Joint Coordinating Committee third session, Ouagadougou, 1-2 December 1976: independent chairman’s report of proceedings

It JOINT COORDINATING COM}IITTEE ONCHOCERCIASIS CONTROL PROGRA},IME IN THE VOLTA RIVER BASIN AREA Third session, Ouagadougou, 1-2 Decenber 1976 INDEPENDENT CHATRMANIS REPORT OF PROCEEDINGS Ihe third session of the Joint Coordinating Comritcee for the Onchocerciasis Control Prograrme in the VolEa River Basin area rdas held at the Palais du Conseil consultatif national pour 1e Renouveau (CCm), Ouagadougou, on 1 and 2 December 1976. The session was attended by representatives of the GovernmenEs of Belgirm, Benin, Canada, France, Federal Republic of Germany, Ghana, Ivory Coast, Japan, Kuwait, Mali, Netherlands, Niger, Togo, United Kingdom of Great Britain and Northern Ireland, United States of America, Upper Volta, the African Development Bank (eOf), the United Nations Development Programle (UnOp), the Food and Agriculture Organization of the United Nations (FAO), the World Bank (IBRD) and the World Health Organization (WttO). The session was also attended by Ehe Chairman of the Scientific and Technical Advisory Counittee (SfaC), the Secretary of Lhe Economic Development Advisory Panel (EDAP), Mr S. Kpognon, Alternate Executive Director, World Bank, and observers from the Comission of the European Corununities (CEC), the Organisation de CoordinaEion et de Coop6ration pour la LutE.e contre les Grandes End6mies (OCCGE), and the Office pour la Recherche scientifique et technique outre-mer (ORSTOM) of the French Government. A list of participants is attached as Annex 2. The session was opened by His Excellency General El Haj Aboubakar Sangoul6 Lamizana, President of the Republic of Upper Vo1ta, in the presence of high auEhorities of the Republic and members of the diplomatic corps. The Independent Chairman, Dr M. G. Candau, thanked the President of the Republic for honouring the Cormittee with his presence and welcomed Ehe guests and participants. In his introducEory statexoent (attached as Annex 4), Dr Candau observed that the results of OCPts first Ewo years of control activities bore witness to the satisfactory progress being made towards the hrman, social and economic developnent of the areas freed from transmission of onchocerciasis. A recent visit to the seven Participat,ing Countries had convinced him of the Governmentsr general satisfaction wiEh the Programe. However, the preoccupation of cerEain Governments with the possible extension of the Progranrme area suggested Ehat the question merited careful examination in the near future. Another subject of concern was the reinvasion of part of the Prograrmre area. The Independent Chairman concluded by emphasizing the need to make fuI1 use of the international scientific community to intensify research. His Excellency the President of the Republic of Upper Volta delivered an address (attached as Annex 3) in which he described the Prograrme as a fine example of a concerted international efforE. unique in its concern with both health and economic development. The difficulties overcome and resulEs achieved gave grounds for optimism that Eransmission could be checked; he therefore called for research to focus on chemotherapy in the hope of curing those already stricken by the disease. Paying tribute to the Contributing Parties and Sponsoring Agencies for their support, he pointed out that the Participating Countries would each have their own approach to the economic and social developmenE of the reclaimed areas, and thaE the Comitteers session provided Ehem with an opportunity for supervisi-on of the Programe and for concerted action. At the conclusion of his address, the meeting was suspended to permit His Excellency the President and other guests to wiEhdraw. After Ehe resrmption, the Independent Chairman read out a cable received from Norway in which the Government confirmed a Norweglan contribution to the Onchocerciasis Fund, subject to parliamentary approval, of 2.75 million itlorwegian Kroner in each of the years 1978 and 1979 (a total of some US$ 1 million). Ihe Norwegian Government went on to express its greaE inEerest in Ehe Programe, attaching particular importance to the aspects of economic development and social justice in the areas freed from onchocerciasis. Ihe Independent Chairroan was authorized to express Ehe Comitteers graEitude to the Norwegian Government. a IPage 2 ELECTION OF T}IE VICE-CIIAIRMAN OF THE SESSION Recalling the procedure adopted at the Cournitteers first and second sessions, the Independent Chairman proposed His Excellency I'1r Salia Sanon, Minister for Rural Development and Chairman of the National Onchocerciasis Comnittee of Upper Volta, as the Vice-Chairman for the duration of the session. This proposal was approved by acclamation. ADOPTION OF THE AGEMA The provisional agenda (document JCC3.1) was adopted without amendment (see Annex 1) PROGRESS REPORT OF THE WORLD HEALTH ORGANIZATION FOR 1976 WIIOTs progress report for the year to September 1976 (documenE JCC3.2) was introduced by the Prograrmre Director, who also described developmenEs since that date. The Programme had maintained and developed all its activities. Larviciding operations had continued throughout the Phase I area, where 93 weekly ci-rcui-ts had now been completed, and since 15 January 1976 in Phase Tl (46 weekly circuits). Transmission had been considerably reduced or interrupted in the treated area, enabling spraying to be halted for much of 1976 in large sections of the Black Voita, Como6 and upper Leraba basins. After 22 months of larviciding, and although Ehe origin of che adult blackflies reinfesting a sma11 part of Phase I had not yet been determined, the Progranrne Director felt that reasonable optimism was justified. Preparati-ons for the start of larviciding in Phase III in February L977 t.ad been under way since early L976. The three new sectors and 10 subsectors had been made operational, and collection of the necessary entomological, hydrological and flight survey data r^ras being completed. A new air company would assume responsibility for all aerial operations in January 1977. The work of the two parasitological evaluation teams and the ophthalmological team rlas on target; simple examinations had covered 156 villages and 38 521 people, detailed examinations 31 villages and 8201 people. By the end of 1977, ampLe baseline medical data would be stored on computer at WHO headquarters to assess the effects of vector control. The Economic Development Unit hfl been established in February 1976 with the recruiEment of its chief. Following visits to the Participating Countries, the unit had begun a detailed inventory of all economic and social development projects in progress or planned in the area, and had prepared a questionnaire for use in updating the inventory. The work of the Administrative Services Unit had included the reorganization of the transport system, including a network for the maintenance and repair of over 2OO vehicles. The Progranlme now had 35 professional and 57O general service staff of 20 nationalities; 95.6i/" of the staff in the Programne area were nationals of the seven Participating CountrLes, O.7"L from other African countries, and 3.7% from outside Africa. The JCC heard details of training activities, which continued to be a major preoccupation of the Progranmre. A11 the 10 entomological technicians trained under contract with OCCGE in 1975-1976 had been recruited and were nor"r the Phase III subsector heads. ORSTOM had continued to play a valuable role in the training of entomologists and entomological technicians from the Participat.ing Countries. Information on the Progranune was disseminated through a quarterly report and the monthly newsletter ONCHO-FLASH, which had a circulation of over a thousand. A number of journalists and two television teams had reported on OCP activiEies during the year. The Chief of the Vector Control Unit provided details of the various entomological activities. Descri-bing the different treatment circuits carried out in the rainy and dry seasons, he reported Ehat, throughout the Phase I and Phase II areas, the results were generally encouraging and in some sections of river it had proved possible to interrupt treatment for a period. 1 , Page 3 By use of wal1 oErps, he showed first the general epidemiological situation before the start of control operaEions in Phases I and II and then the present potential transmission recorded in these areas by the evaluation teams. In L976, over the major part of the controlled area, transmission had been either interrupEed completely or reduced to a I'hypoendemic'r level. 0n1y in the reinvasion zone (map attached as Annex 7) and the Bui stretch of the Black Volta had a trmesoeodemic" level been recorded. In the northern part of the Phase II area results had been excellenE to the end of November. Throughout August, for example, no more than three Simulitm per week had been caught at over 50 caEching points. The progress of studies on rei-nvasion was outlined. Ful1 use had been made of consul- tants and collaborating laboratories. Daily catching points had been established in the suspect area in order to provide regular information. To establish the identity of the migrant females, eBSs had been obtained from them and larvae hatched out for cytotaxonomic examinaEion. Use had subsequently been made of recenEly discovered morphological characEerisEics to differentiate the adults. Larvae, pupae and adulEs had been collected for chemical analysis to assist in identifying the possible source of the invading flies. Areas outside the Prograutrne area had been surveyed. Using an aircraft equipped with a trapping device and Doppler radar, an expert on insect flight had studied local meEeorological conditions influencing f1y movenent. The lower Bandama had been treated for a period but, while remarkable results were obtained local1y, this did not affect the reinvasion problem. However, it did show what could be achieved at minimal cost against a different species of the S. damnosum complex. As the invading flies were shown to be of the rrsavannatt species some PoinEs of origin could be ruled out. It was concluded from the studies thaE they probably came from Ehe west or norEh-west - from north-r"rest Ivory Coast or Mali in the Phase III area, or from outside Ehe Progra:me area in Mali or even Guinea. In Phase III the secEors had been operational since June 1976 and treatment was scheduled to begin in the western part and on the Oti/Pendjari river basin in the east i.n February 1977. The Progr:mers neEwork of hydrologi- ca1 stations had been extended through contracts with national departments or ORSTOM Eo obtain data for Phase III and improve coverage in Phases I and II. The new air coryany was nord tackling the considerable logistic problems of establishing operations and training its staff. ANNUAI REPORT OF TI1E SCIENTIFIC AND TECHNICAL ADVISORY COMMITTEE The Chairman of the ScienEific and Technical Advisory Comrittee (StaC), professor Janssens, reported to the JCC on Ehe STACTs third and fourth sessions, and i.ntroduced the report(document JCC3.3) of the third session, during which a joint meeting had been held wirh rhe Ecological Panel to clarify the functions of the two groups. It was felt EhaE this contact was so valuable as to r.Tarrant similar joint meetings each year. Several STAC members had visited the Prograrme area and in general had been impressed by the progress made. Discussing their reports, Ehe STAC had recomrended greater participation in research by the technical staff, especially the younger workers, and suggested the holding of regular interdisciplinary oeetings of senior Programe staff to dlscuss research and control activities. Clinical examinations conducted by Ehe Epidemiological Evaluation unit were considered satisfactory, though the detection of tight infections should be refined and more sensitive parasitological techniques could be used in certain sEudies. The ophthalmological examinations were of high quality, and regret had been expressed that E.he programe had only one ophthalmologist. The rnobile eye clinics had proved a success. The unitrs sociologists were felt to have a valuable contribution to make. Reviewing research in progress at centres both within and outside ghe programe area, the STAC had stressed that a ruajor effort was needed to find drugs suitable for mrss therapy. Close coordination was reco'rmended with Wllors Special Progreme for Research and Training inTropical Diseases (fOR), of which UNDP was a co-sponsor, and with rhe WffO/faO/mfOp trypano- somiasis research project. Though by no means so serious as to compromise the Progrnmers success, reinvasion remained the outstanding entomological problem. In October 1976 a Scientific Advisory panel(SAP) working group on this topic, chaired by Dr Haskell, had drawn attention to the need for methods of maintaining laboraEory populations of Simulir.m, cytotaxonomic and age determination Page 4 studies, and better capture techniques, and had proposed the establishment of a smal1 agro- meteorological station on the affected Leraba. The STAC had also expressed interest in studies to find the formulation of Abate best adapted to Simulium larvae, noting at the same time that investigations had shol"rn this insecticide to taFIEffe effect on non-target aquatic life in the formulation used; it had again pointed to the need for back-up larvicides in case resistance to Abate developed. The STAC had welcomed the progress made in the computer storage and analysis of programre data, and underlined the importance of adequate funding for research and the training of national counterPart staff in general. The Participating Countries recognized that a proper career structure was necessary if workers were to be attracted into research. DISCUSSION OF AGENDA ITEMS 5 AND 6 The JCC congratulated the OCP staff, the ExecuEing Agency, Governments and research r.Torkers cooPerating in the Progranme on the Programmers encouraging progress. The next essential, it now considered, was to ensure that operations were extended to phase III on schedule while treaEnent of Phases I and II continued, and it warned against any relaxing of vector control activities. Representatives expressed concern regarding the reinvasion of tfeated areas. Further study was needed to determine the origin of the incoming blackflies and to define the geogra- phical limits of the phenomenon. Otherwise, they might be thought to come from inside the treated area, giving the impression that the control methods were not effective. It might be necessary to exEend the Prograllrne area for entomological reasons, even to additional countries. Other representatives warned against exaggerating the problem. It was suggested that the JCC should wait before reaching a firm conclusion; the 1975 reinvasion had been considered unusual, but the extent and pattern of reinvasion in 1976 might equally be unusual. The Comrittee welcomed the studies in progress on the Simuliun species complex, the rearing of laboratpry colonies in continuous culture, alternative insecticides and formulations, and growth control hormones, and drew attention to studies elsewhere on chemical sterilization and biological control. It referred to the need for monitoring of adult and larval populations and for long-term studies on the effects of treatment on non-target organisms. The Participating Countries atttached great importance to the question of extending the Programte area, and cal1ed for studies as soon as possible to determine how infested zones ouEside Ehe area could be included. Ideally, the area would be extended to all the infected territories of the Participating Countri-es, and then to all possible sources of reinvading flies. However, the connexion between reinvasion and extension should not be overstressed. Extensions should be judged on their own merits, whether entomological or economic. If extension to the whole of the Participating Countries was impracEicable, at least all areas scheduled for development projects should be included. Representatives cited the Manantali Dam project in Mali and a proposed sugar refinery just south of the OCP area at Boroutou, Ivory Coast, as examples of projects that would be seriously affected by onchocerciasis. Other rePresentatives, while supporting extensions in principle, pointed out thaE the Progra'nme was in the preliminary stages of its 2O-year life; it would be advisable to advance prudently, ensuring success in the present areas first, and carrying out thorough studies on possible extens ions , Referring to the economic aspects of the Prograrmre, representatives stressed the need for collaboration with other programmes in the area. The importance of the time fact.or was obvious; countries could not wait for perfect control of onchocerciasis any more than they had been able to wait for conErol of other diseases. Indeed, perfectionism should be avoided; the Participating Countries had prograrmes waiting, often extensions of existing prbjects, and wanted action, noE lengthy studies. A representative reninded the JCC that the Programers medical aspects r4rere the first priority; the irnportance of health as a precondition for development was sometimes forgotten. It would be particuLarly useful if supplies of equipment such as syringes and nursesr kits, antibiotics, spraying gear, etc., could be provided. Sone 20 routine items would give reasonable coverage of the resettled areas. The need for WHO and the STAC to develop formal criteria for declaring an area free of transmission, and emphasized. Page 5 therefore safe for development, rdas The JCC considered the STAC report much more informetive than in the past, so that a clear picture of the objectives of research emerged. It considered that OCP research should be coordinated with the work of other parts of WIIO, especially the Special Prograome for Research and Training in Tropical Diseases, and warned that onchocerciasis should not be forgotten by WHO just because there Trras a separate OCP. It was suggested that the Prograrmre should help in equipping national centres and laboratories for research work. Doubt was expressed as to the need for a new central OCP laboratory, which could well be based on an existing centre in the area; local institutions, it was felt, might carry out mrny of the studies described in the STAC report that were entrusted to outside laboratories. Stressing the importance of both medical and drug research, the JCC expressed interest in Ehe results of the field trials with suramin and diethylcarbazine, and called for further work on more effective drugs. Also, because the Prograrune relied soIely on larviciding as a control measure, the need for a back-up chemical in case resistance to Abate developed was eryhasized. The JCC agreed with the Programers emphasis on training, but felt that more should be done. It was suggesEed, in view of the size of OCP, the nuober of ParticipaEing Countries, and the future demands of the maintenance phase, that the Program.e might run its own training scheme. Regarding relations betr^reen Ehe Programe and the Special Programe for Research and Training in Tropical Diseases, the hIHO Regional Director for Africa pointed out that filariasis, including onchocerciasis, was one of the six diseases selected for priority study under the Special Programe. The African Regional Advisory Cormittee on Medical Research hadjust Put the disease on its list of priorities. OCP was in close touch with TDR and that coordination would conEinue. On the transfer of responsibility for the Programne to the WIIO African Regional Office, the Headquarters Support Unit in Geneva would be reduced to a mi-nimuro by transfers to Ouagadougou and a sm"ll nucleus would be established in Brazzaville. WHO was fully aware of the importance of training of both nationals of Participating Countri.es and of outside countries where onchocerciasis was a serious problem. The Programets objective was to assist countries to achieve self-sufficiency. Unfortunately, the work of many units left llttle opportunity for the staff Eo take part in training, and an attempt would be made to find the best rday Eo expand this aspect of the programe. Replying to representativesr questions, the Progrernme Director noted that quarEerly rePorts on oPerati-ons had been circulated since the starE of L975. In future the reports would be prepared in Ouagadougou, and so should appear more promptly. He informed the Qqmiggsg that copies of television films on the Programe had always been requested, so far without success i a formal request had been addressed to the BriEish Broadcasting Coryany television team now in Ouagadougou. As to the change in the air services contract, on the expiry of the present Coryanyrs contract at end 1976, tenders had been caIIed for and hIHO had accepted the best bid taking all factors into account. With regard to the nature of relations with research bodies, contracts were awarded by a research cornmi-ttee. A11 research bodies were required to produce reports, which were then circulated, especially to the STAC. He noted that the centre for studies on chemotherapy at Tamale, Ghana, would open in 1977; centres in the Programe area were m:king a valuable contribuEion to research, and a number had been provided wiEh research equipment. The STACTs recormendation for a mobile ophthalmological clinic would be studied. A representative had expressed concern at Ehe delay, for budgetary reasons, in the construction of a Headquaters building in Ouagadougou; the Programe Direct,or explained that after a review of the situaEion, it was now planned to put up a Eore modest building than originally proposed, at about half the cost. The necessary funds were provided for in the 1977 budget estimates; if these were adopted, tenders could be called for imediately. It was also explained that though an air operations base aE Bamako had been mentioned in the L973 PAG mission report, it had since become clear that there rras no need for a large number of air bases. However, the construction of a base at Bamako or some other site could be justified lf the Progranrme area lras extended to the west of Ma1i. Page 6 The WII0 representative considered that the problem of reinvasion would not compromise the Prograrmre. In the flrst 11 months of 1976, of the 6500 km of river treated, only 2OO km had been reinvaded in Phase I, and there had been no reinvasion in Phase II. Studies with larvae and adult females indicated that the reinvasion came from outside the treated zone, either in Phase III or from outside the OCP area. The females came from untreated savanna areas, probably from the rrorth-west and west of the reinfested area. The results of treatment in Phase III west would be followed carefully. Work was in hand to demprcate the southern limit of the savanna cytotype, and trapping and marking studies would continue, togeEher with studies of the blackfly populations in parts of Ghana, Ivory Coast and Mali outside the OCP area. If the zones of origin could be determined, the possibility would be studied of including them within the Programme area. The Progranrme recognized the need for a buffer zone, and this could be _investigated when the area was under control. From an operational point of view, before the Prograrmne area could be exEended, studies through a ful1 yearly cycle would be needed to obtai,n the necessary entomological, transmission, medical and hydrological data. This would permit a serious study of the necessary staffing, flying condiEions, cost, etc. The necessary informati.on on which to base a decision might be obtained in 18 months, although for areas where many of the necessary studies had already been done a year might be saved. In any case, any extension would have to be adjacent to Ehe present area. Replying to technical questions, the WHO representative referred to surveys made to test the quality of river water suitable for breeding Simulir:m in the laboratory. As to the interval between release and capEure, adult blackflies had travelled 90 km in 36 hours in Cameroon. He noted that OCPts close conEacts with the Comit6 Inter-Etats pour 1a LutEe contre la S6cheresse dans le Sahel (CILSS) included the exchange of meteorological and hydrological data. Following collaboration with OCCGE, ORSTOM and Canadars InEernational Development Research Centre since L972, attempts at biological control of Simulirmr would start ia 1977 . He recalled no evidence of resistance to malathion. Tests had indicated no difference i-n susceptibility of larvae to Abate between treated and untreated areas. A growth inhibitor I^ras to be studied in addition to further insecti-cides. With regard to chemical monitorirng, tests in the Como6 and Leraba experimentaL zone indicated that Abate persisted for only d short time in r47ater. The Chairman of the SAP working group on reinvasion, Dr Haskell, said Ehat he prefeired the term trredistributiontt to rrreinvasionrr to describe this quite usual phenomenon. The eradica- tion of Simulium was not possible; the objecE was to reduce the population in order to interrupt transmission. l,luch had already been learnt, and other promising techniques had been described at the SAP working group. Once Phase III operations were under way in 1977, the redistribution problem would have a different cornplexi-on, and he felt that it would be wrong to disturb present activities by acting too hastily. It might be useful to associate the authorities of suspect areas in adjoining countrles with OCPrs work in order to obtain data. A special meeting could be held in a year or so to re-examine the problem. The representative of WHO noted Ehat no technical criteria existed for declaring an area safe for development. In general, areas reaching therrhypoendemic'r level of transmission could be resettled. WIIO would try to work out criteria by which to judge when an area rdas elther free of the vector or had a sufficiently 1ow 1eve1 of transmission to permit resettle- ment and development. As to the health aspects of reseEtlement, WHO was working on protection againsE both tr)Danosomiasis and schi-sEosomiasis. It had embarked on a field research progremme with FAO and UNDP, including 19 countries, to develop simple tr)r?anosomiasis control techniques, and had a project in Ghana on the control of schistosomiasis in man-mede lakes. In mass chemotherapy, research was being done to discover if suramin was successful at 1ow dosages without serlous side-effects, and WIIO was trying to stimulate the pharmaceutical industry to cooperate in the development of antiparasitic drugs. Page 7 REPORT OF TIIE ECOLOGICAI PANEL In Ehe absence of the Convenor of the Ecological Pane1, the repor-t (doctrment JCC3.4) was introduced by Professor Janssens, who lrad represented the STAC in the Panel. The Panelts most recent meeting had been considerably affected by the replacement of ELro members; it might in future be better either to have a briefing for new members beforehand, or to prolong the meeting by a day. The Panel interpreted its field in the broadest sense, to include, besides biological and environmental monitoring, questions of nutrition, population, land resettlenent and health care coverage. Water Eanagement and control had been stressed. Reporting on his field trip to Ehe Programme area, Dr Smith had underlined the urgency of planning for economic development and had raised a number of questions, including the relative fertility of plateau and riverain soils, resettlement strategy, the use of fertilizers, possible agro-industries, and the introduction of trypanosomiasis-tolerant cattle. A review of operational activities and reinvasion studies had been presented Eo the Panel, which had conmented on the need for further study of the vectorrs migratory habits. The Panel had given its approval to a large-scale trial of the operational suitability of the larvicide Chlorphoxim, subject to the necessary precautions. It had also suggested 24-hour sampling of an untreated river to refute charges that Abate r"s d6m:ging aquatic life, and the formulation of an insecticide, preferably as a sEomach poison, with a particle size and density suited to the feeding habits of Simulium larvae. No i1I-effects of spraying operations on fish had been noted. Professor Janssens pointed out thaE the Panelrs next meeting, in March 1977, would be held in Ouagadougou, and not in Geneva as the reporE staEed. In answer to a question on Ehe suggestion in Dr Smithrs report to the Panel t.haE upland soils are more fertile than i1l-drained valley soiIs, Professor Janssens said that the findings of earlier ORSTOM studies did noE bear out that view. The FAO representative observed that few systematic studies had been carried out; Dr Smith had want.ed to avoid exaggeraEion of the difference in fertility between the two soil types. He also informed the Conrmittee that the Ecological Panel and STAC shared his preoccupation with chemical monitoring, which should be extended on site. A represenEative stressed Ehe importance of the social aspects of resettle- ment, and suggested that the insights gained from social studies on populations now returning to areas not yet freed from onchocerciasis could be applied to planned movements laEer. IIe was informed Ehat the sociologist attached to the OCP Econouic Developuent Unit was carrying out precisely that type of study. ANNUAI REPORT OF TIIE ECONOMIC DEVELOPMENT ADVISORY PANEL In the absence of the Chairman of the Economic Development Advisory Panel (EoAf), its first annual report (docr:ment JCC3.5) was introduced by the Panelrs Secretary, Mr W. de Souza. The report contained the Panelts preliminary reflections on Ehe main subjects discussed at its two meetings in 1976. In the areas freed from onchocerclasis, the problem of health and the organization of health services was accorded high priority by the EDAP, which recomended a siryle and practical health infrastructure specifically adapted to the rural environment, in which the populationjoined in the process of improving health conditions as part of an overall process of comunity deve lopment. The Panel had discussed the relationship between food and health. To increase the Present inadequate mean food intake in Ehe region and to correct inequalities, a thorough study of food requirements should be made. Countries would want the new developnent areas not only to supply their loca1 populations but to produce a surplus for less favoured areas. Ihe solutions to Ehe delicate problems of land tenure and farming system were largelypolitical. The Pane1 stressed, however, thaE farmers settling the freed areas should beguaranteed some stability. The relative advanEages of large- and small-scale farning had been discussed in some detail. Subject to technical studies, a judicious cmbination of Ehe rwo systems would probably satisfy both social and polltical considerations and the need to increase Page 8 production rapidly. The Panel had suggested cooperation with the Office du Niger in Mali, which had 40 years of experience in related problems. Migrants would need to be persuaded to repopulate the disinfested areas, though sPontaneous migration and unregulated occupation of the land might compromise developmentprojects and cause ecological deterioration. Once settled, farmers would have to be induced to stay, through provision of a minimum infrastructure, favourable producersr prices, "rrd "lowest income at least equal to the lowest urban wages. Relations betl^reen planning for the development of areas freed from onchocerciasis aod Eheprograuuring of long-term economic development in the Sahel had been examined, together wtthpossibilities for cooPeration between Participating Countries within the context of national development priorities, for example in cattle breeding and the exploitation of hrater resources. Pending Ehe evaluation of mineral resources, development projects in disinfested areas were based primarily on agriculture and agro-indust.ri.es in which a second, more industrialized leve1 would have to be added to the present artisanal 1evel of foodstuff production. The EDAP had called for closer links with oEher bodies concerned with the progranrne. It had welcomed the collection and storage of fu1l data on the regions to be disinfested and had noted that the findings of earlier research were often stil1 valid. Although thorough studies ldere necessary before projects were launched, Panel members had warned agai.nst insisting on agreement on every detail before action was taken. The support of the popula- tion was vital; development prograrnoes should therefore be preceded by patient campaigns ofinformation, training and consultation. Fina1ly, the Panel asked the Cormittee to let it know what priority to give to the study of the problems it had raised. ECONOMIC DEVELOP},IENT ASPECTS OF THE PROGRA},IME The representative of the United Nations Development Progranme (UnOp) presented a status rePort on the planning of economic development in the areas freed from onchocerciasis, which was circulaEed to the JCC. The report included details of the utilization so far of UN[pts contribution of uP to US$ 5OO OOO to each of the seven Participating Countries to assist in programring the development of the freed areas, and a country-by-country review of development plans and programes in these areas. APart from LINDPTs contri-bution, a number of other bilateral and multilateral sources of financing rdere cooPerating with the Participating Countries. The growing nuriber of activities ca11ed for strong coordination by each Government through appropriate planning machinery. UNDP had emphasized that a planning unit identifiable with the Prograune should exist in each counEry, preferably in the Ministry of Planning, to ensure the integration and coordination of efforts at the national 1eve1. The OCP Economic Development Unit should be in contact not only with national onchocerciasis cornmittees, but also with Ministries of Planning or other ministries responsible for the coordination of international development aid in the countries. He suggested that at future sessj,ons the JCC should base its discussion of this agenda item on the register of economic development progratrmes i.n the freed areas being prepared by Ehe Economic Development Unit, which would be circulated to countries for checking and updated periodical 1y. A fundamental question facing the JCC was whether a coherent overall approach to the development of the disinfested areas would be possible, as in the case of control operations. Clearly such problerns as rrrater resources management, the development of stockbreeding, and land resettlement models went beyond national frontiers. Links with, for example, CILS in the Sahe1, the regional. prograrnme of meteorology and hydrology financed by I,NDP and other sources, the 19-country I|HOfFAO/.INDP tr)ryanosomiasis prograume, the new prograrme for the devel-opment of the river Niger, and the activities developed within the framework of the I'Club des Arnis du Sahel'r could all prove valuabl-e. Page 9 The Chief of the OCP Econooic Development Unit inforred the Cormittee that his unitrs initial activities had been t,o collect baseline data on the areas to be cleared of onchocer- ciasis, keep an up-Eo-date record of planned development activities, assist in arrangernents and briefings for missions, and maintain close contact with representatives of United Nations agencies, banks and technical assistance missions. The information gathered would provide the basis for development project.s in the freed areas. Three main approaches had been followed: visits Eo participating countries to discuss and observe OCP-related acEivities; the quarterly collection of standardized information, by means of questionnaires and personal visits, for storage in FAOrs data bank on Ehe economic development of the Programe area; and special studies on particular problems. One such study proposed l{ras a survey of nutritional status oriented to household consr:mption and expenditure, the object being to help in the preparation of agricultural development projects with an import substitution component. He noted that each Participat.ing Country had its own approach to development of the freed areas, and that socioeconomic studies financed from UNDPts special contribution to each country were moving forward. DISCUSSION OF AGENDA ITE'IS 8 AND 9 Welcoming the report on the EDAPTs first year of activity, representatives agreed that contacts and consultation between the Panel and Participating Countries should be expanded. To avoid working in a vacuum, all the Programers advisory bodies should be more closely linked. The Comittee expressed satisfaction that ,mong priority topics the EDAP report dealt first vrith health and food, and hoped that its recognition of the need to move promptly from the study to the acti-on sEage without undue insistence on detail sras not merely a pious wish. It was suggested Ehat an i,nventory of existing health structures in the Prograuune area should be prepared; iE would be better to remodel the old system, which had long been aimed at the rural population, than to build completely anew. Health and nutrition education would be needed before, during and after the resettlement of disinfested areas. A representative questioned the role of the EDAP and Ehe Programe as a whole in economic developmenE, for which responsibility 1ay with the Participating Governments, each with its own approach. lnformation on all development progranmes in the countries, perhaps collected by UNDP, could help in stimulating aid. A nr:mber of representaEives raised problems relating to the resettlenent and development of areas cleared of onchocerciasis. It was pointed ouE that it would be difficult to devise a standardized approach, because each country followed its own pattern. Present land tenure systems were not necessarily favourable. Moreover, it would be wrong to assume that the disinfested areas were empty; many were overpopulated. A representative observed that migration Eowards the cleared land would run counter to the general exodus froo rural areas, especially of young people. To avoid too old an age structure, acEion must be taken Eo attract the young Ehrough such measures as the establishment of agro-industries, primary education with the stress on agriculture, and local technical colleges. Because it would be inequitable to discriminate in favour of the migrant,s, this implied the decentralization of education throughout the country. Similarly, apart from special protecEion measures against the disease, the health system should be that adopted throughout the country, decentralized to health posts and small hospitals. Cormenting on Ehe UNDP report, a representative suggested that in future the information should be circulated to countries in advance so that it could be supplemented by Ministries of Planning and disseminated to national onchocerciasis comittees. In general, it would be useful if the various sources of aid could assist countries in coordinating aid prograrmes. Citing g1'ts s>(:mFles of animal disease control and water resources development, representa- tives pointed to the value of intercountry cooperation in appropriate fields. It was considered that it would be useful to associate such bodies as CILSS, the Liptako-Gourma Authority, the Conite inter-africain drEtudes hydrauliques (CIEI{) and Ehe'tAutorit6 des Am6nagements des Va116es des Voltas" (AW) with the work of the JCC and its advisory bodies. Page 10 It was noted that CIEH, which was located at Ouagadougou, had what amounted virtually to a databank on the hydrology and other aspects of the region; instead of starting from scratch, iE would be preferable to build on what already existed. Mr S. Kpognon, Alternate Executive Director of the World Bank, expressed satisfaction withthe resul-ts achieved so far. He suggested that a flexible approach should be adopted topossible extensions of the Prograume area, which might be accepted when justified. Responsi-bility for the development of freed areas lay with the Participating Governments, which must establish priorities and coordinate plans, preferably within the regional framework j.ncreasinglyfavoured by the trlorld Bank Group. countries needed to develop the capacity to identify, evaluate, Prepare and manage land development projects; UNDp and the Bank might enri"al. pr.-investment assistance in that phase. Because of the limitations on concessionary IDA assi-atance, all possibilities of co-financing should be explored. Referring to the request for distribution of a report on economic development in advance of each sessi-on, the UNDP representative suggested that the Economic Development Unit should circulate an updated rePort every three months, the most recent being distributed as a JCCdocument. He confirmed that UNDP would assist in the strengthening of national planning. Conrnenting on the question of the scope of economic development projects, rePresentative Pointed out that the Steering Corunittee had concluded that mostbe national, but that a regional approach would be feasible in some cases, for crop research. He felt that the presence of a physician in the EDAp had been since the chairmanrs report accorded due priority to health. The trlorld Bank representative recalled that the EDAPTs role was defined in section E.2 ofthe Memorandrmr of Understanding. In its two meetings so far, the panel had succeeded inidentifying a number of areas and priorities. rn response to its request for suggestions forfurther study, he proposed the subject of planning for resettlement of cleared..".", and morespecifically the design of two projects in which the Bank was assisting Upper Volta; theGovernment could then take the Panelrs views into account and initiate an exchange of views with the Panel on development strategy. In reply Eo a request for information, he confirmed that a project for cotton and ceqealproduction in the Phase III area in South Mali would be financed by the tlorld Bank Group fo theextent of us$ 15.5 million, of which us$ 5oo ooo was for studies in freed areas. Answering a query on drawings on llNDPrs special contribution in Ma1i, the FAO representa-tive said that after initial surveys by three experts (a sociologist, an agricultural planner and a pedologist), the Ministry of Planning now proposed to go forward with a plan of actlonprepared by FAO and IBRD. The plan, costed at USg 1.7 million, would be financed in partfrom the balance of US$ 477 ooo remaining from the UNDP contribution, rogerher with USg 5Oo ooofrom the World Bankrs South Mali programne. REVIEW OF THE PLAI{ OF ACTION AND BIIDGEI OF THE PROGRAI,,IME FOR 1977 Introducing the Plan of Action and Budget Estimates (document JCC3.6), the prograrmeDirector designate, Mr M. L. Bazin, observed that Lg77 would see the transfer of responsibilityfor the Programners execution from WHo headquarters to the African Regional office. Secondly,the whole of the Progranune area would be covered by spraying with the start of phase IIr oPerations in February L977. Thirdly, the air company r{as being changed. Inevitably, the resources received from contributors remained the upper limit for expenditures that can beincurred. For t977, total Prograrme requirements \.vere estimated at US$ 13 137 2OO; of the increase of some 22% ovet 7976, 18% was impuEable to increases in vector control operations and 4% toinflation. The personnel would include 44 professional and 658 general service staff.Expenditure on hours of flight, training and research would remain at about the 1976 level. The Director designate assured representatives that he would do everything he could to meet their PreoccuPations - the strengthening of training, the strengthening of coordination the FAO of them would example farm j us tified , Page 11 beEween vector control and economic development, intensified research on chemoEherapy, iryroved health service structures, the problem of extending the Progreme area, and the effective maintenance of vector control operaEions. He paid tribut.e to the work of the ouEgoing Prograune Director, Dt ZiegLer, and expressed his appreciation of the skill and dedication of the technical team he was inheriting. The Comittee welcomed the improved presentation of the Plan of Action and Budget Estimates; the docrnent was clearer and more corylete than in the previous year, and the budget was clearly related to the planned activities. Ttre increase in Ehe total esti.mate f.or L977 was considered to be justified. It was suggested that adjusted figures f.or L976 might have been shown next to the estimstes presented to the JCC in 1975, and that large, folded maps should be provided to supplement the not very legible ones aEtached to the document. IE was suggested that at a time when the Vector Control Unit was embarking on a large increase in operations and had been urged by the STAC and the Ecological panel to play a larger part in research and training, its professional staff should be increased. IE was also suggested that in fuEure the STAC could be used for prograrme evaluat.ion. The urgent need for research on chemoEherapy was erophasized. It was suggested that Ehefunds devoted to this subject should be increased. After the inEerruption of transmission, adult worms in the body would contlnue to produce microfilariae for many years, and a suitable macrofilaricide was required. The hrHO representative said that the WHO Special programe forTraining and Research in Tropical Diseases accorded priority to onchocerciasis, and that WHO working grouPs on the imunelqgy and the chemotherapy of the disease were to be convened shortly. There was some hope of further cooperaEion with the pharmaceutical industry. Thedevelopment of new antiparasitic drugs was an extremely difficult, costly and lengthy process; meanwhile, work would continue on known drugs. Particular importance vTas attached to the training of national personnel, parEicularly atthe professional leve1, not simply for the Progranrme, but Eo Eeet the broader needs of theParticipating Countries. Ihe Comittee recognized that an adequate career structure was vital; for example, sone African counEries were providi.ng careers in research at t.he samelevel as academic careers. The shortage of cadres in all fields rras coltrpounded by the failure of trained specialists to return Eo their countries after completing their studies, even whenthey had undertaken to do so. In cerEain fields, specialist training was available in Africa,but the Cormittee doubted if Africans were sufficiently encouraged to study subject.s needed bythe Programe. It considered that information on the proportion of naEionals working in OCp at each level and on the ProsPects for future self-reliance on Ehe part of participatingCountries would be useful. If not all the training fellowships available were taken rrt,delegates asked for Governments to be informed so that candidates could be puE forward. Ihe representative of one Contributing Government favoured a large increase in training activitiesif the Participating CounEries could find qualified candidates and identify posts for them.A fuller presentation of Ehe training progrrnme was requested in the docr:ment for the fourth session. rn reply, the WHo rePresentative emphasized that the training of national personnel was an important part of oCP, and t.hat the present trainees would be used in the progir--s.Special machinery for training rras envisaged in the future. The Conrmittee was struck by the proposed increases in t.he oCp vehicle fleet and maintenance structure, and suggested that national meintenance services should be used, or builE up if non-existent. rf that was not possible, the Progrrmme should train it.s own maintenance staff, and not attract scarce personnel from other services. It was noted that Togo already had a central Sarage for all UNICEF and WHO vehicles, so that to set up another just for OCp wouldbe inadvisable. In addition, MIo had established a maintenance and repair training centre atLon6 which received trainees from other countries. The WIIO rePresentative informed the Comittee that the progreme had found that existing vehicle repair facilities were already overloaded and waits were 1ong. It had therefore set up its own network of garages and service statlons. It trained its own staff, who took courses at the central garage in Ouagadougou and worked under supervision on their reEurn to oEher bases. In reply to a question on construction in Benin, the WHO representat.ive explainedthat ocP had not had to build at Kandi because it had been abre ro hire a building and rhar the need for a base at Porga had not yet been definitely established. Page 12 During the discussion, participants pointed out that economic development prograqles should be related to the status of vector control and health care. Once the treated areasbecame safe for development, the problem of coordinaEion with a number of different ministries would arise. It was felt that reports, prepared by the Economic Development Unit, on eqonomicdevelopment in relation to planning in each Participating Country and to aid from all sources would help in thaE process. In reply to further questions, the MIO representative explained that the estimated expenditure on i.nsecticides Ln L977 was lower than in 1976 because it had been possible tobuy at a lower price; there was no reduction in quantity. As to epidemiological studies,incidence had always been studied in addition to prevalence by rDeans of examinations of children born since control operations starEed. In view of the long discussions under other agenda items on the extensi.on of the progranme area, the Independent Chairman considered Ehat the time had come to move towards a decision. He suggested that a report on needs, possibilities and costs should be prepared for the JCCrs next session. In reply, the WHO representative said that the necessary steps would be taken. The Corunittee recorded its appreciation to Dr Ziegler for his magnificent pioneer work asfirst Director of the Prograrmte, and extended a warm welcome to his successor. The Plan of Action and Budget of the Prograume for 1977 were accepted by consensus. FINANCING OF TIIE ONCHOCERCIASIS CONTR.OL PROGRA},IME The Vice-Chairman, H. E. Mr Salia Sanon, took the Chair during the first part of the discussion on this item. The Couroittee had before it a tabular statement of receipts and disbursements from the Programnets inception to 31 October 1976, distributed by the World Bank as administrator of the Onchocerciasis Fund. Ihe representative of Belgiurn said that her C,overnment intended to maintain its L977 contribution at the 1976 level of BF 15 mi1lion. Belgir-unts contribution for 1976 aPPear in the statement to 31 October as it had not yet reached the World Bank. that such a sEatement was useful to representatives in reporting back to Governmen should therefore be found of showing all contributions, whether in cash or kind. the substantial contribution of UNDP did not appear at all. did ngt She coilsidered ts ; a ]method At present The United Kingdour representative said thaE since the daEe of the Bank statement his Governmentrs total pafrent had risen from US$ I.4 million to US$ 2.1 million. He suggested that in future the budget docr:ment should contain a breakdown of donor contributions. Within the limit quoted in that docturent of US$ 13 million, subject to parliamentary approval, his Government would continue to contribute 10% of expenditure in 1977; that represented an increase to some US$ 1.2 milIion. The representative of Kuwait said Ehat of the US$ 6 million pledged by his Government for the Progr:mmers first stage, US$ 2 million had been paid in 1975 and 1976. A request by the World Bank to the Kusait Fund for Arab Economic Development to contribute US$ 2 million in L977, within its total pledge, was expected to be approved shortly. Kuwaitrs continuing support for the Prograune reflected its satisfaction with the progress made so far. The many questions raised at the session regarding the possibility of extending the Prograurme area were an indication of how successful operations had proved within the present boundaries; if the Prograrme had not been a success, no one would have asked for an extension. The Japanese representative announced that his Government had decided to conEribuEe a total of US$ 5 roillion for the period 1974-1979. US$ 5OO 0OO had been given in 1975 and US$ 750 OOO in L976, leaving a blance of US$ 3.75 million for the following three years. The t977 conEribution had noE yet been fixed, but clearly it would be higher than in the past. The United SEates representative announced that his Government would contribute USg 1 million in 1977, rdithin its overall pledge of US$ 6 million for the Progrenrmers first s tage. Page 13 Ihe Netherlands representative asked for regular information on all aid Eo the Programre area, because a concerted approach to its development was essential. Of his countryrs first- stage pledge of US$ 6 million, US$ 2.5 million had been spent so far. Regarding the remaining US$ 3.5 million, his Government was in touch with the lJorld Bank, and would have a positive attitude to requests for 1977. Ihe representative of F'rance said that his Government had so far contributed FF-13 million of its toEal Pledge of FF 26 million; it intended to give FF 4 uillion in L977 within that overall figure. The Canadian representative said that his Government proposed to contribute CAN$ 3 nillion over the six-year period. He announced a contribution of CAN$ 5OO OOO for L977, subject to parliamentary approval. FurEhermore, his delegation was prepared to recomend to the appropriate authorities in Ottawa a possible increase in Canadars contribuEion. The representative of the Federal Republic of C,ermany said that of his Governmentts pledge of DM 13 million for the period L974-L977, N 9 million had already been contributed and the balance of DM 4 million would be paid i-rt 1977. The representative of the African Development Bank announced Ehat, in addition Eo naintaining its contribution at U.A. 150 OO0 (about US$ 18O OOO), ADB had decided to give priority in financing to development programes in areas freed from onchocerciasi.s. The World Bank representative informed the Comittee that the l.Iorld Bank Grouprs Executive Directors had recently approved the provision of US$ 6 million - abouE 107" of Programe costs - over the first six years. wiEhin Ehat total, grants of US$ 1 million would be made in each of the years L976 atd 1977, xo be funded from the transfer of the Bankrs net income to IDA. Pledges for the first stage as a whole, subject in some cases Eo annual parliamentary approval, and including the US$ 6 million pledged by the Wor1d Bank and the USg I rnilllon pledged by Norway, now totalled some US$ 40 million. Support provided by other countries on a year-to-year basis could be expected to reach another US$ 13 million. Adding this to the US$ 40 million already mentioned and taking into account LJNDPrs contribution to the financing of research and training, and estimated investment income of some US$ 600 OOO, Eotal resourcesfor the six years slightly exceeded the original financial target of US$ 54 million. However, the revised estimate of costs for the period r{as novr US$ 61 million. To bridge the gap, the Bank had initiated talks with possible new donors, and a ntmber of Participating Countries had addressed a request for assistance to the European Development Fund. No firm conmitments hadyet been obtained, but the auguries were good. Further, Ghana had contributed / ZOO OOOtowards local costs of the Programe, in addition to support in kind, and it was being asstrned, with the help of other Participating Countries, that at least US$ 5OO OO0 of requirements wouldbe financed from locaI contributions. For L977, the Executing Agencyts cash requirements were US$ 11.9 miIlion. After allowingfor contributions due, but not yet paid, cash and investmenEs in the Onchocerciasis Fund totalled some US$ 4.7 million, against which a further quarterly advance of USg 2.7 oillion would be made to WHO before end 1976, leaving US$ 2 million to be carried over Eo L977.Contributions for 1977 added up to some US$ 11 million. Thus receipts should be sufficient ro meet cash requirements and to leave a balance of rather over US$ 1 million to be carried forward. Nevertheless, the cash position was becoming increasingly tight, so that expenditure musE be kept within the budget limits and strict economy exercised in the Programers executi-on. the World Bank representative emphasized that the Programe had to be tailored to the budget. New financing comitments beyond 1979 would be ca11ed for at the JCC's fifth session at the latesE. Itrat might be the time to consider najor expansions of the OCp area, though smaller extensions might be made before then if funds beceme available or economies provedpossible. Governments might consider providing technical assistance outside their normal contributions for Ehe expensive sEudies such extensions would entail. Itre World Bank would conti.nue to assist in mobilizLng finance for the Progr:nrme, whlch was planned to last 20 years; at the same time, the Bank was only one agency in a broad cooperative venture. Page 14 A table (attached as Annex 6) showing contributions pledged or indicated for L977 was circulated at the end of the session. OTIIER MATTERS Arrangements for the fourth session of the JCC At the invitation of the Government of Kuwait, it was agreed to hold the fourth session of the JCC in Kuwait in early December L977, ot dates to be agreed betvreen the Government and the Independent Chairman. The representative of Kuwait explained thaE the invitation was intended not only to show his countryrs interest in and support for OCP, but also to make the Progranme better known in the Arab world as an excellent example of international cooPeration in the cause of alleviaEing huruan hardship. The Comnittee expressed its thanks to the Kuwaiti Government. The representative of Togo reminded the Connrittee of his Governmentrs invitation to hold the JCC's fifth session in Lom6 in 1978. Expression of thanks to the outqoinq Programme Director Recording its admiration and appreciation for the remarkably effective pioneer work of the outgoing Prograrune Director, Dr P. Zi-eg1-er, in establishing the Programe, organizing oPer{tions and building up an excellent staff, the Corurittee asked the Independent Chairman to expresd iEs Ehanks to Dr Ziegler, and wished him all success in his future work. Ihe text of a letEer from the Independent Chairman to Dr Ziegler is attached as Annex 5. CLOSURE OF I]IIE TIIIRD SESSION The Independent Chairman expressed his gratitude to the Vice-Chairman for his suPPort during the session and to the Government of Upper Volta for its magnificent hosPiEality and the excellent facilities it had provided. He thanked all the participants and Ehe conference staff for their cooperation in the exercise of his functions. i Wishing all representatives a safe return home, the Independent Chairrran declared Ehe third session of Ehe JCC closed. EXCURSION ARRANGED BY THE GOVERNMENT OF TTPPER VOLTA 0n Fridayr 3 December, at the invitation of the hosE Government, a group of some 35 participants visited part of the area being developed by the Autorit6 des Arn6nagements des Va116es des Voltas (AW) and had an opportunity to observe the progress made. ONCHOCERCIASIS CONIT.OL PROGRA}.IME IN THE VOLTA RIVER BASIN AREA JOINT COORDINATING COMMITTEE Third session, , l-2 Decernber 1976 AGENDA Opening of the sesslon Statement by the Independent Chairman Election of the Vice-Chairman of the session Adoption of the agenda Progress Report of the World Health Organization for 1976 Annual Report of the scientific and rechnical Advisory comittee ReporE of the Ecological panel Annual Report of the Chairuan of the Economic Development Advisory panel Economic development aspects of the programre Review of the Plan of Action and Budget of the progranrme for 1977 Financing of the Onchocerciasis Control programe Other m, t.ters Closure of the third session AI.INEX 1 JCC3. 1 1. ) 3. 4. 5. 6. 7. 8. 9. 10. 11. L2. 13. ANNEX 2 PaSe 2 JOINT COORDINATING COMMITTEE Ouagadougou. 1-2 December 1 976 LIST OF PARTICIPANTS Dr M. G. Candau Independent Chairman Joint Coordinating Corrnittee (.lCC) PARTICIPATING GOVERNMENTS Peoplers Republic of Benin Son Excellence Monsieur Issifou Bouratma Ministre de la Sant6 publique M. Nicolas Ahouansou Secr6taire permrnent du Comit6 national de Lutte contre 1 rOnchocercose Ghana Colonel J. B. B. Asafu-Adjaye Executive Director National Onchocerciasis SecreEariat Ministry of Economic Planning Dr S. K. Prah Of ficer- in- charge Institute of Aquatic Biology l.1r N. S. Belo-Giwa Principal Economic Planning Officer National Onchocerciasis Secretariat Ministry of Economic Planning Ivory CaeE! Son Excellence Monsieur J. B. Mockey Ministre de la SanE6 publique et de la Population Dr I. Kone DirecEeur de Ia M6decine sociale MinistEre de la Sant6 publique et de la Population Mali Son Excellence Monsieur Mam,di Keita Ministre de la Sant6 publique et des Affaires sociales Dr Souleymane Sow M6decin Chef de la Division A la M6decine socio-pr6ventive et des Maladies transmissibles MinistEre de 1a Sant6 publique et des Affaires sociales Dr Garame Traore Directeur, Conseiller technique MinisEEre du D6veloPPement rural ANNEX 2 Page 3 Niger Son Excellence Monsieur Ie Chef de Bataillon Moussa Sala Ministre de la Sant6 publique et des Affaires sociales Dr Ibrahim Alfa Ciss6 Directeur des Grandes End6mies Togo Professeur Kostso Kokougan Nathaniels Directeur g6n6ra1 de la Sant6 Dr A. Prince Agbodjan M6decin Chef du Service des Grandes End6mies MinistEre de la Sant6 publique et des Affaires sociales Dr Mensah Robert Dot6 Administrateur civi1, Conseiller technique MinistEre des Finances et de lrEconomie Upper Volta Son Excellence Monsieur Salia Sanon Ministre du D6veloppement rural Son Excellence Monsieur le Docteur Tinga Douamba Ministre de la Sant6 publique et des Affaires sociales Son Excellence Monsieur Boubacar Soumana Ministre du Plan M. Sim6on Sorgho Secr6taire permanent du Comit6 national de Lutte contre lrOnchocercose Dr Jean-Marie Kyelem Secr6taire Permanent adjoint du Comit6 national de Lutte contre lrOnchocercose CONTRIBI]TING PARTIES African Devel r Bank (ADB) Mr M. Bouzid Engineer Operations Department Belgitm Mrs Suzanne Vervalcke DirecEeur drAdministration, Direction de la coop6ration mu1ti1at6ra1e MinistEre des Affaires 6trangeres, du Comerce ext6rieur et de 1a Coop6ration au D6veloppement Canada His Excellency Mr l"tichel de Goumois Ambassador of Canada to Ivory Coast, Mali, Niger and Upper Volta Mr I. Lindsay Earth Sciences Division Defense Research Establishment ANNEX 2 Page 4 Mr P. Racicot Councellor at the Canadian Embassy in Abidjan Mr E. Gauvreau First Secretary Representation of Canada in Upper Volta France Mr Henri H61ids Charg6 de Mission b 1a Sous-Direction de la Sant6 publique et de lrAction sociale MinistEre de la Coop6ration Federal Republic of Germany Dr Winfried Pulst Federal Ministry for Econooic Cooperation Japan Mr Takateru Ohse Medical Expert of the Japan InternaEional Cooperation Agency Consultant at the United Nations Economic Cormrission for Africa Ethiopia Kuwait Dr Galal E. Ahmed Amin Economic Adviser Kuwait Fund for Arab Economic DeveloPment The Netherlands Mr W. Th. Six Second Secretary Representation of Ehe Netherlands in Upper VoIta United Kingdom Mr W. D. Maniece Head of West and Central Africa Department Ministry of Overseas Development Dr A. M. Baker Medical Adviser Ministry of Overseas Development Dr P. T. Haskell Director, Centre for Overseas Pest Research Ministry of Overseas Development United States of America Mr Dennis Conroy Director, African Regional Affairs Office Agency for International Development Dr Joe L. Stockard Tropical Medicine Adviser Health Office of the Bureau for Technical Assistance Agency for International Development AI{MX 2 Page 5 SPONSORING AGENCIES Food and .Agriculture Organization of the United Nations (FAO) Mr T. S. B. Aribisala Direc tor Agricultural Services Division Mr C. G. Groom Senior Officer, Policy and Planning Unit Agricultural Services Division World Bank (IBRD) Mr E. Peter Wright Program Director Western Africa Region Mr Stephen Denning Division Chief Western Africa Region Mr M. J. Sharpston Economis t Western Africa Region Mr Adrian Otten Agricultural Economis t Western Africa Region Mr Abdallah E1 Maaroufi World Bank Resident RepresenEative in Upper Volta United Nations Development Progranrme (ur.rop) Mr Michel Doo Kingu6 Assistant Adoinistrator and Director Regional Bureau for Africa in New York Mr Gian Pennacchio Chief, Division for West Africa in New York Mr Gregorio Feliciano UNDP Representative in Ghana Mr Jean-Claude Petitpierre UNDP Representative in Ivory Coast Mr Jean-Pierre Schellenberg IINDP Representative in Mali Mr Jens ny'gel UNDP RepresenEative in Upper Volta Mr Peter Molt UNDP Acting Representative in Togo Mr AIan Doss UNDP Deputy Representative in Niger ANNEX 2 Page 6 I1r Herbert A. Behrstock Assistant Representative Office of the IINDP Representative in the Peoplels Republic of Benin Mr Jean Causse UNDAT II Director in Niger I{orld Health Or anization (WHO) Dr Comlan A. A. Quenuo Regional Director for Africa Mr A. Groenendijk Director, Division of Budget and Finance Dr T. LepEs Director, Division of Malaria and Other ParasiEic Diseases Dr P. Ziegler Director, Onchocerciasis Control Progranune Mr M. L. Bazin Director Designate Onchocerciasis Control Programne Dr R. Le Berre Chief Vector Control Unit Onchocerciasis Control Progranme Mr J. D. M. Marr Entomo logis t/f iologi s t Onchocerciasis Control Progranme EX OFFICIO PARTICIPANTS Mr Wilfrid de Souza Secretary of the Economic Development Advisory Panel (EDAP) Professor P. G. Janssens Chairmrn of the Scientific and Technical Advisory Cormittee ( STAC ) Mr Stanislas Kpognon Alternate Executive Director World Bank OBSERVERS Organlsation de Coordination et de Coop6ration pour la Lutte collllie 1es Grandes End6mies (occcE) Dr Cheick Sow Secretary- C,eneral- Office de la Recherche scientifique et technique Outre-l'ler ( oRsro}l) Professor G. Caous Directeur g6n6ra1 Dr Jean Mouchet DirecEeur des Services scientifiques cenEraux AI{NEX 2 Page 7 ? Mr B. Philippon Chef de la Mission ORSIOM auprEs de 1'OCCGE h Bouak6 Directeur, Institut de Recherches sur lrOnchocercose a Bouak6 Cormission of European Cormunit ].es Miss GabriEle von Brochowski Delegate of the Conmission of European Cormunities in Upper Volta ANMX 3 PaEe 8 ONCHOCERCIASIS CONTROL PROGRA},IME IN THE VOLTA RIVER BASIN AREA JOINT COORDINATING COMMITTEE lhird session, ou, 1-2 December 1976 ADDRESS BY THE HEAD OF STATE Mr Cha,irman, I Members of the Comittee, Presidents, Minis ters , Ladies and gentlemen, My country is happy to be acting as host to the third session of the Joint Coordinating Couunittee for the Onchocerciasis Control Prograrme in the Volta River Basin area. I"1r Chairman, ladies and gentlemen, coming here to Upper Volta, where the Onchocerciasis Programne has its headquarters, you have come to a country where hospitality in the African sense of the term is not an empty word. Consider yourselves at home and feel welcome among us. Onchocerciasis control is for us West African counEries a fine exaruple of concerEed and disinterested international action to make possible the implementation of a prograrmre uniique of its kind if we take into account both the health and the economic aspects. l Since December L974 we have been closely following, through our ministerial depar the progress of the health work in the field. I tlents, We are therefore aware of the successes achieved and the difficulties encounEered. l The successes have already come ful1y up to our expectations. As for the difficulties, when we look at the nuober of institutes, of scientists and of well-wishers involved, we are inclined to feel some degree of optimism. When phase III of the Programne is eventually launched, the area defined as the onchocerci.asis region will be covered and the high comrand of the Onchocerci-asis Prograrme will thus contain or reduce the transmission of the illness that makes human beings, our kith and kin, flee from their native soil. But does that mean that a picture reproduced i.n a rather widely distributed docr:oent, showing a blind father 1ed by his child, will be seen no more? I.Ie have no guarantee of this, and that is why, following the example of one of our sister countri.es participating in the Onchocerciasis Prograrune and represented on this Corunittee, Upper Volta ventures, on behalf of all six West African countries, to ask Ehat a big effort be made in the field of chemotherapy, so that those of our brethren who are already infected can have some hope of cure. Thus, Mr Chairman, some alleviation will be brought to that human misery which we see about us and which cannot but accord very ill with the economic and social development of our countries. Our unreserved support goes to this Prograrmne, and aII those who are or will be concerned in its promotion will always receive due encouragement and assistance from Upper Volta. Mr Chairman, Dr Candau, Upper Volta was gratified in 1974 when the members of the Joint Coordinating Comittee, on our proposal, approved your appointment as its chief officer. That action was a recognition of your outstanding merits. You accepted this appointment and it is heart-warming to see a man thus sacrifice himself to the cause of mankind. Your presence at the head of this Conmittee i.s an earnest of success for the Programne. I join those who have already done so in wishing you every success in your task. t tANNEX 3 Page 9 In the Presence of this Conrnittee I have pleasure in also paying tribute to anoEher man who, in the difficult post he occupies, is always mindful of the probleus of the emerging countries: I am referring to the President of the l{orld Bank, Mr McNamara, who has played a key role in the preparation and implementation of the Onchocerciasis Control Progr:me, which is the continuation on a larger scale of the caryaign underEaken by OCCGE, thanks Eo two bodies which are very well known to us: the FED and the FAC. Nor must I oEiE to mention the work of those who served on the PAG mission and thus supplied essential baseline data for the Progranrne. I should now like to address their Excellencies the Arbassadors of the countries that are assisting with the financing of the Onchocerciasis Progreme - the represent.atives of the contributing parEies - and ask them to be kind enough to convey to their governments and t,o the agencies they represent our sincere thanks for their contribution. At a time when there is talk of a dialogue between north and south and when rre are all preoccupied by Ehe state of the worldrs economy, hard hit by an inflation which is putting most counEries in difficulty, we have here a fine example of solidarity between developed and emerging countries. We hope to see your nuober increase so that the burden will be less heavy and the successful ouEcooe of the Prograume better ensured. It is Ehe task of the sponsoring agencies and of the working groups that have been set up to be vigilant in ensuring the-success of this Programe, whose final objecEive is the reclamation of some 700 OOO kn2. I have already spoken to you of the health picture. As regards economic and social development, the contacts established beEween some of these agencies and our technical dePartments will enable the future course to be mapped out, with the proviso that Ehe way in which each African country envisages iEs development must be understood. Addressing now the participating countries, I should like, Right Honourable Ministers and rePresentati.ves , to say Eo you that we were united in desiring this progreme and thaE we Possess, in this Comittee where joint planning is possible, an instrr.ment for supervising this Progranme, and that is what should determine our acti-on. Such, Mr President, ladies and gentlemen, were the points I felt it would be useful Eo mention to you at the opening of your third session. I am sure that the reports which will be presented by certain working groups of yourComnittee in the course of this session will demonsErate the urgency of the need to put into effect the economic and social development of the onchocerciasis zones. I wish your session every success. ANNEX 4 Page 10 ONCHOCERCIASIS CONTROL PROGRA},IME IN TTIE VOLTA RIVER BASIN AREA JOINT COORDINATING COMMITTEE Third session. Ouagadougou, 1-2 December L976 ADDRESS BY THE INDEPENDENT CHAIRMAN Mr President of the Republic of Upper Volta, Presidents , Members of the Government and Diplomatic Corps, Members of the Joint Coordinating Cormrittee, Your Excellencies, Ladies and gentlemen, Allow me, Iulr President, i.n my capacity as Independent Chairman of the Joint Coordinating Comnittee, to acclaim your presence among us this morning and express our appreciation of the honour you are doing us by presiding over this inaugural meeting of the third session of the Joint Coordinating Cornmitee for the Onchocerciasi-s Control Programne in the Volta River Basin area. This manifestation of the interest that you personally, Mr President, and your Government take in the prograume t/e have jointly undertaken is an invaluable encouragemenE to all of us. It is thanks to the invitation issued by your Government that we are today holding this third session in your countryts capital and I Erm expressing the feelings of all present when I Ee11 you how grateful we are for your generous hospitality. Ttre year 1976 was one of major progress in the development of our Onchocerciasis Control Prograrme in the Volta River Basin area. The extension, beginning in January of this year, of the vector control operations to zone II, together with the initiation of epidemiological surveys, the establishment of the necessary structures, and the launching of exploratorf operations in connexion with the vector control plan in zone III, all show that the profrarme is following the course mapped out in the plan of action. When, in the early months of 1977, insecticide spraying begins in zone III, the vector conLrol operations will cover the entire Progranme area. The experience of the first two yearsr operations, and the results obtained in zones I and II, together with the knowledge aquired concerning the vector and the disease, give us reason to believe that Ehe Programre is progressing satisfactorily, and that the social and economic development of the regions freed from onchocerciasis - the real objective of our efforts - will acquire ever greater momentum in the years to come. I recently visited the seven participating countries for discussions with 4 government about problems connected with the Prograrme and for an exchange of views on the agenda for our presenL session. I also ca1led at the Programe Headquarters to obtain information about the progress of the work and visited several sectors and subsectors where vector control operations are proceeding. In several countries I took part in meetings of the national Onchocerciasis Control Cox@ittees and I should like in Ehat connexion to stress the importanE role of these Committees in the coordination of the Programre at government l-evel. It became evident to Ee from the various discussions and meeti.ngs I attended that the participating countries are satisfied, on the whole, with the development of the Prograrrme and the results achieved so far. a ANNEX 4 Page 11 Nevertheless, there remai.n problems to be solved and there is one in particular which seelDs to be comon to several countries: that of the boundaries of the progranrme area. The sound argunents that have been advanced in favour of a reconsideration of those boundaries - from both the vector control and the econmic points of view - seem to constitutegood grounds for reopening t.he question before long. Thus, the reinvasion - albeit limited - of the south-western parE of the progrnnrme areais a matter of serious concern to the countries concerned. Secondly, from the economic viewpoint, several governlDents regret that certain districEs for which agricultural develop- ment projects have been planned but where onchocerciasis is rife have not been included withinthe boundaries of the area. The progress achieved in research on the taxonomy and biology of the species which make up the Simulir-m damnosr-m cmplex, and on the possibility of establishing vector colonies inthe laboratory, show how important it is to intensify our efforts in order Eo obtain ever rnoreprecise knowledge of the biology of the various species and their role in the transmission of onchocerciasis. Moreover, the establishment of such laboratory colonies will contribute tofacilitating and expanding international cooperation in research on the vector. While it must be stressed Ehat our Progrrme has constantly benefited from the generous and invaluable cooperation of the int.ernational scientific coomuniEy, a stil1 greater efforthas to be called for from investigators. For, i.n order to try and alleviate the sufferings and destitution of a large proportion of the populations, there is a pressing need also Eointensify research on the biology of the parasite and on the epidemiology, chemoEherapy andimunology of onchocerciasi-s. Ttrat bad hygiene and ill-health are obstacles to social and economic development is norra-days an acknowledged fact. It is difflcult to imrgine how the hrman, social and economic development of a region can proceed when nutritional deficiencies and diseases are rife there. Mr McNamara, President of the World Bank, recently wrote: I'Beyond the specifics of the Bankrs project work . lies our central concern with the fundamental issue of all flr,mesdevelopment: improving the opportunity for individuals to achieve more ful1y their inherentpotential. DeveloPnent is meaningless if it does not in the end enhance the lives ofindividual hrman beings, particularly those individuals whose circumstances . . . constitute an intolerable insult to huoan dignity itselftt. The onchocerciasis Control Progrnme in the Volta River Basin area is an excellent example of concerted international action to alleviate huoan misery and -ake possible the development of the regions concerned. The land utilizaEion projects set on foot by onchocerciasis control will provide in turn Ehe substructure for the establishment of social services such as thosefor health, nuErition and education. Mr President, allow me again to thank you on behalf of all of us for having consented topreside over this inaugural oeeting and to assure you that your presence is a great encourage- ment to us to continue our efforts. Finally, al1ow De to thank the authorities and the guests who have been kind enough Eohonour this meeting with their presence, and to tel1 them how greatly the interest theydisplay stimulates us to give the best that is in us for the success of this progr:nrme. ANNEX 5 page 12 10 December L976 Dear Dr ZiegLer, The Joint Coordinating Committee for the Onchocerciasis Control Programme in the Volta River Basin area hras informed during its third session, held last week in Ouagadougou, that, having been assigned to new responsibilities in the trrrorld Health Organization, you were going to relinquish the directorship of the Progrannne. The Comnittee has asked me to act as its spokesman in telling you how grateful we al1 are to you for the lrork you have accomplished in launching this Progranrne and directing it for three years, and for all the trouble and effort you have devoted to it. Your task has been a particularly difficult and delicate one and you can be proud of what you have accomplished. Your dedication and your active participation in the meetings of the JCC have been much appreciated by the members of the Corrnit.tee, who hereby express to you their gratitude and satisfaction. On behalf of the JCC I wish you every success in your ner^r post and I present to you a to Mrs ZLegler my kindest regards. Yours sincerely, Dr M. G. Candau Independent Chairman Dr P. Ziegler Onchocerciasis Control Prograrrne P.0. Box 549 0uagadougou Upper Volta nd a ANNEX 6 Page 13 ONCHOCERCIASIS CO}IIT,OL PROGRAI.IME IN THE VOLTA RIVER BASIN AREA JOINT COORDINATTNG COMMITTEE Third session. Ouasad . 1-2 Decenber 1976 ES FINANCING OF ONCIIOCERCIASIS PROGRA}.IME IN 1977 US$ nillion) Total requirement for advances to WHO glg expenditures on research and training to be financed by UNDP Total prograrme requirements in 1977 Contributions pledged or indicated: African Development Bank (UA 150 OOO) Belgir:u (BF 15 million) Canada (Can 9 5OO OOO) France (ff 4 niltion) Germany (ot'l 4 million) Japan ($ 1 nillion) Kr:wait (g 2 nillion) Netherlands ($ 1.5 million) United Kingdom (LO% ot Fund requirements) united srares (g 1 million) t{orId Bank Group (g 1 million) United Nations Development programe Total contributions plus expected carry-over from 1976 Total finance available less programe requirements in 1977 Expected carry-over to 1978 18 42 50 80 60 oo oo 50 19 00 oo 57 0 o 0 o 1 1 2 1 1 1 I o 11. 90 o.57 L2.47 lL.7 6 L3.7 6 t2.47 t.29 oo2 a The contributions indicated for Japan, Kuwait and the Netherlands are stil1 subject to official confirmation. 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