National onchocerciasis committees fifteenth meeting Ouagadougou 28-30 may 1991: summary of the report

1ONCHOCERCIASIS CONTROT PROGRAMME IN WEST AFRICA PROGRAMME DE LUTTE CONTRE L'ONCHOCERCOSE EN AFRIQUE DE L'OUEST NATIONAL ONCHOCERCIASIS COMMITTEES Fifteenth meeting Ouagadougou. 28-30 May 1991 SUMMARY OF THE REPORT r - OPENING OF THE MEETING The fifteenth rneeting of the National Onchocerciasis Committees was held from 28 to 30 May 1991..at the headquarters of the Onchocerciasis Control Programme in Ouagadougou. '; The Programme Director welcomed the participants and pointed out that the meeting was all the,more important because it was taking place on the eve of the take- \_ off of the Programme's fourth financial phase (I992-L997) and of the real start of devolutionictivities. He said also that he was very encouraged by the decisions just taken by some'donor countries and organizations to maintain or increase their financial contributions to OCP. The Programme Director said that the donors were impressed by the management of the Programme which was the result of the work of all the staff members. As regards devolution, he indicated that a new unit composed of five persons had been created, thereby meeting the wish expressed by the External Review and approved by the Joint Prograr4rne Committee. Finally, the Programme Director urged the delegates to talk about what was really being done or taking place in their countries. He also informed the gathering that the WHO Regional Office for Africa had appointed a Devolution Coordinator. 2 . ELECIION OF OFFICERS At the suggestion of the delegate of Benin, the delegates of Ghana and Mali were elected Chairman and Vice-Chairman respectively of the fifteenth NOC meeting. 23 . ADOPTION OF THE AGENDA The meeting adopted the following agenda: 1. Opening of the meeting 2. Election of offi0ers 3. Adoption of the agenda 4. OCP Progress report 5. Devolution - Progress report Benin Burkina Cote d'Ivoire Ghana Mali Niger Togo 6. 7. 8. 9. a Progress report on health education on onchocerciasis Ivermectin distribution Guinea Guinea Bissau Mali Senegal Sierra lrone Inventory of facilities and equipment Other matters 11. Date of 16th meeting Adoption of the report Closure of the meeting 4. OCP PROGRESS REPORT Presenting the OCP progress report, the Prograrrme Director declared that resistance to the organophosphorus compounds was no longer a problem. He recalled that six insecticides were available in OCP. The company Merck Sharp and Dohme had 10. 12. , 3respected its commitment and the drug was still being offered free of charge. The search for a macrofilaricide was going on favourably: four potential drugs had been selected and were being tested. ; The Progru--"tDirector concluded by sayrng that the otrtlook was bright and that an effort would be mad'e this year to combine the national teams and OCP personnel more in the control activities. 5 - DEVOLUTION ln presenting this agenda itenr" the Chief of the Devolution Unit recalled the recommendations of the External Review and indicated that the WHO Regional Office for Africa convened a meeting from 6 to 8 June 1991 in Brazzavtlle to discuss the decisions taken in Conakry at the eleventh JPC session as regards devolution. He announced that a task force to reflect on the devolution process had been set up, a devolution Coordinator appointed and that national major endemic diseases prevention and control teams would be established soon. Finally, he pointed out that a working outline had been given to the delegates to help them give concrete information on this subject. The representative of the WHO Regional Director for Africa said that he would like to get as much information as possible by the end of the 15th NOC meeting. 5.1. Prosress reDoft of Benin The Benin delegate declared that the Devolution plan of Benin was adopted by the eleventh JPC session in December 1990. With regard to the situation of the NOC of Benin, the delegate said.that it had been restructured. Epidemiological evaluation had been started in collaboration with OCP. It would be continued with a view to preparing the epidemiological map. Ivermectin distribution was being carried out with OCP. The resources made available were: - Personnel: The unit for reflection and monitoring, nurses of the Local Treatment Teams (LTTs) and the personnel of the public health institutions in the zone concerned (Borgou and Atacora). - hgistics: No logistic resources had been allocated for devolution alone but its activities had been integrated into those of the health centres; 4- Integration: Passive screening was being done in the health centres of Kandi, Gogounou, Banikoara, Segbanan and Malanville each of which had received 100 tablets of ivermectin. Five NGOs were contributing to the smooth running of the health centres in the zone concerned. Eight donors had been contacted for the financing of devolution. 5.2. Proqress reoort of Burkina Faso There was in Burkina Faso a national team charged with epidemiological evaluation and another with ivermectin treatment. The NOC of Burkina Faso was not functional. A proposal for its restructuring and revitalization had been submitted to the authorities. - Epidemiological evaluation: In collaboration with OCP, the national team conducted a survey in March 1991 in 23 first-line villages in six provinces covering six river basins. This survey gave the following results: population counted:9,867; population examined: 7,592; cases detected: 1,13 (1.5Vo). Ivermectin treatment Mass treatment The national team treated 2,7N persons in 13 villages in the Dienkoa basin in April r991. Passive treatment Ivemectin had been made available to some health centres for passive treatment of patients. Unfortunately there had been no feedback to make it possible to evaluate the number of persons treated. Training/Retraining About 200 health workers had been given training in the screening and treatment of onchocerciasis and trypanosimiasis in six provinces. 5Resources made available: Personnel Fourteen nurses had been designated and trained to carry out devolution activities. - Infrastructure and logistics Onchocerciasis control had been integrated into trypanosomiasis control activities so Burkina Faso was.using the logistics acquired for that programme. Intesration Trypanosomiasls surveillance was one of the programmes whose activities had already been integrated with those of onchocerciasis. - NGOs There was no NGO participating in devolution activities. - Search for financing Five donor countries had been contacted. USAID intended to finance devolution activites in eight provinces. 5.3. Progress report of Cote d'Ivoire Little had been done in Cdte d'Ivoire since the last NOC meeting in 1990 but the execution of devolution had been started: a national coordinator and his deputy had been appointed by a ministerial decree; a national treatment and evaluation team was set up in Jgly 1990. The National Onchocerciasis Committee existed in the orgarization chart but was not really functioning. Epidemiological evaluation Skin snips had been taken from2,269 persons in the forest area (Danane), making it possible to obtain 1,424 positive cases (63Vo). Six other evaluations were made by the national team from 1989 to April 1991 with OCP support. Ivermectin treatment The national team treated 1,849 persons in November 1990 in the forest area at .6 Banane while 8,2L5 persons were treated in the Touba region in collaboration with OCP Passive treatment had not yet been started. Onchocerciasis control had for a long time formed part ofrthe prograrnmes for the control of the major endemic diseases. No NGO was involved yet in the devolution prograrnme. The only contact made with UNDP in the search for financing had not yet resulted in a positive response. The difficulties encountered were the following: difficulties of the national team as regards structures; lack of training of the local teams concerning onchocerciasis diagnosis and ivermectin distribution. 5.4. Progress report on devolution in Ghana In Ghana, the Executive Director of the National Onchocerciasis Secretariat(Nos) was also the Devolution Coordinator. A multisectoral devolution committee had been set up. The NOC of Ghana had existed since the beginning of OCP activities with NOS as its secretariat. Placed under the supervision of the Ministry of Finance and Economic Planning, the NOC was a dynamic structure that met once per month. Epidemiological evaluation of onchocerciasis under devolution had not yet been undertaken at the national level. Ghana had received 10,000 tablets of ivermectin which had been distributed in the health centres in the initial area and forest area. The ivermectin trial centre which was in Tamale had now been tiansferred to Hohoe. Trainingwas being continued actively and concerned, particularly, health personnel who had specialized in entomolory, parasitolory and epidemiolory. With regard to facilities, there were 15 hospitals and 53 health centres and some private and government clinics as well as maternity homes where ivermectin treatments could be made. There were 24 districts in the development zone which were sharing 24 field vehicles. 200 motor-bikes had been allocated to the 53 health centres. The Ghana devolution plan had envisaged the integration into its activities of Guinea worm eradication and leprosy control. 75.5. Progress report of Mali The national team which had since 1985 been headed by a Medical Officer/Coordinator vtas, in additior5 composed of a doctor-epidemiologist, two entomologists, hydrobiologists and entomolory and hydrobiologlr technicians. A National Onchocerciasis Committee existed. An epidemiological evaluation had been made in the Farako and Banifing IV basins. In 23 villages evaluated with 6,975 persons enumerated, the prevalence rates were 5.94Vo and 2.'l.Vo respe0tively at Farako and Banifing IV. As regards ivermectin distribution, 41. fixed centres were at present undertaking passive treatment in the initial OCP area. Out of the 6,200 tablets delivered, 1,010.5 had been distributed and 678 patients treated. The resources made available were those of the national team personnel and field personnel. Field vehicles of the 19 centres in the devolution zone were the logistic resources available. With regard to integration, nothing had been done concerning the control of trypanosomiasis and blindness. No NGO was involved in devolution at present. The search for financing had not given any positive result yet. 5.6. Prosress reDort of Niser - The national team was made up of a Medical Officer/Coordinator, an entomology-technician and five epidemiology-nurses. - The NOC had to be revitalized. - The results of the epidemiologlcal evaluation had confirmed the excellent situation. The highest prevalence was oriy 7.ZVo, at Bangou-Kouare, while in the same village it was 68.59 in 7977. Each health centre had received 100 tablets of ivermectin. The personnel of the fixed health centres and state and private infrastructure were being used for onchocerciasis control. The onchocerciasis control prograrnme had been integrated into the leprosy control programme and the Expanded Programme on Immunization. With the USAID funds which had been made available, collaboration would be established between the national team and Helen Keller International (HKI). 85.7. Progress report of Togo There was a national onchocerciasis control team. The situation of the NOC was unstable. Epidemiological evaluhtion and ivermectin distribution missions had been undertaken in collaboration with OCP. As part of training, seven medical officers and 2l nurses had been trained. Onchocerciasis control had been integrated into the activities for the control of the major endemic diseases, e.g., tuberculosis and leprosy. No NGO was participating in the devolution programme and no offer of financing had been received yet. 6 - PROGRESS REPORT ON HEALTII EDUCATION ON ONCHOCERCIASIS The OCP Information and Public Relations Officer introduced this agenda item. He invited the participants to make an evaluation of the actions and objectives to be attained which were discussed by the 1990 NOC meeting and report on what had been done before presenting their reflections on other activities. The sociologist of the National land Development Office (ONAT), who was the author of a study on the populations settled in the onchocerciasis-freed zones in Burkina,* presented the main lines of his report and made three main recommendations: - to inform and raise the consciousness of the populations and the workers and officials of the central departments on onchocerciasis. - to give training to officials and actors in the field of health, students, teachers, etc. - to see to the improvement of the relations between OCP, government departments and the local populations. 6.1. Health education on onchocerciasis in Benin ln Benin, an Information, Education and Communication GEC) Unit existed in theMinistry of Health and had a responsible officer in each of the six regions. As regards the identification and surveillance of the zones at risk, the activities were being carried out by the OCP subsectors and the Technical Intervention Units(TIUs) which used to be the Major Endemic Diseases Units. The onchocerciasis vector was being taught in the primary and secondary schools. The IEC/MOH Unit was participating in the preparation of the "Rural Raclio" programme in local languages. The 9mhin channels of communication (national and regional radios, local languages, political and adnlinistrative authorities, town criers) were being used. The preparation of the epidemidlogical map was in progress. 6.2. Health education on onchocerciasis in Burkina In Burkina, theye was a Directorate charged with Health Education and Sanitation (DESA) in the Ministry of Health. The identification and surveillance of the zones at risk was being undertaken by the national evaluation team as well as the ivermectin treatment campaigns. No specific health education on onchocerciasis activity was being carried out in the field apart from the information given to the populations during evaluation and treatment rounds. OCP, in collaboration with ONAT, carried out in April-May 1997 a public awareness campaign and film shows in the freed-zones which reached some 10,000 persons and would be continued in the whole zone covered by ONAT. 6.3. Health education on onchocerciasis in C6te d'Ivoire There was a National Health Education Department at the National Institute of Public Health (INSP) in Abidjan. The identification and surveillance of the zones at risk had been carried out by OCP in the initial area. For some 20 months now, the national team had been participating in epidemiological evaluation campaigns and large-scale treatment in collaboration with OCP. In 199L, the Cdte d'Ivoire television showed a five-minute programme on onchocerciasis every day for one month (between 19h30 and 19h35). 6.4. Health education on onchocerciasis in Ghana In Ghana, health education activities in the Oncho freed areas of the Northern and Upper regions were currently concerned with the training of health personnel in effective communication skills, family planning, aids, onchocerciasis, yaws, leprosy and guinea worm. The health education officers, as much as possible, were using the integrated programme approach to co-ordinate all primary health care activities with most government institutions and departments as well as some Non-Governmental Organizations. Methodologies used by the officers to get the message across to the public were through lectures, groupdiscussions, drama, songs, radio, video and film shows. a 10 The community.leaders, such as chiefs, assembly men, teachers, members of the Committees for the. Defence of the Revolution (CDRs) and members of the district/village onchci committees had been useful in organizing the people for the health education campaigns. With a view to the implementation of the devolution plan, intensive health education campaigns had so far been extended to areas in the Walewale, Builsa and Tumu Districts which had been among the worst affected oncho areas. 6.5. Health education on onchocerciasis in Guinea In Guineq the health education section was based in Conakry and under the Health Promotion Division. The zones at risk had been identified and would be under surveillance as long as the antilarval treatment continued. The phenomenon of migration of onchocerciasis patients was not evident. Mass treatment campaigns were being carried out. The outline of a booklet on onchocerciasis had been prepared and submitted to EPl-Conakry for comments. Training would be undertaken with the support of OCP as part of the training of the local treatment teams. Programmes had been broadcast by the Rural Radios of Middle Guinea and Upper Guinea and contacts made with news media representatives in Conakry. The OCP Information Officer was involved in these activities. The national teams, during each of their field trips, were improving the populations' knowledge of onchpcerciasis. 6.6. Health educ4tion on onchocerciasis in Guinea Bissau The d'issemination of messages in local languages and Creole was being continued. The retraining of primary health care workers was also being continued. The natiorrA epiO"-iological and entomological teams were contributing to the improvement of the populations' knowledge of onchocerciasis. 6.7. Health education on onchocerciasis in Mali A National Information, Education and Communication (IEC) Centre had been set up in the Ministry of Health. The large-scale treatment campaigns had made it possible to raise public awareness in 307 villages. 11 It had been planned to: prepare and distribute guides on health workers in.the onchocerciasis zones; organize information/training workshops, produce radio programmes at the local station at Kayes, which was the administrative centre of the western extension area in Mali; broadcast other messages in local languages spoken in the onchocerciasis zones. 6.8. Health education on onchocerciasis in Niger There had beerU for five years now, a central structure called "Directorate of Training and Health Education". The Regional Information and Health Education Office (ARIEPS) had audio-visual equipment. The epidemiological map had been reviewed and corrected. The regional fiealth education office had prepared teaching booklets for teachers and pupils in the health districts in the onchocerciasis zones. A 20-minute television prograrnme was shown in Niamey in November 1990 with the collaboration of the OCP Information Officer on the national television. A programme was broadcast in a local language on onchocerciasis and it had been planned to continue with this practice. In collaboration with the national team, ARIEPS was carrying out, once per quarter, public awareness campaigns in the onchocerciasis zone and showing, at the same time, documentaries on onchocerciasis. The commentaries in the films were being translated into the local languages. 6.9. Health education on.onchocerciasis in Senegal Since the 14th NOC meeting (1990), developmental activities centred on information, education and communication had been assigned to the regional health education office at Tarirbacounda. A plan of action had been prepared with the collaboration of the.medical region. The main objective consisted in making the target populations aware of onchocerciasis and its gravity which blindness constituted. Stratery and activities undertaken Information of the general public As regards radib and the print media, the regional health education office had a programme per week. Two interviews (radio) of the Deputy Coordinator at Tambacounda were broadcast (in December 1990 and March 1991), an interview was granted to a correspondent of the daily "[r Soleil" at Tambacounda (in August 1990) and a roundtable was organized at the headquarters of the same newspaper in Dakar, 12 a in November 1990,rwith the participation of the OCP Director, the National Coordinator, the Deputy National Coordinator, and the OCP Information Officer. Other activities had been carried out, particularly: the holding of the meeting of the Regional Development Committee (CRD) in February 1991 at Tambacounda on the region's health situation with an information paper on onchocerciasis; video-shows on onchoc€rciasis in somot20 schools in the region; the information and sensitization of all the Chief Post Nurses (CPNs), etc. 6.10. Health education on onchocerciasis in Sierra Irone Health educationpn onchocerciasis was not a priority in the activities of the Heakh Education Unit of the Ministry of Health of Sierra [,eone. According to the officials of this Unit, this lack of interest was related to the problem of material and logistic resources, considering the meagre budget of the Ministry of Health. Despite these'constraints, the national onchocerciasis control team had carried out a number of activities using the following channels: the national radio to inform the public of onchocerciasis-related problems; dissemination of information in the field, film- shows and conferences. 6.LL. Health education on onchocerciasis in Togo Togo had had a National Health Education Department since 1969. t- The national team and OCP were teaching the village development committees how to identify the blackfly. 7 . IVER]\{ECTIN DISTR.IBUTION This agenda item concerned the five countries in the OCP western extension zone, viz., Guinea, Guinea Bissau, Mali, Senegal and Sierra Irone. The Chief of the Epidemiological Evaluation Unit recalled that large-scale treatment was started in 1987, at Asubende (Ghana). Furthermore, he affirmed the need to repeat the treatment every year. The benefits of the treatment, i.e., the regression of ocular lesions, had been noted in persons having had nvo to three treatment cycles. After treatment of more than 260,000 persons by OCP, the safety of ivermectin could no longer be doubted. For his part, the EPI Coordinator in Bamako pointed out that by intensi$ing ivermectin distribution in the fixed health centres the drug was at the same time being made available and thb capacity of these health centres to provide a correct service to onchocerciasis patients was being maintained while strengthening it. It emerged from the presentations made by the delegates of Guinea, Guinea Bissau, Mali, Senegal and Sierra lrone that everything was going on normally. 13 The situation in each country was as follows: The centres had not yet taken off although the tablets had been put in place. THis was due to the diagnostic difficulties the health workers were facing. Guinea Fixed centres concerned Number of patients treated Tablets distributed 'r. Guin6e Bissau Mali (Western extension) Fixed centres concerned Number of patients treated Tabkets distributed Sierra l-eone Fixed centres concerned Number of patients treated Tablets distributed = 126 = 11,839 = 16,998.5 =93 = 12,755 = 79,769 Senegal Fixed centres . concerned Number of patiepts treated Tablets distributed =49 = 36,954 = 57,925 It should be poirlteO out that non-gouvernemental orgarizations (NGOs) were involved in ivermectin distribution in some of the countries. 7.2. Discussions ' The Programme Director expressed his satisfaction at the work done within so short a time. He stressed also that the distribution methodolory had beem made lighter. Skin snip was no longer necessary before treatment; that procedure was risky because of the possibility of AIDS transmission; data registration would be simptified; the weight parameter (demand for scale) should no longer be an obstacle because the drug was not toxic. As regards collaboration with NGOs, the Programme Director expressed the wish for them to have a sufficient budget and commit themselves to collaborate for five years. 8 . INVENTORY OF FACILITIES AND EQUIPMEN'T The Chief of the Devolution Unit said that this work would allow the workers to know at any time the situation as regards the infrastructure and equipment made 29 540 777 I 74 available. This inventory should be regularly updated. The Programme Director then underscored the importance attached to this inventory by the donors, certain benefactors, members of the Expert Advisory Committee and the WHO Regional Office for Africa. All the delegates then indicated that standardization had been adopted in their respective countries as regards infrastructure and equipment. 9. OTHER M,{TTERS The Programme Director gave an important information on the consumption of ivermectin since 1987, i.e., more than 1,8000,000 tablets, which was a world record in the use of a drug. Forest onchocerciasis was discussed and would be the subject of a consultative meeting between Cdte d'Ivoire, Ghana and OCP. 10 . DATE OF THE 16TH MEETING The 16th meeting of the NOC would be held from L9 to 2l May 1992. 11 . ADOPTION OF TIIE REPORT The report was adopted. It would be sent to the participants for their observations. -