National Onchocerciasis Committees, fifteenth meeting, Ouagadougou, 28-30 May 1991: report

ONCHOCERCIASIS CONTROL 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 REPORT 1 . OPENING OF TIIE MEETING The fifteenth meeting of the National Onchocerciasis Committees was held from 4 to 30 May l99L at the headquarters of the Onchocerciasis Control Programme in Ouagadougou. _ The Programme Director welcomed all the representatives of the Participating Countries, the representative of the Regional Director of WHO/AFRO; th; representatives of the National Land Development Office (ONAT, ex-AW) and the OCP sector chiefs. He pointed out that the meeting was all the more important because 1t y* taking place on the eve of the take-off of the Programme's fourth financial phase(1992'1997) and of the real start of devolution activitiei. He noted also that after the mee_tings he had just had with representatives of the donor countries and organizationsin l-ondon, the WHO Headquarters in Genev4 Brussels, Bonr1 the ftugue and W-ashington D.C. and with officials of the United Nations Development prJgrarlme(UNDP), he was very encouraged by their decisions to maintain or increase their financial contributions. He-asked himself what made OCP, despite the present worldwide difficult economic situation, to continue to enjoy the trust of the donbrs and then said that it was due to three reiNons: (a) OCP respected the terms of the mandate entrusted to it; (b) OCP's results were positive every year; (.) OCP was actively pursuing its search for other operational insecticides and a macrofilaricide to attain its objectives. ^ !e Programme Director said that the donors were impressed by the managementof the Programme which was the result of the work of all thi staff members. As Iegards devolutioq he indicated that a new unit composed of five persons had been .rr-ut.d, thereby meeting the wish expressed by the External Review Lnd approved by the Joini Programme Committee. The duties of the unit were as follows: to fretp the pirticipating Countries prepare human resource development plans; to design uod- *urug" t.uinirfr to undertake a management training prograrnme for national personnel ut ih" centra-I, 2intermediate and peripheral levels; to promote greater participation at all levels by the personnel of the national teams; to raise the awareness of the governments of the Participating Countries to the need to give a high priority to onchocerciasis in the field of public health; to take the necessary steps for the integration of personnel trained by OCP into the national health structures and to promote appropriate pubtic education and mobilization activities; to support operational research on devolution-related subjects; to give technical assistance to the govemments of the Participating Countries for the strengthening, orgarization and management of the control of the major endemic diseases. The Progralnme Director urged the delegates to talk about what was really being done or taking place in iheir countries. He also informed the gathering that the WHO Regional Office had appointed a Devolution Coordinator, based in the WHO Representative's Office in Ouagadougou. 2 - ELECTION OF OFFICERS At the suggestion of the delegate of Benin, the delegates from Ghana and Mali were elected Chairman and Vice-Chairman respectively of the fifteenth NOC meeting. The delegate of C6te d'Ivoire was designated Rapporteur. 3 . ADOPTION OF THE AGENDA The meeting adopted the following agenda: Opening of the rireeting Election of officers Adoption of the agenda OCP Progress report Devolution - Progress report Benin Burkina Cote d'Ivoire Ghana Mali Niger Togo Progress report on health education on onchocerciasis 1. 1 3. 4. 5. J1... 7. Ivermectin distribution Guinea Guinea Bissau Mali Senegal Sierra Lrone Inventory of facilities and equipment Other matters Date of L6th meeting Adoption of the report Closure of the meeting 4. OCP PROGRBSS REPORT Presenting the OCP progress report, the Programme Director declared, notably, that resistance to the organophosphorus compounds was no longer a problem. Six insecticides were available (Abate, Phoxim which had replaced chlorphoxim, B.T., permethrin, carbosulfan and pyraclofos). Ivermectin was even more effective than hoped. It was a safe drug and giving to patients a dose higher than the normal dose was no longer dangerous. The company Merck Sharp and Dohme had respected 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 Progralnme Director concluded by sayrng that the outlook was bright and that an effort would be made this year to combine the national teams and OCP personnel more in the control activities. 5 . DEVOLUTION In presenting this agenda item, the Chief of the Devolution Unit stated that the eleventh JPC session held in Conakry in December 1990 marked a turning-point in the devolution process. He recalled that on the recommendation of the External Review, a Devolution Unit had been created. As regards the WHO Regional Office for Afric4 it convened a meeting from 6 to 8 June 1991 in Brazzaille to discuss what was said in Conakry. A task force to reflect on the devolution process had been set up, a Devolution Coordinator appointed and national major endemic diseases prevention and control teams recommended. 8. 9. 11. 10. 12. 4Finally, he pointed out that a working outline had been given to the delegates to help them give concrete information on this subject. Taking the floor after the Chief of the Devolution Unit, the representative of the WHO Regional Director for Africa said he was impatient to listen to the delegates in order to get as much information as possible. He declared that much emphasis was not laid on health and socioeconomic development in the Participating Countries during the JPC meeting in Conakry.He said that he would like to prepare a report for the Regional Director of WHO/AFRO which would reflect the reality and that it would be the best contribution of the NOCs to WHO/AFRO. 5.1. Progress report of Benin The Benin delegate declared that the Devolution plan of Benin entitled "Programme for Surveillance and Control of Onchocerciasis and the other Major Endemic Diseases in the Republic of Benin" was adopted by the eleventh JPC sessionin December 1990. He indicated that a national coordinator in charge of the management body of the unit for reflection and monitoring of devolution activities and the nurses to form part of the local treatment teams had been designated and would be trained. With regard to the situation of the NOC of Benin, the delegate said that it had been restructured and now comprised only Ministries whose functions were necessary forits smooth functioning, i.e., the Ministries of Health, Rural Development and Cooperative Action, Economic Planning and Finance, Education, Equipment and Transport, and Information and Communication. Concerning activities, the delegate of Benin declared that epidemiologrcal evaluation had been started in collaboration with OCP. It would be continued with a view to preparing the epidemiological map. Ivermectin distribution had been done with OCP: from 17 to 3J. Jairu ary l99lin the Sota basin; from 27 Februa{y to 5 March 1991, in the Koumongoi (Atacoia) basin. The resources made available were: - Personnel: The unit for reflection and monitoring, nurses of the Ircal Treatment Teams (LTTs), the personnel of the public health institutions in the zone concerned (Borgou and Atacora). - t ogistics: No logistic resources had been made available for devolution alone but its activities had been integrated into those of the health centres; - 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. 5With regard to NGOs, the delegate of Benin named five of them which were contributing to the smooth running of some health centres in the zone concerned. As far as the search for financing was concerned, eight donors had been contacted but so far no positive response had been received from any of them. 5.2. Progress report of Burkina Faso uke the previous speaker, replying according to the outline proposed, the delegate of Burkina Faso declared that a new National Coordinator had just been designated after the appointment of the previous incumbent to the post of Devolution Coordinator. There was in Burkina Faso a national team charged with epidemiological evaluation and another with ivermectin treatment. Other teams were to be set up and would be responsible for surveillance as part of devolution. The delegate indicated also that the NOC of Burkina Faso was not functional and that a proposal for its restructuring and revitalization had been submitted to the national authorities. With regard to activities, the following were to be noted: - Epidemiological evaluation: In collaboration with OCP (EPI), the national team conducted a survey in March 1991 in 23 first-line villages in six provinces covering six river basins. Results: Population counted: 9,867 Populatioir examined: 7,592 Cases detected: ll3 (l.SVo) Therewas external migration in the south-western riverbasins (Bougouriba,I-eraba and Comoe) that had been going on for a long time..now (> 10 years). On the other hand, in the Nakanbe-Nazinoir and Sissili river basins there was,an internal migration with a seasonal migration outside the country. Two important remarks could be made: - Generally speaking, the prevalence was higher in the migrant populations than in the resident populations. In the populations having stayed outside, the prevalence was 25 times more while it was trvice more for the populations having made internal migrations. Certains villages presented prevalence rates quite disturbing as regards Burkina Faso: Zoulo, 4Vo; Koumou, 16Vo. Ivermectin treatment Mass treatment The national team and OCP treated the population in the Dienkoa basin in April 1991. In all, 2,7W persons were treated in 13 villages and hamlets, i.e., 57.6Vo of the population concerned. Side-effects were no longer to be feared in the treatment zone. However, emphasis was to be laid on raising the awareness of the populations so that they would attend these repeated treatments. Passive treatment Ivemectin had been made available to some health cenues for passive treatment of patients. Unfortunately there had been no feedback to make it possible to evaluate the number of persons treated. However, requests being made by some centres suggested that passive treatment was being made in the Bougourib4 Comoe, Kenedougou and Houe basins. Training/Retraining About 200 health workers had been given training in the screening and treatment of onchocerciasis and trypanosomiasis in six provinces. A number of training/refraining seminars and workshops had been planned to cover the whole zone conce$ed'with devolution but could not take place because of lack of financial resources. ' ' Resources made available: - Personnel The personnel for devolution was being recruited among the health and social welfare personnel. That was how L4 nurses were designated and trained to carry out devolution activities. Any staff in the onchocerciasis zone remained available for the needs of devolution. 1- Infrastructure and logistics For the moment there were no infrastructure and logistics specially allocated as part of devolution since onchocerciasis control had been integrated into trypanosomiasis control activities. Burkina had logistics acquired for this programme (3 land cruisers, 4 motor bikes, laboratory equipment). OCP had promised to provide a number of used vehicles. Integration Trypanosomiasis surveillance was one of the programmes whose activities had already been integrated with those of onchocerciasis. In 1990, several missions were undertaken by the Banfora and Koudougou teams making it possible to examine 30,000 persons and detect some 40 patients. The implementation of the dracunculosis and schistosomiasis eradication programme should also be mentioned. They were two water-borne diseases whose possible propagation in the onchocerciasis-freed zones could compromise development there. - NGOs For the moment, there was no NGO participating in devolution activities. But collaboration with Helen Keller International (HKI) could start very shortly as part of a USAID finaqcing. Search for financing - Number of donors contacted: The Netherlands, EEC, Kuwait, France, Germany, etc. - Positive response: USAID (United States) which intended to finance devolution ' activities in eight provinces (Bougouriba, Comoe, Poni, Sissili, Houet, Kossi, ouri, Zoundweogo). Difficulties encountered/solutions I-ack of financing for the general devolution plan. As solution: to continue with the search for local sources of financing (e.g., refunds paid to the AW villages). Insufficient personnel and instability of devolution personnel. Solution = creation of promotion for these workers to make them stable. 85.3. Proqress reoort of Cote d'Ivoire The delegate of Cote d'ivoire stressed that little had been done since the last meeting but that the execution of devolution had been started and was promising. A National Coordinator and a Deputy had been appointed by ministerial decree. A national treatment and evaluation team had been set up in July 1990 but no local team had been set up in the regions. As regards the National Onchocerciasis Committee, it existed in the organization chart but was not really functioning. As part of epidemiologicat evaluation, some activities had been carried out by the national team in the forest area (Danane) where skin snips had been taken from 2,269 persons, making it possible to obtain 1,424 positives (63Vo). Si* other evaluations were made by the national team from 1989 to April 1991 with OCP support. The national team treated 1,849 persons in November 1990 in the forest area at Banane while 8,215 persons were treated in the Touba region in collaborationwith OCP. Passive treatment had not yet been started but a programme for the training of chief medical officers of sectors and three nurses per sector was ready and would be implemented in L991. Two training sites had been selected: - Bouake for the 12 sectors in the OCP area (August 1991); - Adzope for the 14 sectors in the forest area (November 1991). A considerable amount of personnel, infrastructural and logistic resources existed and would be made available for devolution. Onchocerciasis controt had for a long time formed part of the progralnmes for the control of the major endemic diseases (leprosy, tuberculosis, etc.) which were the usual activities of the rural health sectors. 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. It would be necessary to continue and intensiff contacts with UNDP and other donors. The difficulties encountered were threefold: (a) Difficulties of the national team as regards structures: (b) I-ack of training of the local teams concerning onchocerciasis diagnosis and ivermectin distribution: a training programme had already been prepared and 9what remained was the finding of financing. (c) The functioning-related problems of the NOC were due to the absence of a clearly defined programme and interministerial representatives designated by name. The new restructuring of the Ministry of Health would make it possible to raise the sense of responsibility of the persons available. 5.4. Proeress reoort 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 with a medical officer as chairman. It comprised the Ministry of Finance and Economic Planning, the National Onchocerciasis Secretariat, the Ministry of Information, the Ministry of Education, the Ministry of Health, the Institute of Aquatic Biology, the Environmental Protection Council and a public health medical officer from the private sector. 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. However, evaluation of Guinea worr\ one of the devolution diseases, had been made. A general epidemiological evaluation would be made very soon. As regards ivermectiq 'Ghana had received 10,000 tablets which had been distributed in the health centres in the initial area and forest area. Recently, 6,000 tablets received from OCP were distributed in the health centres in the initial area as part of passive treatment. The initial area .covered the three northern regions, i.e., Northern, Upper East and Upper West. . The ivermectin trial centre which was in Tamale had now been transferred to Hohoe. As regards training, it was being continued actively and concerned, particularly, staff members who had specialized in entomology, parasitolory and epidemiolory. Each region in the onchocerciasis-freed zone had a chief public health medical officer and a health educator. 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. 10 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 wonn eradication and lepiosy control. Six NGOs were collaborating with Ghana as palt of devolution. Representatives of the donor countries had been invited to the official launching of the devolution plan of Ghana at the end of June 1991. An appeal for the finaucing of this plan would be made on that occasion. 5.5. Progress report of Mali The delegate of Mali indicated that a national coordinator had been appointed within a national team that had been set up since 1985. This national team was, in addition to the Medical Officer/Coordinator, composed of a doctor-epidemiologist, two entomologists, hydrobiologists and entomolory and hydrobiology technicians. A National Onchocerciasis Committee existed and was composed of representatives of the Ministries concerned and headed by the Minister of Health with the National Coordinator in charge of the Secretariat. An epidemiological evaluation had been made in &e Farako and Banifing IV (reinvasion zone) basins. ln Zi villages evaluated with 6,975 persons enumerated, t h e prevalence rates were 5.94Vo and Z.lVo respectively at Farako and Banifing tV. As regards ivermectin distribution, 41 fixed centres were at present undertaking passive treatment in the initial area. Monthly reports being sent regularly shdwed that out of the 6,200 tablets delivered, 1,010.5 had been distributed to 678 patients treated. In the field of training, the National Coordinator attended the higher cburse in epidemiolory in Bamako while five nurses received training at the National School of Medicine and Pharmacy in Bamako. It had been planned to enrol the Deputy National Coordinator for the higher course in epidemiology in Bamako. The resources made available were those of the personnel of the national tean! field personnel, offices of the team and infrastructure of the health centres. Field vehicles of the 19 centres in the devolution zone and the small liaison vehicle were the logistic resources available. 11 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 hence the present difficulties. 5.6. Prosress reDort of Nieer The delegate of Niger presented the report according to the outline proposed. - The National Coordinator and the members of the national team had been appointed by a Ministerial decree. The team was made up of a Medical Officer/Coordinator, an entomology-technician and five epidemiology-nurses. - These was a NOC but it had to be revitalized. - The results of the epidemiological evaluation carried out in October 1990 had confirmed the excellent situation. The highest prevalence was only 7.2Vo, at Bangou-Kouare, while in the same village the prevalence was 68.5Vo in 1977. Each health centre had received 100 tablets of ivermectin. To make up for the insufficient notion of onchocerciasis, a training seminar which was organized made it possible to update the knowledge of the epidemiology, and treatment of the disease, and entomolory and health education for 25 nurses from the centres. As regards resources made available, the personnel of the fixed health centres and state and private facilities were being used for onchocerciasis control just as the logistics. The onchocerciasis prograrnme had been integrated into the leprosy control and EPI programmes. . With the USAID funds which had been made available, collaboration would be established between the national team and Helen Keller International (HKI). Among the different organizations contacted for funding only USAID had responded favourably. Apart from the frequent lack of fuel, the difficulties encountered were not insurmountable. 5.7. Progress report of Togo A national coordinator had been appointed since November 1990 as well as a health education officer for onchocerciasis. 12 There was a national onchocerciasis control team too. The situation of the NOC was unstable because of the departure of some members as a result of frequent transfers. The Committee would therefore have to be restructured and revitalized. Epidemiological evaluation and ivermectin distribution missions had been undertaken in collaboration with OCP. As part of training, seven medical officers and 2l nurses had been trained. There were personnel, infrastructural and logistic resources. Onchocerciasis control had been integrated into the activities for major endemic diseases, e.g. tuberculosis and leprosy. The Togo delegate indicated that no NGO was participating in Despite the many contacts made in the search for financing no had been received so far. the control of the the programme. positive response 6. PROGRESS REPORT ON HEALTH EDUCATION ON ONCHOCERCIASIS The OCP Information and Public Relations Officer introduced the sixth agenda item. He recalled that the populations in the initial Programme areawere not necessarily aware of the relationship existing between blacHly bites, the appearan€e of onchocerciasis and its major ccimplication: blindness. He indicated that the return of the blackfly was foreseeable, that this return would constitute a nuisance and could reintroduce the disease if certain conditions were me! notably the migration of infected populations to the freed zones. . Referring to the fourteenth NOC meeting, he invited the participants to make an evaluation of eighteen actions and objectives discussed in 1990 and report on what had been done and what had not been done before presenting their reflections on other activities that could contribute to the greater welfare of the populations in the sphere of health education. These actions bnd objectives to be carried out and attained concerned, in particular, the creation of national health education centres, the identification and surveillance of the zones at rislg the referral of migrants suspected of having onchocerciasis to health centres, participation in mass campaigns, the organization of training workshops at the intermediate and peripheral levels, improvement of the populations' knowledge of onchocerciasis, retraining of primary health care workers on onchocerciasis, the setting up of village onchocerciasis control committees and the training of health community leaders, etc.. Taking the floor after the OCP Information and Public Relations Officer, the sociologist <lf the National land Development Office (ONAT), the author of a study on the populations settled in the onchocerciasis-freed zones in Burkina, presented the main 13 lines of his report which would be submitted to the OCP Expert Advisory Committee. After a number of observations,viz., lack of information and awareness at all levels, and lack of contact between OCP staff and the populations and field workers, the ONAT sociologist made three main recommendations: - to inform and raise the consciousness of the populations and the workers and officials of some local and central departments so that they would have a better knowledge of onchocerciasis and OCP; - to see to the giving of training to officials and actors in the field of health, students of health schools, teacher training students, teachers and pupils of primary and secondary schools, members of community organizations in these zones; - to see to the improvement of the relations between OCP, on the one hand, and the local government departments and populations, on the other hand. OCP should collaborate more closely with the central and local health services. OCP workers visiting these zones should establish contacts with the administrative authorities and representatives of the populations. 6.t. Health education on onchocerciasis in Benin The delegate of Benin indicated that an Informatioq Education and Communication (IEC) Unit existed in the Ministry of Health. Placed under the supervision of the National Directorate of Health Protection, the IEC had a responsible officer in each of the six regions. . As regards the identification and surveillance of the zones at rislg the activities were being carried out by the OCP subsectors and the Technical Intervention Unia (TIU) which used to be the Major Endemic Diseases Units. He stressed the fact that the onchocerciasis vector was being taught in the primary and secondary schools, that the local treatment teams (LTIs) were participating in the ivermectin distribution campaigns; that the IEC/MOH Unit was participating in the preparation of the "Rural Radio' programme in local languages; that the LTTs were taking part in the improvement of the populations'.knowledge of onchocerciasis and its mode of transmission; that the main channels of communication (national and regional radios, local languages, political and administrative authorities, town criers, film shows) were being used and that village onchocerciasis control committees had been set up and were being trained. Finally, he said that the preparation of the epidemiological map was in progress. 6.2. Health education on onchocerciasis in Burkina The delegate of Burkina Faso declared that there was a Directorate charged with Health Education and Sanitation (DESA) in the Ministry of Health. As part of the decentralization of the structures of this Directorate, Regional Health Education and Sanitation Centres (CRESA) would be established. L4 The identification and surveillance of the zones at risk was being undertaken by the national evaluation team just 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. i ' OCP and ONAT carried out in April-May 7991apublic awareness campaign in the freed zo+es which reached some 10,000 persons and would be continued in the whole zone covbred by ONAT in October 1991. 6.3. Health education on onchocerciasis in Cdte d'Ivoire The delegate of Cote d'ivoire indicated that there was a National Health Education Department at the National Institute of Public Health (INSP) in Abidjan. It had been planned to include a health educator in the NOC to be revitalized. The identification and surveillance of the zones at risk had been carried out by OCP (EPI) in the Programme area but not in the forest area for which it was the responsibility of the national team. For some 20 months now, [h. nutional team had been participating in mass campaigns in collaboration with OCP. Interpersonal contacts were taking place between the national team and OCP (EPI) during epidemiological evaluation and mass treatment campaigns. In 1991, the C6te d'Ivoire television showed every day for one month (between 19h30 and 19h35) a five-minute programme on onchocerciasis. 6.4. Health education on onchocerciasis in Ghana Health education activities in the onchocerciasis-freed areas of the Northern and Upper regions were currently concerned with 11rs llaining of health personnel in effective communication skills, family planning, expanded programme on immunizatior\ diarrhoea, aids, onchocerciasis, yaws, leprosy and guinea wonn. 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, group discussions, drama, songs, radio, video and film shows. It had been observed that the method of the use of songs and drama had been a very effective one in carrying across the health messages to the public.I-ocal singing groups were being used for such cases. The GBC/URA radio station in Bolgatanga had also been fully utilized for sending health messages to the public. Discussions, debates, songs and drama 15 were being played back to the public. The community leaders, such as chiefs, assembly men, teachers, members of the CDRs, and members of the district/village oncho committees had been useful in organizing the people for the health education campaigns. With regard 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. The objectives of intensifying the health education campaigns in these areas were: i) To disseminate as much as possible the methods and efforts being made by the National Government and the OCP to maintain the achievements of the programme; ii) To get the communities completely involved in the control of the devolution diseases and the socioeconomic development of their own areas; iii) To bring the awareness of the people to the symptoms of the devolution diseases and the need for medical attention; iv) To change the conception of the people regarding the cause of the diseases in order to remove any superstitious beliefs and taboos from the minds of the people; v) To enable the medical teams to get the ma,rimum co-operation of the people particularly in the use of the drugs that were being introduced. 6.5. Health education on onchocerciasis in Guinea In Guinea, the health education section was Health Promotion Division. based in Conakry and under the The zones at risk had been identified and would be under surveillance as long as the antilarval treatment continued. A village development committee did not exist yet. 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. 1.6 byProgrammes had been broadcasted Upper Guinea. the Rural Radios of Middle Guinea and Contacts had been made with news media representatives in Conakry to facilitate information on onchocerciasis on radio and television and in newspapers. Messages in local languages had been broadcasted. Thanks to the OCP Information Divisioq posters had been posted in several health centres. The national teams, during each of their field trips, were improving the populations' knowledge of onchocerciasis by informing them of the different aspects of the disease. Ra{io, television and local local newspapers had been used to send across nessages on onchcicerciasis. The OCP Information Officer took part in these activities. 6.6. Health education on onchocerciasis in Guinea Bissau The delegate of Guinea Bissau declared that the dissemination of messages in local languages and Creole was being continued actively. The retraining of primary health care workers was also being continued. The national epidemiological and entomological teams were contributing to the improvement of the populations' knowledge of onchocerciasis. 6.7. Health education on onchocerciasis in Mali The delegate of Mali declared that a National Information, Education and Communication (IEC) Centre had been set up in the Ministry of Health. The mass treatment campaigns had made it possible to raise public awareness in 307 villages. 200 brochures on onchocerciasis had been distributed, with comments, to the authorities. The improvement of the populations' knowledge of onchocerciasis and its mode of transmission was being continued just as the dissemination of messages in Bamanankan. It had been planned to: - prepare and distribute guides on health workers in the onchocerciasis zones; - organize information/training workshops in the regions and districts; - produce radio programmes at the local station at Kayes, which is the 17 administrative centre of the western extension area in Mali; - produce and broadcast messages in other local languages spoken in the onchocerciasis zones; - use national communication channels (particularly, radio and television). 6.8. Health education on onchocerciasis in Niger According to the delegate of Niger, there had been for five years now a central stnrcture called "Directorate of Training and Health Education'with a health education division As regards the onchocerciasis zone, the Regional Information and Health Education Office (ARIEPS) had audio-visual equipment. The epidemiological map had been reviewed and corrected. ' There were no internal migrants suspected of having onchocerciasis. Considering the very low level of endemicity, Niger had not organized mass ivermectin treatment campaigns. The regional health education office had prepared teaching booklets for teachers and pupils in the health districts in the onchocerciasis zones. A 2O-minute television programme had been produced with the collaboration of the OCP Information Officer on the national television. This programme made it possible for viewers to know all the structures of OCP since its creation, to explain the diseasein detail, the developmental cycle, the manifestations and the socioeconomic consequences. A programme was broadcast in a local language on onchocerciasis and it had been planned to continue with this practice. The preparation of posters was being studied. 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 language by the Niger officials so that the populations would understand them better. The Niger onchocerciasis zone was the poorest in terms of village health workers so the timetable of activities in 1991 had made the training of these workers a major imperative. Health education was to be aimed at encouraging the populations to be actively 18 Emphasis was being laid on the intersectoral nature of onchocerciasis control. The populations could be involved in fields concerning their own health but they should--also Le-a*are of the problems, the resources available and above all know that their efforts had social and political support. Tfiris notion, according to the delegate of Niger, called for a change of attitude on the pdrt of both the individuals themselves and the health care workers. It was indispensable not only for the populations to understand the problems but also for them to collaborate in the search for solutions. Finally, the delegate of Niger expressed the wish for the taking of the necessary steps to implement the collaboration of the national teams of the countries in the field of health education to make possible the sensitization of the border villages by the audio-visual teams of neighbouring countries. 6.9. Health education on onchocerciasis in Senegal The delegate of Senegal declared that, since the 14th NOC meeting (1990), developmental activities centred on information, education and communication had been assigned to the regional health education office at Tambacounda. 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. As regards specific objectives, they were: - to inform the populations of the manifestations of the disease; - to inform and raise the awareness of the populations as regards the possible prevention of blindness by taking an adequate dose of ivermectin annually, and the availability of this drug in all the health centres in the onchocerciasis zones. The target groups were: - the populations living in the onchocerciasis zones; - health personnel; - community health workers; - administrative, political and religious authorities. Stratesv and activities undertaken (a) Information of the seneral oublic As regards radio and the print media, the regional health education office had a ,19 programme per week. From July 1990 to May L99L, there were six radio prograrnmes including two in local languages in collaboration with workers of the regional Major Endemic Diseases department. 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 "Ir Soleil" at Tambacounda (August 1990) and a roundtable was organized at the headquarters of the same newsPaper in Dakar with the participation of the OCP Director, the National Coordinator, the Deputy National Coordinator, and the OCP Information Officer. As regard the information and sensitization of limited groups, the delegate of Senegal mentioned the following: - The holding of the meeting of the Regional Development Committee (CRD) in February t99l at Tamba on the region's health situation with an information paper on onchocerciasis; - Video-cassettes on onchocerciasis were showed in five secondary schools in the Tamba district and in eight schools in the Kedougou district; - At Kedougou, school health education officials gave talks on health subjects including onchocerciasis in the schools and during open discussions in the suburbs; - Information and sensitization of all the Chief Post Nurses (CPNs) was made during the coordination meeting of nurses at the beginning of the month of May at Tamba (after a first one in October 1990); - The CPNs in the onchocerciasis zone were given information on ivermectin treatment (3 at Tamba, 4 at Bakel, L5 at Kedougou) as well as three chief medical officers at Bakel, Kedougou and Velingara in the field. - In 47 localities, the awareness of the village chiefs and populations was raised by the CPNs, which made it possible for some of them to undertake advanced strategy ivermectin treatment (in 25 villages). The difficulties encountered were geographical (great distances between the villages) and populational (dispersal of the population, low density, 6 inhabitants per sq. km), resulting in difficulties in assembling the populations and poor attendance at the health centres, and insufficient logistics. With regard to prospects, it had been planned to increase the number of radio programmes in local languages, to show films on onchocerciasis in the villages in the on chocerciasis zone, to increase discussions in the villages in the onchocerciasis zones, to make sure of a regular quarterly supervision of Chief Post Nurses, laying emphasis on information and awareness raising, to increase contacts between the onchocerciasis teams based at Tambacounda and the Bakel and Velingara regions, to train workers in the 20 other development sectors so that each of them could, within the normal framework of his training, raise awareness as regards onchocerciasis as was being done in the Expanded Programme on Immunization (EPI). 6.10. Health education on onchocerciasis in Sierra lrone Health education on onchocerciasis was not a priority in the activities of the Health Education Unit of the Ministry of llealth of Sierra L.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 in the field of health education. To that end, it used the following channels: - The national radio to inform the public of onchocerciasis-related problems: OCP, onchocerciasis as a disease, ivermectin. - Members of the national team were seizing all opportunities during their field trips to disseminate information. Emphasis was being laid on the regular taking of ivermectin, respect for and protection of OCP items (particularly larvicide drums) - The Coordinator of the Onchocerciasis Control Programme who was also a member of the Sierra lrone Association of Dentists and of the national blindness prevention committee was taking advantage of these different titles to send the onchocerciasis message across. - It had been planned to organized film-show campaigns and conferences for as many people as possible. The national onchocerciasis control team was trying to obtain the collaboration of the Health Education Association of Sierra Lrone, a non-governmental organization. 6.11. Health education on onchocerciasis in Togo The delegate of Togo affirmed that his country had had a National Health Education Department since 1969. The national team and OCPwere teaching the village development committees how to identify the blackfly. As regards migrants suspected of having onchocerciasis, they were being treated at the regional hospitals at Kara and Dapaong and in the health centres in the Kara and Savanna regions. 2l Improvement of the populations'knowledge of onchocerciasis was beingundertaken by the national team as well as epidemiological evaluation, ivermectin distribution and information of the populations on the cause of the disease, its transmission cycle and complications. The use of the main channels of communication was being made from time to time on television. 7 . IVERMECTIN DISTRIBUTION 7.1. Country reports This agenda item concerned the five countries in the OCP western extension zone, viz., Guinea, Guinea Bissau, Mali, Senegal and Sierra lrone. In his introductory statement, the Chief of the Epidemiological Evaluation Unit said that mass 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 rycles. After the treatment of more than 260,000 persons by OCP, the safety of ivermectin could no longer be doubted. The national teams had actively participated, in collaboration with OCP, in the preparation of the detailed map of the western extension and defined the zones where ivermectin should be given. For its part, the EPI Coordinator in Bamako made a presentation on the intensification of ivermectin distribution by the tixed health centres. In substance, he said that the objectives were, on the one hand, to make ivermectin available in all these centres and, on the other hand, to maintain and strengthen their capacity to provide a correct service to onchocerciasis patients. Among other strategies, he proposed the information and sensitization of the populations, leaders and decision-makers at all levels, and the mobilization of all available resollrces (infrastructure, NGOs, personnel, all health progralnmes, etc.). The delegates of Guinea, Guinea Bissau, Mali, Senegal and Sierra Irone then reported on the situation as regards ivermectin distribution in the fixed centres. Their presentations showed that everything was going on normally. However, certains difficulties remained, particularly low attendance, registration of patients and insufficient logistic resources. No stock shortage was reported. Nevertheless, the delegates were advised to check the ivermectin expiry dates to avoid wastage. The situation in each country Guinea Fixed centres concerned Number of patients treated Tablets distributed 22 was as follows: 126 11,839 16,998.5 Guinde Bissau The centres had not yet started distribution although the tablets had been put in place. This was due to the diagnostic difficulties the health workers were facing. Mali (Western extension) Fixed centres concerned Number of patients treated Tablets distributed Senegal Fixed centres concerned Number of patients treated Tablets distributed Sierra Irone Fixed centres concerned Number of patients treated Tablets distributed 93 12,755 19,769 29 540 777 49 36,954 57,925 It should be pointed out that non-gouvernemental organizations (NGOs) were involved in ivermectin distribution in some of the countries. 7.2. Discussions The Prograrnme Director expressed his satisfaction at the work done within so short He stressed also that the distribution methodology had beem made lighter: - Skin snip was no longer necessary before treatment; that procedure was risky because of the possibility of AIDS transmission; it could initially be replaced by 23 nodule palpation because it had been noted that there was a linear correlation between microfilarial load and the number of nodules. Discovery of an immunological test would be of great help. - Data registration would be simplified. - The weight parameter (demand for scale) should no longer be an obstacle because the drug was not toxic. As regards collaborationwith NGOs, the Programme Director advised the delegates to insist on a number of conditions to avoid aifEculties which could crop up durin! the execution of the activities. These conditions were the following: L. The NGO should have a sufficient budget 2. It should have adequate human and logistic reso,rces 3. It should pledge to collaborate for at least five years 4. A memorandum of agreement shourd be prepared and respected 5- A meeting should be held annually to evaruate the progress made 8 . II{VENTORY OF FACILITIES AND EQUIPMENT In introducing this itern, the Chief of the Devolutionjustification for this work which would a[ow the workers situation as regards the infrastructure and equipment made Unit laid emphasis on the to know at any time the available. This inventory should be regularly updated and was indispensable in the elaboration of regional health development plans and in the translationbf the devolution plans into plans of action. . The, Programme Director then underscored the importance attached to this inventory_by the donors, certain benefactors, members of the E:rpert 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. The few local or regional differences that appeared were due to the negative "ffi"t of the economic crisis and tothe work of NGOs and the communities. 9. OTHER MATTERS . ft: Programm_e Director gave an important information on the consumption ofivermectin since 1987, i.e., more than 1,8000,000 tablets, which was a world record in the use of a drug. 24 Forest onchocerciasis was discussed and would be the subject of a consultative meeting between Cdte d'Ivoire, Ghana and OCP. However, these countries were asked to intensiff ivermectin distribution in the zone. The problem of preparation of a standard treatment card for onchocerciasis patients was raised again this year. No solution was found. As regards resettlement in the freed valleys, the Director-General of ONAT gave the reasons for its success in Burkina Faso by citing the example of the AW: - the resettlement zone should be sparsely populated; - a decree should assign the management of the lands to the managerial body; - a policy should allow the integration of traditional villages outside the zone; - land management committees should be set up and be under the responsibility of the village communities. 10 . DATB OF THE 16TH MEETING The 16th meeting of the NOC would be held from 19 to 2L May 1992. 11 . ADOPTION OF THE RE,PORT The report was adopted. it would be sent to the participants for their observations. 2. 3. 25 ANNEX 1 LIST OF SUBJECTS TO WHICH CONCRETE ANSWERS SHOULD BE GN/EN SINCE THE ADOPTION OF THE PI-AI{ I INSTITLMONAL FRAMEWORK 1.1. Appointment of a Coordinator 7.2. Setting up of national teams 1.3. Situation of the NOC ACTIWIIES 2.1. Epidemiological evaluation 2.2. Ivermectin distribution 2.3. Training RESOURCES MADE AVAILABLE 3.1. Personnel 3.2. Infrastructure 3.3. l-ogistics ) 4. INTEGRATION 4.1. Activities carried out by the prograrnmes on other major endemic diseases combined with onchocerciasis NGOs 5.1. Number of non-governmental orgaruzations (NGOs) collaborating in devolution activities 6. SEARCH FOR FINANCING 6.1. Number of donors contacted 6.2. Number of positive responses 7. DIFFICULTIES ENCOUNTERED AND SOLUTIONS ENVISAGED 8. SPECIFIC QUESTIONS 26 ANNEX 2 INFORMATION/PTJBLIC AWARENESS ACTTYITIES TO BE CARRIED OUT 1. To create national health educaticn centres; To help members of the village development committee to identify the blackfly; To direct migrants suspected of having onchocerciasis to heatth centres; To participate in public awareness campaigns on large-scale treatment; To prepare and distribute a booklet in the areas concerned; To organize training workshops at the intermediate and peripheral levels; To produce radio prograrnmes in support of information in the regional stations of the=zones concerned; To prompt interpersonal contacts (mediq extension ofEcers); To broadcast messages in local languages and prepare posters; To improve the populations' knowledge of onchocerciasis (mode of transmission of the disease); To stimulate the interest and involvement of the populations in entomological surveillance; To retrain primary health care workers on onchocerciasis; To conduct a qualitative survey in the initial area so as to strengthen better the objectives of communication and of the strategy; To encourage, plays, songs, and stories aimed at a better knowledge of onchocerciasis. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. L2. 13. t4. 1. 2. 3. 4. 5. 6. 7. 8. 27 ANNEX 3 ryERMECTIN DISTRIBUTION . AREAS TO BE DEALT WITII IN CONCRE,IE, TERMS Ivermectin distribution in the fixed centres Methods used in distribution Data on the number treated Quantity of iverme-ctin used Quantity in stock/Records I-ogistics of provision and storage Problems encountered/? Solutions Other help, e.g., NGOs.