Fifteenth meeting of the national Onchocerciasis committees: summary of the report, Ouagadougou, 28-30 May 1991

H-A 6ouv , \-, + \. v ONCHOCERCIASIS CONTROL PROGRAMME IN WEST AFRICA PROGRAMME DE LUTTE CONTRE L'ONCHOCERCOSE EN AFRIQUE DE L'OUEST NATIONAL ONCHOCERCIASIS COMMITTEES Fifteenth meeting Ouagadougou, 28-30 May 1991 SUMMARY OF THE REPORT 1 . OPENING OF THE MEETING The fifteenth rneeting of the National Onchocerciasis Committees was held frorn 28 to 30 May l99l at the headquarters of the Onchocerciasis Control Programme in Ouagadougou. ; The Prograrnme Director welcomed the participants and pointed out that the meeting was all the,more important because it was taking place on the eve of the take- off of the Programme's fourth financial phase (1992-L997) and of the real start of devolution activities. He said also that he was very encouraged by the decisions just taken by some donor countries and organizations to maintain or increase their financial contributions to OCP. The Programme Director said that the donors were impressed by the management of the Programme which was the result of the work of all the staff members. As regards devolution, he indicated that a new unit composed of .five persons had been created, thereby meeting the wish expressed by the External Review and approved by the Joint Progra4rne Committee. Finally, the Programme Director urged the delegates to talk about what was really being done or taking place in their countries. He also informed the gathering that the WHO Regional Office for Africa had appointed a Devolution Coordinator. 2 - ELECTION OF OFFICERS At the suggestion of the delegate of Benin, the delegates of Ghana and Mali were clected Chairman and Vice-Chairman respectively of the fifteenth NOC meeting. G. /,L J2 3 - A.DOPTION OF THE AGENDA The meeting adopted the following agenda: 1. Opening of the meeting 2. Election of oflicers 3. Adoption of the agenda 4. OCP Progress report 5. Devolution - Progress report Benin Burkina Cote d'Ivoire Ghana Mali Niger Io'o Progress report on health education on onchocerciasis Ivermectin distribution Guinea Guinea Bissau Mali Senegal Sierra Irone ' Inventory of facilities and equipment Other matters Date of 16th meeting Adoption of the report Closure of the meeting Presenting the OCP progress report, the Programme Director declared that resistance to the organophosphorus compounds was no longer a problem. He recalled that six insecticides were available in OCP. The company Merck St arp and Dohme had 6 7 8. 9. 10. 11; 12. a 4 - OCP PROGRESS REPORT 3respected its commitment and the drug was still being offered free of charge. The search for a macrofilaricide was going on favourably: four potential drugs had been selected and were being tested. r The Progrurn-"tDirector concluded by sayrng that the:outlook was bright and that an effort would be mad'e this year to combine the national teams and OCP personnel more in the control activities. 5 . DEVOLUTION In presenting this agenda itern, the Chief of the Devolution Unit recalled the recommendations of the External Review and indicated that the WHO Regional Office for Africa convened a meeting from 6 to 8 June 1991 in Brazzaille to discuss the decisions taken in Conakry at the eleventh JPC session as regards devolution. He announced that a task force to reflect on the devolution process had been set up, a devolution Coordinator appointed and that national major endemic diseases prevention and control teams would be established soon. Finally, he pointed out that a working outline had been given to the delegates to help them give concrete information on this subject. The representative of the WHO Regional Director for Africa said that he would like to get as much information as possible by the end of the 15th NOC meeting. 5.1. Proeress reoort of Benin The Benin delegate declared that the Devolution plan of Benin was adopted by the eleventh JPC session in December 1990. With regard to the situation of the NOC of Benin, the delegate said that it had been restructured. Epidemiological evaluation had been started in collaboration with OCP. It would be continued with a view to preparing the epidemiological map. Ivermectin distribution was being carried out with OCP. The resources made available were: - Personnel: The unit for reflection and monitoring, nurses of the l-ocal Treatment Teams (LTIs) and the personnel of the public health institutions in the zone concerned (Borgou and Atacora). - lngistics: No logistic resources had been allocated for devolution alone but its activities had been integrated into those of the health centres; 4- Integration: Passive screening was being done in the health centres of Kandi, Gogounou, Banikoara, Segbanan and Malanville each of which had*eceived 100 tablets of ivermectin. Five NGOs were contributing to the smooth running of the health centres in the zone concerned. Eight donors had been contacted for the financing of devolution. 5.2. Progress report of Burkina Faso There was in Burkina Faso a national team charged with epidemiological evaluation and another with ivermectin treatment. The NOC of Burkina Faso was not functional. A proposal for its restructuring and revrtalization had been submitted to the authorities. - Epidemiological evaluation: In collaboration with OCP, the national team conducted a survey in March 1991 in 23 firstJine villages in six provinces covering six river basins. This survey gave the following results: population counted:9,867; population examined: 7,592; c:ues detected: 113 (1.5Vo). Ivermectin treatment Mass treatment The national team treated z,TDpersons in 13 villages in the Dienkoa basin in April t99L Passive treatment Ivemectin had been made available to some health centres for passive treatment of patients. Unfortunately there had been no feedback to make it possible to evaluate the number of persons treated. Training/Retraining About 200 health workers had been given training in the screening and treatment of onchocerciasis and trypanosimiasis in six provinces. 5Resources made available: Personnel Fourteen nurses had been designated and trained to carry out devolution activities. - Infrastructure and logistics Onchocerciasis control had been integrated into trypanosomiasis control activities so Burkina Faso was.using the logistics acquired for that programme. Integration Trlpanosomiasis surveillance was one of the programmes whose activities had already been integrated with those of onchocerciasis. - NGOs There was no NGO participating in devolution activities. - Search for financing Five donor countries had been contacted. USAID intended to finance devolution activites in eight provinces. 5.3. Progress report of Cote d'Ivoire Little had been done in C6te d'Ivoire since the last NOC meeting in 1990 but the execution of devolution had been started: a national coordinator and his deputy had been appointed by a ministerial decree; a national treatment and evaluation team was set up in.July 1990. The National Onchocerciasis Committee existed in the orgarization chart but was not really functioning. Epidemiological evaluation Skin snips had been taken from2,269 persons in the forest area (Danane), making it possible to obtain L,424 positive cases (63Vo). Six other evaluations were made by the national team from 1989 to April 1991 with OCP support. Ivermectin treatment The national team treated 1,849 persons in November 1990 in the forest area at 6Banane while 8,2'1.5 persons were treated in the Touba region in collaboration with OCP. Passive treatment had not yet been started. ; Onchocerciasis control had for a long time formedrpart of the prograrnmes for the control of the major endemic diseases. \ No NGO was involved yet in the devolution prograrnme. The only contact made with UNDP in the search for financing had not yet resulted in a positive response. The difficulties encountered were the following: difficulties of the national team as regards structures; lack of training of the local teams concerning onchocerciasis diagnosis and ivermectin distribution. 5.4. Progress report on devolution in Ghana In Ghana, the Executive Director of the National Onchocerciasis Secretariat (NOS) was also the Devolution Coordinator. A multisectoral devolution committee had been set up. The NOC of Ghana had existed since the beginning of OCP activities with NOS as its secretariat. Placed under the supervision of the Ministry of Finance and Economic Planning, the NOC was a dynamic structure that met once per month. Epidemiological evaluation of onchocerciasis under devolution had not yet been undertaken at the national level. Ghana had received 10,000 tablets of ivermectin which had been distributed in the health centres in the initial area and forest area. The ivermectin trial centre which was in Tamale had now'been transferred to Hohoe. Training was being continued actively and concerned, particularly, health personnel who had specialized in entomolory, parasitolory and epidemiolory. With regard to facilities, there were 15 hospitals and 53 health centres and some private and government clinics as well as maternity homes where ivermectin treatments could be made. There were 24 districts in the development zone which were sharing 24 field vehicles. 200 motor-bikes had been allocated to the 53 health centres. The Ghana devolution plan had envisaged the integration into its activities of Guinea worm eradication and leprosy control. 75.5. Progress report of Mali The national team which had since 1985 been headed by a Medical OfficerlCoordinator rfas, in additiorl composed of a doctor-epidemiologist, two entomologists, hydrobiologists and entomolory and hydrobiolory technicians. A National Onchocerciasis Committee existed. An epidemiological evaluation had been made in the Farako and Banifing IV basins. In 23 villages evaluated with 6,975 persons enumerated, the prevalence rates were 5.94%o and 2.1%o respe0tively at Farako and Banifing IV. As regards ivermectin distributioq 41 fixed centres were at present undertaking passive treatment in the initial OCP area. Out of the 6,200 tables delivered, L,010.5 had been distributed and 678 patients treated. The resources made available were those of the national team personnel and field personnel. Field vehicles of the 19 centres in the devolution zone were the logistic resources available. With regard to integration, nothing had been done concerning the control of trypanosomiasis and blindness. No NGO was involved in devolution at present. The search for financing had not grven any positive result yet. 5.6. Prosress reDort of Niser - The national team was made up of a Medical Officer/Coordinator, an entomology-technician and fi ve epidemiology-nurses. - The NOC had to be revitalized. - The results of the epidemiological evaluation had confirmed the excellent situation. The highest prevalence was only 7.ZVo, at Bangou-Kouare, while in the same village it was 68.59 in 1977. Each health centre had received 100 tablets of ivermectin. The personnel of the fixed health centres and state and private infrastructure were being used for onchocerciasis control. The onchocerciasis control programme had been integrated into the leprosy control programme and the Expanded Prograrlme on Immunization. With the USAID funds which had been made available, collaboration would be established between the national team and Helen Keller International (HKI). 85.7. Progress report of Togo There was a national onchocerciasis control team. The situation of the NOC was unstable. Epidemiologtcal evaluation and ivermectin distribution missions had been undertaken in collaboration with OCP. As part of training, seven medical officers and 2l nurses had been trained. Onchocerciasis control had been integrated into the activitiqc for the control of the major endemic diseases, e.g., tuberculosis and leprosy. No NGO was participating in the devolution programme and no offer of financing had been received yet. 6. PROGRESS REPORT ON HEALTH EDUCATION ON ONCHOCERCIASIS The OCP Information and Public Relations Officer introduced this agenda item. He invited the participants to make an evaluation of the actions and objectives to be attained which were discussed by the 1990 NOC meeting and report on what had been done before presenting their reflections on other activities. The sociologist of the National l-and Development Office (ONAT), who was the author of a study on the populations settled in the onchocerciasis-freed zones in Burkina, presented the main lines of his report and made three main recommendations: - to inform and raise the consciousness of the populations and the workers and officials of the central departments on onchocerciasis. - to give training to officials and actors in the field of health, students, teachers, etc. - to see to the improvement of the relations between OCP, government departments and the local populations. 6.1. Health education on onchocerciasis in Benin In Benin, an Information, Education and Communication (IEC) Unit existed in the Ministry of Health and had a responsible officer in each of the six regions. As regards the identification and surveillance of the zones at risk, the activities were being carried out by the OCP subsectors and the Technical Intervention Units (TIUs) which used to be the Major Endemic Diseases Units. The onchocerciasis vector rvas being taught in the primary and secondary schools. The IEC/MOH Unit was participating in the preparation of the "Rural Radio" programme in local languages. The 9main channels of communication (national and regional radios, local languages, political and administrative authorities, town criers) were being used. The preparation of the epidemiological map was in progress. 6.2. Health education on onchocerciasis in Burkina In Burkinq the,re was a Directorate charged with Health Education and Sanitation (DESA) in the Ministry of Health. The identification and surveillance of the zones at risk was being undertaken by the national evaluation team as well as the ivermectin treatment campaigns.- No specific health education on onchocerciasis activity was being carried out in the field apart from the information given to the populations during evaluation and treatment rounds. OCP, in collaboration with ONAT, carried out in April-May 1991, a public awareness campaign and film shows in the freed-zones which reached some 10,000 persons and would be continued in the whole zone covered by ONAT. 6.3. Health education on onchocerciasis in Cdte d'Ivoire There was a National Health Education Department at the National Institute of Public Health (INSP) in Abidjan. The identification and surveillance of the zones at risk had been carried out by OCP in the initial area. For some 20 months now, the national team had been participating in epidemiological evaluation campaigns and large-scale treatment in collaboration with OCP. In 1991,, the C6te d'Ivoire television showed a five-minute programme on onchocerciasis every day for one month (between 19h30 and 19h35). 6.4. Health education on onchocerciasis in Ghana In Ghana, health education activities in the Oncho freed areas of the Northern and Upper regions were currently concerned with the training of health personnel in effective communication skills, family planning, aids, onchocerciasis, yaws, leprosy and guinea worm. The health education officers, as much as possible, were using the integrated programme approach to co-ordinate all primary health care activities with most government institutions and departments as well as some Non-Governmental Organizations. Methodologies used by the officers to get the message across to the public were through lectures, group.discussions, drama, songs, radio, video and film shows. a 10 The community leaders, such as chiefs, assembly men, teachers, members of the Committees for the. Defence of the Revolution (CDRs) and members of the district/village onchci committees had been useful in organizing the people for the health education campaigns. , With a view to the implementation of the devolution plan, intensive health education campaigns had so far been extended to areas in the Walewale, Builsa and Tumu Districts which had been among the worst affected oncho areas. 6.5. Health education on onchocerciasis in Guinea In Guine4 the health education section was based in Conakry and under the Health Promotion Division. The zones at risk had been identified and would be under surveillance as long as the antilarval treatment continued. The phenomenon of migration of onchocerciasis patients was not evident. Mass treatment campaigns were being carried out. The outline of a booklet on onchocerciasis had been prepared and submitted to EPl-Conakry for comments. Training would be undertaken with the support of OCP as part of the training of the local treatment teams. Programmes had been broadcast by the Rural Radios of Middle Guinea and Upper Guinea and contacts made with news media representatives in Conakry. The OCP Information Officer was involved in these activities. The national teams, during each of their field trips, were improving the populations' knowledge of onchpcerciasis. 6.6. Health education on onchocerciasis in Guinea Bissap The dissemination of messages in local languagei and Creole was being continued. The retraining of primary health care workers was also being continued. The nationd epilemiological and entomological teams were contributing to the improvement of the populations' knowledge of onchocerciasis. 6.7. Health education on onchocerciasis in Mali A National Information, Education and Communication (IEC) Centre had been set up in the Ministry of Health. The large-scale treatment campaigns had made it possible to raise public awareness in 307 villages. 11 It had been planned to: prepare and distribute guides on health workers in the onchocerciasis zones; organize information/training workshops,- produce radio programmes at the local station at Kayes, which was the administrative centre of the western extension area in Mali; broadcast other messages in local languages spoken in the onchocerciasis zones. 6.8. Health education on onchocerciasis in Niger There had beeru for five years now, a central structure called "Directorate of Training and Health Education". The Regional Information and Health Education Office (ARIEPS) had audio-visual equipment. The epidemiological map had been reviewed and corrected. The regional fiealth education office had prepared teaching booklets for teachers and pupils in the health districts in the onchocerciasis zones. A 20-minute television programme was shown in Niamey in November 1990 with the collaboration of the OCP Information Officer on the national television. A programme was broadcast in a local language on onchocerciasis and it had been planned to continue with this practice. In collaboration with the national teanL ARIEPS was carrying out, once per quarter, public awareness campaigns in the onchocerciasis zone and showing, at the same time, documentaries on onchocerciasis. The commentaries in the films were being translated into the local languages. 6.9. Health education on onchocerciasis in Senegal Since the 14th NOC meeting (1990), developmental activities centred on information, education and communication had been assigned to the regional health education office at Tarirbacounda. A plan of action had been prepared with the collaboration of the medical region. The main objective consisted in making the target populations aware of onchocerciasis and its gravity which blindness constituted. Strate8lr and activities undertaken Information of the general public As regards radib and the print media, the regional health education office had a programme per week. Two interviews (radio) of the Deputy Coordinator at Tambacounda were broadcast (in December 1990 and March 1991), an interview was granted to a correspondent of the daily "[r Soleil" at Tambacounda (in August 1990) and a roundtable was organized at the headquarters of the same newspaper in Dakar, L2 in November 1990,itvith the participation of the OCP Director, the National Coordinator, the Deputy National Coordinator, and the OCP Information Officer. Other activities had been carried out, particularly: the holding of the meeting of the Regional Development Committee (CRD) in February 7991at Tambacounda on the region's health situation with an information paper on onchocerciasis; video-shows on onchocerciasis in somor20 schools in the region; the information and sensitization of all the Chief Post Nurses (CPNs), etc. 6.10. Health education on onchocerciasis in Sierra l,eone Health educationpn onchocerciasis was not a priority in the activities of the Health Education Unit of the Ministry of Health of Sierra Leone. According to the officials of this Unit, this lack of interest was related to the problem of material and logistic resources, considering the meagre budget of the Ministry of Health. Despite these'constraints, the national onchocerciasis control team had carried out a number of activities using the following channels: the national radio to inform the public of onchocerciasis-related problems; dissemination of information in the field, film- shows and conferences. 6.1L. Health education on onchocerciasis in Togo Togo had had a National Health Education Department since 1969 i- The national team and OCPwere teaching the village development committees how to identify the blackfly. 7 - IVERMECTIN DISTRIBUTION This agenda item concerned the five countries in the OCP western extension zone, viz., Guineq Guinea Bissau, Mali, Senegal and Sierra I-eone. The Chief of the Epidemiological Evaluation Unit recalled that large-scale treatment was started in 1987, at Asubende (Ghana). Furthermore, he affirmed the need to repeat the treatment every year. The benefits of the treatment, i.e., the regression of ocular lesions, had been noted in persons having had trvo to three treatment cycles. After treatment of more than 260,000 persons by OCP, the safety of ivermectin could no longer be doubted. For his part, the EPI Coordinator in Bamako pointed out that by intensiffing ivermectin distribution in the fixed health centres the drug was at the same time being made available and thb capacity of these health centres to provide a correct service to onchocerciasis patients was being maintained while strengthening it. It emerged from the presentations made by the delegates of Guinea, Guinea Bissau, Mali, Senegal and Sierra lrone that everything was going on normally. 13 The situation in each country was as follows: Guinea : Fixed centres concerned = 126 Number of patients treated ' = 11,839 Tablets distributed = 16,998.5 a. Guinde Bissau The centres had not yet taken off although the tablets had been put in place. THis was due to the diagnostic difficulties the health workers were facing. Mali (Western extension) Fixed centres concerned Number of patients treated Tabkets distributed =93 = 12,755 = 19,769 Senegprl Fixed centres . concerned = Number of patiepts treated = Tablets distributed = Sierra lrone Fixed centres concerned Number of patients treated Tablets distributed It should be poirlted out that non-gouvernemental organizations (NGOs) were involved in ivermectin distribution in some of the countries. 7.2. Discussions The Prograrnme Director expressed his ;atisfaction at the work done within so short a time. He stressed also that the distribution methodology had beem made lighter. Skin snip was no longer necessary before treatment; that procedure was risky because of the possibility of AIDS transmission; data registration would be simplified; the weight parameter (demand for scale) should no longer be an obstacle because the drug was not toxic. As regards collaboration with NGOs, the Programme Director expressed the wish for them to have a sufficient budget and commit themselves to collaborate for five years. 8 . INVENTORY OF FACILITIES AND EQUIPMENT The Chief of the Devolution Unit said that this work would allow the workers to know at any time the situation as regards the infrastructure and equipment made 29 540 777 49 36,954 57,925 t4 available. This inventory should be regularly updated. The Programme Director then underscored the importance attached to this inventory by the donors, certain benefactors, members of the Expert Advisory Committee and the WHO Regional Office for Africa. AII the delegates then indicated that standardization had been adopted in their respective countries as regards infrastructure and equipment. 9. OTHER MATTERS Forest onchocerciasis was discussed and would be the subject of a consultative meeting between C6te d'Ivoire, Ghana and OCP. 10 - DATE OF THE 16TH MEETING The 16th meeting of the NOC would be held from L9 to 27 May L992. 11 - ADOPTION OF THE REPORT The report was adopted. It would be sent to the participants for their observations. The Programrt"e Director gave an important information on the consumption of ivermectin since 1987, i.e., more than 1,8M000 tablets, which was a world record in the use of a drug. -