Province of Katanga with a population of 727 000 of which 266 000 are at risk in two health zones. The project area is close to the onchocerciasis foci in Kasaï and Angola and the project aims to treat 181 799 people in the first year. REMO was done in this area from January to April 2002 and found 2 zones (one hyper-endemic and one hypo- endemic). REMO still needed to be carried out in Kafankuba. All health and social structures seemed to be favourable for the implementation of CDTI. There have been development projects in the region in the past although it was noted that the participation of the community in such projects had been rather weak. 111. TCC felt that the budget was high in relation to the planned activities and recommended that the project: (i) Reduce the budget. (ii) Take into account the proximity of other onchocerciasis endemic foci when organizing treatment. (iii) Reinforce advocacy activities in order to improve community participation. TCC recommended the approval of the project following the revision of the proposal to address the concerns raised by the TCC and the revision of the budget. TCC further recommended that a TCC mission be undertaken to DRC to provide technical assistance to the project in line with the preamble stated above. Mongala CDTI Project 112. Mongala CDTI project is situated in the Equateur Province and covers 5 health zones, Pimu, Yambuku, Bumba, Binga and Lisala. REMO has been completed in 4 of the health zones in April 2002. The project plans to refine REMO in Lisala and complete the exercise in Binga in 2004. Christoffel-Blindenmission would be the NGDO partner in this project. The total population to be covered was 1.4 million in 2 817 communities and the project indicated plans to reach all these communities by the third year of implementation. TCC noted that this was a possible area co-endemic for loiasis. TCC recommended that: (i) In the data on the total population, the ATO should be provided and should be realistic. (ii) The budget be reviewed with consideration given to the justification for audiovisual kits, 7 motorbikes and 81 bicycles. (iii) The project provide clarification on the implementation of cost recovery. 23 TCC recommended the approval of the project following the revision of the proposal to address the concerns raised by the TCC and the revision of the budget. TCC further recommended that a TCC mission be undertaken to DRC to provide technical assistance to the project in line with the preamble stated above. Nord-Ubangi CDTI Project 113. This project intends to treat a total population of 1 265 000 in 2301 communities. REMO was carried out in this area except for the Kotakole area where it needs to be refined. Loa loa could be endemic in the area and thus the possible rate of refusal of treatment could be high. It should be noted that the project has no NGDO partner. The Committee also noted that the population is quite dispersed and migration for insecurity reasons is reported to be very frequent. 114. TCC was concerned that the ATO was over-ambitious for the first year and needed to be revised. The budget was unrealistically high particularly in regard to personnel and capital investment cost. 115. TCC recommends that: (i) REMO be refined in the area. (ii) Project endeavour to find an NGDO partner for the implementation. (iii) The budget be revised downwards. TCC recommended the approval of the project following the revision of the proposal to address the concerns raised by the TCC and the revision of the budget. TCC further recommended that a TCC mission be undertaken to DRC to provide technical assistance to the project in line with the preamble stated above. Sud-Ubangi CDTI Project 116. REMO was undertaken in this area with great difficulty due to the insecurity in this area, and remains to be refined in some areas. The number of persons at risk in the 6 endemic health zones (Budjala, Bwamanda, Tandala, Gemena, Libenge and Zongo) is estimated at 1.18 million. 117. TCC recommended : (i) The project identify an NGDO partner. (iii) Reduction of the budget. TCC recommended the approval of the project following the revision of the proposal to address the concerns raised by the TCC and the revision of the budget. TCC further recommended that a TCC mission be undertaken to DRC to provide technical assistance to the project in line with the preamble stated above. Tshuapa CDTI Project 118. The project lies within meso- and hyper-endemic foci covering 6 health zones with a population of 1 346 046 at risk. Prevalence ranges between 20 and 47%. REMO was carried out in December 2001 but would need to be refined. The area could be co-endemic with Loa loa. So far no NGDO partner has been identified. 24 119. TCC acknowledged that the proposal was well written. TCC noted with interest the activities of the community awareness groups and the intention of the project to organize Oncho Campaign Days. However, some serious concerns were also expressed. More information was required on the previous issues. TCC recommended the approval of the project following the revision of the proposal to address the concerns raised by the TCC and the revision of the budget. TCC further recommended that a TCC mission be undertaken to DRC to provide technical assistance to the project in line with the preamble stated above. ETHIOPIA Preamble on issues common to new project proposals from Ethiopia 120. Ethiopia has 3 ongoing CDTI projects, Kaffa –Shekka, North Gondar and Bench-Maji, and has submitted 6 new CDTI project proposals, East Wellega, West Wellega, Illubabor, Jimma, Metekel and Gambella. The proposals for East Wellega, West Wellega and Metekel have no NGDO partners. In reviewing these new proposals, TCC noted that most concerns raised were common to all proposals in addition to specific issues regarding each individual projects. 121. To assist the NOTF in addressing the common issues, they are summarized below: REMO 122. Countrywide REMO had been done, and the most recent map made available to NOTF. However, there seemed to be a lack of understanding of the REMO map as some hyper- and meso- endemic communities were not included in the proposed treatment while some hypo- endemic communities were included. This had implication for initiating the project in priority endemic areas, and for compiling population data and should be corrected for all projects. Each project should use the most recent REMO map and adjust the geographic scope and population data accordingly. Technical quality of proposals 123. There is good political will, a satisfactory PHC structure and potential for integration, but technical details of implementation need to be given. More details are needed for project description, Plan of Action and various aspects of CDTI implementation, especially training, health education, mobilization, supervision, monitoring and evaluation in view of sustainability indicators. Budgeting 124. The budgets should be related to activities with justification of every line item annually. Contribution from the WHO country office should be separated from that of government. The NGDO contribution line items should be removed for projects where there are no supporting NGDOs. Government Commitment 125. Government contribution is limited to personnel, duty exemption and a few overhead items, without any adequate contribution to core activities and does not seem to vary from year to year. Duty exemption occurs each year in the budget but should occur only once, the year in which the vehicle is purchased. Government should contribute to core CDTI activities, especially in projects without NGDOs. 25 TCC recommends a support mission to Ethiopia to address these issues. East Wellega CDTI Project 126. East Wellega Zone is one of the twelve zones in Oromia National Regional State with 21 districts and 476 villages. The proposal covers 9 districts with hyper and meso-endemicity. REMO refinement will be done in 3 more districts projected for addition in the second year of the project. TCC however noted that the proposal included Gida Kiremu , a “non-CDTI” area while excluding Sasiga, Bila Seyo, Jimma Arjo, Nunu Kumba and Wama Bonaya weredas which fall in “definite CDTI areas”. The information provided in the proposal shows inconsistency in population data. 127. TCC recommended that the budget be reviewed downwards especially capital items to be provided by APOC. TCC rejected the proposal and requested that the proposal and budget be revised downwards especially for capital items , and resubmitted through APOC Management for review by the TCC reviewers. TCC further recommended that a TCC mission be undertaken to Ethiopia to provide technical assistance to the project and the revision of the proposal in line with the preamble stated above. West Wellega CDTI Project 128. This project intends to cover 7 endemic weredas in 238 communities with a total population of 1 941 430 and 742 544 persons targeted for treatment in the first year and almost throughout the subsequent years. TCC felt that the proposal lacked vital information on key issues like the inclusion of 6 additional CDTI definite areas which have implications for treatment and budget. 129. TCC noted that: (i) The project set quite ambitious targets aiming for 100% geographic and therapeutic coverage in the first year. (ii) The zonal structures did not seem to be used and thus appear not to be involved in the CDTI process. (iii) The area could be a potential Loa loa endemic zone but no indication of assessment provided. (iv) The project needed to use sustainability indicators in the first year. (v) The budget is high particularly on personnel and capital cost. (vi) The project needs to, include 6 additional weredas in definite CDTI areas, involve zonal health staff in the implementation of CDTI and solicit partners for technical assistance in project implementation. TCC rejected the proposal and requested that the proposal and budget be revised and resubmitted through APOC Management for review by the TCC reviewers. TCC further recommended that a TCC mission be undertaken to Ethiopia to provide technical assistance to the project and the revision of the proposal in line with the preamble stated above. 26 Illubabor CDTI Project 130. REMO had been completed in 8 weredas and remains to be refined in 5 weredas before CDTI is extended into these areas. The proposal indicated that the total population at risk in the project area was estimated to be 842 521 in 13 weredas. The Carter Center is the NGDO partner in this project. 131. TCC noted that some weredas (Nono, Ale, Dega and Dedesa) falling in the definite CDTI areas were not included, whereas Gechi which falls in the non CDTI area was included. The proposal did not give details on activities (training, timing for ivermectin distribution, etc) and did not mention UTG and the ATO. No information has been provided on past distribution of ivermectin. 132. TCC recommended that the project: (i) Review the selection of Weredas to include Nono, Ale, Dega, Dedesa and exclude Gechi/Getchi. (ii) Indicate (on plan) timing for Mectizan distribution, spot check,“mop up” distribution, reporting, evaluation and review for 2003. (iii) Clearly indicate Ultimate Treatment Goal (UTG) and Annual Treatment Objective (ATO) for 2003. (iv) Introduce Community Self Monitoring and Stakeholders Meetings from year 1. (v) Specify membership of Task Forces below Federal Level. TCC rejected the proposal and requested that the proposal and budget be revised and resubmitted through APOC Management for review by the TCC reviewers. TCC further recommended that a TCC mission be undertaken to Ethiopia to provide technical assistance to the project and the revision of the proposal in line with the preamble stated above. Jimma CDTI Project 133. This project intended to cover three weredas with a total population of 606 816 people in the first year and extend to the remaining meso- and hyper-endemic weredas by year 3. The proposed project did not coincide with the most recent REMO map. The Carter Center was the NGDO partner. TCC noted the input of the government into staffing and the gradual take over of total responsibility for CDTI implementation by MOH staff. The Committee noted a number of steps taken by the MOH to include CDTI at all levels of its planning process; integrate it into the PHC system where such system was functional; and to facilitate the procurement and distribution of ivermectin 134. Although all elements seemed to be in place for project implementation, the descriptions were general and vague. TCC was particularly concerned about the following issues: (i) The ATO and UTG for each year were not indicated. (ii) The financial contributions from other partners (MOH and NGDO) remained the same over five years not reflecting the projected increase in the number of weredas to be included in the project. (iii) There was no clear indication of how post-APOC sustainability would be ensured. Sustainability indicators were not incorporated into the proposal from the outset . 27 TCC rejected the proposal and requested that the proposal and budget be revised and resubmitted through APOC Management for review by the TCC reviewers. TCC further recommended that a TCC mission be undertaken to Ethiopia to provide technical assistance to the project and the revision of the proposal in line with the preamble stated above. Metekel CDTI Project 135. Metekel Zone is located in the north-western part of Ethiopia and is one of the three zones and two special weredas that form the Benshangul-Gumuz National Regional State. This project covers 4 districts with an estimated target population of 134 800 in 76 communities. 136. TCC recommended that: (i) Meso and hyper-endemic villages in Bullen, Wembera and Dibate should be included in the proposal. (ii) The information on the weredas involved should be included in the proposal. This included the numbers of weredas, the villages in each wereda, the total population and the number of persons to be treated. (iii) Health education should take into account sustainability issues. (iv) Monitoring and evaluation should utilize the tools already developed, tested and used in APOC countries. (v) An NGDO partner be identified. TCC rejected the proposal and requested that the proposal and budget be revised and resubmitted through APOC Management for review by the TCC reviewers. TCC further recommended that a TCC mission be undertaken to Ethiopia to provide technical assistance to the project and the revision of the proposal in line with the preamble stated above. Gambella CDTI Project 137. Located in the Western part of Ethiopia, this project covers a region with a total population of 228 593 people in 9 weredas considered meso- and hyper-endemic. Although according to the last REMO map only 5 weredas may be hyper-endemic, hence the need to refine the REMO in this region. The project was not endorsed by the NGDO partner, Africare who did not have any experience in working in onchocerciasis control in Ethiopia. 138. TCC was concerned about the high budget particularly with regard to personnel and capital equipment with no indication of CDTI implementation cost. It also noted that the same amount was pledged by the MOH every year throughout the project life. TCC wondered how the project could be sustained if all other partner contributions remained unchanged. 139. Although the proposal was well presented and all elements relating to CDTI implementation had been addressed, some more details such as the number of people to be trained and how, would have been useful for an appropriate assessment of this proposal. Also, the proposal did not clearly indicate the ATO, UTG and a detailed budget for years 2 to 5. 140. TCC felt it would be appropriate therefore to refine the REMO in this region and that the project should: 28 (i) Provide more information on the project area. (ii) Provide information on the total population of the area, the ATO and the UTG. (iii) Revise the budget particularly on personnel and capital cost TCC rejected the proposal and requested that the proposal and budget be revised and resubmitted through APOC Management for review by the TCC reviewers. TCC further recommended that a TCC mission be undertaken to Ethiopia to provide technical assistance to the project and the revision of the proposal in line with the preamble stated above. TANZANIA Tunduru Focus CDTI Project 141. Located in the Ruvuma region, Tunduru has a total population of 219 000 with 36 751 at risk and about 24 000 in 24 communities targeted for treatment. This was a resubmission of a new project which was rejected by TCC12. TCC16 noted that the recommendations of TCC12 had been implemented and that the revised proposal was well written with detailed description of activities. 142. However, the project omitted some key information including the handling of side effects, UTG and ATO for year 1, and the project period stated in dates. TCC was concerned that the budget was heavily dependent on APOC funding and needed to be revised. The NGDO partner was stated to be the Christian Social Services Commission, but the proposal was submitted without an endorsement letter from that NGDO. 143. TCC recommended that the project be approved and that: (i) The missing information be provided. (ii) The project should indicate input by the district and from “basket fund”. This should be reflected in the budget. (iii) MOH staff should be involved in handling APOC funds. D. ADDITIONAL SUBJECTS CONSIDERED BY TCC16 144. Item 11: in opening the consideration of RAPLOA and the environmental risk mapping and its consequence on the implementation of the approved CDTI projects, the Chair drew the attention of the Committee to the conclusions at its fifteenth session (September 2002) that field validation of the environmental risk model (ERMr), RAPLOA and the combined method be undertaken in the near future; that the RAPLOA/parasitology exercises in Ethiopia made the need for village by village REA exercises superfluous in this country as Loa loa was not detected in potential high-risk zones; that this approach be applied in the interim pending mapping methods being developed and RAPLOA being validated, for projects where Loa loa was predicted by ERMr models; and that detailed recommendations be developed, in consultation with the Mectizan Expert Committee (MEC), for the operationalization of RAPLOA and ERMr to replace the current TCC/MEC guidelines. 145. So far, field validation had not been implemented by TDR, with which APOC had signed a technical assistance agreement, and the Programme Director was repeatedly faced with requests from governments regarding the application of the RAPLOA methodology to which he was 29 unable to respond. Another problem was the sampling methodology which had not yet been determined. 146. Although the remote sensing Environmental Risk Map had so far proved itself fairly reliable to determine Loa loa risk zones, a Probability Contour Map (PCM) had now been developed which included the determination of different levels of statistical probability of Loa loa. 147. The Committee strongly recommended to TDR that field validation of the remote sensing maps, the RAPLOA methodology and the combined application of the two approaches be undertaken as a matter of urgency. Contact should be maintained with the validation experts and the countries concerned to rapidly launch such validation. 148. As indicated in the summary ( paragraph 15) of the Mectizan Expert Meeting in March 2003, the MEC decided to postpone any revision of the current MEC/TCC guidelines for treatment with ivermectin in Loa loa endemic areas. In doing so, the MEC maintained its position that mass treatment with ivermectin should not occur in communities that are hypoendemic for onchocerciasis and endemic for Loa loa or suspected of being endemic for Loa loa. 149. A working group was established to review the MEC/TCC guidelines for treatment in areas co-endemic for onchocerciasis and Loa-loa. After presentation of the report to the Committee TCC thanked the group for the work well done and for generating discussion on this matter. 150. TCC recommended: - that the preliminary report produced by the working group be sent to TDR (Hans Remme) for its input; - that this issue be looked at in detail during TCC17, and - that in the meantime, the MEC/TCC guidelines should apply. 151. The report/paper is attached as Annex 4 (Note: at the time of preparing this report it was available in French only, but will be sent to “anglophones” once translated into English) Item 12: Update on the evaluation of sustainability of CDTI projects and country plans. 152. This item was .introduced by Dr Uche Amazigo who stated the objectives of her unit as that of assessment in respect to sustainability potential of CDTI projects in their 5th and 3rd year of APOC support; to assist countries to develop post-APOC CDTI sustainability plans; and to prepare the guidelines, instruments and a manual for sustainability assessment. 153. She enumerated the projects evaluated for sustainability during 2002 and in January and February 2003 and those planned for the remaining months in 2003: in all 23 CDTI and 2 headquarters projects. Projects had so far shown unsatisfactory post-APOC sustainability plans and lacking evidence of integration of CDTI activities into existing health system plans; the budget lines were “business as usual”; and NOTF lack of understanding of the sustainability concept. 154. Consequently, APOC Management had undertaken and supported field missions to Tanzania and Malawi to support district authorities to develop three-year post-APOC sustainability plans which had helped the NOTFs to prepare plans which, in the case of 30 Tanzania, was approved by the APOC Management with the signature of a 6th year Letter of Agreement. Also, a meeting was held in Lagos in January 2003 to assist evaluated projects to develop 3-year post-APOC CDTI sustainability plans. 155. Special efforts went into the further development of the guideline/checklist for developing a post-APOC CDTI sustainability plan setting out in details the various steps to be taken. Furthermore, a meeting on CDTI sustainability was held for francophone countries at which the French version of the four evaluation instruments was finalized. 156. During 2003 it was planned to evaluate twenty-three 5th year CDTI projects and twelve 3rd year projects. 157. The results of the 3 year evaluation should constitute the first step in the consideration of the sustainability issue. There was a need to consider on a project-by-project basis the recommendations on “minimal staff” requirement after 5 years of CDTI implementation. The sustainability guidelines should be taken into consideration in the preparation of CDTI project Plans of Action. The indicators for monitoring and sustainability evaluation had been harmonized. Item 13: Independent monitoring of CDTI projects in 2002 in Tanzania and Liberia. 158. The objectives of the exercise were listed as the assessment of progress of treatment coverage and predictors of sustainability indicators like community involvement and partner commitment; to address challenges in the implementation of CDTI programmes; and to build capacity of NOTFs in monitoring CDTI projects. 159. Eight Projects monitored included Kilosa, Tanga, Tukuyu, Ruvuma in Tanzania and Bong, Nimba, Monteserrado and Lofa in Liberia. The reviewers were scientists, project managers, NGDO representatives and Community members. 160. Findings showed that while decisions on CDDs selection and method of treatment were made by communities, the time for distribution was determined by health workers. 161. Lessons from the monitoring showed a need to improve IEC strategies, recording of Serious Adverse Effects and supervision of CDTI. In addition, there was a need to develop culturally appropriate IEC materials which would sustain community compliance to treatment, and the interest of political and civil authorities; poor counterpart funding by governments was also highlighted. 162. Challenges included improving community participation, increasing treatment coverage and community involvement in decision making; as well as improving IEC materials. 163. Item 14: Update on vector elimination activities: Bioko (Equatorial Guinea); Tukuyu Focus (Tanzania); Itwara and Mpamba-Nkusi Foci (Uganda). This agenda item was introduced by the Programme Director who assured the Committee that all the programmes were progressing satisfactorily and following the recommendations of the Meeting on the Review of Onchocerciasis Vector Elimination Projects in the APOC Programme held in May 2002. He specifically mentioned that a contract had been signed with Evergreen for aerial larviciding in the Bioko Focus. 164. Item 16: Report on the financial management of APOC funded projects. The Management of APOC informed the TCC that the transfer of funds to the projects in the countries was 31 improving. The system settled for transferring the money in the field was performing well. However, some projects were not receiving the approved amounts as they were not submitting the monthly returns regularly. Some projects were still experiencing more than 4 months delays. 165. Although the project Coordinators manage well the Trust Funds transferred in the field, misuse of the funds in one project had recently been noted and appropriate action had been taken by the Management of APOC by suspending transfer of funds until the amount misused was reimbursed into the imprest account by the MoH. Item 20: Review of operational research proposals. 166. No new proposals were submitted for TCC review. Item 21: Other matters: 167. TCC expressed its gratitude to the group which developed the new reporting format and the TCC sub-committee who reviewed this format. The Committee further revised the format and requested that it be sent to projects once finalized. 168. The Committee considered the action(s) to be taken in cases where annual technical project reports were not received for its review or only arrived a few days before their consideration. 169. TCC confirmed that the deadlines for submission to the APOC Management of these reports were 31 January for the TCC March session and 31 July for the TCC September session. 170. The Committee realized that the non-submission or late arrival of reports might be caused by negligence at the project and NOTF levels and decided that the projects concerned should be given a “red card” in case of non-submission. In case of late submission not allowing for TCC reviewers to receive the reports two weeks before departure for the TCC session (see paragraph 172 below) , the reports would be rejected for re-submission. 171. Regarding the responsibility for delays at the central level, the Committee would take the opportunity of reviews of NOTF reports to examine their performance in report handling and take appropriate action as necessary, with the possibility of applying the “red card” approach. 172. It was agreed that the Management would ensure that TCC reviewers would receive copies, if possible by e-mail, of the annual technical reports they were designated to review at least two weeks before their departure for the TCC session. 173. Concerning the study on cost per ivermectin treatment, Prof. Deborah McFarland informed the Committee that there had been a delay in the development of this study. However, she had prepared a set of draft instruments to be applied to essential activities which would be discussed with the APOC Management for their further development. They would be applied both to APOC operations and to post-APOC CDTI activities of interest to countries and communities. 174. Prof. McFarland had identified a small group of national consultants and would report to TCC17 on further progress of the study. She would also try to recruit another person to take charge of the study with herself serving as an advisor. She was assured by the Programme Director that in his view her role had always been one of coordinator of the work of a team. 32 175. Concern was expressed about CDTI projects which in their approved Plans of Action included operations in a given area (e.g. a number of districts) but left out part of the area when implementing the projects with the intention of covering that part at a later stage. Not only did this result in the projects receiving APOC financing for activities that were not implemented and the population in these districts initially deprived of treatment, but the late start of treatment would result in the risk of such districts receiving less than five years of APOC support given that the Programme would come to an end within a limited period. The Management would prepare for the September 2003 session of TCC a list of projects with only partial coverage of the originally determined areas and those where parts of them had been covered. 176. It was decided that TCC reviewers would in future receive copies of the latest half-year report of the CDTI projects assigned to them in order to find out if some of their concerns raised by their review of the annual technical reports had already been taken into consideration by the projects themselves. DATE AND PLACE OF THE SEVENTEENTH SESSION OF TCC (agenda item 22) 177. The seventeenth session of the Technical Consultative Committee would be held in Ouagadougou from 15 to 19 September 2003. CONCLUSIONS AND RECOMMENDATIONS OF TCC16 (agenda item 23) 178. A draft report was approved with the understanding that modifications suggested by TCC Members, and approved by the Committee, would be included in the final report. CLOSURE OF THE SESSION (agenda item 24) 179. Following statements by the Programme Director and the Chair, Prof. Braide declared the TCC16 session closed. 33 ANNEX 1 LIST OF PARTICIPANTS 1. Prof Ekanem Braide, Chairman of TCC, Dept. of Biological Sciences, University of Calabar, P.O. Box 3679, Calabar, Nigeria, Tel: (234) 87 230 452, Fax: (234) 087 230 914 / 087 230 911, E-mail: ekanem_b@hotmail.com; onchocal@skannet.com 2. Professor (Mrs) Adenike Abiose, Medical Director, Steering Committee Sightcare International, P.O. Box 10392, Kaduna, Nigeria, Tel: (234) 62 41 73 73, Fax: (234) 62 41 08 73 or c/o SSI/Kaduna (234) 62 24 89 73, E-mail: abiose@infoweb.abs.net 3. Dr Mary Alleman, Associate Director, Mectizan Donation Program, 750, Commerce Drive Suite 400, Decatur, GA 30030, Atlanta, USA, Fax: 1 404 371 1138; Tel: 1 404 371 1460; E-mail malleman@taskforce.org 4. Dr Michel Boussinesq, s/c Valérie Delplanque, IDR, 213 rue La Fayette, 75480 Paris Cedex 10, France, Tél/Fax : (33) 1 42 49 38 15 5. Dr Elizabeth Elhassan, Country Representative of Sight Savers International, 1 Golf Road, P.O. Box 55, Kaduna, Nigeria, Tel: (234) 62 24 83 60 or 62 24 89 73, Fax: (234) 62 24 89 73, E- mail: ssing@infoweb.abs.net 6. Dr Deborah McFarland, Associate Professor, Department of International Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, Georgia 30312, Tel: 404 727 7849, Fax: 404 727 4590, E-mail: dmcfarl@sph.emory.edu 7. Dr Peter Enyong, Tropical Medicine Research Station, P.O. Box 55, Kumba, Cameroon, Tel: (237) 35 42 31, Fax: (237) 35 42 31, E-mail: penyong@camnet.cm 8. Dr Danny Haddad, Country Director, Senior Technical Advisor Onchocerciasis, Helen Keller Worldwide, P.O. Box 34424, Dar-es-Salaam, Tanzania, Tel: (255) 744 560657 , Fax: (255) 22 264 7831, E-mail: dhaddad@hetnet.nl or dhaddad@hki.org 9. Dr Moses Katabarwa, Country Representative, The Carter Center, P.O. Box 12027, Bombo Road, Plot 15, Kampala, Uganda, Tel: (256) 41 251 025, Fax: (256) 41 349139, E-mail: rvbprg@starcom.co.ug 10. Prof. Soungalo Traoré, OCCGE, Institut National de Santé Publique, Centre Pierre Richet, 01 B.P. 1500 Bouaké 01, Côte d’Ivoire, Tél. : (225) 31 63 37 46, Fax : (225) 31 63 27 38, E-mail : pefoungo@yahoo.fr 11. Dr Christine Godin Benhaïm, 33 rue Brun Larochette, 26220 Dieulefit, France, Tél : 33 6 08917193 ou 33 4 75464059, Fax : 33 4 75463934, E-mail : godin@wanadoo.fr OBSERVER 12. Dr Tony Ukety, Directeur du Projet d’Ophtalmologie du CME Nyankunde, Centre Ophtalmologique de Bunia, RDC s/c P.O. Box 21285, Nairobi, Kenya, Tel : (256) 77 54 51 22, E-mail : cob@uuplus.com 34 WHO/GENEVA 13. Dr Ole Christensen, (rapporteur) WHO/HQ/Geneva, Fax: (4122) 791 4190, Tel: (4122) 791 3885 14. Mrs Pamela Drameh-Avognon, (co-rapporteur), NGDO Coordinator, WHO/HQ/Geneva, fax: (4122) 791 4777, Tel: (4122) 791 2642 15. Mr Abdulai Daribi, (co-rapporteur), AFRO/APOC Liason Office, WHO/HQ/Geneva, Fax: (4122) 791 4190, Tel: (4122) 791 3883 WHO/OCP 16. Dr Boakye A. Boatin, Directeur, OCP/Ouagadougou, Burkina Faso WHO/MDSC 17. Dr Sam Bugri, Director a.i. MDSC/Ouagadougou WHO/SIZ 18. Dr A. Akpoboua, DTL/SIZ, Ouagadougou, Burkina Faso WHO/APOC 19. Dr Azodoga Sékétéli, Director, APOC/Ouagadougou, Burkina Faso 20. Dr L. Yaméogo, COORD, APOC/Ouagadougou, Burkina Faso 21. Dr Uche Amazigo, CSD, APOC/Ouagadougou, Burkina Faso 22. Ms Victoria Matovu, COP, APOC/Ouagadougou, Burkina Faso 23. Mr H. Zouré, BIM, APOC/Ouagadougou, Burkina Faso 24. Mr S. N’Gadjaga, ITO, APOC/Ouagadougou, Burkina Faso 25. Mr Fortuné Agboton, BFO, APOC/Ouagadougou, Burkina Faso 35 ANNEX 2 PROVISIONAL AGENDA 1. Opening 2. Adoption of the Agenda 3. New managerial and administrative developments in APOC Headquarters since JAF8 4. Role of the APOC Management Staff in the implementation of the activities in the Special Intervention Zones (SIZ) of the ex-OCP 5. Matters arising from the 100th and 101st sessions of the CSA 6. Matters arising from the 8th session of the Joint Action Forum (JAF) 7. Matters arising from the meeting of the Mectizan Expert Committee 8. Matters arising from the 21st NGDO meeting 9. Follow-up of the recommendations of the fifteenth session of the TCC 10. Update on the REMO/GIS in APOC countries (DRC; Burundi; Angola; Sudan) 11. Update on the RAPLOA and the environmental risk mapping and its consequence on the implementation of the approved CDTI projects 12. Update on the evaluation of sustainability of CDTI Projects and country plans 13. Independent monitoring of CDTI Projects in 2002 in Tanzania and Liberia 14. Update on vector elimination activities: Bioko (Equatorial Guinea); Tukuyu focus (Tanzania); Itwara Vector Elimination and Mpamba-Nkusi (Uganda) 15. Update on Operational Research 16. Report on the financial management of APOC funded Projects 17. Report on the review by the APOC Management of 1st , 2nd, 3rd,4th and 5th year progress reports and subsequent year budgets 18. Review of new Project Proposals 19. Review of 1st , 2nd, 3rd , 4th and 5th year annual technical reports from the following countries: (i) Cameroon (8) Haute Sanaga & Belado; South West I, South West II, Littoral II, Centre 3, Centre 1 North Province and West Province CDTI Projects; (ii) CAR CDTI Project (1); (iii) Congo CDTI Project (1); (iv) DRC (3) Kasai; Uele and Bandudu CDTI Projects (v) Ethiopia (1) HQ Support (vi) Gabon CDTI Project (1); (vii) Liberia (1) Lofa, Bong, Nimba & Montsheredo CDTI Project (viii) Nigeria (15) Taraba; Kogi; FCT; Osun; Enugu/Anambra/Ebonyi; Kano, Omo/Abia; Yobe, Zamfara; Oyo; Jigawa; Benue; Kebbi; Kwara; Ogun; (ix) Sudan (2) NOTF/HQ; Northern Sector CDTI; (x) Tanzania (4) NOTF/HQ; Mahenge Focus; Ruvuma CDTI; Kilosa,Tukuyu Vector Elimination; (xi) Uganda (3) Phase I & Phase II CDTI; Itwara Vector Elimination. 20. Review of operational research proposals 21. Other matters: 22. Date and place of the seventeenth session of the TCC 23. Conclusions and recommendations of TCC16 24. Closure of the session 36 ANNEX 3 TCC16 RECOMMENDATIONS/ENDORSEMENTS/APPROVAL TCC recommended/endorsed/accepted: 1. the application of a policy statement regarding the implementation of CDTI projects for which no NGDO partner had been identified (paragraph 27); 2. that REA be undertaken without delay in the “yellow zones” after completion of the REMO exercise to arrive at the final delimitation of the project areas (para. 29); 3. that the preliminary report on the application of RAPLOA and the environmental risk map, prepared by a working group of the Committee, be communicated to TDR; that the issue be considered in detail by TCC17; and that in the meantime the MEC/TCC guidelines should apply (para. 149); 4. that the new CDTI project reporting format be applied (para. 166); 5. that appropriate action be taken in case of non-submission or delayed submission of annual technical reports (paras. 167 to 171); 6. that the issue of cost of ivermectin treatment be considered at TCC17 (para. 173); 7. that CDTI projects should be encouraged to reach complete coverage without delay (para. 174); 8. that TCC reviewers would receive copies of the latest half-year reports together with the annual technical report submitted for their review (para. 175). 9. to be kept informed about the progress of SIT activities (paragraph 10). 10. postponement of any revision of the current MEC/TCC guidelines for ivermectin treatment in Loa loa areas (paragraph 15). 11. no change at present of the APOC frequency of ivermectin treatment (para. 17). 12. accepted 25 annual technical reports and rejected 5 (paragraphs 33 to 86). 13. recommended approval of 9 new CDTI projects and rejected 4 (paragraphs 87 to 142). 14. that the recommendation/suggestion on the “minimal staff” requirement after 5 years of CDTI application be considered on a project-by-project basis (para. 156); 15. that IEC strategies, recording of Serious Adverse Effects and supervision of CDTI be improved (para. 160).