nI ) JPCI2-B JOINT PROGRAMME COMMITTEE ONCHOCERCIASIS CONTROL PROGRAMME IN WEST AFRICA Twelfth session. Rivadh. Saudi Arabia l-4 December l99l REPORTl CONTENTS OPENING OF THE SESSION ELECTION OF OFFICERS ADOPTTON OF THE AGENDA ADOPTION OF THE REPORT OF THE ELEVENTH SESSTON OF THE JOINT PROGRAMME COMMITTEE REFLECTIONS OF THE COMMITTEE OF SPONSORING AGENCIES PROGRESS REPORT OF THE WORLD HEALTH ORGANTZATION FOR I99I REPORT OF THE EXPERT ADVISORY COMMITTEE . ' REPORT OF THE EXTERNAL AUDITOR . . . PROGRESS REPORT OF THE ONCHOCERCIASIS CHEMOTHERAPY PROJECT FOR l99l PLAN OF OPERATIONS FOR THE FOURTH FINANCIAL PHASE (1992-t997) . . . . PLAN OF ACTION AND BUDGET OF THE PROGRAMME FOR 1992 AND ITS APPROVAL . . . DEVOLUTION ONCHOCERCIASIS FUND AGREEMENT . . FINANCTNG OF THE ONCHOCERCIASIS CONTROL PROGRAMME SOCIOECONOMIC DEVELOPMENT OTHER MATTERS DATE AND PLACE OF THE THIRTEENTH SESSION . . . CLOSURE OF THE TWELFTH SESSION RECOMMENDATTONS AND DECISIONS . . . . ANNEX I - OPENING STATEMENT BY DR R.H. HENDERSON, ADG, WHO ON BEHALF OF THE DIRECTOR-GENERAL OF WHO ANNEXII - AGENDA... ANNEX III - LIST OF PARTICIPANTS . ANNEX IV - ONCHOCERCIASIS FUND 4. 4 8 8 9 2 2 2 I 2 3 J 35 6 7 8 9 l0 I l. 12. 13. t4. 15. 16. t7. ll t2 l5 l6 l8 2l 2l 2t 2t at .t 23 25 26 33 I An Interim Report (JPC.l2-A) was issued and reviewed during the last day of the session JPCI2-B page 2 l. OPENING OF THE SESSION: Agenda item I l.l The twelfth session of the Joint Programme Committee (JPC) of the Onchocerciasis Control Programme in West Africa (OCP) was held at the Intercontinental Hotel in Riyadh, Kingdom of Saudi Arabia, from I to 4 December 1991. The following members were represented: Belgium, Benin, Burkina Faso, Calouste Gulbenkian Foundation, Canada, Cote d'Ivoire, France, Germany, Ghana, Guinea, Guinea.Bissau, Japan, Korea, Kuwait, Luxembourg, Mali, Netherlands, Niger, Portugal, Saudi Arabia, Senegal, Switzerland, United Kingdom of Great Britain and Northern Ireland, and the United States of America. Also represented were the Sponsoring Agencies: Food and Agriculture Organization of the United Nations (FAO), United Nations Development Programme (UNDP), World Bank and World Health Organization (WHO), which is the executing agency for the Programme. Dr. R.H. Henderson, Assistant Director-General of WHO, represented the Director-General; Dr. H.A. Gezairy, Regional Director for the Eastern Mediterranean attended, and Dr. D. Barakamfitiye represented the Regional Director for Africa. Members of the Expert Advisory Committee (EAC) and its Ecological Group were present. Representatives of the Organization for Coordination and Cooperation in the Control of Major Endemic Diseases (OCCGE), the Mectizan Expert Committee and the River Blindness Foundation were also present as observers. The list of participants is attached as Annex III. 1.2 The session was opened by His Excellency the Minister of Public Health and Population of the Republic of Guinea, Dr. Madigbe Fofana, Chairman of the eleventh session of JPC, who stressed the transparency of OCP in its operations and noted its effects in strengthening health care services. 1.3 In a personal message read by his representative Dr. R.H. Henderson, Assistant Director- General, Dr. Hiroshi Nakajima, Director-General of WHO, expressed his regret at being unable to attend the session. Thanking JPC's hosts, he shared his impressions of OCP's progress, and his hopes and expectations for its future now that the end was in sight. The full text is attached as Annex I. 1.4 Dr. Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean, noted OCP's achievements in public health and in removing an obstacle to socioeconomic development. He underlined the importance of devolution and its dependence on effective health systems, which OCP helped to strengthen. 1.5 Dr. Ebrahim M. Samba, Programme Director, emphasized that onchocerciasis was a disease of phe very poor, who qualified for development assistance through OCP. 1.6 His Excellency the Minister of Public Health of the Kingdom of Saudi Arabia, Mr. Faisal Al- Hegelan, welcomed the participants, congratulated OCP on its achievements, and pledged Saudi Arabia's continued support. 2. ELECTION OF OFFICERS: Agenda item 2 2.1 Dr. Abdul Rahman Al-Soweilem, Deputy Minister of Health, Kingdom of Saudi Arabia, was elected Chairman, and Dr. Abdou Moha, Secretary-General, Ministry of Public Health, Niger, Vice- Chairman. 2.2 The Chairman thanked the Committee for the honour they had done his country in electing him. 2.3 Dr. J.A. Adamafio, Deputy Director of Medical Services, Ghana, and Dr. S.I. Kaba, Technical Adviser, Ministry of Health, Mali were elected English- and French-speaking rapporteurs, resPectivelY. 3. ADOPTION OF THE AGENDA: Agenda item 3 (document JPCl2.l, Rev.l) I 1 It ,^ 3.1 The agenda was adopted. (Annex II) JPCI2-B page 3 4. ADOPTION OF THE REPORT OF THE ELEVENTH SESSION OF THE JOINT PROGRAMME COMMITTEE: Agenda item 4 (document JPCIll) 4.1 The report was adopted without comment. 5. REFLECTIONS OF THE COMMITTEE OF SPONSORING AGENCIES: AgENdA itEM 5 5.1 The representative of UNDP, speaking as Chairman of the Committee of Sponsoring Agencies (CSA), commended the transparency of OCP operations and the high standard set by JPC for full participation in the decision-making process. 5.2 As OCP embarked on the fourth Financial Phase (1992-1997), there was every confidence that its objective would be met on target by implementing the Long-Term Control Strategy. 5.3 The results in the Original Programme area were impressive, confirming the effectiveness of the Long-Term Strategy and its main tool, vector control, complemented by ivermectin treatment. In 80% of tne original seven-country Programme area, the parasite reservoir had been virtually eliminated and OCP was phasing out its operations there. In the entire Programme area, nearly 30 million people were now protected from contracting onchocerciasis and over 100 000 cases of blindness had been prevented. 5.4 By the start of the fourth Financial Phase, the centre of gravity had moved from the original Programme area to the extension areas. In this new Phase, OCP would endeavour to consolidate the gains achieved so far and begin the process of handing over disease control maintenance activities to ihe Participating Governments, thus winding down the Programme to a successful conclusion. The search would continue for a macrofilaricide. 5.5 Success would depend heavily upon continued strong support and active participation by the Donor community and upon equally strong commitment by the Governments themselves to the devolution process. For many years, the Donor community had been most generous in its support of the OCP programme of action, with its strong commitment to common goals. Several Representatives at the Donors'Conference in Bonn, September 1991, had again praised OCP as a model of effective cooperation. The consensus among Donors had been that all partners, Donors and Participating Countries alike, were likely to follow the Programme through to its successful conclusion. 5.6 Growing demands on Donor resources exceeded the funds available. Difficult decisions had to be made in the light of new priorities established by Donors and multinational organizations in their cooperation programmes. UNDP, for example, was advocating human development, 'putting the people first', poverty alleviation, the application of science and technology to development, and environmentally sustainable development. OCP was an outstanding example of the combination of all those objectives. It was a poverty alleviation and human development action programme. It was an investment in the health and the productivity of people, with the added benefit of reopening the most fertile lands to settlement, providing perhaps the greatest opportunity in lVest Africa for increasing agricultural production. 5.7 OCP, moreover, was a pioneer in ecological monitoring and the handling of pesticides. The environmental consequences of aquatic pesticide use had been monitored since the inception of operations. In selecting larvicides, an important consideration was that they must be biodegradable and therefore having only a negligible environmental impact on the river systems. It was a remarkable achievement that the elimination of onchocerciasis as a public health problem and constraint on socio- economic development would not be at the cost of environmental degradation. I : trct2-B page 4 5.8 Two specific issues appeared high on the agenda of Donors and Participating Countries alike. The first concerned the preparation for, and implementation of, the devolution process which would be the single most critical issue during the 1992-97 period. lVhile this process would require careful monitoring, CSA remained confident that the devolution strategy was viable and would bring the disease down to very low and manageable levels. Limited focal ivermectin treatment based on epidemiological surveillance had become a reality,-and Participating Countries were already assuming more responsibility for ivermectin distribution. Onchocerciasis control was being integrated into multiple-disease control programmes, country by country, as recommended by the External Review Team. There was already a fully functioning devolution unit in OCP, providing technical support and training in the devolution process, and the WHO/Regional Office for Africa was integrating devolution in its country activities. 5.9 The second issue was when OCP would end. From 1994 onwards, with the cessation of larviciding in the original Programme area, the trend would be towards lower expenditure levels. By 1997, vector control would be confined to the extension areas where larviciding would already have reduced considerably the human reservoir of the parasite. The end of OCP operations could only be determined bn the basis of epidemiological data and the best estimate was about the year 2000. 5.lO The commitment and dedication of the OCP Director and staff were commendable. It was a tribute to OCP and to African governments that 95% of the staff were Africans. OCP was more than a successful disease control programme: it was building and utilizing African chpacity for sustainable development. 6, PROGRESS REPORT OF THE WORLD HEALTH ORGANIZATION FOR I99I : AgENdA item 6 (document JPCI2.2) REPORT OF THE EXPERT ADVISORY COMMITTEE: Agenda item 7.(document JPCl2.3) 6.1 The Programme Director said that the developments of the last year were the most remarkable during his directorship. The entomological situation was much better than expected; the fruits of the efforts of OCP with countries to interrupt transmission were being reaped. The eleven countries were participating in an exemplary fashion, taking nearly full responsibility for ivermectin distribution and ior epidemiological surveillance. The main problem in Africa was mobilization of resources. The World Bank had agreed to finance the Burkina Faso devolution plan. [n Ghana, the Head of State had recorded his support for the planned activities. At the Donors' Conference in Bonn, Donors had pledged their support for devolution, recognizing the development aspects. There was indeed clear evidence of improved economic development conditions in the Programme area. 6.2 The only really serious problem lay in the future: how to maintain the achievements of OCP for future generations. Continued support would be needed from Donors and increasingly from Participating Countries. 6.3 The political instability in some parts of the OCP area was bound to cause difficulties for the programme, but such problems had been successfully overcome in the past. All political leaders in the -area recognized thi importance of OCP, genuinely wanted it to succeed, and always gave it their full support. '6.4 The Proeramme Director referred to the importance of careful monitoring of the long-term !.p..t of iveimectin, especially with a view also to assisting non-OCP countries which were introducing or considering irermictin treatment and which looked to OCP as the expert in this field. The programme area *as iurrently in the fifth cycle of treatment, parasite loads were extremely low, and adverse reactions were virtually nil. al )- JPCI2-B page 5 6.5 In the western extension area some non-governmental organizations (NGos) were involved in ivermectin AistriUution. iucf, organizatioos *ire usually served by volunteers and were making a valuable contributior, "iti"rgr, it-was important to provide them with clear information and guidance so that the limitationi of iveimectin were understood. A meeting held in Geneva in April l99l to discuss ivermectin distribution through the primary health care system had been attended by NGOs' 6.6 OCp possessed an arsenal of six larvicides: temephos which is still used in 80% of the irlgr".rn. area, in rotation with others, resistance to this insecticide having appeared periodically in some river basins. phoxim had replaced chlorphoxim; though relatively expensive it is used instead of Bacillus thuingiensis H-14 @.1. H-14) in alternation with temephos and pyraclofos, a new organophosphorus ro-pounO suitable for the treatment of rivers with discharges from l5 to hundreds of cubic metres per secbnd. carbosulfan and permethrin were very effective but relatively toxic for non-target organisms and thus usable onty at very high river discharge rates and then only in restricted cyclis, while B.r. H- 14, being non-toxic, was especially indicated for low-flow, dry-season conditions, taking into account its high operational price' 6.7 At the end of the dry season (in April), only 4 infective female flies had been found in 1,216 ."ptur6 in the entire irogi"... area foi week Ii. In the rainy season, 16 female flies out of 5,131 "augfrt had been infectivJ for week 33. Transmission was thus extremely low' 6.g Reinvasion from the western extension area had been totally overcome since larviciding had been introduced in Guinea in 1989 and in Sierra Leone during 1990. Annual Transmission Potential (ATp) in the reinvaded zones was nil or negligible for the seiond or third year. Reinvasion studies could thus be susPended in 1992. 6.9 In the extension areas the ATP was still fairly high in some places, but the transmission was attributable essentially only to the forest species. 6.10 Such good results had been obtained from entomological surveillance and epidemiological evaluation that it had been possible to cease larviciding in the major part of the original Programme area; post-control studies would continue for two years in selected places. I Eoidemioloeical evaluation 6.1I Excellent results were reported in the original Programme area: prevalence in most cases was below 5%, except in a few areai where higher figures were due to the infection of migrant fishermen from forest areas further south. The results confirmed that transmission had been interrupted and the parasite reservoir was declining rapidly. 6.12 Completion of epidemiological mapping in both the western and southern extension areas had led to an increase in the number of villages in which ivermectin was being distributed to over I '900' Distribution was carried out by nationalJof the respective countries with minimum OCP supervision, and sometimes in collaboraiion with non-governmental organizations and private voluntary organizations. coverage of ivermectin distribuiion "u"raged 62% and it was essential to maintain that level, at which there -were beneficial ophthalmological changes. In areas where individuals had received ivermectin annually for five years, mean mic.ofilarial loads in the eye had now fallen to less than l0% of the initial tevets. comjliance with treatment was most satisfactory, and monitoring showed virtually no serious adverse reactions. 6.13 The results of tests with the DNA probe were promising, indicating that the probe could be used to predict the pathogenicity of a given- parasite in large parts of West Africa within regions under control, to identify L3 infective larvae in the flies and to distinguish between human and animal onchocerciasis. JPCI2-B page 6 Administration and suoport services 6.14 The Chief of Administration and Support Services noted that the mere fact of not exceeding an annual budget was not in itself proof of good management. Two guiding principles must be borne in mind: improvement of the cost-efficiency ratio and a systematic search for new savings. 6.15 The costs of staff, goods and services were increasing year by year, and improved efficiency would help to avoid budget growth. Some ways of improving efficiency were seminars designed to produce action-oriented specific recommendations, staff training, computerization, strict financial controls backed up by information technology, and the dissemination and application of managerial principles. 6.16 Apart from conventional types of savings, such as restrictions on travel and the use of consultants, any savings would have to be sought in the Programme's three major areas of expenditure: aerial operations, larvicides and staff. Aerial operations and larvicide consumption had already been optimized on the basis of experience and interconnected computer programmes. Besides, the cheapest possible rates were sought for the aerial contract and larvicides. Staff costs were increasing year by year, but were governed by the United Nations system and therefore outside OCP's control: they could be reduced by continued staff reductions, but only within certain limits. For reasons of economy, but also for purposes of devolution and harmonization of employment conditions throughout the Programme area, most of the staff working in the original and southern extension areas would be transferred from WHO /OCP to their national civil services, and would thus be employed on the same basis as their counterparts in the western extension area. 6.17 The trend in the exchange rate for the US dollar had been favourable in 1991, and the Programme should thus end the year with a credit balance. The administrative services would continue to provide full support for the Programme's operational, technical and scientific activities. Comments of the reoresentatives of the Exoert Advisorv Committee 6.18 Although the Expert Advisory Committee (EAC) had considered the recommendation that its membership should include experts in public health and management, social sciences, training and environmental management, the Committee appreciated that the final decision on its composition remained with CSA. 6.19 While ivermectin had proved very effective especially in preventing and alleviating existing eye lesions, it did not have any effect on the adult worm which continued to produce microfilariae. Thus an effective macrofilaricide had to be sought. (See section 8 of this report). 6.20 In the context of devolution, OCP should continue to provide the tools necessary including diagnostic methods replacing skin-snipping as well as the required training. Until such time as skin- snipping could be replaced, which was highly desirable in HIY endemic areas, its use should be carefully controlled. Also, the potential masking effect of ivermectin distribution should be considered. 4.1 With regard to research, EAC reiterated the need to develop new larvicides, for example a new, lbss toxic pyrethroid, to make control less dependent on the three organophosphorus compounds for the discharges between l5 and 70 m3/s. This would remove the accompanying risk of cross-resistance and reduce the environmental effects. 6.22 Immunofluorescence and molecular biological research (e.g. DNA probes) were giving promising results in developing more accurate diagnosis. There should be further investigation of the different {orm of the disease that seemed to exist in Sierra Leone. There was also a need for more accurate dssessment of microfilarial loads and better infective larvae and blackfly identification. I JPCI2-B pa$e 7 6.23 EAC strongly supported the collaborative effort of ocP with the wHo Special Programme of Research and Training in rropical Diseases (TDR) in the search for an effective macrofilaricide' this joint initiative being fno*n as "Macrofil", and in immunodiagnostic techniques. The Committee also endorsed the search for new technology which could replace tedious morphometric methods' geared to the identification and dissection oimigrating fly populations and predicting recrudescence' Comments of the Chairman of the EAC Ecoloeical Grouo 6.24 The chairman of the Ecological Group stressed the economic importance of aquatic monitoring in terms of the value of freshwatei fishing in the Programme area, not to mention the economic value of the water resources themselves. The precautions taken in selecting insecticides for OCP were therefore fully justified. 6.25 The Group had approved the use of pyraclofos and phoxim as substitutes for chlorphoxim which had gone out cif production. It had reiterated the need for active research to find new compounds and new ftrmulations, to enable the Programme to cope with resistance to organophosphorus compounds and to maintain the environmental balance' 6.26 The deterioration in the general environment due to climatic factors and economic and industrial development was having .epe.cussions on the aquatic environment. The activities of people resettled in the onchocerciasis-fried valleys were bound to have some impact on the environment, including deforestation, and it was important to control and minimize that impact. Natural resources such as water and uegeiation were vital for survival in the OCP area and were closely interlinked. 6.27 There was an urgent need to take serious steps at the highest level to deal with environmental problems. Development should be sustainable, so that people would still be able to live in the Lnchocerciasis-freed areas in 20 or 30 years' time. The Ecological Group therefore recommended that the impact of development activities and measures for controlling it should be studied, not only by the Committee of Sponsoring Agencies, but also by the Participating Countries and the Donors. Discussion 6.2g It was observed that the "structural adjustment" policy pursued in several of the Participating Countries could make it difficult for them to retain and recruit the necessary staff as those countries had to increase their efforts in the field of devolution. The representative of the World Bank observed that its policy was to give priority support to projects in the social sector (including those for health, education and training) and encouraged countries to submit requests accordingly in relation to their requirements for devolution. Governments should protect the social sector in their structural adjustment prog,rammes (for further discussion, see section I I of this report). 6.29 In response to a question concerning parasite re-servoir and the risk of recrudescence it was stated that, with CMFL1 generally as low as I mf/sz, the Programme's objective of eliminating onchocerciasis as a public health problem could be considered to have been achieved in the major part of the Programme area. In this connection, the Programme Director reminded participants that it was not OCP's role to eradicate the disease. 6.30 It was explained that there could be a danger of recrudescence especially in border areas such as existed on the eastern border of OCP between Benin and Nigeria. It was recognized that such a problem area existed, but OCP was collaborating with Nigeria and an agreement had been reached with the Nigerian Government on priority treatment of that area. A meeting had been held with representatives of non-OCP countries in Ouagadougou during the year to review methods of rapid assessment and alternative detection of recrudescence. Community Microfilarial Load: the geometric mean of microfilariae per skin snip among persons aged 20 years and more, including those with a zero count. I 2 Microfilariae per skin-snip JPCI2-B page 8 6.31 OCP had, during the last year, made fellowship awards not only to Participating Countries but also to non-OCP countries. It was explained that this was to ensure coordination and to pass on OCP's experience to other countries, in particular regarding the first cyclc of ivermectin distribution. WHO's Regional Office for Africa was cfi)perating in the training programme, particularly in the financing of training for nationals of non-OCP countries. Guidelines relating to training requirements had been prepared by OCP. 6.32 Some delegates were concerned about the low level of participation of women in the training programme and the very low proportion of women among the staff of OCP, and requested a report to the next session of JPC on proposed measures to improve the situation. Participating Countries were urged to ensure that national policies on recruitment and training were adapted to provide a maximum of women candidates (see also the discussion on the budget, in section l0 of this report). 6.33 In reply to a question regarding the research priorities recommended by EAC it was confirmed that OCP had the means to fulfil the requirements for the applied or operational research designed to enhance devolution activities in countries, and to ensure that research findings were made use of in cost-effective ways. 6.34 At JPC's request a plan of action and related budgetary proposals for operational research activities would be elaborated and would be presented to its thirteenth session. 7. REPORT OF THE EXTERNAL AUDITOR: Agenda item 8 (document JPCI2.6) 7.1 The External Auditor had examined the OCP Status of Funds Statement and annexes and found them to be in order. His confidence was such as to have enabled him to leave it to the Programme Director to present that opinion. 7.2 JPC noted the report. 8. PROGRESS REPORT OF THE ONCHOCERCIASIS CHEMOTHERAPY PROJECT FOR l99l: Agenda item 9 (document JPCI2.5) p.l The Manager of the Onchocerciasis Chemotherapy Project (OCT) said that OCT in collaboration Jwith the TDR concentrated on the discovery and development of safe and effective macrofilaricides in a joint project known as "MACROFIL', intended to control both onchocerciasis and lymphatic filariasis. Formal approval for Macrofil by the Joint Coordinating Board of TDR had been given in June 1991. He explained that the'attrition rate" in drug testing - a process in which sometimes many ihousands of candidate compounds were reduced to very few promising clinical agents - was an important feature of drug development. 8.2 Ciba-Geigy, having published eight papers on clinical data about CGP-6140 (amocarzine) intended to produce and register that drug in 1992, when it would be available for use in OCP and elsewhere. Ciba-Geigy was ready to proceed to registration at its own cost. It might not futfil OCP's requirements as six doses over three days was necessary and it was toxic if not properly used. However, it could become an important means of control in foci of recrudescence. CGI-18041, a derivative of the same series, but apparently safer and less toxic, was undergoing further toxicity studies by Ciba-Geigy. Studies by OCT of efficacy on lVfuchereia od Brugia parasite strains in monkeys, using a single oral dose had demonstrated full efficacy. Finally, UMF-078 developed by an academic institution, which showed good macrofilaricidal activity against aBrugia parasite in dogs when administered orally or intramuscularly, was to be developed in a sterile formulation for irritancy studies in animals and rn rziryo studies for mutagenicity. WHO hoped to patent this promising compound by early December 1991. I JPCI2.B page 9 g.3 Behind these developments was the whole range of Macrofil research to identify targets and p"tfr*"y. to ensure that lead compounds continued to be forthcoming; and the keeping-up of contact ina forming of contracts with companies. Synthetic laboratories had to be contracted for resynthesis of productsl The Hohoe laboratoiy in Ghana continued to play an important role in clinical trials while additional collaborators were needed for clinical multicentre studies. g.4 The Director of TDR said that the Macrofil activities had been located close to the Product Denelopment unit of TDR, which had given priority to a candidate macrofilaricide in its initial year of operation. A simple legal agreement had been developed for chemical companies and there was renewed interest in collaborative research activities with industry. t E.5 He underlined the importance of using OCP's experience outside the Programme area and described the joint programme with Nigeria in ivermectin distribution, mappinS and anthropometric studies. Experts from-Ouagadougou were collaborating closely, avoiding duplication and ensuring synergy. TLe search for an immunological technique to replace histopathological examination of onchoiercal nodules was being pursued by TDR in collaboration with OCP. Further work formed the basis of a test able to detect the possible appearance of ivermectin resistance in onchocerca volvulus. 8.6 The representative of EAC, in stressing that a member of that Committee attended all meetings of the Steering Committee on Macrofilaricides, underlined the continuing need for a macrofilaricide and stated that the evidence of rapid scientific advances gave hope of new developments. EAC supported the TDR/OCP collaborative project, and had requested that priority be given to OCT *hir"rer possible, as it was felt the OCT budget was relatively modest (see the discussion on the Budget in section l0 of this report). Discussion 8.7 In reply to a delegate who quoted a report stating that if an effective macrofilaricide were discovered and developed it would render larviciding unnecessary, the Programme Director said that if really effective, safe and simply administered it would, but humans were much harder to control than flies. For example, when people began to feel better they were apt to interrupt drug treatment. Any product developed, tested and registered still had to be used for some time in man before it could be guaranteed for effective community use. He knew of no control programme that had Qeen sucJessful through drug administration alone. He confirmed that a field-applicable macrofilaricide, when available, would be used as a complement to larviciding. 8.8 As regards collaboration between OCP and non-OCP countries in research, the Programme Director said that knowledge was shared freely and readily, and the Regional Office for Africa gave some financial support. For some operational research, OCP had to rely on workers outside the Programme, so that it was truly a collaborative effort. In reference to the onchocerciasis project in Malawi supported by one of the Donors, the Director of TDR said that, Malawi was involved in OCT/TDR trials of ivermectin. 8.9 Several delegates expressed appreciation of ocT and its collaboration with TDR, associating themselves with the concern expressed regarding the size of the budgetary provision (see section l0 of this report). g. PLAN OF OPERATIONS FOR THE FOURTH FINANCIAL PHASE (1992-1997): AgENdA item l0 (documents JPCLZ.9 and JPCI2.l0 Revision) 9.1 The Plan of Operations summarized the main features of OCP operations for the period 1992- 1997: continuation of larviciding to control transmission; community-wide application of ivermectin for the control of disease manifestations including prevention of ocular manifestations; and preparation for, and implementation or consolidation of, the devolution process. There would also be an intensified search for a macrofilaricide- JPCI2-B page l0 9.2 It was expected that what larviciding there still was in the non-reinvaded original Programme area would cease by 1994, and that as vector control activities gradually ceased national efforts in the field of devolution would rapidly increase; residual larviciding in the formerly reinvaded zones would become part of vector control activities in the extension areas. The Plan specified the conditions for such activities, including epidemiological evaluation and entomological surveillance (the latter continuing for two years after larviciding had ceased). Monitoring of the possible effects of larviciding on the aquatic environment would focus on the southern and western extension areas. 9.3 OCP's Biostatistics and Information Systems Unit would play a key role in decisions on cessation of vector control and would contiirue to improve its modelling function for prediction of possible recrudescence. 9.4 The Plan further outlined measures for continued ivermectin distribution with increasing national participation and strengthened collaboration with NGOs. 9.5 There were sections on devolution and socioeconomic development (see the relevant sections of this report) and the benefits of and risks to the operations in the fourth Financial Phase were analysed. 9.6 The total cost was estimated at US $ 175 million. It was stressed that great pains had been taken to ensure that budgetary estimates for the planned activities were kept as low as possible and compatible with the achievement of Programme objectives. Reductions relating to larvicides or larviciding operations would represent a risk to the success of the Programme as it neared completion. Excessive use of cheap larvicides - which are the more toxic - would represent a threat to the environment. 9.7 EAC and the External Review Team had reviewed the draft Plan and their comments and recommendations had been incorporated. Discussion 9.8 In reply to questions on staff costs it was explained that the move towards national employment of OCP staff was well under way; oer diem paid to national staff were lower than the rate paid in the United Nations system. Lump-sum payments were made to supplement the national pay scale in relation to increased responsibility for those seconded to OCP. Harmonization of such benefits paid by different organizations was desirable in order to avoid rivalry among them for national staff. OCP would follow up a recommendation for elaboration of an equitable system. 9.9 The representative of a Donor country requested that the research component should be distinctly presented and adequate financial provision made, as any false economies in that component might be paid for dearly in terms of the eventual success of the operations during the fourth Financial Phase. 9.lO The Programme Director, explaining that the research component had been built into vector control and other operational aspects of the Programme, said that the former practice of separate presentation would be reverted to for JPCI3. It was pointed out that the TDR support could not be itemized in such a presentation. 9.1I It was noted that OCP incurred substantive expenses in CFA francs; it would be convenient if losses on exchange resulting from contributions paid in national currencies and other non US $ currencies having to be converted to US dollars could be avoided during the fourth Phase. The representative of the World Bank said that currency of contributions had been discussed at JPCll. The Bank considered that the Onchocerciasis Fund could be adapted to hold contributions not only in US dollars but also in CFA and French francs. This would help to avoid exchange rate losses, as well as losses due to sums in some currencies having to be converted twice. I g.l2 The Plan of Operations for.the fourth Financial Phase was aooroved. JPCI2-B page I I Io.PLANoFAcTIoNANDBUDGEToFTHEPRoGRAMMEFoR1992ANDITS APPROVAL: Agenda item ll (document JPCI2'4) lo.l Introducing the plan of Action and Budget for 1992, the chief of Administration and Support Services described the general outline of the document' lO.Z The proposed budget for lgg2amounted to a total of US $ 32,453,000. Compared to 1991, the amounts p., .",rgoij i.r. stable or had decreased, particularly that for aerial operations and i"i"i.iA"rlreducedfrom some US $ 6.1 million to about US $ 4.2 million following the large provision made for renewing stocks in lggl. As requested at JPCIl,_the'Personnel services'section showed io a ringfe presentlation the estimates both for the OCP staff employed in the original and southern extensiJn aieas and for the national staff employed by the governments in the western extension area. lo.3 The programmes of activity by unit included the new Devolution unit established following a ,e"o.rnendation of the Externainjrie* of the Programme, carried out in 1990, and approved by JpCl l. The unit co-piisea five professional staff members after internal transfers; the Office of the programme Director,;nd ottrer staff to varying degrees, were also involved in devolution activities' The unit's budget covered the staff, coniuttant iervices, fellowships and training, and various operating costs. lO.4 Three programmes of activity were considered as administrative and managerial and had been giouped tog.tt ri in the budger ttri orrice of the Director, Administration and Support Services and l,O.inistraiive Support in Geneva. Their cost amounted to I I .17% of the budget. lO.5 The administration of OCp assured representatives that the stringent budgetary policy applied in the past would continue. Discussion l0.6 It was explained that provision for devolution was at an early stage and that it was anticipated there would be an increase in the future. It was confirmed that the staff of the Devolution Unit, which also covered socioeconomic development, was being created by redeployment and not by recruitment. lO.7 The programme Director responding to questions as to why the Information Officer was one of those to be thus redeployed and what the planned use of consultants would amount to, replied that information was an imporiant part of OCP's catalytic role in the devolution process. He and other OCp staff also served the catalyiic purpose of OCP in devolution on their frequent visits to countries. Other important componen$ oi d"uolution were training - shared with the WHO Regional Office for Africa - as well as transfer of know-how and technology. Consultant services would be resorted to in fields where specific expertise not available in OCP was required for limited duration. lO.E As regards the role of the Devolution Unit in analysing studies in the Programme area to identify sitei for agro-pastoral production and development in zones freed of onchocerciasis, it was explained that emphasii would shift to the CSA which was considering initiatives to follow up studies at ttre national level resulting from the Hunting study and the other regional studies on resettlement prospects (see section l4 of this reporfi socioeconomic development). lO.9 A number of representatives, noting that the budget for the Onchocerciasis Chemotherapy project (OCT) amounted to only somewhat less than 7% of the total, suggested that it should be incieased. It was agreed that the OCT Manager and the Steering Committee for the project should examine further the financial requirements with a view to possible transfers of funds to OCT within the overall OCp budget, or with a view to other measures to increase the OCT budget, including the immediate provision of additional funds if any research developments in the period so warranted. JPCI2-B page 12 10.10 Since the elaboration with Ministers of Participating Countries of an OCP training policy at a meeting in Yamoussoukro, C6te d'Ivoire, in 1984, there had been strict observance of measures to keep down costs, discourage overspecialization and prevent the brain drain, with particular attention also to ensuring local applicability of acquired skills. OCP and the WHO Regional Office for Africa would cooperate in the devolution-oriented training of candidates from Participating and non-OCP Countries. l0.ll Several participants referred to the comparatively low proportion of women employed and trained by the Programme. It was recognized that while OCP followed WHO employment policy, including vacancy notices'encouragement to wofnen candidates, and although the Director's efforts with representatives of Participating Countries had redoubled since the question had first been raised in JPC, the role of women in development and the principle of equal employment opportunities required that more should be done. It was agreed that a report would be prepared for the next session of JPC on the efforts made by OCP to employ more women, including an analysis of the sex-ratio of candidates for OCP training. 10.12 In response to concern expressed that there was an overall increase in the budget for staff costs in spite of a 20% reduction in number of posts, the Chief of Administration and Support Services undertook to provide a detailed explanation of cost increases in a written report to all members of the Committee. 10.13 The Plan of Action and Budget of US $ 32,453,000 for 1992 was aooroved. I l. DEVOLUTION: Agenda item 12 (document JPCI2.7) I l.l The Programme Director stressed that the objective of devolution activities was to ensure that the Participating Countries would be able to maintain the achievements of OCP for decades after the Programme itself was wound up. Much progress had been made in the past year. Collaboration between nationals of Participating Countries, the WHO Regional Office and OCP had been established, and OCCGE1 was cooperating in the fields of training and ivermectin distribution. The devolution documents of the seven original OCP countries had been approved by JPC and it was now up to the countries concerned to implement their plans, hopefully with Donor support. ll.2 The Chief of the Devolution Unit announced that since the previous session of the Committee, that Unit had been set up at Programme Headquarters in Ouagadougou and the WHO Regional Office had appointed a Devolution Coordinator. The Devolution Unit had a staff of five: the Unit Chief, a parasitologist/epidemiologist, an entomologist, an agricultural economist and an information expert, all of whom had been appointed from within the staff complement of the Programme. In addition, the heads of the entomology sectors and subsectors were constantly involved in the information and awareness programme directed at local authorities and the general public. I 1.3 The role of the Unit, as recommended by the External Review Team, was to provide training, foordination and advice, and above all to act as a catalyst. Even before the establishment of the Unit, f36 nationals of Participating Countries had received training fellowships from OCP, and 4l further fandidates were currently under consideration. In-service training was continuing, mainly in the lreas of epidemiological evaluation methodology, ivermectin distribution and post-treatment monitoring. Countries had expressed their training needs for the fourth Financial Phase in the areas of ophthalmology, parasitology, public health, management of health services and entomology. Some training for intermediate and local staff was being provided in collaboration with OCCGE. Organisation de Coordination et de Cooperation pour la lutte Contre les Grandes Endemies. (Organization for Coordination and Cooperation in the Control of Major Endemic Diseases) 1 JrcI2-B page 13 I1.4 The Unit was laying much stress on public information and mobilization. In collaboration with the vector control unit-(vcu) it was cbnducting a large-scale information campaign. on their routine field visits, vcu itaff informed the villagers that the returning blackflies after cessation of larviciding represented no danger and explained the role of ivermectin where indicated. In areas at risk of recrudescen.., tt. corimunities were being asked to participate in systematic ivermectin treatment. It was noped that this community involviment would accustom the public to distributing ivermectin themselJes, lead to high covirage at lowest cost, prevent, delay or confine any recrudescence of the disease, and pripare the public to accept educational messages and collaborate more in health activities. I 1.5 The Unit was supporting operational research on the nuisance value of returning blackflies and its effect on socioecondmic deielopment in onchocerciasis-freed valleys, had prepared and distributed to participating Countries a guidi to ground insecticide treatment, and was preparing a list of sites of socioecono-ic importance, by country, where ground treatment would be appropriate' It was also conducting operational researctr.in some river basins on systems for epidemiological surveillance, on the frequJncy of ivermectin treatment, on approaches to be taken by officials in sentinel villages, in order to recommend low-cost approaches to Participating Countries. I1.6 participating Governments were showing genuine political will and were prepared to do ali ir: their power to carry out devolution of ocP activities. It might seem paradoxical to urg,e countries to give iriority to devolution at a time when other diseases were taking an enormous toll of human lives, but there was no real paradox. After the successful 20-year campaign to bring onchocerciasis under control, a sustained efiort by countries to maintain the achievements would represent an efficient use of resources. ll.7 The Representative of the WHO Regional Director for Africa added that since the previous session of the Committee a number of measures had been taken to support devolution. The Regional Dir""to, had appointed a Devolution Coordinator, based in the office of the WHo Representative in Ouug"Oougou;iir. Coordinator's responsibilities and programme of work were outlined in a document befoie the Committee. A Devolution Task Force had been set up, consisting of representatives of the Regional Office and OCCGE, the Devolution Coordinator and the OCP Devolution Unit. The neiionat Office had also supported the creation of national disease prevention and control teams' wfr6se tasks would include thi plannin g, orgrnization and monitoring of devolution. I l.g The Regional Director had furthermore requested wHo representatives in the Participating Countries to encourage the allocation of specific budget lines for devolution. Proposals were being prepared for integratJd parasitic disease control activities at district level, as malaria, trypanosomiasis and other parasitic diseises affected the same populations as onchocerciasis and would be dealt with Uy tt e same health personnel. A vertical programme could not be converted into a horizontalpiog."... unless there was an efficient health system at district level. I 1.9 The Representative of OCCGE confirmed his Organization's willingness to collaborate in setting up national devolution programmes. Such collaboration had already started, with the preparation of tr-aining modules for local staff. OCCGE's institutes of entomology and ophthalmology were available to participating Countries for staff training. A training programme in epidemiology and health services management was being set up in collaboration with the Centres of Disease Control, Atlanta, U.S.A. and several universities in the western world' I I . l0 The Representative of Burkina Faso informed the committee that his country's devolution plan had recently been revised. The cost was being financed by the \Yorld Bank over a five-year period, and the planned activities covered informatlon, health education and communications; selective ivermectin treatment of all first-line villages by the communities themselves; and epidemiological suryeillance. At a ceremony held in a r€setiled village in 1991, responsibility for national devolution activities had been formally launched in the presence of the Head of State. JPCI2-B page 14 ll.ll The Representativc of Ghana reported that his country's devolution document had been officially approved in October 1991. The document had been widely circulated to Donors and some offers of support had alrcedy been received. The devolution plan combined onchocerciasis control with the elimination of guinea-worm, the eradication of yaws and leprosy control, and satisfactory progress was being made. Ivermectin distribution via health facilities had proved ineffective and was being replaccd by community distribution. I l.12 The Representative of Cote d'Ivoire said his country had the necessary staff, infrastructure and logistic resourc,es for devolution, but was having to adjust its onchocerciasis control and training activities to the availability of funds. 11.13 The Representative of Niger stressed that the political will for the devolution process was pres€nt in his country, since socioeconomic development in part of the country depended on maintaining the achievements of OCP. National resources had been used to train nurses for devolution activities, and to undertake public information. A Donor had already agreed to finance one-fifth of the devolution, and an NGO was to provide substantial assistance with divolution in the field. Discussion I l.l4 All the Participating Countries reiterated their willingness to cooperate in dcvolution, but pointed out the extreme difficulty of committing funds to devolution at a time of structural adjustment and lower external funding. Some national health services were having to reduce their own staff, which made it all the more difficult to absorb OCP staff under the arrangements for devolution. In some countries of the Programme area fewer than half the population had access to basic health services, and in such circumstances it was unreasonable to place an additional burden on national health budgets. Before real progress could be made towards devolution, it was necessary to ensure that countries had the necessary base of skills, infrastructure and resources, not just in the capital but nationwide. ll.l5 OCP and the lVorld Bank would assist countries in seeking external funding for the implementation of national devolution plans. Some countries regretted the present piecemeal {PProach, whereby each country had to seek funding separately on a bilateral or multilateral basis, dnd would prefer a more coordinated approach to the funding of devolution. A difficulty was that {pplications for funding normally had to be channelled through thi Ministry of Finance, which might liave quite different priorities from the Ministry of Health. I I t.t6 Some participants expressed concern that the composition of the OCP Devolution Unit did not fully reflect the wishes of the External Review Team. In particular, there was no social scientist the Programme was endeavouring to remedy the situation. I I .17 Although the provision in the budget of the Devolution Unit for short-term consultants to assist oountries with their devolution activities was only US $ 56,000, the Programme Director had authority to transfer up to l0% of funds from other budget lines if he deemed it necessary, and could make approaches to CSA for further support. ll.l8 A delegate pointed out the need to set out an agenda for operational research on devolution, specifying the units responsible in the case of OCP-funded research. ll.l9 The Committee welcomed the setting-up of an institutional framework for devolution, but participants expressed concern at possible overlapping of the responsibilities of the OCP Devolution Unit, the WHO/AFRO Devolution Coordinator, the WHO-AFRO/OCP/OCCGE Task Force and the WHO country representatives. It was also felt desirable to develop measurable objectives and output indicators for those bodies. An assurance was given that every effort was being made to coordinate their activities and avoid duplication. OCP was asked to submit to the JPC at its thirteenth session a paper defining the respective roles and responsibilities of the bodies concerned, together with measurable objectives, work plans and monitoring systems wherever possible. JrcI2-B page 15 ll.2o A start would be made in 1992 on drawing up devolution plans for Guinea, Guinea-Bissau, Senegal and Sierra Leone. However, since OCP activities had started in those countries only a few yearJago, it was important not to rush into devolution before the ground was prepared. I l.2l participants agreed that local health workers must know when Eg! to give ivermectin, so as to safeguard the efficacy of epidemiological surveillance and ensure the early detection of recrudescence. The-OCp Manual of Procedures for Ivermectin Distribution and Monitoring Adverse Reactions did not cover the matter adequately and would be revised. 11.22 A problem encountered in the field was that villagers were not easily convinced that the blackfliei they saw returning in large numbers were harmless. Since they knew an effective drug was available, they were reluctant to cooperate in providing skin-snips unless they were given the drug. I1.23 In response to a query on the role of NGOs, the Programme Director reminded the Committee of the guidelines for collaboration by NGOs approved at the ninth session. By and large those guidelines were being respected by the NGOs concerned. 12. ONCHOCERCIASIS FUND AGREEMENT: Agenda item 13 l2.l The representative of the World Bank introduced the text of the Agreement that had been considered by Donors at their Conference in Bonn in September 1991. In order to complete section 3.01 of the Fund Agreement, the Bank needed to receive the amounts of Donors' commitments and the language they would like included to express such commitments before January I l, 1992 so that the agreement could be ready for signature in Washington, D.C., on 24 February at a ceremony to which the Participating Countries would be invited to attend. [t was essentially the same as the previous Agreement. Apart from the contributions of individual donors, a second change, in section 3.04, concerned the Bank's reporting. The Bank would now only report once a year to each Coniributing Party on contributions, receipts and disbursemenS to and from the Onchocerciasis Fund, in the form of a statement certified by the Bank's external auditors. The cost of such statement and report would be charged to the Phase IV Fund as an operating expense. The third change involved section 3.04 where a provision had been included that the Bank would waive all other operating expenses of administering the Fund except for the cost of the audit statement. The fourth change, inlection 4.01, concerned interest earned on amounts disbursed from the Fund but held temporarily in WHO, specifying that such interest would be used exclusively to finance the Programme. 12.2 Some Donors were still discussing the Agreement with their legal authorities. The Representative of the World Bank appealed to them to complete their internal reviews well in time for the signature ceremony in Washington, D.C. 12.3 The Legal Adviser, introducing the accompanying Memorandum of Agreement, said it was essentially the same as that for the third Financial Phase but contained some modifications relating to devolution and socioeconomic development. Section 2.2 (i) made provision for transfers between budget lines exceeding l0% and supplementary budgets to be provisionally authorized by the Chairman of CSA pending final approval by JPC. Section 2.2 (iii) named among the CSA's duties the study of particular aspects of the Programme, including socioeconomic development and providing "support for the Participating Governments, as appropriate". 12.4 The number of members of EAC had been kept at 12, but the range of disciplines to be covered would be broadened in accordance with the concerns of JPC (section 4.1 (ii)), when five members were to be renewed in the near future. 12.5 Certain new tasks relating to devolution and socioeconomic development were included in the section on National Onchocerciasis Committees (section 5.2 (iv) and (v)). JFCI2-B paSe 16 12.6 The Memorandum also contained a reference to increasing involvement of Participating Governmcnts in control activities in the context of devolution (Appendix II). 12.7 The representative of Kuwait announced that his country's name should be added to the list in Article III of the Fund Agreement. l2.t The Programme Director welcomed Kuwait back to OCP and thanked all Donors, the CSA and the World Bank representatives for their part in ensuring continued support for OCP. The reprcscntative of a Participating Country also expressed appreciation. i3. FINANCING OF THE ONCHOCERCIASIS CONTROL PROGRAMME: Agenda item 14 l3.l The representative of the lVorld Bank reported that total expenditure for the third Financial Phase of OCP (Phase III) was US $ 180 million as against US $ I85 million of funds available for that Phase. The surplus of US $ 5 million would be carried over into the Phase IY Fund along with the US $ l0 million contingency reserve. Recalling the difficulties encountered early in Phase III, problems of resistance of Simulium to larvicides, exchange rate fluctuations, and the new responsibilities the Programme had assumed, it was a major accomplishment for the OCP community to have overcome a US $ 35 million deficit since 1987. He paid tribute to the donors for their steadfast support and willingness to provide supplemental increases when they were needed, to the Programme for economizing on expenditures and to the Participating Countries which made it clear that overcoming onchocerciasis remained one of their highest development priorities, which had in turn earned the confidence of Donors. 13.2 The US $ 175 million proposed to finance Phase IV represented less than one US dollar per person protected per year, and was 26% less in real terms than the total for Phase III. However, required Donor contributions for Phase IV would exceed slightly (by about 6%) those for Phase III (US $ 165 million compared with US $ 157 million) due to a smaller surplus carried over at the end of Phase III than at the end of Phase II and lower anticipated interest earnings. 13.3 The lVorld Bank had been in contact with all Donors individually as well as collectively at the Donors'Conference in Bonn in September l99l when their commitments indicated that there would be an estimated shortfall of about US $ 12 million. t3.4 Twenty two Donors had confirmed that they will participate in Phase IY and there remained two possible new Donors. He welcomed the renewed support of Kuwait, an old friend of the Programme and a long-time supporter. The River Blindness Foundation, whose observers were present at the current session of JPC, was also a possible new Donor. Indications were that, about half the Donors expected to contribute at the same level as for Phase III, while two would probably reduce their contribution. Nearly one-third of the donors had indicated a willingness to increase their contributions over levels for Phase Three. Given projected expenditures of US $ 175 million and current estimates of available financing through 1997 of approximately US 163 million dollars, the Bank was projecting a shortfall for Phase Four of l2 million dollars. This approximation suggests the need for Donors who might have the flexibility to do so, to follow the example of the Kingdom of Saudi Arabia and consider increasing their support for OCP prior to the signing of the Phase Four Fund Agreement in lVashington on February 21. ln the longer term, the Bank intended to seek to bridge the projected financing gap for Phase Four by encouraging supplemental increases from selected Donors and by recruiting new Donors into the Programme. JPCI2-B page 17 13.5 Donors made the following pledges to OCP's Phase IV: Itrorld Bank: France: Germanv: Beleium: Calouste Gulbenkian Foundation: Portueal: Kuwait: Luxemboure: Saudi Arabia UNDP: United-Kinedom: United States of America us $ 15.8 million in instalmens of $2.63 million per annum, subject to the decisions of its Board of Directors (8% more than for Phase ur). FF 45 million in instalments of FF 7.5 million per annum, anticipating that a surveillance network would be established permiitingiontrol of recrudescence, and that training in management and sociaisciences would be assured with a view to devolution. The representative noted OCP's reputation and example in respecting the environment, which should be kept up. DM 2 million to be paid in 1991, D'llz million in 1992. commitment to 1993 and the remaining years of Phase IV could not be expressed in figures yet, but there was no danger of Germany's abandoning ocP after its association of 17 years standing and contribution totalling DM 35 million since the beginning. Belgium francs l6 million in 1992,subject to parliamentary approval, and further instalments to be determined by the authorities on an annual basis. A loan to Mali from the Belgian survival Fund for devolution activities was also announced. US $ 50,000 in 1992 as a first instalment. US $ 5O,OO0 per annum starting in 1992, subject to parliamentary approval. us $1.5 million for Phase IY. Kuwait was unable to contribute at the same rate as earlier because of the costs of national reconstruction, but would assist in related agricultural and other programmes in countries and provide'concessional loans" and advisory services. Luxembourg francs 5l million for Phase IY (about us $1.5 million) in annual instalments of francs 8.5 million making Luxembourg one of the highest contributors oer caoita of any contributing country. US $ 14 million for Phase IV. us $ 7.5 million for UNDP's 5-year financial period. ocP was the only programme for which UNDP was maintaining the same level of funding. A sum in 1992 at least as high as the f 950,000 contributed in l99l (46% higher than in the first year of Phase III). UK was proud of its itatus asan original Donor, but could only pledge one year at a time. us $ 2l million for Phase IV subject to the establishment of objectives by stages of Phase IV activities; submission by 1995 of ouistanding national plans for devolution; evidence of continued progress in cooperation in devolution and socioeconomic d.retrprn.nt, continued monitoring of environmental effects in JPCI2-B page lt association with the Environmental Monitoring Programme and establishment of national monitoring bodies. The United States could not commit itself to contributing beyond Phase IY. Switzerland: Netherlands: Swiss francs lE millions for Phase IV Dutch guilders 27 million in annual instalments of guilders 4.5 million. The Netherlands would also give increased support for primary health care activities and devolution in Participating Countries in relation to fundable projects, particularly in Mali. Reoublic of Korea An amount to be announced later. The Government had confirmed its continued support for Phase IV. Japu: 1YHO Executins Aeencv: (as above) US $ 250,000 per annum. 1VHO also waived programme support costs, which represented a considerable amount. Canada: Can $ 1.7 million per annum (as for Phase III) Eurooean Economic Communitv: ECU 7 million for Phase IV (almost US $ 9 million). African Development Bank US $ 2.24 million (at a minimum) for Phase IV 13.6 The representative of Guinea thanked the Donors on behalf of the African Participating Countries, who undertook to do all in their power to maintain the achievements of the Programme. 13.7 The representative of the World Bank said that, assuming that Donors who could only commit themselves one year at a time continued to contribute at the anticipated rate, contributions totalled US $ 144 million, which together with the US $ 5 million carried over from Phase III and US $ 4 million to be earned in interest came to US $ 153 million, leaving a deficit of about US $ 22 million. This constituted a solid basis for launching Phase IV and continuing its operations over the next several years. 14. SOCIOECONOMIC DEVELOPMENT: Agenda item l5 l4.l The representative of the World Bank said that socioeconomic development was one of the mainjustifications for the Programme through the benefits it offered for the zones freed from onchocerciasis. Socioeconomic development being outside the mandate of OCP itself, the CSA had assumed responsibility for supporting the development activities. How it had done so since the JPC had endorsed the original mechanisms paper at its seventh session in Accra in l9E6 was fully covered in the previous year's progress report, together with a description of subsequent events leading from completion of the regional preparatory survey known as the Hunting study in l98E to the Land Settlement Review and resulting seminar in Ouagadougou in 1990. 14.2 OCP areas had been recognized to offer for agricultural and riverine production perhaps the largest under-utilized arca in.Africa. But rapid migration and settlement would be accompanied by substantial risk of deforestation and soil degradation. 14.3 CSA agencies and governments were already cooperating in projects in the OCP areas, such as environmental action plans in Burkina Faso and Ghana, projects supporting the sound management of natural resources in Burkina Faso and the Bougouni region of Mali and in a study of the environmental effects of settlement near the Kompienga dam in Burkina Faso. JPCI2.B page 19 14.4 In this context CSA proposed: (l) to organize a Confercnce on Environmentallv Sustainable Seitlement for senior officials from the Participating Countries, preferably Ministers of Planning,fffi*" and related sectors, and experts from international and bilateral agencies, to discuss policy isires; (2) to sponsgl a studv of the use and environment4l Qffects of oesticides qnd asro-chemicals building oo OCP's e*perience with pesticide use and monitoring and the advice of EAC's Ecological Group. 14.5 The representative of UNDP added that, while there were already signs of success in terms of national programmes for development, opportunities existed for more national exploitation of the 'development dividend' using the experience accumulated in the Hunting report and the Land Settlemlnt Review. There was no CSA budget for economic development but the Committee would play a'productive" role at the regional level in coordinating subjects supported by the World Bank, UniOp and other agencies and Donors. It was hoped that countries would seize the opportunity for planning more specific resource mobilization and investment negotiations in country-specific meetings. 14.6 The Representative of Eftlne-Fj5q, adding to the report made in 1990 by the Director of the Office National pour I'Am6nagement du Terroir (ONAT) on the work done in analysing the potential of "oncho-freed'areas to which tens of thousands of people were returning, and mapping them as part of a master plan for development, said that some 2,000 km of roads and tracks had been made and over 30 wells sunk; IO,OO0 more cattle were maintained, and cereal and other crops were being cultivated; per capita production and income had risen. The peasant organizations were a real support to the development effort. ONATs strategy had been widely appreciated. He mentioned the visit of the President of the lVorld Bank in 1991, and visits by President Mitterand of France and the Director of the French Fonds d'Aide et de Cooperation. But the full potential was not being used; the level of support varied under the present "collegial'system of coordination; some areas benefitted from preferential support, some had become development experiments, some were rather neglected, and the threat to the environment of rapid unplanned resettlement was recognized. He supported the CSA's proposal for a conference, welcoming the possibility for collective reflection and planning, which would provide an opportunity to put agropastoral development on the right track. 14.7 The Representative of Ghana said that countries recognized their responsibility for socioeconomic development of the oncho-freed areas. The Hunting report and the Land Settlement Review had been found useful; in Ghana recommendations on rice-growing and road- and bridge- building had been followed and health centres were being established. He repeated the concern expressid the previous year about Ghana's vulnerable position vis-i-vis the Volta catchment area and the need for measures to prevent pollution and deforestation, especially with the move away from traditional systems of "shifting' cultivation allowing land to lie fallow to systems that relied on agrochemicals and pesticides. He agreed that the CSA's cooperation in following up the Hunting report and Land Settlement Review and ensuring the adoption of policies for appropriate exploitation and protection of resources was timely. He welcomed the provisions concerning employment of women. He suggested that countries should be invited to send three participants rather than two, to allow representation of all sectors concerned and particularly environmental protection authorities. l4.E The Representative of Benin stressed the need for coordinated efforts at all levels to ensure the exploitation and protection of resources: the proposed international conference should find a response at the national level. In Benin there was a national commission at ministerial level covering several sectors to ensure integrated policies. National policies should be reflected at the local level, where popular efforts must be harnessed and education provided concerning land use and agricultural policies, reafforestation, environmental protection, and health. Local funds might be established for specific purposes as wits done in Benin for women's associations. JPCI2-B ga;ge 20 14.9 The Representative of Guinea-Bissau said that in the Western extension area experience was already being accumulated concerning development and protection of the environment in an intersectoral approach linking authorities for planning, agriculture, tourism, rural development and health. She supported the proposal for a regional conference, for which national preparatory committees should be formed and country reports submitted after consultation between countries. She also supported the Ghanaian proposal that each country should be invited to send three participants. 14.10 The Representative of C6te d'Ivoire described the national socioeconomic development programme covering infrastructure, road-building, well-digging, sanitary installations and establishment of farming communities for livestock raising and sugar, soya and cotton crop-growing in the freed areas. Coffee and cocoa plantations had also resumed after the success of the extension of OCP operations. He, too, welcofted the CSA initiative. l4.l I The Representative of the WHO Regional Office for Africa associated himself with the remarks of representatives of OCP Participating Countries on the need for multidisciplinary action and intersectoral coordination, recalling the declaration made by Ministers to that effect and the Bujumbura appeal for integrated health measures. The proposed conference on sustainable resettlement would fit in well with the planned conference in 1992 on community health in Africa. 14.12 The Representative of the EAC Ecological Group, referring to the CSA initiative for monitoring of land use, stressed the need for coordination of all monitoring. In particular, land use monitoring and monitoring of rivers must be combined and synchronized to ensure valid results. Sometimes benefits in one element could be offset by losses in the other; the importance must be recognized on the one hand of fishing as well as livestock farming in protein production, and on the other of the need for irrigation of land crops and the prevention of water pollution and depletion as well as deforestation and soil erosion. Ecologists were the physicians of land and water. The monitoring sites established for OCP represented a source of long-term data on the status of fish and invertebrates in the area that were not available in many other parts of Africa; they should be kept up and coordinated with the results of other studies; the situation of other and untreated rivers should be studied for comparison. That could not be assured by the current OCP teams. It was hoped that a formal ecological group would be established to ensure the continuity of ecological monitoring, evaluate development plans, make recommendations and help to ensure that resettlement was sustainable. 14.13 The Representative of FAO promised FAO's continued cooperation in the OCP areas, in which it was investing considerable resources. Of its activities in the I I countries, some 250 were directly related to the aims of the Programme. The FAO Conference had recently endorsed a plan for the Sahelian subregion, where the soil nutrient status had been found to be particularly fragile. FAO would be closely involved in discussions of such aspects of sustainable resettlement and socioeconomic development, and its Regional Office was organizing, as a follow-up to the Ouagadougou seminar, exchange of experience in Burkina Faso, C6te d'Ivoire, Niger and Mali. Most countries in the area were parties to the International Convention on Plant Protection and had established national authorities which should be involved in monitoring of the environment and ensuring dialogue. Study of the effects of pesticides and agrochemicals in the environment was very important in relation to resettlement, but the means of scientific analysis were not everywhere available. He hoped that by the time of the proposed conference it would be possible to plan cooperation in such environmental iaspects and to determine its limits. 14. I 4 One delegate welcomed the attention to environmental questions; the manner of implementation of measures to ensure planned development was problematic and would require thorough preparation and coordination. For example, many forest reserves were protected sites only in name. He warned against overambitious proposals, and preferred the convening of national conferences to an iiternational conference to determine policies in the field. Another delegate, in supporting the CSA tnrooosals showed that while countries should make their own decisions on development, cooperating lae.nci.s could play a useful 'proactiven part and should remain vigilant and ready to help. Thelpiopor"A conference should seek to establish clear policies and measurable objectives for sustainable resettlement. JPCI2-B pa;ge 2l 15. OTHER MATTERS: Agenda item 16 l5.l The Representative of Luxembourg reminded the meeting that during the announcement of contributions to finance Phase IV of OCP he had raised the question of proportionality of contributions. He now requested that relevant documents should henceforth include an indication df Donor countries' contributions oer caoita of their-population. 16. DATE AND PLACE OF THE THIRTEENTH SESSION: Agenda item 17 l6.l The Representative of Niger announced with regret that owing to their economic constraints the Government would have to withdraw its invitation for the next session of JPC. The Programnte Director said that members would be informed in due course of the venue for the thirteenth session of the JpC to be held during the second week of December 1992. The Representative of Luxembourg confirmed his Government's invitation for the fourteenth session in 1993. 17. CLOSURE OF THE TWELFTH SESSION: Agenda item 18 17.l The session closed with the customary exchange of courtesies. Participating Countries and Donors voiced satisfaction with the conduct and results of the session. Particularly hearty thanks went to the Kingdom of Saudi Arabia for its overwhelming hospitality. Warm commendations rewarded .the untiring dedication of the secretariat and staff. RECOMMENDATIONS AND DECISIONS participating Governments encouraged to make allowance for support to devolution in ongoing and new public health projects funded by the World Bank. The Committee of Sponsoring Agencies to consider at an early date the membership of the Expert Advisory Committee (EAC) to reflect the need for expertise in devolution-connected specialities. OCP to prepare for EAC a paper detailing, by research activities, the financial requirements throughout the fourth Financial Phase, including allowance for operational research, also in respeJt to devolution. This paper to be presented to JPC at its 1992 session. The OCT Manager and his Steering Committee will estimate the Project's financial needs for consideration by the Committee of Sponsoring Agencies (CSA) with a view to a possible transfer of allocations within the overall OCP budget or an increase in the total budget. JPC noted the report of the External Auditor on the status of funds statement and annexes. JPC endorsed the close collaboration between OCT and TDR in the joint Macrofil project- OCP will look into the issue of organizations competing for national staff in order to arrive at an inter-agency harmonization of the financial benefits of such staff. Allowance will continue to be made for Donors to pledge in national currencies, US dollars, or French Francs. The proposal for the Plan of Operations for the fourth Financial Phase was approved. 2. 3. 4 5 6 7 8 9 JrcI2-B pagc 22 10. A document specifying the effors made to increase the OCP employment of women, including the sex ratio of candidates in the OCP-funded training programme, will be prepared for discussion at the 1992 session of JPC. ll. OCP will transmit, in a near future, a paper explaining the relatively high cost increases of the OCP staff complement, to all participants in the current session of JPC. 12. The proposal for the Plan of Action and Budget in the amount of US $ 32,453,000 for 1992 was approved. 13 OCP witl submit to thc Jrc 1992 session a paper presenting the roles of, and relationship between, the OCP Devolution Unit, the WHO/AFRO Devolution Coordinator and the WHO- AFRO/OCPIOCCGE Task Force attcmpting also to identify measurable objectives, work plans and monitoring systems. 14. The lYorld Bank, in collaboration with OCP, will help to attract Donor slpport to the implcmentation of national devolution plans. 15. The OCP Manual of Procedure for ivermectin distribution and monitoring adverse reactions will bc rcdrafted. 16. JPC endorsed the holding of a high-level conference on policy issues of environmentally sustainable settlement and the preperation towards the agro-chemical monitoring within the OCP area- 17. The OCP expertise will be available to help also non-OCP countries IE JPC decided to hold its thirteenth session during the second week of December 1992. The venue will be communicated at a later date. JPCI2-B w$e 23 ANNEX I OPENING STATEMENT BY DR R.H. HENDERSON, ADG, WHO ON BEHALF OF THE DIRECTOR-GENERAL OF WHO Thank you Mr. Chairman, The Director-General of 1VHO regrets very much that he is unable to attend this session of the Joint Programme Committee as a prior commitment coincided with the timing of your Committee. Dr. Nakajima has therefore asked me to read to you the following message: 'Excellencies, Ladies and Gentlemen, 'It has been my pleasure for a number of years to share with you my impression of the progress, achievements and workplans of the Onchocerciasis Control Programmc. The Programme Director keeps me constantly informed about developments within OCP and the reports I receive about its progress are a source of satisfaction to me. "Mr. Chairman, the Onchocerciasis Control Programme has reached an important milestone as it now completes its third Financial Phase and moves into the fourth Phase. Let me therefore take this opportunity to look back for a brief moment on OCP's achievements during the past six years, and then share with you some thoughts about the future of the Programme. "During the early years of the third Phase, OCP encountered operational difficulties. Resistance to the universally used larvicide was spreading throughout the OCP area and threatened to jeopardize the progress of the Programme. This crisis, however, was overcome and the results of vector control have, since then, been impressive. In the major part of the original area it is no longer trecessary to carry out larviciding, as the prevalence of onchocerciasis has reached the level at which transmission cannot be sustained. And vector control in the extension areas is now well underway with the expectation of similarly good results within the foreseeable future. 'Mr. Chairman, last year I stressed the importance of the use of ivermectin to control clinical manifestations of onchocerciasis and to prevent impaired vision and blindness. It is encouraging to seq therefore, that community-wide ivermectin distribution has become an integral part of control operations and that national teams carry out the major part of the work, as they already do when it comes to epidemiological evaluation. "And this, Mr. Chairman, brings me to another issue to which I made reference at the JPC session in 1990, namely that of devolution. I am encouraged by developments in this field particularly during the past twelve months. Several of the countries directly concerned have started implementing their devolution plans, in some cases with Donor support. Also, the appointment of an inter-country Devolution Coordinator by the Director of the WHO Regional Office for Africa and the creation of a Devolution Unit at OCP Headquarters will be helpful in supporting further acceleration of the process. The increasing involvement of Participating Countries in OCP operations augurs well for the success of devolution. "I would now like to turn to the future. Mr. Chairman, during its current session, your Committee will consider a proposal for a Plan of Operations for the fourth Financial Phase. The planned operations for the coming six years do not differ in substance from those implemented during the third Phase. Yector control will be confined almost exclusively to the extension areas, while large-scale ivermectin distribution will continue to combat the clinical effects of onchocerciasis and p.euent its ocular manifestations, in particular in zones without vector control. The Plan of Operations also makes provision for continuing the search for a macrofilaricide and I would like to encourage OCP and TDR in this joint effort which could eventually provide us with an additional means of transmission control and greatly facilitate the control of recrudescence. ,, JPCI2-B page 24 Annex I ',The proposed Plan of Operations lays great stress, and rightly so, on the preparation for, and strengthening of, the devolution process. Mr. Chairman, in my address to yourCommittee last year, I insiited thai'the ultimate srccels of ocP will stand or fall on the extent to which future instances of recrudescence will be detected and controlled". As I have already mentioned' I am impressed by ih. progrrs made during the last twelve months, but there is still a long way to go if we are to iu."La-i" fully integrating effective surveillance and control of onchocerciasis within the existing national health care lysteris. I see these as challenges to the countries concerned as well as to the internationat community. what is at itake is to mainiain, on a sustainable basis, the achievements of thc programme, and tiris requires functional health care systems with a strong public health *^pooIot. In itris connectionl would suggest, Mr. Chairman, that OCP could very well becorne an example of how a vertically structurgd programme, oriented towards the control of a single disease, a- "u"otrrally make a critical contribution to multidisease control and overall health development. I wish, thereiore, to reiterate WHO's commitment to supporting the devolution process which is clearly within the organization's constitutional role of cooperating with Member States in strenjthening their healih care systems and coordinating external support in that respect. ',Mr. Chairman, Ladies and Gentlemen, the end of our Programme is in sight. The implementation of the plans for the tgg2-1997 period will prepare the ground for a rapid tapering off of OCp operations and allow them to come to an end by the turn of this century. The never failing adhesion among the partners of the Programme has been one of ocP's remarkable features. I have no doubt that b-y remaining united we shall, through our joint efforts,'share the satisfaction of witnessing the removal, for good, of a serious public health problem which for ages has threatened and burdeneO tt e lives and *eil-being of numerous people in West Africa and prevented them from fully exploiting the potential resources of their land. ,'Before I conclude my address, Mr. Chairman, allow me, as Director-General of the Executing Agency of our programme, to thant< all those who have contributed so generously to moving OCP a to"ng o,ay towards iL sr,rccessful conclusion. My sincere gratitude goes to the Participating Countries and the Donor community, who, together, have made the Programme possible and who have never failed to provide the requiied finaniial, logistic and operational support, including the provision of staff by tire participatini Countries. Also Donors should be congratulated for so willingly closing the funding gap that occurred early in the third Financial Phase' ,,I am deeply grateful to the members of the Expert Advisory Committee and the Ecological Group whose independent advice and recommendations have helped OCP to conduct its operations in accordance with scientifically and technically sound principles, and to ensure that prolonged larviciding, as carried out by the Programme, has no untoward effect on the environment' ,,My warmest thanks are due to the Committee of Sponsoring Agencies whose members have spared no efforts in helping to guide oCp towards meeting its objective as well as in dealing with house-keeping matters.'Th; Committee's interest in, and support to, socioeconomic development is particularly welcomed. The special efforts of the World Bank to ensure financial backing for the iourth Financial Phase deserves special commendation' ,,The programme is fortunate in having a corps of competent and devoted staff who do not shy away from ,roiting under often very taxing conditions. We owe them full recognition for their sterling Performance. ,,And last but not least, Mr. Chairman, I would like to thank the Government of the Kingdom of Saudi Arabia for hosting this, the twelfth session of the Joint Programme Committee. t feel confident that the excellent arrangement made by the host country will be conducive to an interesting "nA pioOr.tive session of the Committee. I wish the twelfth session of JPC the best success". This, Mr. chairman, concludes the message of the Director-General of wHo. Thank you. S JPCI2-B page 25 ANNEX II l. 2. 3. 4. 5. 6. 7. 8. 9. 10. ll. t2. 13. t4. 15. r6. t7. 18. AGENDA Opening of the session Election of officers Adoption of the agenda Adoption of the report of eleventh session of the Joint Programme Committee Reflections of the Committee of Sponsoring Agencies Progress report of the lVorld Health Organization for l99l Report of the Expert Advisory Committee Audit report Progress report of the Onchocerciasis Chemotherapy project Plan of Operations for the fourth Financial Phase (1992-1997) Plan of Action and Budget of the Programme for 1992 and its approval Devolution Onchocerciasis Fund Agreement 1992 Financing of the Onchocerciasis Control programme Socioeconomic Development Others matters Date and place of the thirteenth session Closure of the twelfth session JrcI2.B p^ge 26 ANNEX.III LIST OF PARTICIPANTS PARTICIPATING GOVERNMENTS Benin. Reoublic of Son Excellence Madame Veronique LAWSON Ministre de la Sante publique Dr. Hippolyte S. AGBOTON Conseillirr Technique, Ministire de la Sante publique Burkina Faso Dr. Siguigna Amadou OUIMINGA Ministre de la Sante, de I'Action sociale et de la Famille Dr. Sie Roger KAMBIRE Coordonnateur national de la Devolution, Ministere de la Santr!, de I'Action sociale et de la Famille M. Y. Emmanuel NIKIEMA Directeur general de I'Office national d'Amenagement des Terroirs (ONAT, ex AVV) Ministere de I'Agriculture et de I'Elevage C6te d'Ivoire Dr. Mathieu SAKI ZADI Directeur de la Sant6, Direction de la Sante communautaire, Coordonnateur national de Lutte contre I'Onchocercose, Ministire de la Sante et de la Protection Sociale Ghana Col. Emmanuel M. OSEI-OWUSU PNDC, Secretary for Health Dr. Joe A. ADAMAFIO Deputy Director of Medical Services, Ministry of Health Mr. James K. FOSU Executive Director, National Onchocerciasis Secretariat, Ministry of Finance and Economic Planning Guinea Son Excellence Professeur Madigbe fOfeNe Ministre de la Sante publique et de la Population Dr. Mohamed L. TOURE Chef de la Division Pr6vention, Ministere de la Sante publique et de la Population Dr. Kabine KABA Coordonniteur national adjoint, Programme de lutte contre I'Onchocercose JPCI2-B page 27 Annex III Guinea-Bissau Son Excellence Madame Henriqueta GODINHO GOMES Ministre de la Sante publique Dr. Antonio TAMBA-NHAQUE Directeur general de la Sante publique Dr. Fernando MENEZES d'ALVA Directeur regional de la Sant6, Coordonnateur national du Programme de Lutte contre I'Onchocercose Mali Son Excellence Madame Fatoumata N. DIAKITE Ministre de la Sante publique, de I'Action sociale et de la Promotion feminine M. Sory I. KABA Conseiller technique, Ministere de la Sante publique, de I'Action sociale et de la Promotion feminine Dr. Isaka NIAMBELE Coordonnateur national Equipe nationale oNcHo, Division de I'Epidemiologie M. Mohamed M. BEN LABAT Charge d'Affaires, Ambassade du Mali en Arabie saoudite Nieer M. Abdou MOHA Secretaire general, Ministere de la Sante publique Dr Hassane BARAZE Coordonnateur de la Devolution ONCHO, Direction de I'Hygiene et de la Medecine mobile, Niamey Seneeal Son Excellence Monsieur Assane DIOP Ministre de la Sante publique et de I'Action sociale CONTRIBUTING PARTIES Beleium Mme Sonja KEPPENS Secr6taire d'Administration, Administration generale de la Coop6ration au D6veloppement (AGCD) Dr. Johan YAN MULLEM M6decin de I'Administration genrirale de la Cooperation au D6veloppement (AGCD) JPCI2-B page 28 Annex III Canada Mrs Sherry D. GREAVES Senior Programme Officer, Multilateral Technical Cooperation Division, Canadian International Development Agency (CIDA) France Dr. Jean-Louis BOPPE Chef du Bureau de I'Afrique de I'Ouest et des Caraibes, Sous-Direction de la Sant6, Ministere de la Coop6ration et du Developpement Germanv Mr Bernd WESTPHAL Minister-Counsellor, Embassy of the Federal Republic of Germany in Riyadh. Gulbenkian C. Foundation Mr. Joio FORJAZ VIEIRA Assistant to Director Jaoan Mr Norihiro OKUDA Counsellor, Embassy of Japan in Riyadh Korea. Reoublic of Mr. Woo-Seong CHONG Counsellor, Embassy of the Republic of Korea in Riyadh Kuwait Mr. Abdul-Ruhman AL HASHEM Head, lVest African Countries Division, Kuwait Fund for Arab Economic Development Professor Ramzi AL KHALIDY Agricultural Advisor, Kuwait Fund for Arab Economic Development Luxembourc. Grand Duchv of M. Gaston STRONCK Secretaire de Legation, Ministere des Affaires 6trangeres .? JPCI2-B page 29 Annex III Netherlands Mrs. Christina M. DUIJVESTIJN Senior Project Officer West Africa Section, Ministry of Foreign Affairs Portueal Mrs. Esmeralda F.M. AMARAL Head of Services, General Directorate of Cooperation, Ministry of Foreign Affairs Saudi Arabia. Kinedom of Dr Abdul Rahman AL-SOWEILEM, Deputy Minister of Health for Executive Affairs Ministry of Health, Riyadh I I176 Dr Ihsan A. BADR Associate Medical Director, King Khaled Eye Specialist Hospital, Riyadh Mr Ayed AL-JEAID Economic Adviser, Ministry of Finance and National Economy Dr Ali SHATA, Ophthalmologist, Al Noor Hospital, Makkah Dr Mohamed REFFAT AL-MONJED, General Director, Makkah Mr Sami AL YOUSUF, Economic specialist, Ministry of Finance and National Economy Dr Abdullah AL-OWEDI, Consultant Ophthalmologist, Ministry of Health, Jeddah Eye Hospital Dr Othman M.Z. AL OMAR Chief of Medical staff, King Abdul AzizUniversity Hospital, Riyadh Switzerland Dr. Andri BISAZ Chef de la Section Afrique Ouest, Direction de la Cooperation au D6veloppement et de I'Aide humanitaire (DDA) s/c Ministere des Affaires etrangeres Professeur (Dr) Andre ROUGEMONT, Conseiller Technique, Chef de I'Unite de Sante communautaire et de Medecine tropicale, Hopital cantonal universitaire, Genive United Kinedom of Great Britain and Northern Ireland Mr. John David MOYE, Head, Health Policy Section, Health and Population Division, Overseas Development Administration JPCI2.B paSe 30 Annex III United States of America Ms. Paula FEENEY, AID Affairs Officer, Agency for International Development U.S. Mission, Geneva, Switzerland SPONSORING AGENCIES Food and Aericulture Orcanization of the United Nations (FAO) Mr. Cyril G. GROOM, Assistant to the Assistant Director-General, Agriculture Department, FAO, Rome United Nations Develooment Procramme (UNDP) Mr. Benjamin A. GURMAN, Senior Regional Programme Officer, Regional Bureau for Africa, New York World Bank Mr. Birger FREDRIKSEN, Division Chief, Population and Human Resources, Sahelian Department, Africa Region, Washington D.C. Mr. Bruce BENTON, Onchocerciasis Coordinator, Population and Human Resources Division, Sahelian Department, Africa Region, Washington D.C. Dr. Bernhard H. LIESE, Director I{ealth Services Department, Washington, D.C. Dr. John ELDER, Economist, Onchocerciasis Unit, Population and Human Resources Division, Sahelian Department, Africa Region, Washington D.C. Vs. Suzanne VERVALCKE, Consultant, Onchocerciasis Unit, Population and Human Resources Division World Health Orqanization Dr. Ralph H. HENDERSON, r'-.ssistant Director-General, representing the Director-General, WHO, Geneva Dr. Hussein A. GEZAIRY Regional Director for the Eastern Mediterranean, Alexandria Dr C.-H. VIGNES Representarive of the Legal Coun_sel, WHO/HQ Dr. Ebrahim M. SAMBA I)lrector, Onchocerciasis Control Programme in West Africa, Ouagadougou { JPCI2-B page 3l Annex III WHO Secretariat Dr. D.A.T. BALDRY Chief, OCP Liaison Office, Onchocerciasis Control Programme, IYHO/HQ DT D. BARAKAMFITIYE Programme Manager Communicable Diseases Control Programme, WHO/AFRO, Brazzaville Dr. K. BEHBEHANI Product Development Unit, UNDP/lYorld Bank/lVHO Special Programme for Research and Training in Tropical Diseases, WHO/HQ. Dr. Boakye BOATIN Chief, Epidemiological Evaluation Unit, Onchocerciasis Control Programme Dr. O.lV. CHRISTENSEN Consultant, Onchocerciasis Control Programme, \YHO/HQ Dr. C. GINGER Manager, Macrofil Chemotherapy Project, Onchocerciasis Control Programme, WHO/HQ Dr. T. GODAL birector UNDP/lVorld Bank/WHO Special Programme for Research and Training in Tropical Diseases, WHQ/HQ Mr. Chand N. KAUL Chief Finance, WHO/HQ Mr. G. KOULISCHER Chief, Administration and Management, Onchocerciasis Control Programme Dr. D. QUILLEVERE Chief, Yector Control Unit, Onchocerciasis Control Programme Miss M.L. RAVELONANOSY Programme Officer, Onchocerciasis Control Programme Dr. A. SEKETELI Chief, Devolution Unit, Onchocerciasis Control Programme Dr. Ambroise W. TIEMTORE Coordinator of ONCHO Devolution, for WHO/AFRO, Ouagadougou EX OFFICIO PARTICIPANTS Exoert Advisorv Committee (EAC) Professor Alexander S. MULLER Professor of Tropical Health, University of Amsterdam, Academic Medical Centre, Department of Social Medicine Professor David H. MOLYNEUX Director Liverpool School of Tropical Medicine a I JPCI2-B page 32 Annex III Ecoloeical Grouo (EG) Dr. Christian LEYEQUE French Institute of Scientific Research for Development through Cooperation (ORSTOM) Professor Kenneth CUMMINS Director of Pymatuning Laboratory of Ecology, and Department of Biological Sciences, University of Pittsburgh, USA OBSERVERS Mectizan Exoert Committee Dr. H. Bruce DULL Executive Secretary L Dr. Youssouf KANE Secretary-General, Bobo-Dioulasso River Blindness Foundation Dr William BALDWIN President Dr Donald B. EASUM Vice President a Unaudited INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT AS ADMINISTRATOR OF THE SPECIAL ACCOUNT OF THE ONCHOCERCIASIS(RIVER BLINDNESS) CONTROL PROGRAMME - PHASE III STATEMENT OF CASH RECEIPTS, DISBURSEMENTS AND FUND BALANCE (Expressed in United States dollars) JPCI2-B page 33 ANNEX IV ,l' l Receiots Contributions African Development Bank Belgium Canada European Economic Community Finland France Germany, Federal Repuoric of Gulbenkian Foundation lnternational Bank for Reconstruction and Development Italy Japan Korea Kuwait Luxembourg . Netherlands Norway OPEC Fund for International Development Portugal Saudi Arabia Switzerland United Kingdom United Nations Development Programme United States of America World Health Organization Sub-total Income from investments Balance from Phase [I Total receipts Year ended 3l Dec.9l $ 400,000 1,526,917 1,208,526 t27,281 2,870,574 75,000 2,630,000 246,270 146,413 49,982 2,000,000 1,643,357 1,500,000 2,500,000 16,924,320 l ,61 l,366 18,535,686 $ 29.000.000 ( r0.464.314) January l, 1986(inception) to 3l Dec.9l I L +t $ 1,892,431 4,260,7 50 8,557,440 7 ,981,498 I,558,778 8,096,550 6,855,083 150,000 14,630,000 4,460,000 9,300,000 120,000 2,500,000 709,t76 I 5,760, I 40 3, I 85,373 300,000 49,gg2 12,000,000 12,869,514 8,112,250 9,770,000 20,980,000 2,000,000 156,098,965 10,475,140 22,594,373 189,168,478 $ r 74.600.000 14.568.478 Disbursements Transfers to World Health Organization, as Executing Agency Excess of receipts over disbursements Fund balance consists of:ffits $ 14.568.47E
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Joint Programme Committee twelfth session, Riyadh, Saudi Arabia 1-4 December 1991: report
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