Terms of reference for the mid-term review of the activities in the Special Intervention Zones (SIZ) and effectiveness of onchocerciasis surveillaiice systems of the Ex-OCP countries

JOINT ACTION FORLII\4 Office of the Chairman African Programrne for Onchocerciasis Control (APOC) Programnre africarn de lutte contre I'onchocercose JAF-F'AC FORUM D'ACTION COMMLTNE Bureau du Pr6sident JATlO/INF/DOC.6 ORIGINAL : ENGLISH October 2004 TERMS OF REFERENCE for the Nlid-Term Revierv of the activities of the Special Intervention Zones (SIZ) AND for the Revietv of the effectiveness of the Onchocerciasis Surveillance Systems of the ex-OCp Countries JOINTACTION FORUM Tenth session Kinshasa (DRC). 7-9 December 2004 JAFlO/INF/DOC6 Page 1 l. Introduction and background 1.1 With the cessation of OCP operations in December 2002 the Programme had met rts oblective i.e. to eliminate onchocerciasis as a disease of public health importance and as an obstacle to socioeconomic development throughout practically all of the Programme area. 1.2 However, in four lirnrted and defined areas the entomo-eprderniologrcal situatron remained unsatisfactory after several years of combined vector control and rvermectin treatment. These areas therefore qualified for "Special Intervention" and were referred to as "special Intervention Zones (SZs)". They included the basin of the Pru (Volta Lake) in Ghana, the basin of the Oti and its tributaries (Volta Lake) in Togo, the adjacent Upper Oueme river basin in Benin, and the basrns of Mafou and Tinkisso (Upper Nrger) in Gurnea. In addition to these limited areas, the whole of Srerra Leone where onchocerciasis control activlties were suspended after a maximum of llve consecutive years of combined larviciding and ivermectin distribution was included as a hfth SZ. 1.3 It was therefore decided by the last Jornt Programme Commrttee in December 2002 that for all five zones ivermectin distribution should be reinforced to achieve 100% geographical and at least 85% therapeutic coverage (65% in Sierra Leone), ivermectin treatment to be given annually in the Pru basin and Sierra Leone and semi-annually in the remaining three basins, all up to 2072, whrle aerial larviciding would be continued during five years after Decemb er 2002 in the Upper Oti and the Upper Oueme river basins. 1,4 The principal method of control in the SZs is ivermectin treatment under communiry direction [Community-directed Treatment with Ivermectin (CDTI)]. Aerial larvicrdrng, combrned with CDTI is applied in the Upper Oti and Oueme river basins. Furthermore, an important element is capacity building and mobilization and sensitization. 1.5 The cost of operations in the five SZs has been estimated as US $ 12,098,732 covering activities until the end of the project in 2001 . 1.6 The general objective of operations in the five SIZs is to bring the entomo- epidemiological parameters to levels rvhich correspond to the OCP standartls and rvhich can easily be maintained by the Participating Countries. 2. General obiective of the review 2.1 To assess the progress towards meetrng the specific objectives of the operations in the five Special Intervention Zones; and to make recommendatrons for improvement of the strategies applied, the structure and the operations, as well as for follow-up action post-2007. 2,2 To assess the effectiveness of the onchocerciasis surveillance systems in the ex-OCP countnes 3. Specific obiectives of the revierv 3.1 To review and assess the SZ management arrangements at all levels (headquarters, Kara, and country levels), taking into account the support received from APOC. To review and evaluate the processes and performance of CDTI, Vector control and surveillance rn the SZ to tnform on prospects of whether operatrons rvrll succeed in reachrng objectives. 3.2 aJAFlO/INF/DOC6 Page 2 3.3 To review and evaluate the performance of the onchocerciasis surveillance in the ex-OCP countries since December 2002 to inform on prospects of whether the surveillance systems in these ex-OCP countries are effectrve enough to maintain OCP achievement. 3.4 To assess prospects of sustainability of onchocerciasis control beyond 2007, taking rnto account integration, parlnerships and extemal support. 3.5 To assess the need for ongoing support within the ex-OCP countries but outside the SZs To assess the adequacy of the support given by the Special Intervention Team to countnes outside the Special lntervention Zones. 4, Terms of reference 4.1 Programme Management 4.1.1 To review and assess the Management arrangements at the headquarters of SZs operations in Ouagadougou, in Kara and at counlry level, taking into account the support received from APOC. 4.1.2 To examine the financial management at the headquarters of operations in the SZs vrs-d-vis the APOC structure and programmes in the field. 4.2 Programme implementation, financing and its impact 4.2.1 To review and evaluate the performance of operations m the five SZs and assess the prospect that operations in the SZs will succeed in reaching their objective; and propose, when required, improvements in the various components of the operations. 4.2.2 To review the process of CDTI implementation and in particular evaluate the overall geographical and therapeutic coverages attained so far and make recommendations to ensure CDTI achieves coverage at, or above, the required levels. 4.2.3 To review and evaluate the progress, performance and impact of the vector control activity, and the likelihood that vector control will achieve the local elimination of onchocerciasis transmrssion and the reservoir of the parasite. 4.2.4 In view of the limited funds available for the SZ areas, to consider different strategic options that will allow optimal utilization of the remaining funds towards sustained elimination of onchocerciasis as a public health problem. 4.2.5 To propose such activities that will facilitate sustainability of ivermectin keatment for the required period and beyond. 4.2,6 To review and assess the role and input of the drfferent partners (WHO country offices, MDSC, NGDO) in the conduct of the activities in the SZs and the other ex-OCP countries. 4.2,7 To assess whether the Special Lrtervention Team has given required support to countnes outside the SZs. 5. Organizational aspects Based on past experience with the ex-OCP, the Special Advisory Comrnrttee (SAC) of the SIZ composed of experts with skills in ophthalmology, enton-rology, public health/epidemiology, 3.6 5.1 I a JAFlO/INF/DOC6 Page 3 social science and ecology/environmental protection has agreed, as a group ol experts, to undertake the review and to co-opt one expert with experience in the adminrstratron and finance, to join the group. The review wrll be completed and presented to the Executing Agency of the SIZ (WHO) and the Frscal Agent (The World Bank) in the context of the APOC CSA by the end of October 200s. The Headquarters of the operatrons in the SZ and the Management of APOC will provide support for the review exercise. 5.2 5.3