Ad hoc meeting of national coordinators and entomologists (Benin, Burkina Faso, Ghana, Niger, Togo): OCP, Ouagadougou, 12-14 March 2001

l;'f# EAC-rt J6t WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE ONCHOCERCIASIS CONTROL PROGRAMME IN WEST AFzuCA PROGRAMME DE LUTTE CONTRE L'ONCHOCERCOSE EN AFzuQUE DE L'OUEST AD HOC MEETING OF NATIONAL COORDINATORS AND ENTOMOLOGISTS (Bertur, Burliina Fuso, Glttutu, Niger, Togo) OCP, Ouagadougou, 12 - 14 March 2001 OCP/EAC22.3A rl.. 1 1. INTRODUCTION A meeting of National Coordinators and Entomologists of Participatirlg Countries (Benin, Btrrkina Faso, Ghana, Niger and Togo) rvas held from 12 to 14 March 2001, at the OCp lieadcluarters in Ouagadougou. Several OCP staff as rvell as the Programme Director also attended this meeting (cf. List of participants. ir-r Annex). This OCP-initiated meeting served as a consultative framework prior to preparing the zones meeting for in-depth and specific discussions, in concert with the various OCP Programme chiefs of Units. 2. OBJECTIVES OF MEETING Review ltroblenrs thal nti_chl cotlltrontisc the achier,enterits o1'O('lr. Rcvieu (take stock) the level of transl'er ol-Onclro control l'estduili activrties lor eaclr country. Evzrlttatc nectls in this dircction to cnable cach of the meurbcr counlrics adclress the post-OCP situation rvithor.rt much di ffi cu ltrz. 3. OPENING OF MEETING The Progranlme Director in his speech recalled the expectations of the Programme tttanagemeut lrom the meeting, namely: a concrete and detailed report on col-l1mon actior-rs by the various countries for a giverr river basin, as u,ell as actions carried out on intemal or specific basins. The said report musl also contain a rvell-spelt out schedule of plar-rned action per country for 2001. Tlre \/CLI chre1, on his paft, underscored the ovcrlaF'r oi'al1 coordinatron activities for more lralpitble atrd cffectrve outcor-ne. Hc recallcd thal thc- report rvrll also bc presented to the EAC mecting to be held fi-onr 4 to 8 .lune 2001. 4. DELIBERA'I'IONS After the welconte address and the introduction of the ob.;ectives of the meeting, the Chief of PET gave the floor to participants to elect an office for the meeting. Members were as follows: Chairperson: Dr. Sanou Souleymane, National Coordinator of Burkina Faso Rapporteur I: Dr. Dossa Coffi Sylvain, National Entomologist of Benin. Raltporteur II: Dr. Diallo Salamatou, National Coordiuator of Niger. Participants were to acldress the follou,ing subjects A) Problems and actions to be condlrcted in the zones that are conllrron to the countries. The basir-rs in question are as follows: Oti-Pendjari. Mo (epidemiological situation of Moala in Ghana), Sota Alibori and Tapoa in Niger (cf. Table A) B) Countrv specific issues: Togo (Oti and tributaries), Benin (r)ueme and Okpara), Ghana ( (ulpawr.r Mole, Bui and Pru), Burkina Faso (Dienkoa and Bougouriba) - (cf. Table B.1. C) Actrvrties transfered to Participatrng countries (conceptual framework) a-rp 2 The summary of discussions on the analysis of the health situation in the context of onchocerciasis and prospects, per country, in the common and specif,rc basins, in relation to the implementation of the framework for transferring onchocerciasis control activities is presented. Details per country/basin are found in Tables A and B that are appended to this report. I. ACTIONS TO BE CARRIED OUT ON RIVER BASINS COMMON TO THE RESPECTIVE COUNTRIES I.1 The Nieer and its tributaries This basin is common to Burkina Faso, Benin and Niger. Larviciding dates back to more than 7 years. Impact analysis that was conducted both in Benin and in Niger gave satisfactory results. However given the possibility of the reestablishment of new unknown villages up along these water courses, especially where they cross the W Park, with the blackfly densities still high in the Benin area, it was planned to ascertain an effective treatment with ivermectin. Currently ivermectin treatment is given on a twice/year basis in the eligible villages on the Benin side. A demographic and entomological prospecting in the Niger area of the W Park is also called for. A survey of early detection of recrudescence could be undertaken on the Diamangou by the Entomologist of Niger. I.2 Oti-Pendiari and tributarict This basin is made up of tributaries of the Mo, the Koumoungou, the main Oti River or Pendjari, the Keran and the Kara and runs through Benin, Burkina Faso, Ghana and Togo. Prevalence of infection varies between 9 and 620/o, due to the following reasons: geographical inaccessibility, poor management of ivermectin treatment in some villages, lukewarm attitude of health workers, lack of interest of local and health authorities in some countries. To ensure that prevalence rates come down, the following actions will be carried out during the entomolo gicallepidemiological year 200 I : Collaborative monitoring between OCP and national coordinations in areas where there are bottlenecks to ivermectin distribution. Enhancing Community Directed Treatment with Ivermectin (CDTI) capacity through complete prospecting of ill villages under ivermectin treatment. Putting in place a material incentive strategy for health workers and distributors. Engaging supervisors at the prefecture and departmental levels to ensure strict monitoring of ivermectin distribution. Organising exchange workshops for officers of the national coordination, the national administration, health workers and the general public. JII. ACTIONS TO BE TAKEN ON SPECIFIC BASINS 2.i Oueme-Okpara Basin in Benin This basin has been under larviciding since 1988. CDTI was generally introduced in 1997, but epidemiological and entomological results of most of the points that have been monitored thus far are still unsatisfactory. This situation is caused by the reinvasion of water courses by flies from Nigeria. For this reason, the meeting requests that OCP and APOC put in place a framework for exchange among OCP, the Benin national coordination, and the national coordination offices of Ogun and Oyo states of Nigeria. The coordination of Benin was requested to: draw up a complete list of eligible villages and those currently under ivermectin treatment; undertake enhanced monitoring and check on frequency of treatment; ensure re-training of health workers and distributors; monitor population migration in the villages under treatment; ensure that the entomologists uses the tools designed by OCP (to utilise the control data) for the continuation of actions that may be conducted in Benin. 2.2 Haho-Sio basin in Togo Vector control combined with large scale distribution of ivermectin gave epidemiological and entomological results with a downward trend. The meeting recommends the continuation of the actions on course, as well as a survey of the distribution of ivermectin at the eligible points. 2.3. The Pru. Kulpawn-Mole and Bui basins in Ghana The control means employed on the basins of the Pru, Kulpawn-Mole and the Bui have been larvicides only or combined with the widespread distribution of ivermectin. The results of epidemiological evaluations carried out in 2000 show an obvious downward trend, but not without epidemiological indices. The persistence of infection, despite the use of the above mentioned means, calls for more vigilance on the part of the national coordination of Ghana, to whom the following recommendations were made: Involve all the social strata, administrative and health outfits in the control effort, during a workshop, where the lead control actions on the basins concerned will be discussed and selected in a participatory manner; cany out a survey on population migration, especially on the Pru taking into account, in a comprehensive manner, the population around the Pru, while giving special attention to migrants; camy out ground treatment in the areas that are inaccessible to aircraft; Step up IEC in the villages that are monitored; Improve the efficiency of ivermectin distribution in all villages; Discuss, in a participatory manner, the fomr of incentives to be given to distributors and healtli workers; I ?4 2.4 Dienkoa and Bougouriba @ After larviciding activities ceased, a residual focus of infection was observed in 1992, but a combination of ground treatment and enhanced ivermectin distribution was able to control the infection. The area is currently without transmission and the end of treatment is scheduled for 2001. With regard to Bougouriba, the results are less impressive, especially in the districts of Dano, Diebougou, Batie and Gaoua. Actions are on-going (for a of discussions among leaders of the National Coordinators, population and health authorities) for enhanced ivermectin distribution and the intensification of IEC. It was agreed that the background to ivermectin distribution be given in all the basins to highlight the lapses so as to correct them as early as possible. IIr. ACTIVITIES TRANSFERRED TO OCP MEMBER COUNTRIES (CONCEPTUAL FRAMEWORTO After reviewing other subjects, participants brought the latter under 3 chapters, namely incentives for health workers and community distributors, the integration and decentralisation of residual activities of onchocerciasis control and sources of funding and partnership of participating countries. With respect to incentives, several actions were noted that could encourage and sustain the interest of health workers in managing control activities on a continuous basis. These include training/re-training of health personnel, regular supervision, in-kind or financial incentives, information feed back, periodic reviews, which would bring all stakeholders together, and finally decentralisation of activities. In Niger, for instance, health workers of Health Centres (CSD are given fuel and per diem from HKI funding for supervision of IEC activities in the villages. Community Health Workers and Village Brigadiers, on the other hand, are given soap and salt as incentives. In Burkina Faso and Benin, there are no incentive packages as such, but negotiations on the form of incentives are underway with the community or management committees of training centres. In Togo, incentives to distributors and health workers (supervision of CDTI) are based on cost recovery. With respect to the integration of activities, it is worth noting that in all the countries, oncho control activities are included in policy documents, and onchocerciasis is part of priority diseases, except in Niger where the disease has become less of a priority. In Benin, onchocerciasis control activities are integrated at three levels (national, intermediate and peripheral). For this reason, those in charge of controlling the disease take part in training, and supervision of health workers, and in epidemiological surveys. In Togo, integration is effective at the regional, district and peripheral levels, for control activities are integrated into the minimum package of activities of health services. Control activities are included in the plan of action of dispensaries, districts and regions, and are financed on cost recovery funds (e.g. incentives for community distributors, supervision by the CDTI nurse). a t5 In some countries such as Togo, Benin and Burkina Faso, onchocerciasis control activities are integrated into other diseases, namely, Trypanosomiasis, guinea wom1, lymphatic filariasis and schistosomiasis. On the other hand, in some other countries, like in the case of Niger, this integration is nominal, since each programme has its own Coordinator and is run separately. In all the countries, decentralisation of activities is effective at the district level, where action plans are drawn up, except in Niger, for the same reason mentioned above. In the case of Togo, CDTI activities are entirely decentralised, with the exception of epidemiological surveillance activities which are only partially decentralised (the regional team, for instance, is yet to be autonomous, since it does not have evaluation equipment). a The creation of databases and training of regional teams on the use of the "EPICROSS" software are planned for 2001. Entomological activities are being decentralised to the regional level, but there are still no tools for dissecting blackflies. The situation in Benin is similar to that of Togo. The problems encountered are at the district level. Onchocerciasis control activities are not carried out on a timely basis. This is due to the fact that the senior medical officers are in charge of other health progralnmes. In Niger, workshops were organised to sensitise staff at the district level to incorporate oncho activities in their plans of action. As a matter of fact, this activity is yet to be carried out in all the districts. Some training activities were undertaken: training of district teams on epidemiological surveillance; CSI officers on oncho diagnostics; CHW on oncho IEC; village brigadiers on ground larviciding; village fly catchers on blackfly catching techniques, and teachers of educational units on oncho IEC in order to sensitise pupils/students in the area. In Burkina Faso, the situation is similar to those of Togo and Benin. Difficulties are in the area ofdata collection (lack ofnecessary tools, no data collection). With respect to funding sources, all the countries have allocations by their States, except Niger In Burkina Faso, onchocerciasis control activities are supported by a World Bank loan (Nutrition Health Development Proj ect) (WHO/AFRO/HKI). In Togo, Sight Savers Intemational (SS! supports IEC activities. A search for other donors (Organisation pour la Pr6vention de la Cecit6 - OPC, Christoffel Blinden Mission - CBM) are on- going. In Benin, oncho control activities are in the main financed from the national budget. The Benin Coordination is cunently in search of other donors. Contacts have been made with OPC and SSI. ln Niger, WHO/AFRO and HKI are involved in IEC activities 6Reflectir-rg on these subjects made for an evaluation of the level of implementation of the conceptual framework of oncho control residual activities in the country. Thus, generally, it could be said that several activities found in this document have already been taken into account by the various countries. There is still a lot to be done, however, to ensure that all the activities are actually financed by the countries. RECOMMENDATIONS The analysis of the results of onchocerciasis control in the basins of the Oueme-Okpara indicates an unsatisfactory epidemiological situation in the villages bordering Nigeria, where oncho control is supported by APOC. Consequently, the meeting recommends that APOC and OCP promote a framework for sharing ideas between the two countries (OCP/APOC, NC) RECOMMENDATION 2 After 2002, the essential residual activities to be conducted in some States will consist of entomological surveillance and vector control by ground larviciding. To this end, the meeting recommends the creation of a medical entomologist position at the West Africa Multi-disease Surveillance Centre, who could coordinate residual entomological activities to be undertaken by the countries after OCP ceases its operations. RECOMMENDATION 3 At the end of the Programme in 2002, the oncho situation will still not be completely under control in all the basins, where there are still unresolved issues. Given that ground treatment and CDTI might be the only available "arms" in the various countries, the meeting recommends that the outcome of feasibility studies on ground treatment be made available as quickly as possible, and that if need be, training and re-training of health workers within the national coordination outfits be pursued; and that donors be solicited for the provision of necessary insecticides for ground treatment in eligible basins (OCP; Countries). RECOMMENDATION 4 In order to optimise the results of control activities on both sides or along the common river basins, the meeting recommends the harmonisation of CDTI activities by the National Coordination on both sides and along river basins common to the countries (NC) RECOMMENDATION 1 c) -o(n I C) F O N a oo Hp. 0) h I >rd z I t< a. 0) h I d a N 0)fZd !() C)p o (n o .o bo d.n -C)(!0)qo. 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DI) Ao; E.il 3 = E or -CQ>iihicB() ' 2 >l&IH?9P t-- a tl8 Annex 1: LIST OF PARTICIPANTS Benin Dr Julius E. Gaba, National Oncho Coordinator Dr S. Dossa, National Entomologist Burkina Faso Dr Souleyane Sanou, National Oncho Coordinator Dr M6t6 Bonkoungou, National Entomologist Ghana Dr Kofi Ahmed, Director Oncho Control Niger Dr Salamatou Diallo, National Oncho Coordinator Mr. Lamine Seni, National Entomologist OCP Dr Boakye A. Boatin, Director OCP Dr L. Yam6ogo, CVCU Dr E. Soumbey Alley, CPET a.i. Dr K.L.B. Akpoboua, ATO Dr K. Siam6vi, PET )?