IOnchoccrciasis Control Prograntnte in \\'est Africa I)rrrgranrnrc de [-u(te contre l'Onchoccrcose en Afrique dc I'Oucst JPC - CCP.IOINT PROCRAMM E COMMITTE,E Office of the Chairperson JOINT PROGRAMME COMMITTEE T*,en[z-first session Yaounde. l4-15 December 2000 Item 8 of the Provisional Asenda COMITE CONJOINT DU PROGRAMME Bureau du Pr6sident JPCZI.7 OzuGINAL: FRENCH September 2000 AFRO CENTRE FOR STJPPORT TO MULTIDISEASE STJRVEILLANCE AND CONTROL IN WEST AFRICA TABLE OF CONTT'N'I I. INTRODUCTION II. JUSTIFICATION III. MISSION IV. OBJECTIVES V. STRATEGIC ORIENTATIONS VI. INTERVENTIONS VII. MANAGERIAL STRUCTURE AND FUNCTIONS VIII COLLABORATION WITH PUBLIC HEALTH INSTITUTIONS AND ORGANIZATIONS ...... IX. RESOURCES X. IMPLEMENTATION PROCESS RESULTS TO BE ACHIEVED AT THE END OF FIRST YEAR OF IMPLEMENTATION MONITORING AND EVALUATION IMPLEN,IENTATION PLAN AND BUDGET FOR THE FIRST YEAR ANNEXES Table l: Plan of implementation qf activities during the first year Organogranrme .. Page 2 2 2 3 3 4 4 5 xI. xII. XIII 5 6 6 .7 8 t0 JPC2I 7 Pagc I I INTITODUCl'ION Comntunicable diseases are predominant in the African region. However, there is paucitl,in quality information lor early detection and control. Operational national disease surveillance systents constitute tl'le cornerstone for effective disease control. Indeed, suclt sysrems provide basic data for planning, resource allocatton/mobilization, early epidemic detection and response, and evaluation of the results and impact of health interventions. In the wake of the deadly eprdemics of meningitis, yellow fever and cholera that affected West Africa in the period from 1995-1996, the WHO Regional Office for Africa (AFRO) and partners facilitated a meeting of West African Ministers of Health and of Interior in October 1996 in Ouagadougou. After the analysis of the situation, the meeting resulted in the signing of a Protocol for Cooperation in Epidemic Prevention and control and in the adoption of a sub-regional Plan of Action. This consjituted the basis for the establishment of the West African Epidemiological Block. As a result of the activities of the Onchocerciasis Control Programme (OCP) over a period of 26 years, the burden of this disease -which was a major concern in some endemic countries in West Africa- has been drastically reduced. Today onchocerciasis is no longer a major public health problem, nor is it an obstacle to social and economic development in West Africa. Therefore, the activities of OCP which are being gradually transfered will completely cease by the end of the year 2002. However, maintaining the gains achieved by OCP will require sustaining onchocerciasis surveillance and integrating it into national disease surveillance systems. In September 1998 the Regional Committee for Africa has adopted Resolution AFRO/RC48/R2 on Integrated Disease Surveillance Strategy (IDS). In essence, the IDS Strategy calls for the establishment of a system for integrated surveillance of priority diseases in Member States. Such a system aims at simplifying data collection and management tools and guidelines. It also facilitates pooling together resources for surveillance and rapidly using the information generated at each level of the health system. The establishment of an Integrated disease Surveillance Center in the current OCP facilities in Ouagadougou will allow the preservation of gains achieved in onchocerciasis control through its impressive infrastructure and highly qualified personnel and activities. At the same time it will create a center of excellence in integrated surveillance of communicable diseases in West Africa. II. JUSTIFICATION When OCP is phased out rn 2002, onchocerciasis is expected to be only a disease wtth sporadic occurrence in West Africa. Since it is not eradicated, the threat of recurrence will persist. Therefore the surveillance of the disease needs to be maintained in the Sub-region: this necessitl,was stressed during the l9d'and the 20t sessions of the Joint Programme Comnrittee (JPC) of OCP. The need for strong epidemiological surveillance systems was recognized as a key element for eprdemic preparedness during the above-mentioned Ministerial Meeting. However, rhe fact rs that, overall, national disease surverllance systenrs are still performing poorly in the African Regron. These sl,sterns often fail to detect eprdenrics in a timely manner or to generate tintely data ueeded for decision-nrakrug, plaunrng and evaluation of health interventtons. JPCzI 1 [)aee ] It rs alstt lntp()rtant to strengthen cprdemiologrcal survcillance lor tltc preVelltl()n and control of HI\//AIDS Indeed, the incidence of this rnfectiotr is on the ltcreasc in Wcst Afrtca, thus calling for ncrv surveillance approaches, such as the IIIV/AIDS/STI second gelleratlorl surve illance Laborarorres u,itl.r high technrcal capabilrtres and highly qualrfied persounel are likewise essenrial for the ntonitoring ol antimicrobial susceptibility and the predrction o1' geographical spread of reslstance as we[[ as for the predictton of the occurrence of epidenircs at sub-regional and regional levels'. The solid assets of OCP, in tenns of rnfrastructure, material and personnel, could be wisely used to establish a sub-regional reference center for integrated surveillance of communicable diseases. Provisions for the creation of such center of excellence have been made in the 2000-2001 biennial Plan of AFRO. Thisprqjecthas already been the subject for in-depth analysis and discussion. III. MISSION The mission of the Center is to provide high level technical support to Member States of West Africa in the area of surveillance for onchocerciasis and other prioriry communicable diseases. The centre will be a referral centre for national public health programs. IV. OBJECTIVES To provide high level technical information to West African sub-regional countries for the effective management of priority communicable disease prevention and control programmes ; To offer facilities for high level quality assurance to the laboratories and diagnosttc services of West African sub-regional countries; To predict the antimicrobial susceptibility of aetiological agents of priority communicable diseases , 2 3 4 5 To predict the occurrence of epidemics of priority communicable diseases in the West African sub-region; To facilitate the exchange of information that is critical for effective prevention and control of priority communicable dtseases, \/. STRATEGIC ORIENTATIONS The Center will establish and regularly update an eprdeuriologrcal database on prlorlty conlmunlcable diseases occurring rn the sub-region It will provide detailed information oll tlle epideuriologl,of these drseases. rncluding laboratory assays for the confirmation of the dra_enosis Thc Center rvrll provrde useful rnformation relative to the identification of rrsk factors of priority conrntunicable drseases and appropriate controI intervetrtions. The center u'tll ernploy and prontote the use of up-to-date statistical and epidcntiological methods of nrodel rsatrt'rn and pred tctton The laboratorres of tlte Center wrll be adequately equipped and stalfed for the isolatrolt, ideutrficatrop. conl'rrrnatron and clr charactenzatlon clf aetrolclgical agellts of prttlrrtl' I JPC21.7 Page 3 communicable diseases. Appropriate mechanisms rvill be put in place iu order to ensure quality control in the sub-region. The center's laboratories will rnaintain a reference bank of strains of aetiological agents responsible for priority conrmunicable diseases. Antimicrobial susceptibilities will be deterniined and a database will be established to monitor trends over time. The extensive radio-communication network of OCP will be ntaintained and reinforced for the exchange of information between the Center and the countries of the sub-region. VI. INTERVENTIONS The Center will contribute to the strengthening of epidemiological surveillance systems in the sub-region, in particular through its radio-communication network and its expertise in the area of communicable disease surveillance. It will be responsible for the compilation and analysis of sub-regional surveillance data and will regularly publish an epidemiological bulletin on onchocerciasis and other priority communicable diseases occurring in the sub-region. The center will offer laboratory expertise for qualiry control in the sub-region. It will also test samples for the confirmation of diagnosis and will organize visits to national public health laboratories and other national laboratories invested with similar roles. The Center will regularly conduct epidemiological surveys and will collect biological samples in order to monitor the susceptibility of aetiological agents of prioriry communicable diseases. The data obtained will be combined with meteorological data and data from sources such as artificial satellites in order to perform advanced epidemiological analysis, including elaboration and testing predictive epidemiological models. The Center will organize high level training sessions in disease surveillance and laboratory diagnostic techniques for prioriry diseases occurring in the sub-region. Regular refresher training of staff in the area of epidemiological surveillance and applied research will contribute to the scientific development of the Center. vII. MANAGERHL STRUCTURE AND FUNCTIONS The Center will be placed under the technical supervision of the Director, Division of Prevention and Control of Communicable Disease (DDC) of AFRO. It will entertain close collaboration with the Programme of DDC Division, particularly regional programmes on Integrated Disease Surveillance (IDS) and Emerging, Re-emerging and Other Epidemic-Prone Diseases (EMC). The Center will be headed by a regional adviser. Its activities will be implemented by four functional units. The Unit for Epiderniological Surveillance will be headed by a medical epidemiologist. It will include the sub-units of epidemic diseases, diseases set for elimination or eradication and diseases of major public health importance. The unit for epidemiological surveillance will receive surveillance daLa from the countries of the sub-region. It will also directly collect data through special epidemiological surveys, u$ate the sub-regional database, analyze sub-regional data and communicate appropriate information on disease trends to countries, WHO Regional Office and partners. The Unit for Inboratories will be headed by a lab specialist (microbiologist) and will include bacteriology, parasitology, micrology and nrolecular biology laboratories headed by specialists. The role of this unit is sevenfold: to contribute to the confirmation of aetiological .II'C2 I 7 [)age -1 agents o{'priontv cor.r.rrrrunrcablc diseases occurnnq m the sub-reqirttt. t,r rtt(rrlltor attttttrtcrobial reststance: to contnhutc to qualrtv control rn natronal publrc health Iattoratttrtcs and lrigh level trainrng of laboratorl personnel tn the diagnosrs ol priorit\/ conrlruurcablc drseases. Tlte urtit for laboratorres u,ill contnbute to the charactenzatron of tlte strarns ttl'aetrrtlogical agents and vectors u,here applicable, de te rnrination of geographrc distributton and lttotltonr.lg of trends. Tlte Docuttt(tttottott Utir v':ll be headed bv a librarian It rvrll Include library and publication sub-unlts headed bl,speciahsts The role of this unrt is to gather and disseminate documentation or.r prronty communicable diseases occurrin-e rn the sub-regton and to support the publication of surveillaltce and epidenttological rnvestigation [indin-es The Adnurustratit,e Unlt u,ill be headed by an adminlstrator. lt rvill tuanage personnel and financial matters as well as the fleet of cars. the r-naintenartce of building, mail, and coutntunication equiputent. This unit u,ill facilitate contmunication u'ith and among the countries of the sub-regton. VIII. COLLABORATION WITH PUBLIC HEALTH INSTITUTTONS AND ORGANIZATIONS The Member States of the sub-region will regularly provide epidenriological data and rnformation related to surveillance of onchocerciasis and other priority communicable disease to the Center through their national disease surveillance units and through WHO country offices. In return, the Center will perform in depth data analysis, including sub-regional trends and predictions and will provide feedback to the countries. The Center u,ill also collaborate with other rnstitutions and or-eanizations sharing a similar purpose, suclt as the West African Health Organization (WAHO). researcl't instirutions, training institutions, non governmental institutions, WHO inter-countr)' teanls and reference laboratories. This collaboration will, among other things, be manifested through the exchange of technical informatron on the surveillance of priority diseases. The exchange of biological samples for the confirmation of diagnosis and quality control will be a key component of this collaboration, as will the design and implementation of joint projects. Collaboration with other sub-regional institutions and organizations will be in total harmony with the guidelines laid down by the Regional Office in the matter. Apart from the sub-regional cooperation, the Centre rvill prontote exchanges with other Centres of Excellence of simtlar orientation in Africa and elsewehere IX. RESOURCES Ir.nportant huntan. rtraterral and linancral resources rvrll be Iteeded to ensure the functroning of the Center Fortunately, the bulk of such resources is already available at OCP in terms of personne[, rnfrastructure, telecor]rnrunrcatiorl equrprttettt. office equrpt)leut, laboratory equiputenr and vehrcles The available resources are descnbed in the annex The resources needed at the inception of the actrvities of the Ccrtter arc clescribed below. Hutrtatt Resttttrccs . IIead ol'Progranrnte, Regronal Aclr tser . Adnlnrstrator . Sccretarv JPC71.1 Page -5 tpidemiologist Laboratory Expert Librarian Drivers (2) Security Officers (3) Clerks (2) Cleaners (2) Material Resources . Micro-computers * Printers (6) . Typewriter (1) . Fax machines (2) . Medium capacity photocoPier (1) . High capacity photocoPier (1) . Four-wheel drive vehicles (2) . Staff bus (i) . Service car (1) Financial Resources' . Funds to cover personnel salary . Operation budget X. IMPLEMENTATION PROCESS During the first year (2001), the activities of the Center will focus on the surveillance of four diseases, namely onchocerciasis, malaria, HMAIDS and meningococcal meningitis. These diseases have been selected for their public health importance and the need to maintain the gains achieved by OCP. Surveillance activities of the Center will be extended to other priority communicable diseases during the biennial period 2002-2003, based on a plan of action prepared from the inception of activities in the Center and adopted by the end of the year 2001. The plan of action will spell out expected results, activities, resources needed and monitoring and evaluation indicators among other variables. The results indicated below are expected from the different functional units of the Center at the completion of first year. XI. RESI.'LTS TO BE ACHIEVED AT TTIE END OF FIRST YEAR OF ACTTVITY Head of pro7ramme . Biennial Plan of Action prepared . Essential staff put in place . Mechanisms for the management of the Center established I First year of budget is presented on page I a JPC2I.7 Page (r Adniristrative Unit . Center Budget lines created . A plan for staffing and equipping the Center prepared . Secretariat, mail and maintenance services operational . Radio-communication system operational in each country of the sub-region. Epidemiological Surve illance Unit . Data bases on priority diseases in the sub-regional established and regularly updated. . Sub-regional epidemiological data regularly compiled, analysed and interpreted. . Sub-regionalepidemiologicalsurveillancebulletinregularlyissued. lnboratory Unit . Laboratories for the confirmation of onchocerciasis, meningococcal meningitis, HIV/AIDS and malaria and for monitoring of drug resistance operational . Laboratory personnel trained/re-trained in diagnostic techniques for the diseases mentioned above. . Mechanisms for the transmission of biological samples from Member States to the Center established. Documentation Unit . Sub-regional epidemiological bulletin regularly published and disseminated XII. MONITORING AND EVALUATION Monitoring and evaluation of the activities of the Center will follow the same process as that is the case for all the programmes of the DDC Division of AFRO. A quarterly report of activity will be submitted to DDC. A mid+erm review will be conducted at the end of the first year and a biennial evaluation at the end of each biennial period. Due to the start of the project during the biennial period 2000-2001, the first mid-term review and the first biennial evaluation will overlap. )flII. FIRST YEAR IMPLEMENTATION PLAN AND BI.]DGET Table 1 presents the plan of implementation and the budget for the activities proposed at the inception of the Center. In the implementation of the decision creating the Center, the Head of Programme will put in place the essential staff for the inception of activities. First year activities will focus on the preparation of a plan of action, establishment of a management system, creation and update of a sub-regional epidemiological database, re-training of laboratory personnel and publication of a sub-regional epidemiological bulletin. The above- mentioned activities will be jointly financed by OCP and AFRO funds. Additional funds around 400,000 USD will be sought from other partners. ANNEXE,S TABLE 1 : PLAN OF IMPLEMENTATION OF ACTIVITIES DURING THE FIRST YEAR...... ORGANIZATIONAL CHART JPC21.1 Page 7 10 8
(t & zri& a zDh l\ o ri9^F(o >v)op FE F{rioo la tl F F ooO tnir)\o O O O O OOO OoN O O O OOo O & rI] Fr OOO oo cl c<(J o OOO rn ra) o& 9\ oao OO|/.) ooO O oaa O oool o kq) c6 o t X X X ra X X X X X t\ X X X X X X X X X o L() () Q() E o o <! 0)k(-) -i -i C) E bo (! IQq -$ O6 5E '= 0) E3dz { q E tr(! q() oo =Eo= E() -ctr .96 =doGt= @(dCIE "1 L € otr () bo! .o o() otr 3()!0)o5 a (g a. d =co .=o -oN! c.rvo COo c.l UO o.oo(U ,t ,*HO 4 !c d botr (a< c! osqA o? .-E =6)(!!: a. .:i.(L)- o.3 q () o oOtr o o () 6)5E rl]o \ dco .Y(!bo96)(!hE -o€ O(E -oq- bOoo tro d()OE r\ O.v6) -i oj 6(! ! (! tr o bo C) I ,oa o q (! d c.l Ej.9 =boqo(€6 e ts'Eti-o .Y6()e C- 6.Hdd =6)Oo)Pa'a-1q oO=A€ 9.6 ,a; oj q c) c) (J q) X 6)d i:o6Oq ,''590 ig:3 3& U6Eqi-14 . = .-.= ()6Q=E3F!9ESd 6 a(J € (go =d .y()ffbq6) -6re =^qa .td\t c.i , JPCZI.7 Page 8 & ri F. cn & fr rn t< oz & a rn H t-. FU tr o zo t-( Fzri ari r)AFa h o z rl 0{ .i E] rl rq F tJPC21.7 Page 9 --o .= gg.., -r-o= -a- oL )\F < Xiio-o 0i O.ii .i!-V 4dt^ a z;) tr o riu^EO)age Fq t- F]oaD te Fl 3 oF Ooo O oOO O OOO O ol oO &tl. OOO 1r)\o o- &I{ F. o OOo OO oOO O@ OOO O C'l OOO rrr dt! OOO rr) @ c.l 0<U o &IL oOO rn ral oil tu OoO rn d&t! OOO(n oilr) eocl o Lq) E C! o t X X X J F oF ro X X X ol X X X (J ; 9P >.ubO 'OO HU(llk o> d_ - /a! boo EE9 =.= <!(\l@r au^ - o.i: -i aa; :9q = >., c)k .r 9 6o.='c (! HE3gQ.E O!(* 99 u o-> rL! (! = r.E:u^rH '=; o'=u !q'= tr " 6: E()-o (J =04s93 .i ca H .6) otrtr tr3o =-o.Y ()ortE F3oE= - e Hs ^ o;: e =',troilQ oo,oE: E ,i E>i c.) do boo o -. 6) kOo>\ oo.= o'E .= Q@coE U-v6u>7P n co (! .9 99q:oOa C'O E"Oa .! : 9';c-r<!o 90!'5 .-HTLE'a(!ai oOa9 I-9aA 2=doHVL- € Ea6 { c.) U)q)L o() q) Xri =o! ap'5 oa SA^ a-vO H tr ".S :i L.< .' w!o2ac'oq2E E';'E h EL |- O U.=;,3E AZEZJ 3E E h 9 aa; C' X z F] ooo c) o & JPC2I 7 Paqc l0 CJ oq o a Oo IJ. () OJ -oo o 'o cg 0) (,)() CN '- oO 0) c- o -o O. L L -o J = (.) p 0) L U) oLt o^oo ,r6q)(h >i E6ttr E 'i, oo 0)?8 q) o!6 C! z c! (.) o O. o)q(-) CU = 0.)FA C)a ! l-.1 a ,J.] o ,v (_) OCgqk 6J@\OC OJ acg -= 0-) 0)o p(! (g'oto. -E0J-a(q cg o)0)-q o LJ- _o o- U c! -=> .aa oo o o L (_) (.)(g ca p L o G 6 '] oo o (n(d r< A >tbo o o ca r<(! (.) 0.) o 2 oo o t< Ft H U F] z F N z rh c