Reflections of the Committee of Sponsoring Agencies

,JOINT PNOCNEUME COMMITTEE Office of the Chairman Onchocerciasis Control Programme in the Volta River Basin area Programme de Lutte contre I'Onchocercose dans la R6gion du Bassin de la Volta JPC.CCP COMITE CONJOINT DU PROGRAMMEBureau du Pr6sident JOINT PROGRAI"IME COMMITTEE Fifth Session JPC5. 3 ORIGINAL : ENGLISH December 1984 3-6 December 1984 Prouisional Agenda item 5 REFLECTIONS OF TIIE COMMITTEE OF SPONSORING AGENCIES Introduction 1. The members of the Comittee of Sponsoring Agencies have attended all the meetings of the OCP Statutory bodies as well as the meetings of Donors and National Onchocerciasis Comrittees. The focus of attention has natural-ly been on the Long-Term Strategy proposal. With exposure to the many views expressed the CSA wishes to share its reflections on the progress of OCP to date, on the merits and irnplications of the Long-Term Strategy proposal and related matters as well as socioeconomic development in the hope that these reflections will facilitate the decision making process. Progress to date 2. The CSA has reviewed the various documents before the Comittee and wishes to highlight the following significant points: 3. As can be seen from the Progress report, in 902 of the original OCP area, the Prograsrne is right on course and, somewhat ahead of the schedule originaLly foreseen for meeting the objective of controlling Onchocerciasis and opening up the river valleys for development because of an effective operational strategy and the fact that the length of the parasite adult worm life is, in this area, approximately 11 years rather than the 15 to 18 years originally envisaged. This has a significant impact on the Long-Term Strategy because a shorter period of operations is possibLe with beneficial financial impLications to both Participants and Donors. -2- 4. In the periphery of the Programe axea,reinvasion by blackflies fron outside continues tL pose a probLem. It prevents complete control as witnessed by the numblr of children infected since the Progralme started' It requires a high level of control and surveillance to be maintained' and' consequently, ties up a large part, of the Progratrmets resources in this area. The results of trial treatments undertaken during the exploratory studies in the Western Extension area indicate the positive effecE control of the source of reinvasion woutd have on the western flank and provides additional justification for the extensions. 5. Resistance continues to be present but the Prograrne' through thej*rffioi1"'.,i"idesavai1ab1etoit,iskeepingonestepahead.This, together with the new candidate products emerging from the larvicide screening process, augurs well for the futlre. This view is supported by both t'he Expert Ldri"oty Conrmittee and the Ecological Group' 5. Although research has been given due emphasis during the year in line with the the recorrrmendations of the Expert Advisory Coumittee, the CSA would draw the attention of Ehe JPC to the fact that there is a limit to the capacity of the Prograrmre to resPond to ever-increasing demands and to the lack of experienced research workers' 7 The CSA no tes that the onchocerciasis Chemother Pro ect is alreadY showing progress with some interest ing Leads alreadY deniiriea. The csA wishes to draw the attention of the JPC to the fact that if and when a suitable drug is available there wr11 be a need for an effective delivery system in each country so that the drug can be an effective maintenance tool ' This, of course, has implications with regard to devolution and strengthening the national health services. 8. The controL of forest sPecies of the vector is absorbing a significant proportion o rogramme s resources. The pertinence of the control of Ehese species (at a cost exceeding US$ 1 million per year) to the attainment of the Programers objective has been studied and the CSA aligns itself with the EAC recomrendation that' until S.soubrense is proved to be a vector of importance in transmitting savanna onchocerciasis , control activities specifically aimed at it should be suspended. 1985 Budeet g. The csA has reviewed the plan of Action and Budget for 1985 and found it to be analytically clear and consistent. It allows a realistic anticipation of demand in line with 1984 expenditure with a total growth of only 52' The Prograrnme is to be cormtended for the continuing strict monetary control it exercises on its expenditures. The CSA recormends approval of the Plan of Action and Budget to the JPC' t t. 3- 10. The CSA, following the attendance of its members at review meetings by all parties concerned in the Progranrne and its own detailed and intensive consideration of the Long-Term Strategy now before the JPC, recomends its approval by the JPC. In coming to its conclusion to reconrmend such approval the CSA has also noted that : - the Expert Advisory Conrmittee has confirmed its technical and scientific soundness; - the National Onchocerciasis Co'nmittee have support.ed it and in Ouagadougou in June 1984, as in Lom6 in June 1983, indicated their willingness to assume responsibility for devolved activities, a key aspect of the Long- Tern Strategy; - and finally the CSA recognizes that the Long Term-Strategy meets the Terms of Reference the CSA itself drew up and presented to the JPC in 1983. 11. In the course of its own del-iberations, the CSA has reviewed issues raised on various occasions and feels it would be useful to relay two of them which are particularly important to the JPC because of the impact they will have on the success of the Progra'mne and on OCPrs future activities. The issues are : (a) the increased corrmitment, financial and othervise, required from the Participating Countries, in the devolution of maintenance activities - a major move which the LTS suggests could start being implemented in some countries as early as the third financial phase, and (b) the role of OCP in socioeconomic development in the Onchocerciasis controlled areas. L2. The question of an increased financial co"r-itment by the Participating Countries has been raised by the donors who, as a group, now contemplate new co'r-itments to enable the Progranme to reach its objective. It is triggered not only by the need for a more significant counterpart funding but also by the need for the Participating Countries to prepare themselves in time to meet the recurrent cost of maintenance. It is evident that the Participating Countries are conscious of their responsibilities in this respect in view of their acceptance of the principle of devolution confirmed in Lom6 and Ouagadougou, and that some definitive action is already being taken. However, in raising this the CSA is conscious of the critical financial situation prevailing in Africa and the fact that the Participating Countries are atso maintaining their obligations in cash and in kind to the Progrannne as a priority. Socioeconomic DeveLopment 13. The role of OCP in the socioeconomic developmenE of the Onchocerciasis controlled areas has been raised by donors and Participating Countries. They I Long Term Strategy { , 4- are eager to see the succe.ss in removing a major obstbcle to.developrnent translated into socioeconomic benefits to the Participatine Countries. This eagerness is shared by the CSA, composed as it is'of fdur development agencies, all conmitted to develoPment in West Africa. However, the CSA tfrint<s that the managerial or staff resources should continue to be concentrated on the control of the disease and preparing nationals to take over the maintenance activities. The role of ocP is to docr:ment apProPriate action resulting from its vector control activities and the resources devoted to socio-economic development in the Programne area should be uaintained at its present level. The four agencies of CSA are jointly comritted to assisting OCP in this task. L4. How these development oPPortunities are or will be exploited have emerged as crucial questions for both donors and Participating Countries because the answers, along with the important benefit to health accrued directly frou this Programne, will justify co'r-itment to its success' The ansrrers cannot be provided by OCP which is essentially a health Programne and not an overaLl rural development agency' 15. The responsibility for determining the priority of development opportunities and launching development projects rests with the Governments of tire participating Countries themselves where these opportunities are now extensive. Rccoidingly the CSA considers it time for national planning and development units to indicate in clear terms how best those areas under onchoclrciasis control and ripe for develoPment could eontribute to national development as a whole. Participating Goverrunents have aLready indicated their awarenessto this need through their broad representation at the meeting in Ouagadougou in October to discuss issues' 16. It has been said many times that this Progranme is a success in int,ernational cooperation. Around it has been created a comtunity of partners comprising donors, Participating Countries and international specialized agencies ,ti"t have coordinated efforts and resources successfully. The CSA invites all participants in this JPC to reflect on how the land resources now under onchoclrciasis control can best be developed in a coordinated fashion to the benefit of the rural peopl-e in the Participating countries. a