Onchocerciasis Control Programme in West Africa: Committee of Sponsoring Agencies, report of the thirty-fourth session, London, 24 and 25 February 1988

r" F- -_-*t RESTRICTED ocP /csA/34 ENGLISH ONLY ONCHOCERCIASIS CONTROL PROGRAMME IN WEST AFRICA COMMITTEE OF SPONSORING AGENCIES Report of the Thirty-fourth Session London, 24 and 2! Februarv 19BB I ocP/csA/34 page 2 A. OPENING OF THE MEETING B. ADOPTION OF THE AGENDA c. APPRoVAL 0F REPoRT 0F CSA.33 D. MATTERS ARTSTNG FRoM CSA.33 E. ISSUES ARISING FROM JPC.B REPORT OF OCT REVIEW GROIJP PROGRESS REPORT ON OCP OPERATIONS INCLUDING IVERMECTIN TRIALS H. AMENDMENT TO PLAN OF OPERATIONS FOR THIRD PHASE I. REVIEW OF INTERIM REPORT OF HUNTING TECHNICAL SERVICES J. !{ORLD BANK CONSULTANCY TO OCP COUNIRIES RE DEVOLUTION K. OCP FINANCING AND SCHEDULE OF DONOR VISITS L. PRELIMINARY THOUGMS ON DONORS' SEMINAR M. ANY OTHER BUSINESS N. AGENDA FOR NOC O. DATES AND PLACES OF OCP MEETINGS P. APPRoVAL 0F REPORT 0F CSA.34 ANNEX I PART]CIPANTS Page a 3 3 3 3 3 4F G 5 5 5 6 6 6 7 7 7 7 B 9ANNEX II ASSESSMENT OF OCP FINANCING SITUATION PHASE III 0cP/csA/34 page 3 A. OPENING OF THE MEETING L: The thirty-fourth session of the Committee of Sponsoring Agencies was held 'in the world Bank'Office, London, on 24 md 2J reuruary 198s""";;;-;h;chairmanship of Mr otto Essien. rn his opening comments he paid tribute toMr Mowbray Nicholas, the outgoing chairman, who since the ]ast meeting of thecSA had retired from FAO and requested that the best wishes of the committeemembers be conveyed to him in his new appointment. B. ADOFTION OF THE AGENDA 2. The following agenda was adopted : 1. 2. 3. 4. 5. 6. t. B. 9. 10. 11. 72. 13. 14. Approval of report of CSA.ll Matters arising from CSA.IJ fssues arising from JpC.B Report of OCT Review Group Progress report on ocp operations including ivermectin trialsAmendment to Plan of Operations for third fna"eReview of interim report of Hunting Technical Servi,ceshlorld Bank consultancy to OCT couniries re devolutionOCP financing and schedule of Donor visitsPreliminary thoughts on Donors' SeminarAny other business Agenda for NOC Dates and ptaces of OCp meetingsApproval of report of CSA.34. - c. APPRoVAL OF REPORT OF CSA.33 3' The draft report, of cSA.lJ, previousry circulated to members, wasapproved. D. MATTERS ARISING FROM CSA.33 4' The committee rdas informed that both the Expert Advisory committee (EAC)and t'he Ecological Group (EG) now had fulr membership with the recentappointment of Dr Aboagye-Atta of Ghana to the EAC and Dr Hans de rongh ofNetherlands to the EG. E. ISSUES ARISING FROM JPC.B 5' Most of the issues highlighted are dealt with separatery under thedifferent agenda items which fo:_tow. 6' with regard to forest onchocerciasis the committee was informed that, at arecent meeting in c6te d'rvoire, the Minister of Health had reported thesituation as stated in the final communiqu6 of JpC.B. ocP/csA/34 page 4 7. Clarification was sought on how "the role of women" in socioeconomic developnent should be dealt with in future. The Connittee considered that this subject should be integrated into all socioecononic studies and not treated as a separate entity. In this context women should be considered as a resource and as active participants in the socioeconomic development process. F. REPORT OF OCT REVIEhI GROUP 8. The OCT Review Group had net in Geneva in January following serious reservations expressed by the JPC of OCT with regard to a lack of transparencyin the research arrangement process, the lopsided allocation of funds to anglo- sa)<on countries, the restrj.ctive approach to working with pharmaceutical companies, the lack of follow-up by TDR in management and some conflict-of-interest issues. 9. The report before the CSA expressed the views of the group which included three donors and two members of the EAC, and the Directors TDR and pDp of WHO. The CSA was represented by members from the Bank and WHO as agreed at CSA.33. 10. The Connittee noted that the report reflected a very frank exchange of views which would call for some significant changes in the management andfunding of OCT. The mandate approved by JPC in 1982 remained unchanged. While recognizing that the most conpetent technical supervision should continue to beprovided by WHO, the Committee felt that it should present recommendations to the Director-General of WHO as to how best this should be undertaken in orderto satisfy the concern of the Donors. 11. The implementation of changes to the systen at an early date was important and should be authorized by the csA for subsequent approval by the Jpc. 72. The Committee accepted the revisions to the OCT structure, management andfunding incorporated within the report presented to it but recommended that a shortened version be written which would be adopted by the CSA for submission tothe JPC. Its early circulation to the Donors would be appropriate to make them aware of the actions being taken. A certain flexibility had to be retained withfurther reviews being undertaken in future as necessary. t3. With regard to EAC now having responsibility to report on OCT to JpC eachyear the CSA agreed that an appropriately qualified person with relevant drug deveropment experience be sought and coopted on to the EAC in an advisory capacity. 14. sources of alternative funding were cumently being sought and the Committee was informed of positive contacts established with the Science and Technology Directorate of the Commission of European Communities (CEC) which could result in approximately US$1.00 million per year being available through 1990 for funding ocr-approved proposals. The availability of such funding, however, would require the coordination of appropriate research proposars between the CEC and OCT. The McConnell Clark Foundation did not seem hopeful atpresent and approaches were being made to the Wellcome Trust. ocP /csA/34 page 5 G. PROGRESS REPORT ON OCP OPERATIONS INCLUDING IVERMECTIN TRIALS L5' The Committee was informed that the resistance problem appeared to becontained and the Programme was now planning to undertake full ,'attack phase"operations in the Southern Extension area and to push ahead as far as possiblewith similar operations in the hlestern Extension to t"y to make up some of thetime lost in previous years. 76' rmprovements continued in the formulations of B.t. H-14 and a Japanesecompany had produced a promising new organophosphor6ui larvicide showingpositive effects in triars tn,ithout cross-resistance to temephos or chlorphoxim. L7 ' The ivermectin trials continued to be undertaken with very encouragingcollaboration with the countries concerned. The experience was such that thereno!' appeared to be real promise of using the drug tn a much wider scale from1989 arttough definitive results from the trials would not be available until-the latter part of 1988. 18' The quality and standard of service being provided by the aerial operationscontractor were now, satisfactory to all concerrrla urra the improvements made toequipment to meet the programmeis denands had been very encouraging. H. AMENDMENT TO PLAN OF OPERATIONS FOR THIRD PHASE L9' The committee considered d first, incomplete draft of the modification tothe Plan of operations for the third Financial phase which, as regards plannedoperations for the years lggg and 1gg1, and their uuag"ta"y implications,should be worked out at an ocP Staff Seninar rn March rg8a. rt was stressedthat the eventual budgetary forecasts, to be based exclusively on contror bylarvicidinB, should be presented as best estimates *itt, built-in frexibility soas not to constrain progranme operations. rt was also stressed that theseestimates would be presented as financing targets to be sought in fund-raisingcontracts with Donors. 20' At the same time the final document should address the timetable forcessation of larviciding in the core area and shourd provide some prelininaryindications regarding the future use of rvernectin. rn those areas wherechemotherapy might play a role some tentative estimates of the respectivebudgetary inplications for ocp should be provided. The inportance of thedocument in connection with fund-raising for the 1989-rp!1 period wasunderlined. I. REVIEW OF INTERIM REPORT OF HUI{TING TECHNICAL SERVICES 27' The committee expressed overall satisfaction with the work undertaken andwas pleased with the quality of report submitted. '?: rn discussing the rnterim Report from Hunting Technical services Ltd.attention was drawn to the constraints mentioned not being pecuriar to the ocparea alone' but representative of the crassic p"ouiur" of rural development.Noting that the rore of wornen was not addressed in the report, the committeedirected that the finar report should give this ""uj."t due consideration. Thecommittee arso considered trr"t "trJi.es of factors iitiuiti.rg development shouldnot be isolated but rather integrated with other studies. ocP/csA/34 page 5 23. HTS nade a presentation to the Comnittee updating the report and indicating the contents of the final report. It highlighted the case studies IIIS intended to propose for each country in its final report. The tean enphaslzed the excellent cooperation it had received fron the representatives of all the Sponsoring Agencies in the countries. J. WORLD BANK CONSULTANCY TO OCP COTJNTRIES RE DEVOLUTION 24. The Bank inforned the Comnittee that a consultant had been recruited to visit Mali and Burkina Faso to look at the health institutional set-up in these countries together with resources available and budget allocated and, on these bases, to discuss with the authorities what could be done to strengthen thepublic health structure especially with regard to the needs of OCP. Depending on the result from this mission, a decision would be made on similar nissions to other countries. It was enphasized that these nissions would be undertaken in close collaboration with the Programme and the assistance of the other Sponsoring Agencies would be sought as necessary. The Conmittee sa!, the OCP as the tool necessary to spur developnent of public health systems. 25. Since the advent of Ivermectin as a rneans of control, the concept of "devolution" had drastically changed and what would be required of the countries had becone clearer. In the core area the I'devolution" activities would probably be confined to case-finding (passive or active) to detect possible recrudescence of the disease followed by containment by Ivermectin while, in the Extension areas, the Participating Countries would eventually be involved in large-scaIe distribution of Ivermectin over an extended period for the purpose of disease control. "Devolution", therefore, would eventually consist of strengthening the health care systens of the Participating Countries to be able to cope with case finding and drug distribution. K. OCP FINANCING AND SCHEDULE OF DONOR VISITS 26. The Bank circulated a table showing contributions received into the Onchocerciasis Fund until the end of 1987. The total received during 1986 and 1t8l amounred ro US$78 775 O34. 27. An assessment of the OCP financing situation for the remainder of Phase III, representing a possible scenario in additional fund-raising and in cost- savings, was also distributed as expressed in Annex II. 28. The Committee discussed the possible Joint tactics of the Bank and OCP in contacting Donors, old and new, to ensure that the maximum financial support is forthcoming over the remaining years of the Phase. The Donors had to be assured that the Progremme continued to be cost-effective in its operations and that OCP was managed efficiently. On the other hand it riras essential at this stage to avoid overselling the Progrnmme. L. PRELIMINARY THOUGHTS ON DONORS' SEMINAR 29. The Donors' Seminar should be carefully focussed and not be a "rehearsal"for the JPC. Accordingly, it should focus on the two issues of particular concern to the Donors, viz. financing requirements to fill the gap and OCT review. The Bank requested that this subject be raised again at the next session of the CSA before a decision is made on the agenda to enable some further feed- back from the Donors. ocP/csL/34 pa8e 7 M. ANY OTHER BUSINESS 30. UNDP informed the Committee that the project under which its future fundingof the oCP is provided had been formally approved by its Action Committee. TheLand Settlement Study Project had also been approvei with some conditionsincluding the stipulation that national institutions and experts be used to the maximum extent possible through appropriate sub-contracting arrangements. 37. UNDP also announced that it hras supporting a two-h,eek seminar ofophthalmologists in March in association with OngfS and would welcome thecollaboration of OCp in this. N. AGENDA FOR NOC 32' The NOC should restrict itself to a consideration of devolution andsocioeconomic development. The Committee recommended that every effort be madeto have the Hunting Technical Services final report distributed to theParticipating Countries ahead of time with a covering letter explaining that thecountries would be given the opportunity to share their experiences in mattersreferred to in the report. 33' The Committee also proposed that the Terms of Reference for the LandSettlement Review be circulated for discussion by the countries and possibleinput which courd require them being revised. rn this respect it would beessential for UNDp to be represented at the meeting. 34' As socioeconomic development was becoming more and more important to thecountries, the committee emphasized again the need for each country beingappropriately represented at the NOC. 35' In order to ensure closest involvement of the Sponsoring Agencies, UNDp andthe Bank were requested to circulate the schedule of roundtables andconsultative groups respectively in each of the ocp countries. O. DATES AND PLACES OF OCP MEETINGS 36. The following schedule of meetings was agreed : National onchocerciasis committees - ]1 May to 2 June, conakryExpert Advisory Committee - 13 to 1/ June, Ouagadougou.CSA.35 - lZ Lo_11 Ju1y, London (starting fO a.i.).CSA.36 - 7 to B Seprember, London (starfing i ".i,.1.Donors' Seninar - 11 and 12 October, paris. CSA.37 - 28 November and I December, Dakar.JPC.9 - 2t November to 2 December, Dakar. P. APPRoVAL 0F REPORT 0F CSA.34 37- The report of CSA.J4 was approved at the close of the sesslon ocP/csA/34 paSe I ANNEX I Members IJNDP FAO World Bank PARTICIPANTS Mr Otto Essien (Chairnan) Mr Cyril Groom Mr Bruce Benton Dr Bernhard Liese Dr Ebrahim M. Sanba Dr Claude-Henri Vignes liH0 Secretariat: . Ginger, Secretary, Onchocerciasis Chemotherapy Project, Geneva .M.Marr, Chief, OCP Liaison Office, WHO, Geneva (Secretary) . Christensen, Consultant, Qnchocerciasis Control Programme, Geneva Invited from Hunting Technical Services to present report only: . Brunt .L. Gooch . Potten Dr Mr Dr c.D J.D 0.li M.A c.R D.H Mr Mr Mr aUS $ (nillions) 175 7 L82 160 9 $l nillion $/ million $J million ocP/csA/34 page 9 ANNEX II ASSESSMENT OF OCP FINANCING SITUATION PHASE III Revised expenditures - modified plan of 0perations Indicative OCT budget - tg}g-L991 ($2.1 million/year) Total required Projected available financing (current estimate) gap22 13 Optimistic assessment of extra financing that can beraised new Donors (Nordic countries,Austria) existing Donors (Switzerland, Japan, Netherlands, France, World Bank, Canada, possibly oneor th,o others )from EEC for OCT $1J million subtotal Savings that would be needed from OCp/OCT _ 198g_1991. J