First meeting of OCP commission: history and structures of the Onchocerciasis Control Programme

IWORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTT ONCHOCItrICIASIS COIT?ROI IR0GR/:i'X'r-rT llT TIII VOITA RfVIR BASIN llt.ri itIRST i-rflrfll\c Otr' OCP COI,tffSSfON HISTORY ,'ND STNUCTUR.DS OF T}IE ONCI{OCjRC UISIS CONTROI ?ROGRT',MID R. Villars t Ouagadougou, l,4ay 1979 t ) HISIORY AIVD SI]RUCTURES OF TTIE ONCHOC BCIASIS CONIBOI ?R.OGRAMIryIE For a period. of some thirty years prior to the lawrching of thls Progrqn'mee lnterest in the problem of onchocerciasis and awareness oflts serious ad.verse effects on public health and econony had been growing steadily. During the 1950s surreys were carried out in $Iest Africa to asserls the importance of the disease and possible control methods were studiecl both in the francophone cor:ntries, under the auspices of OCCGE, antt 1n Ghana by a team from the Royal Coomonweal,th Society of the B11nd. In 1956 a Si-uirlium Control Unit was fo:metl by the Ministry of Health of Glrana. The first I?IIO Erpert Cornmi ttee on Onchocerciasls whtch met in MexicoCity ln 1955 discussed many aspects of the biolory and control of Simrliun d,awtosun, which he,d been identifieat jrr 1926 as the vector of onchocereiasis. During the fifties a^nd sixties IYHO convened several neeti-ngs related to this disease and its control lncluding conferences on African onchocerclasis in leopoldville arid Btazzavi,llel i-n 1954 and 196L respectiveIy, a meeting il Geneva in l-964 on the entomological needs in onchocerciasls eontrol, as rve11 as scientiflc advisory groups on the cllni-caI aspects of the disease. Specialists were employed. to visit and. investigate some of the most affected areas - West Africa, Sud.an, Central America and Venezuela. In the late sixties the African Regional Office assigned a IIIHO Onchocerciasis Atlvisory Iean to Ghana. All these con-ferences and mi ssions playetl a vital part in assembling info:mation about the role of Si-uulium 1n onchocerclasis arrd. about control III9OSUfOST OCCGE carried, out geograpir:icaI recorueaissance ln nost of the affected. areas of the Volta River basin and. developed nethod.olory for vector control and epidendological evaluation, i:r oost instances in close cooperation w:lth I[HO. D;rlng the L96os a control campaj.gn vras lanrnched. over a.n area of some 60 OOO kn2 by the Governments of fvory Coast, MaIl and Upper Volta wittr the assistance of the E\rropean Develolment Fr:nd antt OCCGE. Ikris campaign provi- tletl a gooct tleal of basic technical i-nfo:mation for i-urplenentlng a larger scale pro8ranme, ILre second WI{O trrpert Committee on Onchocerclasis, which met 1n 1966, noted that campaigns were hampered by lack of funtls, by the difficulties of coordlnatilg control pro3rrmmes in ad.jacent countries and by a sertous shortage of trainetl staff. Fina11y, 1n f90g some 50 experts gathered in t\:nis at a conference sponsored. by USAID - OCCGE and IYHO - to consider the feasibility of onchocerciasis control. Other partlcipants i:tcIud.ed the lttorld Bsnk, FAO, FED and. ORSTOM. At that tine it was estimatetl that 20 nl1lion people i:r the worl-d were lnfected., of whom the majori-ty were in Africa, and that in Upper Volta alone 4OO OO0 out of a population of 4.5 Billion were sufferers. The I\rrris meeti.:ag concluded. that eontrol of onchocereiasis ln the savarma zone of lYest Afriea was technical-1y feasible and. that the time was ripe to undertake a large-sca1e ca-l;aign against the Simulium vector. It recomended.that priority be given to the Yolta river and contigous river basinsr frldthat an lnternational stud.y mission be set up to assemble all eristing info:mation and to prepare a detailed assessment of the costs and benefits expected. from the proposed prograrm,eo t 2 During 1959 and L97O, as a result of the f\rnis raeeting, the seven Governments - Benin, Ghana, fvory Coast, Ma1i, Niger, fogo and Upper Volta - confi:med thelr interest i:: a regi-onal onchocerciasis control programme and fomulated. requests to UND? who agreed to provide fi;nrls for a Freparatory Assistance lllj-ssion - or PAG l,lli-ssion. to these Govern- ments. In 1970 an inter-'agency meeting reviewed'thc d.raft tenns of reference and agreetl the mandate for the mi ssion, FAO, which had been follovring develolments closeIy, attendetl tkris meeting i:r the role of adviser and indicated its concern about expanding agricultural d.evelopnent in the areas where onchocerciasis was endemaic and its jnterest in collaborating ln the hogramme, fbe PAG Mission, financed by UIfDP, was launeired in July 1971r dtr YfH0 as ftcecutirlg Agency in asso6iation with FAO, whlch had responsibllityfor certai:: aspects of the work. Tkre nlssion which conti-nued through 1972 anc, 1973 was b6,sed. irl Ouagadougou in prernises provid.ed by the Governnent of Upper Volta. the visit of L{r I\[acNnmaral fteesldent of the World. Bank to Upper Voltain March 1972 consolid.atetl the interest of the Sarik i-n onchocerciasls control and. led to the creatlon by the head.s of the four agencies, the 3ank, FAO, UIilDP and VfHO, of an inter-agency Steoririg Conrmittee. Thc role of this Conn:ittee has been to coordj-nate activities between the four agencies in plarueing and subsequently, implementing the Progranrme. At the request of the other agencies, the Bank agreed to noblLize the firnds required for the proposed ?rogramme. The report of the PAG l,lission was issued. in August L977. It was entlorsed. by the seven Governraents on 1 November at ari inter*.courrtry meetlng he1d. in Accra at wtrich, the Governmeirts, together w'ith YIHO, also signed an Agreement governing the operations of the Prograrmel lo:ov*e as the Operatlonal Agreement or Accord Cadre. Itre Onchoeerelasls ControL Prograrme began on 1 Jarruaty L974 urith headquarters in Ouagadougou; aetual control operations started i.:r tr'ebnrarXr t975. DJ.:ning 1974 the Operational Agreement uras supplenentetl by ind.ivid.ualCowrtry Protocols v*rich defined the contributlons of each Govclrsnents. Each eotmtry set up a National Onchocerciasis Covnmi ttee to coord.inate actlvlties withi-n the country and to liaise w'ith the Progre'nme. Since 197? these Corrmittees have met together on arr aru:uaI basis, Ihe initial managenent st:ructures of the hograrrme included an EeologlcalPanelr establised. by the Steering flenrmi f,f,ss to help ensure protection of the environment, and a Scientific Advisory Panele set up by WHO, comprlsing sone 2OO specialists from whom the OrgarrizatLon could. seek scientifie and technical advice either by correspondence or through working groups. In June L974 a meeting of donor and partieipating governements and. agencies at the lYorld Bank office j.:e Paris agreed. to extend these structuresto include first of all a Joint Coord.inating Cornmi ttee, with an overallpolicy-supervision ro1e, eomposed. of representatives of the seven governnents, a-3- all contributi.:rg parties and the four sponsoring agenci-es r arld presltled by an fndependent ChainrEulr secondly a Sci-entifie and Technical Advisory Committee, appoi-nted. by IYI{O fron members of the Sclentific Advisory panclto prorrid'e an independent evaluation of the technical aspects of the ftoS-raryer md finally an Dconomic Development Advlsory Po:re1, appcintedby the Steerirg Comnlttee to review the econonte developent aspects. These structures were descrj-bed in a Memorandum of Understand.lng which was,approved by the JCC at its first sesslon ln Abidjan in rlebzuara 1975.4n Onchocerciasis ftmd Agreenent coverlng the financing of the first phase -that is the first six years - was signed i-n Washlngton in lv1ay 1975 by 9 donorGovernnents, the African Development Bank, BD, tla, mml and I?HO. The number of donors now totals sixteen In 1976 responsibility for the ?rogrqmme was transfened froro WHOHead'quarters to the WHO Reglonal Office for Africa and all activities were centraJ-izetl i:a Oua6adougou. With the end' of the fj-rst phase of tLre Prograrnme drawj-ng near, and i-norder to provide a basis for the second phase oi trru progro.,;s, an evaluation was mad'e in 1978 of both the technical and economi c aspu-t" by y[Ho and. theBank respectively. Tkre cristing stmctr:res were reviewed.. rt was recognized.that the hogranrme had received valuable support from the Scj-entific andleclrnicaL Advisory Corutittee particularly ai-regarcls research. The role ofthe Ecological ?ane1, in reviewing data to[ect6d by th9 aquatic monitoringteamsr had been equally useful. on the other hand., tne'fi6fa io ue coveredby the Economic Devclotrment Advlsory Panel was too vast, f'l:erefore und.erthe proposed' future structures, whith have yet to be fo:ma11y adopted., STAC and ED/.P have been nerged. to fom an trxpert Ad.vi-sory Committle. Tlrere willalso be an Dcologi-cal group possibly atiached to the D'iC. The Joint Coord.i-nating Conrmi ttee w:iIl be mai-ntained antl will- be presided by a chai:man selectedat the beg{nning of each anrrual sesslon. The Steering Conrmi ttee will alsocontinue.