Devolution: mission visiting seven participating countries

B'o WORLD HEALTH ORGANIZATION WORI{]IE GROUP OF NATTONAL EXPM.TS Oi\I NEVOTUTION Tri-rd. meeting Crj.a.sadousou. 24-26 Arri1 1984 SYI.rIIIESIS NEPORT ORGANISATION MONDIALE DE LA SANTE Annex I IEVOLUIIOi'I : I{ISSION VfSIIIIG THE S\trN PIF.TTC IP .TI}IG COU].J[RES ?,l c ( I. N.ilItODTTC IION Gnigin of the loission tlithin the perspective of the future f,ransfer of OCP activities to the health serrices of the Participating Countries, the 0nchocerciasis Control ProgTa^Eloe tras begun with the recomnendations of its 3gencies and in close collabonation with the Participating Countries, the stud'y of the urechanisrtsi which should. Iead to a harmonious transfer of lts activities in order to gparantee a firn hold. of the results aphieved' when the nand'ate of, the Progra.ume will have expi:ecl. r-vro workj.ng Spoups cornposed of national Experts have alrea.d.y ret (ZZA7 i,iorernber 1932 and.25-29 July 198J)and have made recormendations. 0biective of the rnission One of the recommend.ations of the 2nd. workir:g group consisted in the send.ir:g of a mission to the 7 Participating Countries so as to appraise thej capabilities to take oyer certain activities of the kograrnme on the basis of the'criteria and stardard's f ixed b;' the neetlng:. Compos i tion of the nission TLre nission was con:osed. of two perroanent rnembers ' - I)r. P, :hsunbuko - l\rblic l{ea1th .l-dviser ocP - Head of }Iissj-on. - Dr. A. d.tA1n6ld.a - Co;rsul tant OCP and. of two non-perrnanent delegates at the 2nd. neeting' of the l/crking Group of National kperts. T:ese were : - Dr J. Foundouhou - I{ead. of the Dept. of Statistics and ilealth Irrf . i'iinistry of i\:bLic Eealth - Cotonou, B6nln. - Dr I. i(on6 - Djrector of International Relations i{inistry of Rrblic ilealth, /'bid.jan, Republic of Ivory Coast. - l}r, Y, I'boagye-Atta - Djrectcr cf lledical Services, Irliristry of Ilealth, Accra - Ghana. - Dr iI. illen, Peovjncial D!'rector cf Sanroantergar ilepublic of Upper Vo1ta. - Dr i,i. Traor6, .lTationa1 Direetor of Planning iiealth thainirrgt i,iinisf,ry of Rrblic Ilealth anfl Social Affairs - Ba.nako, trepublic of I4a11. - Dr I{. Dagar Secretary General I'Linistr;r of Public lIealth and Srcia1 Affajrs, i{iamey, Itepublic of illger. - Dr Karsa 'Ichasseu, nirectcn of Epi-d.emiological Divi-sion, Minist4r of Pr.rblic l{ealth, Iom6, Republic of togio. ( aa r t, flre nission visited. the seven countrles froro the 15th Febnrary to 5 Apit 1984 i.e. 49 days spend.ing on averate I d'ays in each country' Preparation of the mission So as to enable 113 m{ssions to d'ispose of appropriate working d.ocurnents it was reconrmend.ed. at the 2nfl neeting of the lr/crrking Grorp that Ocp will m:ke available to each counf,ry a d.etailed deunent on the folloping' - OCP activities in each canntzy zone by zone -Situationofthecountryrelativetothed.efined.stand'ard' - Irteans to be used. etc... - fhe cost of activities in the country - OCP will send' the required' d'ocuments in good' tire' In return tle Participating country should lrcnrid'e working docur:ents indicating their operational capacit-y vis b vis onch@erciasis control' Sorne coufltries have alrea,tly peovid.ed. these dmuments, f oo others the mission obtained. this information on its arrivaL in the counf,ry. i,lethod of work of the nission fhe sarne nethod. of wcnk was used' for each country " .{fter the courtesy visit to the l,rTIO Coord.ination of Prograrmes, there IiI i were -f.grodiscussj.onswiththel[nisterofl{ealththefirstonthe arrivalofthemissiontoerplaintheobjectiveof,theroission and. Ii-sten to the lrii:risters point of virrtr on Devol-ution' 'Ihe second on the departr:re of the nission in nrder to hear the observati-ons and comrents ma.d.e on the repo=t of the lGssion with the collaboration of national technicians' - The repcrt is then approved. by the Minister and his collaboratcrs d'uringthesynthesisneetilrgchaired.bytheMinisterheld.before the d-eparture of the mission. - Between these trro sessions vrith the lriinister, the nission met nationaL health officials as well as officials from other ylinist=ies, gometimes indivi6ua-l1y srctjmes in lrorki-ng SEoups so a,s to collect all necessary information anC amive at a consensus' - In most coun-bries, the rn-i.ssi-on a-ttended. a meeting of the ltlational onchocerciasis comnittee specia]*ly corwened for the eca'sion. aaa t\ p -1- II. Description of the present state of OCP activiti€s in the Participatjr:g ( Countries All the activities und.ertaken by OC? in the countries are canied- out by two structures in the Programne ; the Epideniological Eraluation Unit (Apf) and. the Vectcn Control Unit (YCU). Remind-er of OCP activities tivities of the EPI J. These activities aim at a d.ouble objeetive : - evaluate the degree of effectiveness of vector control by heeping a close elre on the incidence of the d.isease, which can be niJ- if transmission has been completely intern:pted., or on the contrarXl persist at d.ifferent levels if checkir:g up operations were badly d.one. - to obserrre the natural evolution of the di.sease anong the infected. patients before the lauching of vector conf,rol operations, esDecially to deternine the risk cf ocular complications and the various stages cf change toward-s recovery vrith the grarlual agir:g and d'eath of the worms follo*ing an intern:ption in transnission. To achieve this d.ua1 objective, Epid.eniological Xvaluation is done b1' a fo11ow up of a sanple of villages within the ho5rarL:ne area. In these villages a.re nea-sured. froia the parasitolo3ical and. cphtahnological view point the overall evolution of Onchccerciasis lrithin the village as well as the evolution of the disease in each ind.iviclual- member of the vi1lage. To aceorrplish its mission the El'I Unit follovs up the evolution of, Oachrcercia.qis in time by a pericdic exa.nina.tion every two or tlrzsrg yeus this by the followin6: methods : - Simple evaluation . thrrough census of the vl11a6c population . a skin - snip o:: ea.ch illian crest with irolths fcrceps . a microscooic read.ing of tire skin snips after J0 mi:nrtes of incubation in distilled water. 'Tne m-icrof ilaniae are then counted., 'frte nega- tive snips a.re d.istilled, ano re-read after 24 hours of incubation in physiolqical serum. . a measu:e of vjsual acuity by Sjogren's hand. test. aaa ( -4- - Detailed. evaluation . a thororgh census of the vilJ-ege population 1 a skin snip of each iIlian crest with ilolthrs forceps . an exarllination of bhe snips as in the slnple evaluat-ton rnethod . a medical examinatiol ,iivi'g the d.eta:-Is of d'ermatolOgica-I lesio:rs of onchocerciasis and. the nr:mber of nodules . a thorough ophthahological exa.nination . rrnasure of visual monocular acuity, VCU activities this Unit undertales all the vector control, evaluation and entomolo- gical research activities and is made up of tLrr"ee d'ivisionS . Division of Aerial Operations uhich j-s responsible for all vector . control activities which so far have been ca:sied. out in prirrciple by weekly aerial application 66 Larvicides. . Division of Entomological Eualue.tion rloes the continui:rg: su,=reillance rf breed.ing sites catches and d.issects blacldlies and calculates transmiss ion intens itY. . Division of Applied Research responsible forbhe strveill-ance :f the aquatic Erwjror:oent and. Tba.ining. In its evaluation activities VJI- uses two ;nincipal i:rd'ica.tions 2 - flee Annual Bitirg Rate (ABi) = theoretical number of blaclfly bites per rnen and per Jrea.r. - the /-nrural- trarsuieeion Potential (1OP) = theoretical arnual number of i'.:fective Onchocerca V l-a.wa,o roccived. per man lef lfeaf. ltesently VIU consid.ers a zone 'to betunder conf,rolt if 2 - ATP I loo III. SIrJA! I0]i flJ EAC:I C0-;;llfif PJ?U3LIC n,; :)lr' :T\i'vr' !griLJ 0Ci) ac tivitles OCp activities cover the ncrthein paxt oi the cotrntry along the pend.jari-, gti and. illger rivers in the Itovinces of Zo,t (eUioC-to,rn f,bomv), tl rt 5 Bcrgor (cfrief-town Parakq:) and Atakore. (Cirief-town Natitir:gou) - an area of about 55r00o 1@2. In 1978, OCP activities in Senin were e,.:tended to the south f ollorii:g the request of the Benin gc,\rernment anxious to get under conf,rol the foci present ]rere. These cover the upper and miodle basins of the Cu6n6 river on a surface area of about 45'OOO h2, i.e. the hovinces of }trinc (Ctrief-to,,rn iokosso), of the Atlantic (Chief-tcx,rn Cotonou) and of the Or6n6 (Ctrief-town Po:rto i{oro). Ierricid.e operations have not yet begun in this zone which is part of the southern extension area of the kogranme and is risl'. zone for the treated. axea. OCP structures and activities 11 B6nin, the entomolqgical evaluation network which was formerly 1n llati- tir:gor has been transfer=ed. since July 1982 to Parakou which is in a nore central position fo11owir6' the extension :ctivities to the south, this for a better supervision of the whole region. The entomological sunreiLl-r"nce sector in Parakou is divided into four sub-sectors : - Natitingou and Kand.i for the treated zone - Para.lcoa ard. Sohicon for the extensiott zone Entonological eval-uation is done or: 11 catching points (weekly) and 1J points (twice nonthly). lhe zone has 21 hydrological sev:rices (12 in the extension zone). Readings are done by the hydrolc3ical se::rices of 3enin. The number of kilometres trea.ted reduced in L982-L981. fn 1!81, 2 55i Ictr were treated in the rainy season and B2t in the cl-qr season. Parasitological-epioeniolqlical eval-uation d.one in {/ villages have id.entif ied. { types of onchocercal f oci : - the northern foci-Sota, .{Iibori, I'b}rou - the southern foci-O:6m6, Olcpara, Zan, Iiouff o a-nd. i'iono - the western foci-the tsenin portior: of the Oti-Pend.jari and'its tributaries (Keson, Koruor.rgo:, Binah) ( ( -6 lhese are ffi>erenclemic fei. - ftre rnain feus bord.ered. by I{aIi - llanrarou - Kpessouror - }'ieiac1rg:ouIou - Kouboro - Stenisi - Baoussi is mesoend'emic' Actual state oflr o#ess Trhe present epid.eniological sit'ration in th'e Senin zone shows a good' state of control of the oisea"se. ort of 12 vilLagps re-examj.ned. fcr the 2nd timr 5 ]rears a.fter the corrrr*nceri=nt of vector conirol operabions, no child under I years is suffering from the d.isease except at tire village of Tchalenga on tl:e Binah where a littlegj.rlof{yearswasfoundwithrajcrofj-Iaria. ' The d.isease has d.isappcared. before the age of 10 yeaxs on the Teron and. Alibcrri and. before 1! years on the 3on1i, tributary of the Sota' In all these villages prevalence is steadily decreasing as r^re]I as ocular lesions which are becoming rare before the a6e of 10 yeaxs arrc] are greatly reducec bettreen 10-14 yeaxs. In this a6e 8r@Pr the rrsk of developing ocular losions is tod.ay very slight. frhe i:reversible rcul-ar lesions and' the blind.ness rate ae decreasing progressively' As for results obtajned. in treated- zone, th tlresholds for the libcration of oncho valleys have ra,rely been reached. since the i-'e8in-:ing cf contlol operaticnsr especially in bhe reinvaded valleys' TLre transrrission of onchocerciasis is no longer a d'a:.ger for the populatiors in the Pendjarir Upper l'b}rou and Upper lGran basla's' except ln the regions of cepaste and Tafound.e vrhere rtfP is stili hjgh because of re irnras ion. The situation ls not so good in the niddle valleys of lblirort AJ.iborl and Sota. At each rainy seasonr these zones are ;einvaded't tL1g inpact on the transroission of the disease j-i: the controlled' zore is stiIl within a.n area of about 1r5 l**fron o:re point to the other in the::ivers affected. aaa (Situa'; ion in relation to stand.a.rd.s In refe:ning. to stand.ards a,1opted. by the 2nd t/crking Group cn Devo- lution, one notices that in Senin : - no village tod.ay presents prevale:rce lo,rer o= equal to 10 ?6 - cnlg the village ,rf ly'anrarou (no. 115) on t."re Bouli-Soba, d.istrict of Senbereke presents incid.ence equal to 0.0 %, ^hevalence is 27 %. Ocular lesions are greatly clecreasirg ever3rurhere. o11 th6'dntcimological p1an, in referring to the accepted. stanclard's ATP and. ABR are generally above the clefined. thresholds except for the Pend.ja.ri 1.Ia]Iey i:r the ncrth eastern part of the zone. ?lsrlchere anmal transro.ission recorded. is high e:-tner because of reirwa-sioa or due to d.jfficulties in treatment in mountainous zones. Situation in rela.tion to criteria gnchocerciasj-s has always been a majcr concern for the health authorities in Benin. Befcne the rto=a:urle, oncho+o;rtrol activities were a1rea.dy integrated in the najor encleieic cliseases activities or in the regional structures of OCCGE;. Ihis ad.ded to tire desire of the countr;r f,s see the sorthern e::tersio'-rs take off rapiclly justifies its d.eternination to ta.ke over OC-) act-ivities a-nC inte.;rate than i.r the hea.l-th se:sriees. The existe:rce of a. per;lanent na.tional secretcia.t in charSe oi the cocrdination of OCP activibies confirns thc poli',;icaI wiIL of Benin Iiea.lLlf s t4tq lqAqq rq_or in'tegra. Senin accepts to transfer into these health se::rices the follouring OCP activi-ties. In tite short tern, siaple and. detailled- epid."r161agica1 evaluations which will be ent-rrrsted' : a) At the central- level-, to the Of-iice of Piealth ltotectic:i t:'xough'bire eDllem:Lologlca} a.n<1 pleve.rtjvc rse-:t-ice uhich has qualificC staff and. whicir will be made responsj-ble ,f orL;le supervision anC transn-ission of i:rf ornation gatneied' ii: tlre villagcs. b ) At the intermedia.r''' a.nd' peri-pheraL levels aaa ( -B- Ttrey will be under tire responsibility of the pi:ori;rcia1 L]irector of Iirealth services and. the Technical rnterrrention serrice will calry out the tasls. ftte central epid.eniological 'beam will have to help in the orSa:risatio;r and e:<ecu.bion of the tasks i;r the fie1d, especially d.uring';he detailecl evaluatio:'tg. -Intherediunterm,theentonologicalvectorevaluatio::swilIbe facilitated. b;r the existence of a vector control service which the }linlster intend's tt reong'anize and' reorientate' Fers 1 Sore human resou.rces are avail 'b1e. Hourever, this person::eI rnrst be retraj.ned on onchrcerciasis. Ihe crganisatj.on of persorunel envisa8es 2 1 entomologist and. 1 epid.erniologist pe= province, 1 entomolqlical technicia''r's and. epid.erniolcgi-ca} n'rrses per piovince' Ihe follorving staff need.s were expressed' : - Entomologists 6 - Entomological tecimicians 18 - Epidemiologists 6 - EpiCemiological nurses 18 Iinancia1 resources and r.:.n:riqq rreang Supplementary rreans will be necessary for the cryrying out of these actirrities and will iaclude equiprnent, 1og:istics and runni;:g expenses' 'frIe l.linister plans to set up mechanisiis fo: bud.6ptary forecast taki::g into account future obli3ations a-fter tl:e nandate of OCP' I::terc ou.ntr1,- oTqanr-sar ]-on fn the opinion of the hcal'bh authorities of Sen.i-n, the intercountrar organisation whicl: will succeed. OC? ;mst be envisaged' i'r a regional frarnewor]< larger than the present OCP area aiter all- the exte:rsions required fo; tire control 0f onchoCerciasi-s would have been real-ized.. -\bsorption of- Benin nationals vrorking in C!! ior the tsenin authoritir,'s, the secoacLnent of the Benin nationals rust be comqlleted. in their mother cor,-r:try anci the stucly of the detern-ination cf thejr status after OcPts manda.te nust star:t now. (9- NEil'.]LIC Oi TI/OP.Y COJST OCPts activities in Iv Coast .A.reas covered OGP covers all the northern, central and southern pa'rlts of the country, an a.rea of 246 OOO km2r i.e. -i;he prefectu.es of : Korhogo, Ferkessed'ou51or, Dantanerl(atiolarZonkorgbeurBoundialir-r-rr:6kou5rtsoncloulcour3ouna,0d'ienn6' Boualc6, Touba, Bouaf16, ltbengourou, S6gu61a, Dimboliro, Abid.jan, Da1oa, Sassancl:a. The Progra;one therefore covers all the savanna parts and. the 3:eater part of the forest of the counf,ry. 'Ihe first par (110 OOO 1o2) of the operations started. d.'.ring phases I, II, IIi of the ltOgrarnnp arrd. sprcad subsequently to the forest zone (phase IV) at the ,:equest of the Ivorian Gcnrernment demand.ing the extension of larvicid.e treatment toviarcls tite south and also to::espond- to the r"rish of OCP to con:;roI the reinvasion problem on the 3a'riama and Ieraba. In Ivory Coast, there has been resistance to organo-phospnorors i:r the southern zone ancl persiste::ce of reinvasio:r fron a.d.jacent untreatcd' foci of the west (Guinea). The regions concerned. stiLl ccrnstitute high risk zones for the disease3 OCP, s s ac t ivit i allea QCP und.ertakes its entonological eva.l'.tations i:r lvorl'' Coast tboq3h - Bouak6 sector sub-riivided i::to ! sub-sectors I sub-sectors of Bouak6, I(orhog:o, 3ondouko:, Od-ienn6 ard' Sdgrr61a. ,'le:rial operations are carried out fron Bobo-Dioul-e.sso iUpper rlolta). Epideiaiological :-nd ophtha}nologioal evaluatio:rs ii: the 22 prefectures have been done in 96 aad- 27 villages res-Dectively. Preser:t1y, there are 20 ind.icatcr-villages includ.irrg 7 of detaile"- evaluatioa the j-.:i and /l.H. values are calculated from fly ca-tches b:f 19 teans of 'rector co1lec'bons at 1{ vreekly and- 2fi bi-nonthly catching points. 1rhe water-gau.Te network covcrs 46 stations while the length of rj:rers treated, whlch varies accord'ing'i;o the season, vas 670T krn r1',.:ring the rainy season and. 1615 d.uriqg the d'ey s;L-ason. I:r 1!91, tiris cane d'orrm to 600 h1. ( e cnrered. -10- hesent state ofIr o,T:ress mad.e Generally speaking, the follovring is th-: situation aJter less than 1c yeaxs of vector control z - tre the entomolog:icaI fieIc., the vector popula-trons have been red'uced in such inoportions that the transrnission of the pathogenie agent is practically inte:rrrpteo in t]re initial hogramme, i.e. in an area cf 1OO OOO km2 in the north. I{onrever, the per-sistance of reinvasion from the adjacent unt::eated foci of the Viest (Cu:-nea) as ye11 as the appeaxance of resistance of forest species to organi pl:osphorous Lrsecticid.es help in maintainir'€ transnission in the Phase fV a'rea' It shorld. however be noted. that this a.rea covers the forest foci where the clisease, although beinE of harmful effect is neither a major public health Foblern noi an obstacle to socio-econoni'c d'evelop- rent. - The trrelimj-nary results of the necical evaLuation rlata confirn the effectiveness of the treatnents : in nearly Bo i6 of the f,reated. a.Tea, chiJ'&:en born since the beginni-ry of the operations a-re safe from reinfesta'tion by the disease and. it has been impossible to sh6r a siqgle sure case of novr inf:sta- tion amorig child.ren of less than 5 yeaxs in the zone. CL:hjca] maniiesta'bj'ons' especially eular lcsions, a.re in regression everar"r?'rere' S ituat ion in rel-a'tion to s'bandard.s ",Jith refelrence to the stancard.s a.d.opted. d'uring the neetj-+g of the liori<j'ng Gro:.p, it has been noted- that in Ivory Coast z - nO village Dlesents a prevaleitce inferior or eou:iI to iC )'/o at the moment' - tuo vi11ages, Fod.iolokalia (no. B!), or: thc Saud'are, in the sub-p::cfec- ture of S-i.nematial-i a.nd. Ganse (no. 1S9), on bhe Comoe, in the sub- prefecture of llassian, ha-ve r.n incicLence ec-ual to 0.0 fi. hevalence in these h.re villc€es is respectivzly )2.9','o and 14.5 l'r. Referrirg; to the entonological- standa:os (provisional entonolcgical vaLues for the period I'Iover'lber 1932-Cctocer 1!3J), the threshoLC of t}:e 'TPs is rvithin the norrs in the Korhogo sub-sector ; this threshold' has been a-'ctained. in 50 ?6 of the brca.d.ing sitcs i, the Rond.oukou and Bou"ke sub- sectors ; + 29 94 :-n tne odienne sub-eectol anrl + 20 )( in the seguela sub- sector. (-11 - Dl_ tuation izr rel-abion to ;he criteria Oncheerciasis has always been regard.ed. by the Ivorlan autnorities as a major public health problem to wirich they have cLlways accorded the greatest priority. Consequently, they requested the extension of the programrne to tile south and made an exceptional contribution of nore than 2 nillion dollars. Tiris is why they have confirned. their ceterminaticn to pursue and finish the wcrk started. so llell by the Progfaume. However, for them, the transfer mrst be progressive. Bealth struc es for ti For the Ivory Coast, the activities likely to be taken crver by the national structures a.re ? - Epid.emiological evaLuation - Entonological evaluation These activities r+iI1 be the responsibility i - At the central leve1 : . of the office of ItrbLic Health and- Population - At the intermediary and peripheral leveLs, the execution will depnd on the offices of rural- irealth sectors with their mol-'iIe teans wl:ose essential rnj-ssion is the coi-ltrol of the Lmjor natj-onal- endeni-c diseases includ.i:rg onchocerc ias is. Vlithin the framework of tne prirnary health care policy whi-ch Ivcry coast has ad.opted., the n:ra1 health sectors will maice the locd populations take part rnore closely i:r the su.ll/eillance and. control of the rnajor end.enic d.iseases. Pers onnel Tkre country is well provid.ed. with health personnel right d.own to tire Ievel of the officies of rural health secto=s everlrone of which has a medical off icer (trca;.), a rned.ical off icer (assistant), nurses and laboratory technicians. Hovlever, this staff rnrst be ret-rainecl on onchocerciasis to be able to face thejr new d.uties. The Governrent has already laurrctrrid. a sensitizatLon ( aaa a-72 ancl irrf ormation campaign which will be hig'hljAhted in October l9B4 at the anrmal neeting of the Doctors in charge of rural health vrithin the sectors. The authorities have invited 0(lP to this meeting d.uring lrhich a d.ay will be set asid.e for Onchocerci.as is. Financial resourc es and nrnning means Ihe country possesses i - A relatively important health infrastructure with adequate running: neansi. - Basic equipment at most of the nrral health sectons. Ikre Minister plans to strenghten the technical and. logistic means at the rural health sector offices and. their mobile fsams. The authorities esteem that a bud.getary complement for certain fieltl activities can be found. through a nat]onal effcnt or external aids. I::terc ounf,rv f ac ilitv Ivory Ccast is of the opinion that all the efforts und.ertakcn in each of the Participating States for Devolution to succeed. will useless if ri6ht frorn nor a thortugh stud.y, which ai-ms at the setting up at tl're end of the Prograr,rme of an intercountri' organisation capable of supervising and coordi- nating the nationaf efforts and give d.irectives for the harmonisation of sub- regional activities is nlt under-taken. I-bsorption of fvorian Ders onnel cf OCP Ihe Ivorian government is ready to absorb the Ivorian personnel at the end. of OCP. It has requested, the ko.3ramne to send. the complete list of this personnel with a view to planning their return to the Ivorian Civil Se::rrice. REPTBLIC iF'. GHA}IA Areas c overed. Ie Ghana, OCP covers the Bassin of the Vo1tas, fYom the Black Volta in the north-west t,r River Oti in the Ea-st. The area of the hogranrae includes aaa (- 14 - the Upper Region cf Ghana and the ]icrthern Region which repiesent 14.4 % ot the area and18 96 of the total population of the country. The Volta and. Bror,g-Ahaf o Regions (42 OOO icl2 ) are in the futr:re extension zone. fnese regions a.re a ms.jor risk zone of the clisease and a threat to the area unoer control. It is fon these reasons that the extension of insecticid.e operations to the south has been :equested. OCPrs struc s and activities in the area c overed. The entomological activities are cerried out in Ghana by the VCU sector af Tarnrl6 ard. its sub-sectors : Bo)6atange, Tarnale, I(intamp.r and Hohoe. [Lte aerial operations base is at ltara in Togo. [Lre b*o parasitological and ophthal- mological tearas of the Progfarrre cover Ghana also from G.ragadougou. Ihere *e 14 weekly catching Points visited. by 17 vector collectors. and. 11 bi-nonthly points regularly Ihere are J0 water-gauge stations nonitored. by the hydrological services' The length of rivers treated (which varies accord.ing to the season ans the climate) was 2 15t }an durir:g the rair4l season and 1 456 fu d'uring the dry season in 1!81. EPI nonitors /2 vi)-lages in the 21 d.istricts. There are 2J indicators- villages 15 of which are subject to d.etailed. e.''aluation. hesent state of progless mad,e Generally speaking, yeaxs of vector control the following is the situation afber Less than 10 In the entomological fieId., the vector populations have been red.uced. in such lroportions that the transnission of the pa.thogenic agent is practically intermpted. in 85 ?6 ot the Ghanaian area of OC?. helj-n-inary results of tire d,iseases a,nd medical evaluations confiru the efficacy of larvicid.e treatinent by the absence of any case of onchocerciasis within the age group of less than ! years. Ihe prevalence of infection ancl of ocul_ar lesions have greatly d.ininished.. The least protected regions are those of l(intarnpo and ilohoe uhere reirnrasion still p:evails. ( -u- TLre situation in the country 1n relation to the standard.s l{ith reference to the stand.ard.s ad.opted by the Grcup of Experts, been f ound. that no lndicator-viI1a,ge has a prevalence of less than tO %. incid.ence of 0.0 % nas been f ound in 4 viI1ages. As regard-s the entomological stand.ards, limits in the region of BolgataBae and Tamale, which are the only areas treated. it has An the APfs are within accePtable i.e. jn the Volta and. Oti basins Ghana,s situation with reeaxd. to the criteria One of the objectives of Ghanars health policy is the surueillance and control of endemic d.iseases. Tleis control activity is camied. out through a well st:r:ctured. system both at the central and regional level-s where all the central senrices are represented.. It is worth nentioning the ex.lstence of laboratory se::rices at aL1 the health 1eve1s, an effi.cient system for the nofification of resul-ts, a highly qualified. personnel and. supcortir:g serricdrt. (Institute of /'-o^uatic Biolqy, Tbainir:g Centres, etc.) capable of guaranteelng the perfect execu,;ion of the activities to be fransferred. which, in tlie short term, a:ee epideniolrgical evaluation, and., in the ned.ium tern, entorological evalua.bj.on. The Gkrana Goverruoent was the first to sh6r,l its political ccnrnittnent as regard's Devol-ution an6 rna.d.e concrete proposals at the 1a-st J iiCC meetings. Consequently it is read.y tc take-trver transfe:red OCP activiti-es. TLrese activities will be und.er the responsibility ? - at the central 1evel : of the trpid.erniological and Corurunicabl-e Diseases Division (which already, thanls to the polryalency of the central teamr und.ertakes the control of end.emic-epid.enic cll-seases includin6 those caused. by vectors). - at the regional Level , they will be cagied. out by the tealrrs of this DiT ision by integrating then with the surveiLlar.ce of rther endemic d.iseases. aaa (1E Financial res es anrl runn rfleans TLre liinister of Ilealth has an annual bud.get in vrhich soecif ic roention is ma.d.e of onchocerci.asis control. Appropriate equipnent inclucling microscopes exists in each Health Centre. An er:tomological equipnent has also been instal- Ied. at the l,lalaria Unit of the Epid,ei'niological Division and at the Sntomological Unit of the Volta River Authority. There is a prevalelt insufficiency of vehicles and the greater part of those which exist are used. in the prirnary health care prograflIsles. .0dd.it j.onaL necessary means The Ghana gc rerrunent has requested. the training of : - 2 entomologists - 2 parasitolcgists - 2 microbiolcgists and - 2 chenists (for the Institute of Aquatic Biolory) It has also requested. OCP to re-train the field. entomological techni- cians in the fie1d. of onchocerciasis. Aclditional- rneans should come from other bilateral aiCs : means of transport, laboratory equipnent, r-arious neans of j-nforr'.ation, n:.n:ring ixeansr et. Itt ete og-ntLqf :Cp ilily The Ghana Goverruocnt is of the opireion that OCP should be maintained its present structure or nod.jiied. by common a6reerrent in ord.er to preserve the lnternational creCibility and its manegerflellt ability. Ghanaia4 !9!E onnel enplcvei by OCP The Ghana health authorities vrould like to be given infonnation on the Ghanaian persorr::eI vrorki-ng in OCP ; the inforn-aticn shoul-d include age, qualification, working p1ace, etc., in ord.er to perm.it their future absorption into the public services of the country. C -15- REPMLIC OF UPPER VOLTA Zone covered CCPcoversZ)o,Cootgn2ofUpperVoltaj-.e84%ofthenationalterritory. Therefore the risk of Onchocerciasis no longer exists in Upper Volta except in the case of reinvasion. OCP structures and activities in these zones Entomological- evaluation activities are carried out by the sectors of Bobo- Dioulasso and Oragadougou and the sub-sectors of Bobo-Dioulasso, Diebougou anC Oragadougou. The activities of the iiPI Unit are ensureci by two parasitological- teams and 1 ophtalmological team which serve a1'l 7 countries. Present state of progress made 'From the epid6miological viewpoint, there has been an evident regression of the disease. Therefore prevalence is now at a hyperendemic leveI (5Cf, arrd nnore) and at a meso-endenic ]evel Go-6a,;) in the nrost affected foci' Children less than 10 years are free frorn onchocerciasis in all the river basins. In certain vi11a6es like I'Jadiel on the tsfack Volta r,vhich used to be hlryerendemic, 1! year-old chilCren have been found free frorn onchocerciasis. Fron the ophtalmological vier,rpoint, the exa.nination of )B/ people in / villages to be found. in h;'perendenic foci at 5-year i ntervals has shovr: that the number of peopl-e iree from ocular onchocerciasis has gone up from 20! 05.695) to 281 (4?.y"). ?]re nurnber of people suffering frora kerati.tis has gone from 20 13.4i;) to 10 (1.?rJ) and. those vrith the slight presenee of microfi.l-aria from 2O2 G4.4?3) to 149 Qr.1';-) and those with more microfilaria in the eye from 79 (5.5?o) to 10 (1.7j"). Lastlyr the group presenting serious ocular lesions at the initial stage from 57 0.2:;) to 55 e.4%), at the advaaceci stage from 50 (1o.4:,) to 70(11.%:). The ocu]ar l-esions are rare every-where and never in the group of 5-14 years. On the entornologica.!- l-evel, the transmission of the disease iras been interrupted in the rvhole of Upper Volta, except in the reinvaded foci of the Ieraba Entomological sur',,eil-1ance is presently bej.n6 done on 12 weekly catching points and, 25 catching points (tvrice ntonthly) Aerial Operations are ca:'ried out only on the Black Volta, Cornoe and Leraba. The vihite and red Volta rivers as wefl a^s the Oti tributaries are treated. only on request, this depending on entomological resuits. 4n ( Villages : - Banga.sse (n" 006) on the koulpeclogo (Provin:e of Conini;'anga): prevalence Lt9.Ci.. - DissonSne (n" 31) on the KoulpeolcSo (?rovince of Diabo): prevalence 1\.5i- - lJadiel (:r' O6;; cn the .ilacl< Volta (P:'ovincc of Batie): prevalencc r+t5-5), - Boa-l-a (n" u8O) cn thc Ji.sili (Province of Leo): prevaleacc 55.2i"- In al-I' th:se villagec i::cider:ce evcrywhere is 0.0'l-. On the cntomo-,-o6ica-l- ':Ian, the zones of e:'d.c,.tic oncirocercia.sis preser-t Ovel:)'r.1rherc posit"i',-e i::dicatio:rs . (,0c,; < loo crito-ria fixed by the Prid rJor Grou: r'he health -serviccs are very rnuch iirterested in onchocercia-sis as a Ciseass. I,ris interest is shown b1- tl-re firn political t'riI-l- ex:,::essecl by the i,rinister of i,:ublic ieal-th ai:ci the ije.iio:.a1 Cncl-iocercia-sis Corr,'ittee" - Sqrlr_t.;al_-: t_.uct"1o:_ s q-i"t jgl at Lo_t- The Up.ter Volta hcal-til a.uthorities e.ccept the traii,:fcr of -=ir,lirIe and C,etailed epj-demioio3ical survcil-lance witlrin the cxisting syeten: heal-th postt heal-th centre, meciical ce:iurc 1'rovi*cia1 .L,epeu'tlelt of fuol-ic lical-th. i,! !:- ^ l- - Ar rne nealth centr.e, co,lecticn by the heal,th officer of rtatistical Cata co;:cerli-ng oilcnocerciasis a.s r,,el1 those of othe;'diseases under control. - Parasitological exar::ination vrill be Coi-ie at the i-eciice.l- Centre- - 1'he Provilcial- irealth (::ep.rtr.ie:tt ',rili ccl-l-ect al--r- iteel-th i;'for,natior. i:icltrdi;:.6 c-rchoccrci:;5i5 cc-;cerni;'3 the Frovi.:ce, r.'i]t ev,luate the situi.tio,l a::d will- tal<e ap,,r'cpriatc r,loe.slrt'es to supl;oi't actic:rs a.t the ;l--::i;.rlteral'lcvel. - l-t thc central- Icrrcl, thr-cu;h tl,e co;:]-lcLent lecl:lrcal ,Jera-r-tt,tent; (r..rept. of Iiea].i,' , Dert " of -,1:iie.liolo.,y, uept - of Stu'-ic;- ;uld. I''l a:r:ii:,5) tlre ce.lt:.al-i-s,ation cf Cata tha.t rvi-l- be cor;rt:u;-icated to LCji or te the facirit:' repiaciug it. I'he authorities also thi;ilc tl.ra.t at tlre p:'ilar;' hcalth postr: vil-l-age heal-tlt agc,];s cculC- help in the su::vci;'a::ce, ce.tchi:r5 oi'ti'apii;:g of l:i,-ntiiiur. da.:rrosu::. ,"Sr: = r r irT) Situation in relation to t,re ( -18- Staff Here there is a lack of certail categories of qualified personnel requirecl- for Devolution. These are: Epidemiologists Parasitologists Ophtalmologists Entornologists This meaas rnore effort in the training progranrne' Upper Volta wiIL therefore pursue and reinforce its training programme so as to solve this problem. Finacial ressources and means for functioning At this preparatory phase it will be necessary to plan and foresee problems of equipment, logistics and functionin6. The Government considers urgent the stud.y of the cost estimates of enlightened OCP structures to enable it to ]rave an idea of the probleu of recurrent costs at Devolution and so prepare a suitable pl-an in advance. Inter-count facil-it For the Goverrul,ent of Upper Vo1ta, at the end of its rnandate - at Devolution - the strnctures of the Progratime will be rnodified. Experience will then show what the structure of the intercountry facility for the coordination and execution of the common ta,sks unrler its :'esponsibility vri1l be so a-s to preserve what has been achieved by the Progra"rme. Absorpt ion of OCP Voltaic Personnel fhe Voltaic Governnent vrould lii;e to know what personnel wiLl be handed ove:' at Devolution so as to prepe\re nel budget estimates for the OCP Volta:-c persor'^ne1. REPIIBLIC OF },1AII OCP activities in l'Ial-i - Zones covered OCp activities cover the whole territory stretching from the East coast of the River iliger, from the guinean frontier in tire South-East right up to the Nord- East to Barko, i.e. about 125rOOo 1sn2. Iron the administrative view pointr the Programme covers 4 regions partially or totally : - Region of Koulikoro - Region of Sikasso (-19- - Region of Segou - Region of Mopti and particularly the Adninistrative cepartments of Sikasso, Kadiolo, Ya:afo1i1a' Yorosso, Ifu1ondi6ba, Bougouni, Koutia1a, Tomiilian, Doi1a, Bandiagara, I(ita eoC the riSht bark of the river Niger in the District of Bamako. This zone calIed the focus of the River }Iiger is nade up oi : - the Bamako focus r+hich sur:.ounds the capital upstrcarn of Koulikoro r'rith the natural and artifrcial sites of the Niger (Sotuba, tsaguin6cia, Tie;'f:'l-a) and on the sma].I affluents of the 2 Uarks. - the hyperenctenic focus of Sankaran-O:assouloubale particulary serious at Yanfo1ila*. fhe foci of the Baou16 bassins (Bougouni' Dioila) of the Bagoe (sikasso' Kolond.ieba, Kadiolo) where are to be found vast inhabited area.s' - The Bafing focus especialry the rotio and its upper basin called the K'aralio focus. - The sna.ll foci of the San ltegion uhich are both meso and hyperendemic tii:is crce.ting a transition with the Bandiagara focus' - The h;poendemic focus of Bandiagara compl-icatcd by the crcation of nr:'rercus smaLl barages and reservoirs - OCP s tructures anri activities in the covered zone In this zoner lOJ localities have served as epider.riological evaluation viilagcs' and presently 1p serve as indica'ucrs. Entornological activities are carried out from the Bamako sector and frotr th' 4 sub-sectors (Bamako, Sikassor Bougouni, I(outiala) ild a seasonal station at Baldiagara. Entomological eval-uation is clone oir 12 weekly catchinS points and on 74 bi-monthly points. There are in this zone 20 vratcr-gauge stations' The lcngtir of thc rivers treated. in 1981, vas z.o?O kn during the rainy sea-sol1 and'1 5i5 t*,:-t the drY se€rson. * This focus no longer exj-sts because of the Selingrre cl-am which ha-s got rid of ( the S. damnosum gites on the Ouassoulou-tsale -20- Presetlt state of SS Generally, the transnrission of the r.lisea*se has been practically interz'up-'c'd in most of the initial area, reinvasion in certain foci of tire 3aou1e sJ]d B:lgoe basils, has been the cause of l.fP going well beyond. the toferabilityth:resho]d' l,ledica] data confirm the efficiency of entomological results. In the zonc'as a who1e, children born since the beginning of operations are safe from the disease. The prevalence of infection and clinica.l problems such as ocrrlan' fesions have d,ecreased, with the exception of the villages of Niako on the Baoule and l(anke'la on the Kankelaba, vrithin the hcavily reinvaded zone' Situation of the ir: relation to the defined standards The whole lvlafian zone meets the standards defined for the trar,sfer of the activities of tire Programme " From the entomological viewpoint, there are serious problems in the re- j-nvasion zones rvhere not only does trasmission stilI Bo on but is also a source of endogenous re-invasion. Hovreve:' in the sub-sector of Sikasso LTP is bel-ovr the threshold of tolerabilitY. This is the same for the North-iartcrn regions of the Bamako sub-.sector. - trpidemiology - two vi11a6es, Kanfelah (C6i) and }dan (O54) both of thern cn the Farako (Sikasso) present prevalence befovr ltti and inciclence equal tc o, cr;. - Two other vi1lages3 I'.abale (no 15O) on the Grounbo,/Banifing It/ (Sikasso) and Zoumayere cn tlre Iotio (Silcasso) prcsent preva-Ience below 1gJ and the annual incideace is fron Cr2i.3 and Or*c. - Ophtallology - here there is a general decrease o{ serious ocular lesio:rs t thus confirming the para^sitoJ-o'iical resuits. Situation in :'elation to the critcria dei:-ied The plalian Govepn-nent attaches great irnportance to the controlTSf,chocerciasis in the whole national territory and cspecially in the e'xtension zone towards thc Senegal river basin. It is firmly decided to take-over OCP activities. Tiris porical commitment is made evident by the decision to make the national serviccs (-21 - ensure Bround. treatrnent in the Farako zonet ensure the integration of schi;boso- miasis control vrith the part:-cipation of the villate conraunitiest OI'CHO control in the Bandiagara zone ancl also create for epiderniolo5;icaI cvaluation in the extensi_cn zoner, an rronchocercia.sisfrteam vrhich wili also be responsible for devolution activities. Sanitary iatenration structures and activities devolved The Malian health authorities have plenned the transfer of the following activities : - Epidemiological evaluation - Ground larviciCe treatment in the Farako region - Entomological evaluation in the Sandiagara region already uncier the responsability of the Primary i{eaIth care services -.-qnti vector operations in the same region. The coordination of these activities will- be done at the centraf leve1 b;'' rthe onchocerciasisrr tea-n already tra-inecl ald responsible for entomological evaluation in Uhe extensicn zone. - The NationaL i{ea1th Depar:rnent in charge arnong other things of vector co'r;rol operations and having uncier its responsibili-ty functional regional d- departments arrd 4 health engineers at thc central- Depaltment ' The execution of these tasks at the intemediairy and peripheral levels wiIL be undertaken by the district health servicies with the support of the main epidemiological tean. SersonneI The country has the required pe:'sorurel right do,*n to the district heal-th centres. Each district i:a.s two d.octors, a Iab. technician and male nurses" hiith a littIe nore traininr; these peonle do the required epideraiological evaluation. A nationa-l- team of epiciemiological surveilia:rce is being trained for the extension zoner it r.riI1 aJ-so serve for the CCI zone. This tcefi wili be strengthened by two medical doctors and two rnal-e nurses presently l-rcing traine'd in entornolo6y. ( -22- Financi aI :'esources and functioni Most of the financial meeurs are not available at the national level and concerning certain expenditure relative to recurient costs, t::aining, logisi:ic; etc. these should come from external sources. Certa.in organizations v"itirin tll' zone could be askcd to intervene in the devolved OCP activities' To this end ti:e Government will organise at the end this yearr a consultative nneeting of organisations cooperating rvith Mali in the OCP zones and under OCP auspices sc a,s to obtain their hetp in the underta.!:ing of ocP activities. y,ali thinks it indispensable that Devolution be undertaken simultaleously with vector control extensions in the I'Jestern part of the country (Senegal River Basin). Int_er-c oun!1y Fac ili t:l Concerning this inter-co1:rkt tacil.ity the Ivialian authorities think a decision should be taken only after having made an inventory of the activities that the regional health organisation could undertalce by comparing costs and efficiency. The final decision sha]] be a political- one, but Mali presumes that this structure wilL be a modified OCP, as the formcr r'riIl- be in charge of operations in the cxtension zone. Absorption of lliaIran pe rsonne1 working at OCP At the present stage, the Renublic of l..a-r-i is looking into the problens very carefully bccause of aspects lika costs and the r.o1e of tl:-is personncl in the extension activities. REFUBLIC OiT IIIGER OCPts act ivities in Nieer Areas covered The field of action of CCP in i,li55er covers an area of 1l OOO }cn2 and concerns the tributaries on the right banli of the ltriger lli-ver. The sub-sector is su-r.rcunded. in the north by the Repul-r}tc of llal-i, in tire south by Benin (Kandi sub-sector), in the trest by Upper Vo1ta (Oragadougou sub-sector) and in the east by tbe Dosso prouj-nce (Niger) ' The sub-sector covers the districts of Say and Tera in the lliamey Province with a rural pcpuie,tio: of about 454.O99 inhahitants' (-27' - OCPis strlc tures anC activitiqs, in the area covered Entomological sulareillance This is ca:ried. out by the lliarley sub-sector and. covers the tributaries on the rlg-ht bank of the Niger River. Irhe evaluations cover J r'reekly catching points and 4 - 1! d'ays catching points. The whole zone has J vrater-gau6e stations. The lenght of rivers treated in 1981 vras 610 Io in the rainy season and O 1o in the d.ry season, fhe network of treatment ha's been considerably reduced since then. kesent s of fl:e trrresent results of ocP, after less than I years of treatnent, have been spectecular. In the entuolog;ical fie]d, the populations have been reduced in such lnoportions that the transmission of the disease is practicalty interrupted' in 1OO g6 of the zone : it has been possible to reduce entoroological evaluations and the vol-ume of larrricid.e treatment has greatly d.i-minished'. The results of analysis of medical eval-uation data corrfirrn the effectiveness of the veetor control ; in the ivhole of the treated axea ]1o chllcI born since the beginning of the operations iras been found to be infected'' flhe prevaleiice of the infestation anc that of the clinical rnanifestations, espccially ocular, ha've decreased every,rhere in such e vay that the erad'icatj-on very soon of onchocelcias-'s can be ervisa6ed.. The whole onchocercal focus is thus und'er control ; the surveillance strategy ad.opted. (obsenration of the Gbasse point on the Sota in Benin antl intenrention on the river basin in case the site is positive ) aim a't protecti'4 the i'iiger zone fron reinvasion. ftrom the socio-econonic point cf view, the results are equally renarkable the whole Say District is the object of a consid.erable movenent of spontarteous colonisation and vast clevelopaent of tlle valleys. Situation i4_I'h89!--il relation to stand.ards Vtrith reference to the stand.ard.s adooted d.uring the -uleetirg of the 2nd' \/orking Group on Devolution, it has been noted bhat in Ni3er : - the LgB2-1981 epidemiological. results show that the village af Datran5:- (no. i167, sub-prefecture of Say, Ldrninistrative Post of Tcnod'i) plasents at the same time a prevalence ir:fericr to lOO i6 and an incidence equal to oof. ...f ( DD -24- As regards the entomological results, the ATPs are below 1OO since 19-t9' everywhere in the whole sub-sectorl the ABRs are also bcloru 'IOOL') everyrvhere since 1979, However at the Garbey-Kourou site iuhich for favourable hydroJ-ogical rea-sono in 1983 was invaded by a loca1 bl-ack f1y population, the ABR was 4272 vrith an ATP of 4. Situat ion in Niner in relation to criteria Onchocerciasis has, with trypanosomiasis, aliuays been a subject of major preoccupation to the health authorities of NiSer in the Say District' The Minister of Rrblic Health and f.iocial Affairs thercfore found the trar:-sfer of OCPfs residual activities to the national health system a nornal evofution and expressed, the deteruination of his Governrnent to organize and plan this transfer under the best possiblc condrtions for it to succeed. - Health struc tures for inteeration Niger has accepted to transfer to its heal-th services, in the short terr:tt the simple a^nd detailed evaluations. These eval-uations could be entrusted: - A.t the central level: - to the Office of I{ygiene arrd Mobile lviedicine (Dmfl{) uhj-ch wil} very soon have qualified person:nel if the tra-ining needs are met. At the intermedigry and pcripheral levels- - The technical- services of DIIMNI collaborate with the nurses in charge of the medical centres, rural di-spensarics and medicaf- posts for the information, organisation and parasitological exarnine.tions in the villages by incl-uCing the research on onchocercia^sis other diseases. In the iC -terrn, the Dfill.i can equal.ly be responsible for entomolog:iceJ eval-uations: d,o::': tlrcugn;h.c Divrs:-oi: vhich lril-l bc crcatcd uithin it for the control of parasi-tic diseases and others a'ocTISctors incfuding onchocc'rcia:isi.s- It must be rccailed that the sub-sector staff i..; mr-dc up 1OCf.i of i'liger ni-uionaf- and that the Go.rernernent is determinccl to absorb them at the r-nd of CCPts na:ici:-rtc- - Personnel Although part of the staff is availarble, lliger is counting on OCP and thc other traditional sources of health collaboration for the t.raining of: (-25- - 1 Epidemiologist - 1 Ophtalmologist - 1 Laboratory technician - 1 Entomologist Financial resources and means To carry out these new activities, supplementary equipment, logistics a'rrd training resources will be necessary. The Minister esteems that the relativelv smal1 volune of work to be done uill- make it possible to find these resources quite ea^siIy. Intercoun Facili From the point of view of the liiger Governmentr OCPrs operationaL technical experience of management and rescarch must be safeguarded and must constitute an instrument of coordi:ration anC intervention during Devolution' Absorption of Niger nationa].s worki in OCP Niger is disposed to absorb the totality of its nationals working in OCP (on1y the problem of the vector col-lectors will be posed for the future surveillance of the breeding sites can be taken care of by the village heaith workers ) . REPUBLIC OF TOCO Zones covered OCP activities cover the whole northerrn region right up to the northerrn limits of the central region on the Mo i.e. 9 prefectures' The Tone (Chief toval Miamtougou) the Binah (Cfriet tovm Pagouda) the Kozah (Chief town Kara) ttre Bassar (Chief town Bassar) the Assoli (Chief tovm Bafilo) and the Tchaoudjo (Chief town Sokode). Ihe main watercourses concerned are the Oti, Keran and Kara basins and part of the I'io Basin, i.e. 3II area of 18rO0O 1cn2' There is a zone with the risk of onchocerciasis coming from the untreated zones where extensj.ons wiII be done (27 OOOlsn2). OCP structures and activities In this atea 57 localities have served as cpidemiological evaluation villages atd 22 serrye as indicators' ( -75 Entomological evaluation activities are carried out from one sector: the liara sector and from three sub-sectors, DapaonSr Ihra in the treated zone and Atakpane in the extension zone. Entonological evaluation is douc on 1 weekLy catching points and JO catching points fortnightly (including the extension z'one)' Ttre vrhole zone including Atakpame consists of 26 Li;rimetric stations " Readini;s are d.one by the hydrobiological department of the University of Benin in Iome which !6 a'lse responsible for aquatic monitorin6. The length of rivers treated hao reduced in 1982-1983t in 1981 it vras 2 164!cm during the rainy season and 1095 lso during the dry sea,son. Present slate qf__plggres_E- Tbansmission of the d.isease has been practically interrupted in more than 85{- of the zone, except in a nearby reinvasion zore bordering the Progr?fifi€ ar€€ro Ihis is confirmed by the epidemj-oIogicaI results for the zone under control where prevalence and incidence are getting lower and lower as rvell in the permanencB of the transmission of infection i-n the reinvasioD zorl€. However, in the whole zone, children born since the beSinning of vcctor control activities a:re free from the disease. Situation of the country in relation to the defined standards In relation to the defined standards, the epidenniological rcsults 1g82-1g8r in the Republtc of Togo show that: .- no villages presents prevalence belo'.r 1Oftl although this has greatly decreased every.rhere " - no villages presents incictence equal to A!'. However in most indicator villages incidence is just around this threshcld. Ophtalmological results equally show a heavy decrease in ocular lesions. On the entomoloSical plan the sub-sector 6f Dapaong has A-TP below 1@' In the l(ara sub-sector, 5Ai of the sites show AIP an:ound the limits of the defined standards. Situat ion in relation to crlteria. Onchocerciaais control is verT irnportant in the health policy of the Republic of Togo which ha.s ahrays considered its control a.s a preliminary to (-2r- socio-ecotloiyric development of the :'egions conccrneci, especially the Kara savr.;] the Centre and Plateau:< re6ions. This p::iorit;'5iiver. to onchocerciasis con'.i'o1 explairis the exteirsion i'equested by the Goverru:lent. Consequently, Togo accepts a-s priority the relaunc5ing of r:aintcna:rce alro- surveillance ac'Livities i,r tire natiolal servic<>s rvhen Devolution ;tandards ;.re met ard the first stcps taken. - iani t ary inte grat i oq_s!rqc_!u1c_s The I'linister of i-IeaJ-th is plannin6 to incl-ucie epider,riol-ogical evaluatiori of onchocerciasis in tire routine activities oi t}e heal-th service of the i;CP zoile. lhis surveillance uiI} inclucle ti:e notification of diseaces by geograliri ::one and the clata concerning onchocerciasis l.ri-1-1 be transr,Titted not only to tllc Division of Epider.rio'l06:,r but al-so to OCI'or to the fnter-Countrir Faci)-ity. It al,so thin];s that i:; the a.ccessible si tes l.ri'th l-or,v C.ensity, FarlLla] larviciie treatment ca:r be envisag,ed. ontonoio..ical crcdrg&ha-rr1.].J. dlso be doa;:.uhe.D. one- fi:ds ^o offiriont- 'f.Gtggi::g method. These activities wiil be cc'fiied: - j't the cerrtral ieveI, to the uIrI l-'ri'rision vrhic'r shall be iesponsible for ti're supervision all the activities transferrcd., tnisr h:'the creation of t national polyualent tearn" - To- thc med-ic;J- offic^rrs in chrrgu of tiu-. Dcpart*Jtlfu f--sub-divisioas r.coporsi-bLc-f.E th' hesf-th c::'c o.f ilre (t]P c,nc:-. Person:lel- The execution of these te.sks rrili rnean uoro cuafi'fieci staff - In v:el'r of the adciitional r,vork r'oqucstecr fron tLr, r.redical oif:-cer i:: cha-':Se of the OCF zone, it is suggesteC th* a. tecl.r.ilicia:r i:.:r entor;oi-o6y be serrt to a.ssist hi.;t vrho vril1 be in cira;5e of vector-bornc d.isee.sc. -'his teal r.rl:ich as fron ncw wil-i col I aborate '..ritit the sector arcl sub-sectors vdlI be tlle nucleuo of the orgaiiisation responsible for tire futu:'e activitics in epic"ei-.iolo5;' airc'- entc.'ro'l c3;r. ( I2B As soon as they are selected, the officials will attc'nd a refresher course at OCP and will participate in Kara at a seninar Togo has requested OCP to organise for the personnel in OCP zone. This information uiIl be given befoie measures are taken. The re-training period v.ri11 be agreed upon by common accord between OCP and the Togolese Gouvernment. Financial resources and functionins. Supplementary means should be envisaged at the national 1eve1 in order to cover staff logistics a-nd running costs. A specific line item to be included. in the next budget. The budget 6ituation is a constraint that the country feels necessary to mention right a'i,'ray' Inter-country facility Togo feeJ-s that the facility ta-king over regional activities at Lrer.'olutioi should be jointly defined by the }iinisters of HeaLth at the next i'lOC meeting. of lese staff A list of Togolese staff workin5; with OCP has been requested by the Minister of Health. This list trill give the a6e, function, place of vrorkr ':tc. so as to plan their return and their future intc5ratj.cn vrith the -rsstter:cc of the JPC. CONCLUSIONS a) A11 the seven Participating Coui:trj-es of the Prograr,,me considered the Devolution of OCP to be j-ncunbent upon them and expres-sed clearLy their political will and Cornrnitnent to tal<e o'rer OCPrs activities which vrill be transferred to them. Ttre importance gi"";"to these meetings by the personal participartion of the l,iinisters as trelfthe fj-e1d staff, sometines sumnoned in this regard, il-lustrates this political commitmcnt. In the short term, aJ-I have agreed to take over the epideniolo6ice.l surveillance; as regards entomolo6ical surveil-fance, nost are Cisposed tc take it over in the short terrn by beginiiing collaboration vrith the sectqrs and sub-sectors and. by organising the structurbs into rvhich their activities and staff wil"I be integrated' a( 29- b) Ever;rwhere structures exist and are availablel in somc of tire countries these structures are already in e position to take over the epidemiological surveillance; in others, they are such that they c:rr be modifiect quite ea.sily to undertake this surveiliance. l-11 the couirtries are ciisposed to make the necessary moctificatiorrs to the health structures in this directic:r. - No Participati:rg country d.esi:'es to create a vertical organisatio:l charged ::rth the control of onchocerciasis. AJ-l, on the contrary, think of integrating it into the surveillance of a given group of parasitic diseases. The idea of a national polyvalent team responsible for the organisation and supcrvision of the epidemiological a:rd entomological activities in the field vras expressed in most of the countries. c) Ilost of the staff are already available and have been installed; some transfers are pIamed.. Everi.r,,rhere, however, whether it concerns staff a-lready available or to be recruited, retre.i-ning or required trainin6 is necessaxy. This is why aJ.I the countries have expressed the desire for OCP to help them in persorurel training, either by fellovrships for training or courses or by the organisation of seninars. The most ur6ent staff needs in each cotrntry have b'gen identified- The Participating countries would like an effective collaboration to be established in the field betvreen the OCP staff and the national health technicians in the Programme aJea as from novr. I4ost suggested that, in this regardr vrrit';eir instructions be given by OCP and the Governments to their:'espective services. d) Thc Participating countries recognize that the implenentation of De'rorutron will necessitate additional clualified staff char6ed with this task, vehicles, equipment, laboratory prodrrcts and running !'nealrs. To transl-ate their political will into reality, they envisage the setting up ri6ht now of the nechanisns necessary for a heaLth budget, tai..ing into account new obligations. Some hi'we even decitled to make a budget a.llocation in this conr:ection in their next buCget " For others, it vri1l be an external aid lvhose volume r,rill- be knor*n es sooll as the cost of OCPts activities vrhich j-s reciucing is cletermined" ( t, -10- e) lhe opinion of all the hea.lth authorities of the sever:. Particinatu:1 Countries is that for reasons related to the effectiveness of Devolution and with the ain of preserving all tire achievemcnts of the P:ogra,rrnc, the intercour.t;y faciiity which vrill succeed OCP must be OCP modified because of thc transferrod activitics, but maintaining some reduced activities of a regional nature. I'ol sorne, this nrodified OCP should take into account some other problems prevailinS in the whole sub-region. ,lnyway for all, whatever the intercountry facilitlf rrhich will come after OCP, it will constitute an instrunent especially of coordination and intervention, operational rcseeLrch, inforrnation and traini::9. f) A11 the Participating Countries are preoccupied vrith the future of their nationpls working in OCP and have asked for inforrnation on tiieir carier, conscious as they are that finally it is rea11y the expertise'of these national technicians that will guarantee the success of Devolution. SoBe wish that, firstly, the OCP staff be transferred to their own countries whilst remaining at the expense of OCP; they will col-laborate rvith the national health technicians in the OCP zone making them familiar vdth the work of OCP. Final1y, a1l- the Participating Couirtries have expressed the wish to ha'"e, at the end of OCPis mandate, an i-ntercountry facility capablc of carrying out effi- ai,cntly the re5ional activities of naintenance, supcrvision and interventior., in permanent contact with the heeltlt services t'rtrich rri}l take over the other activities presently carried out by OCP. tt. WORLD HEALTH ORGANIZATION cllGANl I sATioi'.1,\4,oI..lDlALE DE LA S/TNTE IrgRI_go4sT. LIORIC.;G GRCUP OF }IATIO}LA.L E,'3il.TS O1; DEVOI,UTIOII Annex II Third lileetinS Orag:ad.o.\qo3r -?HS- April 1984 LIST 0F PTI3TICIP-'I;TS Dr I. Kone, Director of International Relat:ons, I'iinistry of -Bublic Health and Population, &$jgg UTPXR VOTTA Dr I'{. Ilien, Erovincial Directur of Sanrantenga, ]klie. I.IATI Iilr 11. Traore, llational Director tf Pla.nn-irg e.nd. iiea.ith and Social traininS;, Itinistry of h:bl-ic Health and Socj-a-I Affairs, lgg3Lq NIGiR. Dr lI. na€a, Secretaq. (4ne1E.I, I'iinisEf of Rlblj-c llealth aod Social Affairsr b-";r TOGO Dr T. I(a-rsa, Di-rector of Epid.emiological Division, l{inistry 9f fublic Eealth, !^ogu_ OCP Dr P. I-rasr:mbuko, hrblic Health Adviser. O:chocerciasi-s Control hogra.uune, -o.l4g1,.gqo-lf. ( ( tI WORLD HEALTH ORGAI.-IIZATION ORGANISATIO}I i,.TCi.IDIA.LE DE LA S/TNTE Anne>: IfIITCR,]f,}IG G,OUP Oi }iATIOhAL lIiim.TS OiI DivoLUTroI{ Third Meeting Orarag.q4so_r-1r_2.4!5_!ti-t1J994. 1. 2. 5. 4. ,. 6. 'l . o Agerda of the roeeting for a. sy::thesis cf the Reports of the iiissions to the I Participating Countries (r7 relruarr - 7 A!ri1 t9B4) Opening cf the neeting Election of Officers Ad.option of the agencla Review and adoption of the. dra.ft synthesis report Prorcosition tr irnplement the reconr-,enclations of tl-le i'iiss:-on rn Devolution Iclentification of new approaches to collabo:-'ation between OCi) and. the Participating Cou:rtries Designation of Rapporteur for the ilOC Closure of the meeting ( t, ( WORLD HEALTH ORGANIZATION AtsR: ATP: ORGA.NISATION lY\Ol.lD|ALE DE LA SAI-.ITE Anne:: fVr,/Oiilglic GROUP 0F I{-=TIOIIALjxlm.rs Oit Dr.-vcLUTIOir Third. meetir6' -Qrre_{qs6,q.u.,J!-25_!pr_tl-}9_84 Standards for Devo1l.-t-i-or fi::ed ( :-r' . the _2 n d_ jlqr-l i._n:.f 9F.9]'-_'t Arurual Biting Rate = annual theoretical mnber of blackfly bites per rtan and. per 5rear = (=IOCO Annual Transmi-ssion Potentia.I = amua.l tireoretica"l nulber of infective0. volvr.:.]us larvae received per man and. per Jrear =S.100 Incid.ence: FrequencT of ner.I cases C-r;rin6 the periocl under consicleration in relation to the total popula.tron exrJcsec'l- to the "is5 d0 Prevalence: Total numbei of case: present eLt a.n;'tirne during this rleriod. in relation to tne population exposed- ={StO O. vol-vul-us r.:icrifilaria in the ante:rior se,3--rent oi the eye = 0 }Tr'-TI Oi]AL CR-ilLiIIA Ad-ninistrative criteria: national- adlinistrative structure at d.ifferent Ievels I na.tional prierities r political coru-ritnent. Institutional criteria: infrastructures, lersonttel, logistics, etc. Budgetary criteria: general health el:ilenses, expenses related. to lrotraiuule previsions, source of fir:ancing, etc. ( a