Opportunities for training in onchocerciasis control methods for OCP countries

,,@ i I OPPORTUNITIES FOR IBAINING IN ONCHOCERCIASIS CO}TTROL METIIODStI roR ocP couNl'*IES 1. INTRODUCTION Training has always been an important component of the WHO programme is to enabl-e the to their populations resources. of tectrnical cooperation with the Member States. The aim countries to improve the health care services offered and to attaln self-reliance within the 11mits of their The manpower needs for the- control of onchocerciasis can be assessed from the tasks to be performed in relation to the method of control. The present strategy for the control of the dlsease seeks to eliminate the vectors through theapp1icationofinsecticidestothebreedingsitesof@, the knownvectors in West Africa. The results of the vector control operatj-ons are evaluated by means of entomological and epidemiological surveillance methods. Ski1ls in hydrometric reading of the river discharge is requlred to calculate the appropriate amount of insecticide needed to eliminate the tllackfly larvae vithout undue harm to the non-target riverine organisms. Tlre ecological impact of the insecticide should be monitored. The large bociy of information collected requires careful processing and analyses. The categories of technical personnel required for the vector control operations and for the nonitoring and evaluation of the results include: (i) (ii) ( iii) ( iv) Entomotogists and Entomological Assistants Epidemiologists/Parasitologist/Ophthalmologist and their ass is tants Hydrobiologists and assistants Statisticians and statistical assistants. Since the control of onchocerciasis should be followed by socj-oeconomic development, a programme for the control of the disease should seek to strengthen the infrasturcture for health care. Provision should be made for fhC.training of community health workers. In anticipation of the discovery of a suitable drug for mass chemotherapy, consideration should be given to tiq. grade of personnel that w111 supervise its distribution and use. 1t is most likely that nurses or "lnfi-rmierst' will be used for this purpose. This short paper describes the facilities and mechanisms employed by WHO to support the countries in meeting their manpower needs for the control of onchocerciasis. -2- 2. I/ECHANISi{S OF WHO C0LLABoRATION WITH THE COUNTB,IES FoR MANPOWER DEY{ELOPMEI{T ltre mechanisms employed to promote 1VHO collaboration in manpower development include: (i) (ii) (iii) (i.v) the award of fellowships; support to national trainlng institutions; establishment of regional training institutlons; encouragement of technical cooperation among oevetop!8&t countries (TCDC) and (v) Seminars, workshops, and short courses. 2.1 Fellorvships WHO fellowships are available to the lllember States, upon request, for the training of personnel in various disciplines according to the national priorities. This opportunity can be exploited to promote national capability in the methods gf onchocerciasis control. Ttre training can be in institutions of the African Region of WEO or in any other region. 2.2 Suppor:t to National lnstitutions Support to national .braining institutions for health manpower development is one of the ways the Organization promotes self-reliance. The support is provided for a limited tj-me and may be through a financlal grant, supply of equipment and books, or assignment of WHO personnel. Example of Institutions supported in this manner are medical schools, schools of public health, nursing schools and post-basic nursing schools. Table 1 shows nursing training instltutlons in West Africa. The only WHO reglonal institution for nursing education in West Afrlca is the CESSI in Dakar, Senegal. -3- Table I Distributi.on of Institutions for Nurs Tralni in West Africa € fl Co,Fegorq eate+iy t 1- 2- .)- Aides soignant or MCH aids Infirmier auxillaires or Auxiliary nurses rnfirmiers dip16m6s, sagesFemmes or Registered Nurses, Registered Midwlves centres Enseignement sup6rieur en soins infirmiers (GESSr) Post-basic nursing education 1VHO Regional institution for nursj-ng. Country Category of nursing training 1 2 3 4 Benln Cape Verde The Gambia Ghana Guinea Guinea Bissau Ivory Coast Li.beria NIali IUauri tania Niger Nigerla Senegal Sierra Leone Togo Upper Volta 4 I 2 22 I 1 4 2 , I L4 2 2 I 1 1 t L4 1 I 2 4 I I I 49 2 1 2 2 1 I 1 2 1,t, l}q -4- 2.3 lvhere the requlrement for personnel with specific skills are limited so that it 1s unecononical or impractical for some coturtries to invest in institutions of their own, lVHo has tried to establish regional trainipg centres to meet the common needs of the countries. Some of these reglonal instltuti.ons were started as pioneering efforts to develop prograrunes that are better suited to the needs of the countries or to provide training in neglected disciplines. Examples in West Africa are the Regional Centre for HealthTroiniaqDevelopment, Cotonou, the Gen$d Centres for Health Servi-ces personnel in Lagos and Lome, and the Centre Enseignement sup6rieur en soins infirmiers (CESSI), Dakar. 2.3.I The Regional Centre for Heal_th Der.,elcpnent, Cotencu This training centrb was started in 19?7 by WHO, but since IggO 1t has become a nati-onal institution receiving WHO support. It provides integrated trai-ning for public health administrators, epidemiologists, nutritionists, sanitary engineers, statisticians, health educators, nurses, labolatory technicians, architects, agronomists, veterinarians, sociologists, econornists arnd community development workers. The duration of the tralning is 11 months. It is probably too early to assess the extent to which the centre i-s meetlng national needs. But judglng from the enrolment, its popularity is in no doubt. 2,3.2 Training Centres for Health Services personnel Ttrere are two regi"onal centres in West Africa which cater mainly for the training of middle level health personnel. One is based in Lagos for English-speaking countries. The other for French-speaking countries 1s in Lom6, Togo. The progranune of work of the two centres for 1981 is given to ilLustrate the scope of the training available, and also to provide the opportunity for speculation on ways in which they could contrlbute still further to the training of middle leve1 personnel to suit the requirements of epidemiological and statistical assistants. Proposed courses for 1981 (Lagos Centre) (i) Course in systematic course desi-gn and community mobilization for trainers of primary health care workers. Ttre participants include nurses, midwives, health centre superintendents and sanitarians. Duration - 12 weeks Period 19 January to 1O Apri1 198I. -5- (ii) Course in health services management for middle-1evel health personnel. Participants include nurses, midwives, heatth centre superintendents and sanitarians. Duration - 8 weeks Period 13 April to 5 June 1981 (iii) Course in environmental health and malaria control techniques for middle-Ievel health personnel. Participants inelude sanitarians, health centre superintendents, and public health nurses. Duration - IO weeks Period 4 May to 1O July 1981 (iv) Course in health services management for middle leve1 health personnel. Participants a.re as in (1i) above. (v) Course in environmental health and rnalaria control technlques for middle-1eve1 health personnel. Participants as in (j-ii) above. Duration 1O weeks Period 5 October to l-I December 198I There is a school for the maintenance and repair of electro-medical equipment in Freetown for Engllsh-speaking candidates. Proposed course for 1981 (Lom6 Centre) (i) Training course for the trainers of primary health care workers. educators,Particlpants include doctors, nurses, midwives, health sanitarians, laboratory technicians, and pharmacists. Duration - 12 weeks Period 5 January to 27 March I98I. (ii) Training in the maintenance and repair of electro-medical equipment. Participants should have suitable background knowledge of elementary mechanical and electrical engineering. Duration - 32 weeks Perlod 5 January to 4 September I98I (iii) Course in community health. Participants i-nclude doctors, nurses, midwives, health educators, sanitarians, laboratory technicians, pharmacists, engineers, agronomists, veterinarians, architects and sociologists. Ttre objective is to encourage cooperation among those rvorking within communities and to improve the coordination of their activities. Durati-on - 13 weeks Period 6 April to 3 July 1981 -6- (iv) Course in health education. Participants include a1l comrnunity health workers and school teachers. ltre objective is to improve their capaci-ty to educate and inform the public on healthy living and ways of preventing the spread of dlsease. Duration - 6 rveeks Period 3 August to 11 September 198I (v) Course in community health. Particlpants as in course (iij.) Duration - 12 weeks. Period 28 september to 18 December 198r (vi) Refresher course for have completed a two uty'."r=t three yearsI o'rratio., - 1o weeks. Period 5 October to 1l December 1981 2.3.3 centre d'enseignement sup6rieur en soins infirmiers (GESSr) The CESSI are regional centres that organize post-basic nursing courses with the aim of producing nursing tutors, and management experts in nursing for French-speaking countries. There are two such regional centres based in Dakar antl Yaound6. They are expected to become natj-ona1 institutions in due course. They will however continue to admit candidates from other countries in the splrit of technical cooperation among developing countries (TCDC). Post-baslc nursing courses are avaj-labIe in Ghana, Liberia and Nigerj.a, but othefe are national lnstitutions which offer places to candidates from other countries on the basis of TCDC. 2,4 Technical Cooperati.on among Developing Countries(TCDC) Technical cooperation among developing countries (rcDC) is one of the important mechanisms employed by WIIO to promote cooperation in heal-th development. In the sphere of trainlng it implies: (i) Loan of personnel. The loaned staff may continue to be paid by the donor country o-n by WHO. (:.i1 Exchange of teachers and examj-ners with WHO financlal support. (iii) Adlilssion of foreign candidates to national institutions ryith financial support of the host country or on trVHO fellowships. (fv) Consultations by members of expert advisory panels. sanitarians. Participants are persons who year course in sanitation and have given of service. -7 2.5 qeryInars, workshops and short courses TVo travelling seminars on epidemlological surveillance of communicable dj,seases are organized each year by wHo. T'he one for English-speaking parti-cipants starts in the USSR and ends in f,ameroon. Ttre other for French- speaking countries starts in France and. ends in Upper Volta and Ivory Coast. It is e:<pected that soon the entire course wil} start and end in the countries of the Itegion. seminars, workshops and short courses are organized as a means of contributlng to the retraining mechanisms existi-ng in the countries of the Region. Seminars and workshops have been organized on malaria, cerebrospinal meningitis, trypanosomiasis, sexually transmitted diseases, Ieprosy, tuber- cuLosis and other important communicable dj.seases. :. TRAINING ]N TI{E DISCIPLINES REQUIRBD FOR ONCHOCERCIASIS CONTROL Itie opportunities for training in ophuralmotogy, f,Vali"f ogy and statistics as f o.Llows: 3 . 1 I.)n trrrlo 1_ct*,, At present, in order to quallfy as an entomolog(st, natlonals of the Ii,egion go to institutions in America or Europe. It 1s however j-mportant to note that some of the existing oCP entomologists were recruited during the planning stage of the programme from among zoology graduates of universities in the pt:ogramme aTea. A1] the training they received to enable them to cope wlth their duties as entomological sector supervisors was provided by institutions in the programme area. Most of them have subsequently had broad training j-n entomology, parasitology and pest control technorogy in institutions in Burope and America in order to acquire a higher qualification such as the Master of Science (lvl .Scr) or its equlvalent. The master's degree has enabled them to assume higher responsibilities withln the OCp. It also enhances thej-r emplolment chances with other potential employers. I{HO has recent}y initiated technlcal cooperation with the Universitj_es of Jos, Nairobi and Abidjan to develop postgraduate training in medi-ca1 biology that should offer skiIls for the control of a broad range of vector- borne diseases affecting both human and animal populations. There will be entomology, epidemiology, parasitology, for the OCP countries may be described -8- oltro-clivcthe need to ensure that attradive emplo;anent opportunities aTe created in the countries of the Region to discourage the exodus of the graduates in search of more Lucrative jobs elsewhere. The ocP, the rnstitute de Recherche.s sur 1'onchocercose (rRo), Bouak6 and the organisation de Cooperation et Coordination sur Ia lutte contre Ie grande Endemie (occcE), Bobo Dioulasso, also provide excelrent experience in methods of onchocerciasis control for entomology graduates from Europe and America. ocP has established suitable training courses for middte-level personnel engaged in onchocerciasis control. The prospective candidates however are expected to possess previous knowledge of elementary biology of the vectors. .some countries do not provide such basic knowledge for their natlonals. The possibility of offering elementary courses in entomology at Lome and Lagos has been considered, but no definite recommendations have been submitted. 3.2 idemiol is ts Parasitologlsts, and O thalmolosis ts Although epidemiology, parasitology and ophthalmology are taught in the medical schcors of the countries of the Region, the available courses, so far seldom confer qualifications that are recognized for promotion in the national health services. Ttre Universities of lbadan and Kampala have courses in publj-c health. But these are not yet popular. Ttre present practice is to seek such training in American and European institutions. The OCp offers fellowshiSs to candidates from ocP countries and provi.des fierd experience for interested Africans as weII as pon-Africans. Other countries of the Region can use the financial- allocation offered by wHo to train their national_s according to their priority concerns. organized systematic training for epiderniological assistants does not exist in many countri.es. ,tOn-the-job', training is the common manner of developlng this cadre of workers. consequently they have no paper evidence of the training and tend to feel insecure. 3.3 Training Opportunities fSr E€elgiSls Although the universities of the Region are not knorvn to offer recognized courses in or to undertake research on related problems. have departments of zoology, they methods of ecological surveillance The only institutions known to be engaged in organlzed and systematic ecological monitoring of the river system5 fl -9- are the Laboratoire d'Hydrobiologie of the IRO, Bouak6, Ivory Coast and the Institute of Acquatic Biology (IAB) of Ghana. The Department of Zoology of the Unlverslty of lfe has also started ecological monitoring of the rivers of Nigeria, but it is not knorvn whether the department is so organized to conduct sustarirted and uninterrupted work or whether it all depends on the interest of an individual. OCP has recently started offering fellowships for the trainlng of hyd::obiologists. Ttre candidates are sent to Europe or America and subsequently go to the IRO or IAB to gai-n practical experience of lVest African conditions. 3.4 Statistics Tralnlng in statistical methods is ava1lable in most universities of the African Region. It is the practice to offer university graduates the .opportunity for further training in demography and health statj-stics in European and American lnstitutlons of higher learning. Statis bical ass j.stants usually acquire their knorvledge through tlepartmental trltj.ning offered bv statistical instittrtions in tl-reir corrnLries. $'llO offe3s strppol't f or specral tralning in health statistic.s to such middle level. workers. !'renctr-spealiing candidates are usually sent to institutions in Dakar, Senegal or Yaound6 in the Cameroons. General comments Hydrobiological and ecologicat problems are relatively new areas of concern of the governments of the countries of lVest Africa and even of the entire African Region of WHO. Few countries therefore have specialists of this typer and secure career opportunities for them are rare. Although it should not be difficult to organize sultable courses for this discipline in the universities of the B,egion, at present one has to go abroad to obtain recognized qualifications in this subject. promotion opportunities are definitely I imi ted. Graduate training in medical entomology and pest control is at present obtained abroad. But the universities of Jos, Nairobi and Abidjan should soon be able to provi-de more suitable courses in thj-s disciprine. Emproyment opportunities exist but are timlted and promotion prospects are poor. i'1t f' - 10- Postgraduate courses for epidemiologists are available in Nigeria and Kampala. WHO organizes seminars and short courses in epidemiological surveillance. Opportunities for training, employnent and promotion for epidemiologists are therefore reasonableo Special experi.ence in the methods of onchocercj.asis control is obtainable within the OCP. To obtain recognized degrees in Ophthalmology and Statistics, one has to go ahroad. Employment and promotion opportunities are reasonably good. The rnai-n area of uncertaj-nty relates to the grade of middle level- worker in all di-sciplines. Although employment opportunlties exi-st, organized training that offers recognized qualifications are few or non-existent. Prospects for promotion are poor for this grade of health worker. The 1IHO courses provided at Lagos and Lom6 are relevant to the needs of the countries and contrlbute to the improvement of the quality of services rendered by the ministries of health. Unfortunately, the training received at these training centres do not qualify recipi-ents for promotion in most co-rntri.es of Lirc ltegion. Correcti.on of this anomaly lies solol y in the hitn<ls oI th-e l-:L)vurnli{-,riLr-. I I ivil L rr:c1urr'(' tllltt 1l)e 8ovc.r-Ilirients slrc;rrlrl sulriril t orrl-\' canrl.i-<latcs tlrat are about to be recruited or promotcd to unclergo the courses at the regional training centres for middle leve1 personnel. After completion of training the personnel should be recruited or promoted as appropriate. TNAINING OPPORIIJNITIES IN TTIE IIO,THODS OT OAICHOCERCIASIS c0{firoL Catcgory of Personnel h0 tr .A d H +, o o 'rl k o sl Ic o o .r,l .u a +) I U' t-l Ft d o +) o ot{ +J c c) c) A ci ,A b0 ,n & o o EItdL 00 okA orl o rd (,) dIr C)oho4 oE o 5 o o .F) +, ..{ +l o l-{ o{ o ok 0) o o +, o oh GI a c) o EpideniologlCts: Easlc training PostgraCuate tralnlng I'ield experience + + + + + + + + + ldemlology asslstants : + + uEntouologlsts: Baslc tralnlng Postgraduate training l'reici experience + + + + + Entoaology asslstants + + Cptr tha Lrnologis ts: Baelc tralning Poslgraduate tralnlng FioId .experlence + + + + Hydroblologlsts: Basic trainlng Postgraduate tralnlng l'Ield experlence + + I'lydroblo logica 1 essl s tants + + )tatistlclans: Baslc tralnlng.Postgraduate tralning Fleld experlence + + + Statlstlcal asslstants + + Nurses: Baslc trainlng Post-bas1c trainlng Fie1d experience + + + + + + Soc:ologists: Basic training Fleld experience ,+ + Baslc tralning Fleld experience Irconomls ts : + + + + I I I I