Context for the fourth financial phase (1992-1997): bringing the Programme to a successful conclusion

Onchqcercinsis Control Programme in W6t Africa Prognamme de Lutte contre l'Onchocerrose en Afriqtre de l'Ouet' JOTNT PROGRAI\{ilIE COMMITTEE Officc of thc Chairman JPC .CCP COMITE CONJOINT DU PBOGRA.}TME Bureau du Pr€sident JPCIZ.1O Revision ORIGINAL ENGLISH October 1991 JOII{T PROGRAMME COMMITTEE Twelfth session Riyadh, 1-4 Decenber 1991 Provisional agenda item 10 Context for the fourth Financial Phase (1992-t997): bringing the Programme to a successful conclusion Main features of the strategy and ope Financial Phase conducive to bri ns the Programme to a successful 1 I end 1.1 The Progranne Director's proposal for the Plan ofl Operations for the fourth Financial Phase (document JPCLZ.9) sets forth a number of operationalprinciples and expected achievements, the impact of which will lead OCP to its final stage: phasing out the Programme with the assurance that its accomplishments will be maintained. L.2 From the overall strategic point of view, operations will adhere to the lines laid down in the Long-Term-Strategy, thus consolidating the results obtained during the third Financial Phase. This applies in particular to vector control which, for all intents and purposes, wiII have ceased early in the Phase throughout the Original OCP area, thereby completing ahead of time the twentS' year programtre agreed upon in 1974. The subsequently approved control operati.ons in the Extension areas, implemented during the third Financial Phase, will continue unaltered throughout the fourth Phase. 1.3 Therefore, at the end of the L992-1$!l period, vector control will be confined to parts of the Extension areas where larviciding will already hat,e reduced considerably the human reservoir of the parasite. In other words, the epidemiological situation in L997 will be such as to a11ow for a definite phasing- out of vector control. 1.4 Maintaining the achievements of the Programme will depend on the extent to which the Participating Countries wil-1 be able to identify and control recrudescence. Consequently, preparing for, or implementing, the process of devolution will be a critical issue and a major preoccupation of all parties of the Programme throughout Lhe 1992-1!!J period. The role of OCP will be to provide technical support to the Participating Countries in respect to onchocerciasis surveillance and control, and together with WHO and the other Sponsoring Agencies, to ensure that such activities are firmly anchored in the national health systems of the countries concerned. JPC12.10, page 2 2 Rev Phasing-out the Progranme 2'7 rn the preceding section a brief account has been given of the salientfeatures of the Plan of operations for the fourth Financiar Fhase which, takentogether, set the scene for winding down the Programne during the post 1!!Jperiod. 2'2 The preparation of tinefra.mes for OCP operations and their cessationhas, over the past years, been guided by the duration of vector-control believedto be required to ensure virtual elinination of the human parasite reservoir.This period has recentry been estimated to be nologer tnan i4 years - thesexiPum-lifespan of the onchocercal adult worml according to predictions madeby the OCP mathematical nodel. 2.3 However the experience of progranme operations to date indicates thatthe duration of larviciding necessary to eliminate the human reservoir of0 vo1vul us is in general two to three years less than the maximum of 14 yearspredicted by the model. As a matter of fact, it has been necessary to continuelarviciding for 14 years only in the periphery of the reinvaded zones of theOriginal OCP area. It is worth noting in this regard, that the far westernExtension area in question has never been exposed to reinvasion. 2'4 Furthermore, the probability exists that the added effect oflarviciding and connunity-wide ivernectin distribution when carried outsimultaneously could shorten the required duration of larviciding. Recentobservations made in the Western Extension area suggest that this could be thecase. 2'5 During the phasing out period (beginning 1998) vector contror wirl berapidly discontinued and it is expected ttai ocp operations would cease by theend of the current decade. Ttris is the nost likely scenario and costs for thephasing out period would not exceed US $72 million and would decline fromus $26 million il-rggg (as compared ro us $26.! mirrion for t997), ro US $24 in1999 and to US $22 million in the year 2OOO. Under the nost pessinisticscenario, which is highty unlikely, and which would require llrviciding for afull 14 years, Programme operations would continue in linited areas until 2OOZ. 2'6 The search for a macrofilaricide applicable on a large scale underfield conditions will continue unabated durinl the fourth Financi"i.pt"""-""a even into the phasins-out period, if necessary. Should such a macrofilaricidebecome available before the cessation of Progranme operations, the entirestrategy would need to be reconsidered and the inplementation of a revisedstrategy' including the use of a nacrofilaricide, would probably lower the costs even more. 3JPCL?.10, Rev. page 3 Impact and results of OCP opera!!qqs when the Programme comes to an end 3.1 By conducting OCP operations until the end of the phasing-out period, the Progranme will have attained its objective: "to elininate onchocerciasis as a disease of public health importance and as an obstable to socioecononic development throughout the Programme area and for the Participating Countriesto be able to maintain this achievement". 3.2 Ttris means in more specific terns, that by that time probably 4O-50 million people in lrlest Africa will no longer live under the threat of onchocercal infection and its serious ocular nanifestations. 3.3 0n the development side, nore than 2! million hectares of fertile, riverain land, previously deserted due to fear of onchocercal infection, willhave become available for cultivation, enough to feed ca L7 nillion people.This land has the potential of contributing inportantfy-to poverty-allevtation. 3.4 It is worth stressing that these results will be obtained without any ecological damage in spite of continuing aerial larviciding over extendedperiods. 3.5 [{hen the Progromme ceases operations, it will have nade a substantial contribution to manpower development in West Africa. Close to 1000 Afrlcans will have worked with OCP and thereby acquired considerable experience intechnical disciplines as well as in the field of management. To this should be added the 400 to 500 fellows who have received OCP grants for graduate andpost-graduate studies in disciplines connected with onchocerciasis control. 3.6 Eventually, also, it can be expected that the devolution process byits very nature will contribute to and catalyse the developnent of public neatttr systems in the Participating Countries with the support of all partiesinvolved.