World Bank/OCP Initiative concerning the implementation and financing of devolution Plans

Onchocerciasis Control Programme in West africa Programme de Lutte conre I'Onchocercose en afrique de I'Ouest JOINT PROGRAMME COMMITTEE Office of the Chairman JOINT PROGRAMME COMMITTEE Fourteenth session Luxemboure. 7-10 December lQa3 JPC - CCP COMITE CONJOINT DU PROGRAMMEBureau du Prisident JPCI4/INF IDOC.2 ORIGINAL: FRENCH November 1993 Provisional aeenda item 7 WORLD BANK/OCP INITIATIVE CONCERNING THE IMPLEMENTATION AND FINANCING OF DEVOLUTION PLANS Prepared and submitted by the Committee of Sponsoring Agencies I tJPCl4/INF IDOC.2 page I World Bank/OCP Initiative concerning the Implementation and Financing of Devolution Plans 1. Ever since the start of the Onchocerciasis Control Programme in West Africa (OCP), the Joint Programme Committee, on the advice of experts, has stressed the need for epidemiological surveillance of the disease in the areas freed from onchocerciasis, once OCP comes to an end. Such epidemiological surveillance of the disease and the control of is possible recrudescence becomes the responsibitity of the countries concerned with the advice and technical support of OCP. The process of transferring this responsibility from OCP to each of the countries has been termed "devolution". 2. Each country has prepared, with the support of the OCP Devolution Unit, a devolution plan covering five years which integrates epidemiological surveillance and residual activities for the control of onchocerciasis within surveiltance and control activities of other endemic parasitic diseases of public health importance. The tong-term objective of these devolution plans "expanded" to other diseases is to develop, based on the experience acquired through onchocerciasis control, a national capacity in the field of effective control of infectious and parasitic diseases. 3. The World Bank announced at the thirteenth session of the Joint Programme Committee that in case bilateral financing was not forthcoming, it would accept to study, at the request of the countries concerned, the integration of t'inancing devolution activities within plans for health projects. Burkina Faso has been the first country to officially request Wold Bank financing of activities connected with devolution. During the last two years, these activities have been financed within the framework of the Health Care Development Project (Projet de Ddveloppement des Soins de Sant6 (PDSS)) and will continue as such, as a component of the new Health and Nutrition Development Project @rojet de Ddveloppement Sant€ et Nutrition (PDSN)) which is being finalized. 4. Several countries have contacted the World Bank to study the financing of the activities listed in their devolution plans, i.e. Ghana, Guinea, Guinea-Bissau, Mali, Niger, Senegal and Sierra Leone. Discussions are underway, or foreseen, between these countries and the World Bank to establish the agenda and finalize the investment plan. The technical aspect of the activities and the possible modifications needed in the context of the implementation of the plans are studied by the OCP Devolution Unit, by the WHO/AFRO devolution structure and by the technical services of the World Bank. 5. The recent experience of Burkina Faso as regards financing of the activities in the devolution plan has made it possible to define the steps necessary, on the one hand, to secure the durability of OCP's attainments, and on the other, hand to work out a strategy for the control of infectious and parasitic diseases. 6. The first step is that of enhancing the national capacity in the field of epidemiological surveillance. The purpose of associating in the devolution plans a few diseases, quite dift'erent in their epidemiological manifestation, is to allow the countries to experience diversity in the practice - and experience required for the control of infectious and parasitic diseases. Thus, surveillance activities for a disease like onchocerciasis with a very low prevalence and no transmission, are different from surveillance and control activities of such epidemic diseases in full progression as schistosomiasis, dracunculiasis and tuberculosis. The experience acquired by the countries in the field of devolution activities will ensure the long-term development of a national capacity to control the infectious and parasitic diseases. tJPCI4/INF IDOC.2 page 2 7 . The second step consists of assembling information regarding the disease for which control strategy is to be developed. The epidemiological data referred to previously, is one part of the required information. The successful experience of the Programme in this field has guided the discussions between the OCP countries, the Programme and the World Bank so as to ensure that the strategies selected are based on a scientific study and on ttre search for cost/effectiveness. This approach can alone allow for the preparation of a long-term plan of action which is financially affordable and, consequently, durable. 8. The third step is connected with the need for decentralization of activities and of responsibilities. All OCP countries have, following the Alma Ata and Harrare Conferences, embarked upon a process of decentralization of the health services. The World Bank, in collaboration with OCP and WHO/AFRO, has given thought to the division of surveillance and control activities of infectious and parasitic diseases between the central level and the peripheral units. This reflection should make it possible to establish, for each disease, the balance of activities between these two levels of the health pyramid and, as a consequence, help to rationalize the utilization of the human and financial resources available in each country. g. In respect to the questions raised by the preparation of devolution plans in the OCP countries, a joint WHO/OCP/IVorld Bank reflection process has been put in place in order to study in general: (i) the practical aspects of surveillance and control of infectious and parasitic diseases in West Africa; (ii) the entire experience of OCP, and (iii) the prospects for implementing strategies and their financing.