Joint Coordinating Committee fifth session, Lomé, 5-8 December 1978: Independent chairman's report of proceedings

rcc/ 5 JOIM COORDIIIATING COMMITTEE ONCIIO(ERCIASIS COI{TROL PROGRAI'IME IN I1IE VOLTA RTVER BASIN AREA Fifth sesslon, Lme . 5-8 December 1978 IITDEPET{DEM SIIAIRMAN,S REPORT OF PROCEEDINGS 1. IMRODUCTION AI.ID OPENING OF lEE SESSION: Agenda ltem 1 1.1 The fifth sesslon of the Joint Coordtnating Comittee for the Onchocerciasis Control Programne in the Volta Rlver Basin Area was held at the Maison du RassemblemenE du Peuple togolais, Loa6, Togo, frou 5 to 8 Deceuber 1978. The session \ras attended by representatives of the Governments of Belgiuo, Benin, Canada, France, Federal Republlc of Getmany, Ghana, Ivory Coast, Japan, Kuwait, Mali, Netherlands, Niger, Togo, Unit,ed Kingdoo of Great Britain and Northern Ireland, Uoited States of Arnerica, Upper Volta, the African Development Bank (ADB), the United Nations Develop.ent Prograrme (UNDP), the Food and Agriculture Organization of the United Natlons (FAO), the lJorld Bank (IBRD), and the World Health Organization (WHO). Observers frm Guinea and Senegal lrere present at the invitation of the Independent Chair:uun. The sessiorr rras also attended by the Chairman of the Economic Developnent Advisory Panel and observers from the Inter-State Permanent Comittee for Drought Control in the SaheI (CILSS), the Comission of the European Comrnities (CEC), the Organisation de Coordination et de Coop6ration pour la Lutte contr:e les Grandes End€mies (OCCGE) and the Office pour la Recherche scientifique et technique Outre-Mer (ORSTOM) of the French Goverrment. A list of participants is attached as Annex 2. L.2 The inaugural meeting was presided over by the Representative of the Founder President of the Togolese People's Rally and President of the Republic of Togo. 1.3 In his address of 'r"l"m. to the C@rittee (attached as Annex 3), his Excellency Mr H. Bodjona, Minister for Public Health, Social Affairs and the Advancement of Women of Togo, said that the presence of Dr Il. llahler, Director-General of WIIO, was an encouragement Eo all those who vere worklng together against the scourge of river blindness and a guaranEee to contributors that the financial resources they provided were being used wisely to eliminate that scourge and alleviate the suffering it caused. He also expressed his thanks to Dr C. A. A. Quenum, WIIO Regional Director for Africa, for the solicitude he had always displayed for the problems of the Region, and to Dr M. G. Candau, whose agreement to serve as Independent Chairman emphasized his continuing interest in the world's health problems. L.4 The Indepeodent Chairman, Dr tl. G. Candau, thanked the Representative of the President of the Republic for honouring the Comittee by his presence, which demonstrated the interest of His Excellency the Founder Presldent of the Togolese People's Rally and President of the Republic ln the Progrme. -In his introductory statenent (attached as Annex 4), Dr Candau said that 1978 had been marked by the consolidatlon of the Progrme's activiti.es in the whole of the initial OCP area. It had also seen the extension of acttvities in the Ivory Coast and the start of studles on extensions ln Benin, Ghana and Togo. The Coumittee would be considering the evaluation of the technical and economic aspects of OC? and the continuation of activitles in the second stage (1980-1985). The experience and data acquired on the epidemiolory of onchocerciasis and the biolory of the vectors warranted a study with a view to the refineoent of control strategies, whlch would also be influenced by the phenomenon of reinvasion. He hoped that studies could soon be extended to the natural llmits of the main vectors, in both particlpating and neighbouring countries. He called for a stlll greater research effort to find slopler and less costly metfuods of vector control and to extend knowledge of the disease and lts treatment. In concluslon, he stressed that in the long run OCP's succesa and the benefits lt brought would depend largely on the development of the pentranent health services in the partlclpating countries, whlch would need to be ready to rcc/5 Page 2 assume responsibility for any continuing onchocerciasis control activities on the programe's terminaEion. The close cooperation between Participating Governmentsr Contributlng Parfies and Sponsoring Agencies ensured that OCP's activities would assist in the econonic and social development of the region and that its people would enjoy a healEhier and moEe prosperous life 1.5 In his address to the Cqrmittee (see Annex 5), the Director-General of lIfIO, Dr H. Mahler, said that the results obtained by OCP in the entomological sphere were excellent; operations were proceeding according to plan and 75% of the operaEional zone was under control. Despite the increase in activities in 1978, the Prograrmre's effectiveness had not diminished, thanks to sound management and cooperation between the Participating Goverrments. He welcomed thejoint meetings of National Onchocercj-asis CouEniEtees, of wtrich the first had been held in Abidjan in June L977 ar,id the second in Cotonou in June 1978. The role of those Corunittees would certainly increase as Progranure activities were integrated into natiooal Prograrutes. He paid tribute to OCP's advisory bodies, particularly the Scientific and Technical Advisory Connrittee (STAC), and pointed to progress involving industry in the production of alternative insecticides and chemotherafeutic drugs for testing. If, as the STAC suggested, some control continued to be necessary even after 2O years, the challenge was to find a control technique that was less complex but equally efficacious, less cosEly and therefore Eore cost-effective. He had asked OCP to set up a working group to study the Programe's long-term future, and to answer these questions: is there a simpler and less costly technique for larviciding? Could a combination of envi.ronmental modification, localized larviciding, and careful siting of villages keep the prevalence down to an acceptable level? What use could be made of other vector control methods, e.g. control of adult flies? Would the extension of the Prograune reduce logistic costs? Another urgent question was whether the OCP organization could be used to combat other diseases, and thus increase the Programne's cost-effectiveness. In keeping with WHO's objective of health for all by the year 2OOO and with the Alma-Ata Declaration, all governments should be mobilizing resources to develop national systems of primary health care. It would be each participating country's responsibility to incorporate within this system a suitable structure for keeping the country free from onchocerciasis. As to economic development aspects, the National Onchocerciasis Comnittees had emphasized their exclusively national relevance. He hoped that the countries would take up the challenge of launching carefuLly prepared developnent projects that would enable them to derive optimum profit from OCP's huge investments. 1.6 In his opening address (attached as Annex 6), the Representati-ve of the Founder President of the Iogolese People's Rally and President of the Republic reaffirmed Togo's fu11 support for OCP's activities to control onchocerciasis in an area with some 600 OOO sufferers, many of Ehem blind. WHO's success in eradicating smallpox suggested that onchocerciasis too could be controlled. OCP was no!, in full operation. fhe results of the first six years were posiEive, and he hoped that the recent evaluation reports would enable the JCC to move forward to the second stage with the necessary resources. He stressed the importance of joint action to solve the developrnent problems of West Africa, and welcomed the close cooperation among contri- buting and participating countries and international and bilateral organizations in carrying out the Programne. He thanked all contribuEors for their unselfish humanitarian cooperation. The economic and social development to which all African governments aspired would only be possible if onchocerciasis was mastered. Progress in control technolory and further training vould enable the participating countries to assume responsibility for control activities. He expressed particular appreciation of the efforts of the Independent Chaimran,. the Director- General of WHO, the LrHO Regional Director for Africa and OCP staff at all levels. On behalf of the President of the Republic, who had always emphasized the development of the whole man - and hence the Promotion of health, the extension of health care to all the people, and rural development - he wished the Coumittee victory in its struggle against onchocerciasis. L.7 At the conclusion of the inaugural meeting, the JCC briefly suspended its proceedings to enable the guests to withdraw. 2. ELECTION OF TIIE VICE-CHAIRMAN OF THE SESSION: Agenda item 2 2.1 On the resumption, the Independent Chairman took the Chair. He proposed His Excellency Mr H. Bodjona, Minister of Public Health, Social Affairs and the Advancenent of Women of the Togolese Republic as Vice-Chainnan of the session. Ihis proposal was approved by acclamation rccfs Page 3 2.2 The Independent Chairman, rostrum. on behalf of the JCC, imzited Dr Mahler to take a Place at the 3 I) 4 1 ADOPTION OF TIIE AGENDA: Agenda item 3 The provisional agenda (document JCC5.1) was adopted without amendment (see Annex 1). PROGRESS RXPORT OF THE WORLD HEALfiI ORGANIZATION FOR 1978: Agenda item 4 4.1 WgO's progress report for 1978 (document JCC5.2) was Presented by the Prograrne Director, Mr M. Ls. Bazin. 4,2 Entomological operations in 1978 had been marked by the quality of the results, recorded daily or weekly at some 25O capture statj.ons. - The Simul-ium population had been reduced to very low levels, with virtually no transmission, on the White Volta, the Red Vo1ta, the Black Vclta (except between Chache and Bui), the OtL/Pendjari, and the Niger tributaries in Mali, Niger and Upper Volta. This represented 75% of the OCP area, including the whole of the Phasre TI area and the northern part of Phase I. t+.3 Spraying had been affected by climatic conditions, and particularly a prolonged drought. L)perations had been reduced, and had not reached optimum level-s until July. Ihe Sota river in -Benin had been treated in March, the Mekrou and Alibori in I'Iay, the Tapoa in Niger in June, and the Sassandra and lularahou6 in July. The cmbined treatment of the last two rivers had greatly restricted reinvasion, which had begun on 10 April and for wtrich 16 capture stations, 9 vehicles and 38 catchers had been provided. 4.4 After discussions on the definition ofrrflying time", the air company had agreed to accept LtlO's definition, i.€. moment of t'lift-offtt to tttouch downrl, not including warming up and coolj,ng tlorrn. Tachometers had been installed in all helicopters. It rtas nor. known that in 3?,82 lrelicopter landings in L977,320 hours had been unproductive - at $ SS4/teticopter hour, a loss for OCP of $ 126 O8O. The new definition should lead to savings of some$ ZSO 0Oo in ttre last two years of the first stage. OCP had agreed to supply aviation fuel in the ar:ea. At the same time, the cost of a helicopter hour had been reduced by $ 22 and of a fixed-wing aircraft hour by $ 48.50. Ihe measures had come into effect on 1 January L978. 4.5 The proposed extension studies in West Mali and the Senegal river basln would be dealt witir under agenda item 12. Satisfactory progress was being made with the extenslon studies in Benin, Ghana and Togo, to which OCP had sent missions during the year. 4.6 The Epidemiological Evaluation Unit had visited villages in the Phase I area for the second time. ft had been found that the ocular effects of the disease had stabilized, even in severe cases, and that there were very few new cases with severe'ocular lesions. From 1975 to 1978, the Unit had examined 85 614 people, L5 964 of them in detail. 4.7 From three trainees it 1977, OCP had progressed to over 20 itr, L978. That was the result of preparing an explanatory docr:ment and discussing it with countries through personal visits and at the rneeting of National Onchocerciasis Comj-ttees in Cotonou in June. That cooperation vould continue. 4.8 In research, a working group on a replacement insecticide had met in Geneva in Ju1y. The meeting had brought together research workers, WHO staff and representatives from prirrate- sector chemical companies, rrrho were informed that the potential market was grorring as a result of the extension of control operations and, indeed, that the OCP market was open to alternative products according to price and equal quality. The private sector had agreed to pass new compounds and formulations to OCP for testing. A further meeting was planned in Ewo years' time. The American Cyanamid forrmrlation of Abate had been tested by ORSTOM at Bouak6 and found to have the same qualities as Procida's Abate. Cyanrmid had since been asked to tender for quantities of 5OOO, 10 OOO and 15 OOO litres. rccfs Page 4 4.9 In talks to define the respective spheres of work, it had been decided that the Wt{O Special Programne for Research and Training in Tropical Diseases (TDR) would be responsible for drug promotion, fundamental research and contacts with the pharmaceutical industry, while OCP would carry out field trials of recormended drugs. 4.10 The second meeting of National Onchocerciasis Comnittees had taken place at Cotonou in June. The meetings were important because they were held between JCC sessions and enabled OCP to review the progress of activities in detail with the participating countries. The agenda at Cotonou had included reinvasion, coordination between OCP and the countries for flights and Landing rights, extensions, training, the evaluation rePort for 1974-L978, and plan of action and budget for 1980-1985. OCP had found the meeting particularly helpful : understanding countries' views on training, the services to be provided by the Economic Develop,ment Unit, and the eventual transfer of the Prograrmne to the national authorities. further meeting of participating countries had been heI-d in Ouagadougou in September to discuss a first draft of the economic evaluation rePort. over- the in A 4.lL With regard ro liaison with the general public, the BBC (United Kingdom) was Presenting a series of prograrures on OCP. The ceremony of inauguration of the new headquarters building held the previous week had been transmitted live on radio and TV in Upper Volta. The concen- tration of OCP staff in a single building would increase efficiency, strengthen team spirit and morale, and reduce costs. ? 4.lZ The new building had a surface area of L326 m' on three floors, with 56 offices divided by central corridors. The conference room, with an area of 156 rn2, would hold 90 people. Construction of the building and conference room had cost 80 million CFA francs (about $ 372 OOO); the cost of 50 OOO CFA francsfm2 was in line with estimates and with normal costs in Ouagadougou. 4.L3 Operating costs of OCP in 1978 had been some $ 11.5 million, or $ 2 3O3 3OO less than estimated; some of the savings were attributable to the present management system, which now included weekly reporting of expenditure. 5. ANNUAL REPORT OF THE SCIENTIFIC AND TESI{NICAI ADVISORY COMMITIEE: AgCNdA itCM 5 5.1 In the absence of the Chairman of the STAC the Independent Chairman invited amember, Dr p. Haskell, to introduce the Conrnittee's report, with the exception of sections dealing directly with other items of the agenda. 5.2 Dr Haskell said that the report (document JCC5.3) of the STAC's seventh rneeting, held in BrazzavL1Le in August 1978, was long and cornpLex. It included, in Annex II, the report of the Scientific Advisory Panel Working Group on Insecticides (July 1978), and in Annex III, the STAC's recommendations. 5.3 With regard to sectiot 2 of the report, dealing with the Progress of activities, he paid tribute to the OCp's scienti.sts. Progress had been made in identifying the comPonents of the Simulium damnosum complex and in training staff to identify the different species. Support to basic research in such fields as taxonomy and cytogenetics must continue. The considerable advances in reinvasion studies v/ere described in paragraphs 2.6-2.L4. The dramatic reductions in blackfl-y catches folloving the extension of treatment to rivers supporting savanna species showed the efficiency of control operations. Reinvasion had two facets: redistribution in the OCp areal and reinvasion from outside. The STAC considered that the Progress made in understanding this not unexpected problem should enable its nuisance value to OCP to be greatly reduced, though studies would have to continue over a period of years. The STAC had noted (paragraphs 2.12-2.13) that the distribution of savanna species south of the extension line was well documented i-n the Ivory Coast and data were being gathered in Ghana, Togo and Benin. Invasion of the savanna by forest species was considered unlikel-y. The STAC had reconrnended that a second SAp Working Group on Reinvasion be convened; the Group woul-d consider the implicatione of extension in this fieLd. i rccfs Page 5 5.4 With regard to section 5, the STAC had shown great interest in the findings of the SAP Working Group on Insecticides. Clearly, OCP's cooperation was necessary if private industry was to help to develop the much-needed alternative to Abate, since the Prograrmne's requirements r^rere not large and a nev insecticide might cost $ 10 million to develop. However, the industry would examine existing compounds and new formulations, and make them available for testing. The STAC had reccrirunended that OCP set up the necessary facility for screening and evaluating these compounds and feeding back the resultant data. Some requirements for such a facility were listed in paragraph 5.2; however, because of the difficulty of finding suitable sites in the participating countries, testing might have to be done ouEside the OCP area. 5.5 The STAC had recognized the possible value of adulticiding (paragraphs 5.4-5.7). The problem was not so much in finding suitabte insecticides and systems - success had already been obtained in tests against the vectors of trypanosomiasis - as in learning enough about blackfly resting habits and methods of application for this approach to be effective. Further work in this field was recommended. 5.6 Section 6 of the report dealt with health infrastructure in the participating countries. The STAC had felt that the NationaL onchocerciasis Cormnittees had a key role to play in developing the health services in the countries. If a drug suitable for mass treatment was found, a network of basic health services to deliver chemotheraPy and other care would be essential. Ihis would require more posts in the health mini.stries and auxiliary networks. Moreover, it was useless for OCP to train scientists if they had no such posts to return to- 5.7 As section 7 indicated, the STAC had approved the transfer of WIIO's responsibility for the Chemotherapeutic Research Centre at Tamale to TDR. 5.8 The STAC had congratulated OCP on its work on endemicity levels (section 8), which it considered very important. The definitions of hyperendemicity (onchocerciasis affecting over 60% of the people in a conmrunity), hypoendemicity (under 35% of people) and mesoendemicity (between 35% arrd 60%) outlined in paragraph 8.2 would be valuable guidelines for the econmic developrnent aspects of the Progranure. The finding that up to 35% of the population could be affected without the disease being socia1ly aPParent was particularly noteworthy. The STAC had recormnended further work on the status of the disease, also with a view to socioeconomic deve lopment. 5.9 The STAC's concern over progranrne staffing was reflecEed in section 10 of its rePort. The STAC representative welcomed the expansion in the OCP training ProgrEIIIme, which meant that more national staff would be available. However, the present scientific staff were under considerable strain; the OCP area was gror^ring and they were being asked to do additional tasks, with little margin for emergencies. The STAC considered that the Prograrrne Director should be authorized. if necessary to build up the vector control and epidemiological staff with funds from other parts of OCP. 6. DISCUSSION OF AGENDA ITEMS 4 AND 5 6.7 The JCC congratulated the Prograrmne Director and the STAC on their rePorts. It was agreed that the WIIO progress report and those parts of the STAC report that had already been introduced should be discussed together. 6.2 The CorEnittee \^ras in favour of setting up a facility for testing and screening insecti- cides. OgP had recently tested a new microencapsulated formulation of Abate on the Bagou6 river in Western Ma1i, unfortunately without conclusive resul-ts because of problems with the product. Suitable test areas of high endemicity in Senegal were also mentioned. Trials had been carried out with an American Cyanamid forrmrlation of Abate, which seemed to have effects on Simulium and non-target organisms similar to those of Procida's Abate. In answer to a questl;;, the STAC representative expressed the view that sufficient pressure on the total Simulium population would eventual-l-y select out genotypes resistant to Abate, so that an alternative i-nsecticide was necessary. However, major resistance was unl-ikely to appeat fot three or four years. rccfs Page 6 6.3 Interest was shown in the potential of adulticiding and the possible changes this approach might impIy. The JCC's attention was drawn to the widespread use of area control of adult biting flies in Canadal insecticides were not accepted for general use in this way unless they gave at least 90-95% kill of mosquitos and blackflies. A number of compounds were being tested and the penetration of different types of foliage by aerosols and other formulations was being studied. 6.4 The Connnittee was informed that the present experiments in adulticiding did not involve a change in stratery, but were designed to support larviciding. OCCGE had been working for a year on adulticides and the resting places of adult females. It had devised a test of adult sensitivity, and was testing various products of different stages of develop,ment. Meanwhile, some Progress had been made in Western Mali, where adult females had been found resting. Ihe inurediate need, however, rras an adulticide ready to use. OCP's studies on reinvasion had shor.m that incoming females first laid their eggs in the reinfested sites. Thus in theory they could be located in their resting places and killed before biting man, wtrile larviciding would continue to be used aiainst the local Simulium population. 6.5 A representative suggested that paragraph 4.8 of the STAC report should have menEioned Western l"Iali as a source of reinvasion. Another representative noted that the WIIO progress rePort referred to reinvasion in the west of the OCP area, but not in the south and south-east. The JCC was informed that treatment in the Ivory Coast extension area had had IittIe effect on reinvasion in Mali, which indeed probably came from the west. The problem of reinvasion had been first recognized in the west of the OCP areal in L979, it was hoped Eo reduce research activities in the west and place greater emphasis on the east. Because of clioatic conditions in West Africa, the direction of reinvasion was from south-west to north-east, and the areas first affected were Western Mali and Northern Ivory Coast. 6.6 It had originally been intended that the second SAP Working Group on Rei.nvasion proposed in the STAC's rePort (paragraph 2.14) should carry out studies first on the planned extensions to the south, and then on the Senegal river basin to the west. However, it had not proved possible to bring the members together as expected and new plans were being made. Both staff and associated workers were attempting to inforrr the scientific conmunity of OCP's work through presentations at meetings and articles in journals, and it was hoped that there would be an increase in relevant entomological research as a result. 6.7 In answer to questions, it was noted that the table at the foot of page 2 of the WHO progress report contained some errors of addition. The cost per litre of Abate was $ 6.63, whiLe each helicopter hour cost $ 372 and each fixed-wing hour cost $ 146.50. The cost of the Progranune, if the length of river treated was taken at 551 OOO lcn, was some $ 22 a kilo- metre in 1978; the cost of aircraft and insecticide $ras about $ 7 a kilometre. I'lore flying hours per litre of Abate had been needed in L977 than in 1976 because in the later year operations had begun in Phase III, where the terrain called for rmrch flying for small applica- tions. 1978 had seen the start of operations in the south part of the lvory Coast area, where fixed-wing aircraft could be used more efficiently. It was hoped that ulEimately the number of helicopter hours flow could be reduced. The 1978 spraying season had been wet and one month longer than in 1977, rthLch explained the increase in insecticide used. 6.8 A representative asked for further details of the age-groups involved in the epidemio- logical evaluation activities described in paragraph 17 of the WtlO progress report. He was tol-d that in evaluating the effects of insecticide treatment all the inhabitants of the villages were examined but special attention was given to children born since the start of OCP. The children aged tI^ro to three years in 1975 r^rere now in the six to seven year age-group; some L5-2O% of them had been infected in 1975 and stil1 vrere. However, the present O-5 year age- grouP had no cases. In some villages in Mali r,rhere the youngest infected people in 1975 had been 12 years otd there were now none under 15 years. Thus the disease was being eliminated from the base of the age structure upwards. 6.9 The JCC noted that as TDR was responsible for research on all parasitic diseases, including onchocerciasis, it had been fel-t appropriate to transfer to that prograrune the responsibility for suPPort to the Chemotherapeutic Research Centre at Tamale. While coopera- tion between OCP and TDR was acknowledged to be very cIose, it was suggested that a definite procedure for coordination was needed. JCC/ 5 PaBe 7 6.10 Several representatives expressed approval of the transfer. llany countries contributed to both these WI{O progranures and their complementarity was evident. It was hoped that WHO would succeed in interestlng the private sector in this non-lucrative work. 5.11 The Dlrector of TDR, Dr A. O. Lucas, said that when TDR began the Tamale Centre had already started and OCP was pursuing other work to find new drugs and develop existing ones. The TDR Scientific Working Group on Filariases had given high priority to finding a drug that would ki1l adult Onchocerca from screening to clinical trials. He welcomed the incorpora- tion of the Tamale Centre into the network of centres taking Part in this work. A network had been set up in cooperation with the pharmaceutical industry in wtrich drugs were being screened in animal models, while clinical trials at Tamale were being supplemented by trials outside the OCP area. Some compounds were being synthesized for TDR on the basis of leads in the literature. The Scientific Working Group had allocated about $ O.5 million for basic drug research arrd $ 2OO O@ for drug trials and innnrnopathological studies in 1978. Financial constraints should not harnper work in 1979, for rdrich a rational PrograrEne had been drar.m up; extra funds might be needed when a specific lead was found. 6.L2 The Chief of the WHO Filarial Infections Unit, Dr B. O. L. Duke, said that the position regarding the chemotherapy of onchocerciasis was very unsatisfactory. Suramin, vfiich killed adult \rorms, and diethylcarbamazine (DEC), which killed microfilariae, had been available for 30 years. Both were difficult to use, neither was suitable for large-scale treatment, and no good new drugs had been found since. Ihe present approach was, first, to investigate the improved use of the drugs available, chiefly at Tamale, and secondly, as mentioned by the STAC, to carry out small-sca1e trials.with a variety of other parasitocidal drugs, including the veterinary anthelminthics, to investigate their effect on Onchocerca. 5.13 Attempts were also being made to find new drugs, especially a macrofilaricide that was non-toxic. lhe pharmaceutical industry alone had the facilities and expertise for this very expensi.ve work. TDR had begun by approaching companies in Europe, Japan and the United States of AmerLca personally and explaining how vital a new drug'was. Ihe response had been sympathetic, and some companies had agreed to try to help. Very few, however, had screening programmes for filaricides. By providing support for academic research in the Federal Republic of Germany, Japan, the United Kingdom and the United States of America, the capacity had been built up to screen 25OO compounds a year. Work was also going forward with synthesis foLlowing knoqin leads. A11 proposals for clinical trials had to obtain ethical clearance. 6.L4 Candidate macrofl-laricides that passed preliminary screening in smal1 animals were now being handed on for further testing against Onchocerca gibsoni in cattle in Australia. When new leads were found, increased funds would be needed to develop them. 6.15 The Tamale Centre was al-so studying drugs to suppress the severe irunrne reaction that occurred wtren microfilariae were kiIled. TDR was trying to interest workers in studying immunopathological aspects, and in investigating these reactions in animals. Ihere were few scientists competent and willing to do such work. 6.L6 OCP was compLimented on its sound management. Concern was expressed, however, as to the inevitable logistic problems of so vast a programne,- and the strain under which the senior staff worked. Recruitment, too, r^ras difficult, as section 10 of the STAC report underlined. It was suggested that management consultants might be used if the Prograrmre Director so wished. 6.L7 The Progra:rnre Director confirmed that it was difficult to find and keep staff with the necessary ski1l and experience who were prepared to work in the field, though emergency reserves were avaiLable if necessary. As to the criteria for recruitment, OCP recruited according to needs. After each post had been advertised, details of al-1 candidates were forwarded to the WIIO Regional Director, who convened a selection corrnittee to make the appointment. Paper work was a great consumer of staff time and, as the JCC had seen in 1977, OCP's fleet of some 225 vehicles caused many problems. Nevertheless, administrative diffi- culties were kept to a minirmmr by an exceptionally competent staff. rccf5 paSe 8 6.18 It was noted (paragraph 2.8 of the WHO p{ogress report) that two consultants had been recruited for studies in connexion with reinvasion, and the hope was expressed that workers from the OCP area could be engaged. The JCC was informed that a Togolese consultant had already been taken on, and that it was hoped to recruit another Togolese consultant in the near future. 6.L9 In view of the discrepancy between various sectors, a representative asked how the pay of sector and subsector staff was fixed. The Progranrne Director said that the pay scales in the Niamey subsector, which were fixed by IJNDP, were lower than in other sectors; its staff were poorly paid in relation both to other OCP staff and to goverrunent staff. Revisions were made after complex surveys r,rhich onLy the IIMP Resident Representative could carry out. He had written to LINDP on the subject. The IJNDP representative added that a pay revision exer- cise was now in progress in Niamey. It would take into account goverrtrtrent and private sector salaries and the cost of living. The results of each country survey were sent to IINDP headquarters for decision. 6.20 The representative of Niger said that it was because he had received no reply from the IINDP Resident Representative that he had raised the matter with the WIIO Progranrne Coordinator, who had then informed OCP. The staff's feeling of frustration over the delay was jeopardizir.g the Progrmne's success. The WllO Regional Director said that he would take the question up in the usual way for WIIO staff. 6.21 The JCC welcomed the increase in the number of OCP trainees to more than 25 in 1978. However, the total seemed unlikely to meet the Participating Governments' needs, especially since 12 of the trainees were from Guinea, which was outside the OCP area; it was not clear whether the shortage of nationals of participating countries was due to the lack of candidates or OCP's inability to find training opportunities for them. fin" Coo*ittee was informed that the total of trainees matched neither needs nor OCP's possibilities. A document explaining the possibilities had been circulated to the countries but time was needed to select trainees. The absence of candidates might mean that countries were obtaining training from national or other sources. A training programme for the coming 5-10 years would be worked ouE in consul- tation with the countries. With the help of IRO, Bouak6, the Progranune would be able to provide training for any candidates forthcoming. One of OCP's benefits was its ability to provide training for staff from other river basins; the trainees from Guinea, for example, were part of that country's preparations for the future. Training would need to concentrate on treatment methods within reach of the participating countries r,rhen they-took over OCP's activities, and West African institutions outside OCP should also be usedJ 6.22 One representative said that training posed a fundamental problem, since staff frorn his country assumed that if they went for training a post in OCP would follow. Clearly the participating countries must prepare to assume responsibilities for the maintenance phase, and OCP's nature and stratery at that stage wouLd determine what traj.ning was relevant. It was all the more important, therefore, to develop appropriate technologies rapidly and to PrePare' for example, for surveillance by the people. 6.23 Several representatives stressed that it was important for the parEicipating countries to estahlish positions and select persons for training in order eventually to assume certain maintenance functions. 6.24 In answer to questions (paragraph 2,77 of the STAC report), the JCC was told that a workshop had been held in Lama-Kara in October to give staff from the east of the area instruc- tion in cytotaxonomic identification techniques. Senior OCP staff members had also given training to sector and subsector chiefs in Benin and Togo. Ihe length of training for entomologists varied according to the level and needs of each candidate. As to OCP's oum staff needs, technicians from Niger r.rere non, in training at IRO, Bouak6, and staff from Benin and Togo were being recruited. The WHO Regional Director \^7as PrePared to recruit one or tr^7o training officers at OCP headquarters to deal soleLy with training of personnel. rccf5 Page 9 7. REPORT OF TIIE ECOLOGICAI PANEL: Agenda item 6 7.t Introducing the item in the absence of the Chairman of the Ecol-ogical Panel, the FAO representative noted that the Panel's report (JCC5.4) was addressed, in accordance with its mandate, to the Steering Conunittee. The Independent Chairman had transmitted it to the JCC chiefly for information. 7 .2 With regard to the ecological effect of vector control operations, the Ecological Panel was satisfied that aquatic monitoring in OCP was adequate and that no significant ecological changes had taken place. It believed that the same protocol should continue to be followed. 7.3 The ?anel had conrnended OCP for its continued study of the problem of reinvasion. It accepted that aerial larviciding was the only cost-effective method of controlling Simulium in the OCP area, but believed that ground applications of Abate, which might be possible in some areas in the dry season, should be considered. Mechanical habitat modification should also be considered, and the need for careful design of dam spillways should be borne in mind. 7.4 At its next meeting, the Panel proposed to undertake case studies of the ecological implications of two development projects. It had asked one of its members to PrePare a discussion paper on the ecological effects of agricultural methods used in areas with similar conditions in different parts of the vrorld r'rhich might be applicable in the OCP area. 7.5 A representative expressed surprise that the Ecological Panel had again produced a rePort that touched on every subject but said nothing concrete. He also found it remarkable that the Panel should seem irritated by the JCC's cormnents at its previous session and refer to its terrns of reference. He was not clear what those terms of reference r47ere; in any case, the JCC was the governing body of OCP and could decide as it wished. The Panel would do better to confine itself to the ecological implications of vector control operations. If it could not collaborate with other groups or corunittees, it should avoid distracting them with incautious extrapolations, tendentious suggestions and hasty conclusions. The Panel's role was still not clearly defined, and there was a lack of essentiaL cohesion and unity. A situation in which the Panel had failed to answer the World Bank's questions, so that WHO had had to clarify the issues, seemed quite abnormal. 7.6 It was suggested that the JCC was not given enough technical information to judge the reports of the STAC and the Ecological Panel, which were often contradictory. More informa- tion should be provided more frequently. 7.7 The importance of continued ecological monitoring was stressed. be kept on the possible effects not only of Abate, but also of other adulticides. A careful watch should insecticides, including 7.8 1t was felt that the Panel was questioning previous assurances that larviciding with Abate would cause no medium- or long-term damage to the environment, for example in its statement (paragraph 5) that the analysis of the aquatic monitoring data was essential to prevent irreparable damage to the environment or the finding (paragraph 18) that there had been a 307. reduction in the abundance of organisms. It was not clear if the fish migrations noted (paragraph 21) were normal and aLso occurred in untreated zones, or if they were an attempt to escape treated areas. It was in any case doubtful if fish populations were an adequate index of environmentaL hazard. Some of the details of the Panel-'s recormnendations to the hydrobiologists were not appropriate in a report before the JCC as a policy organ. The Panel had appeared (paragraph 33) to conmrend a draft PaPer on the evaluation of environ- mental hazards of the use of Abate, but had pointed to many shortcomings; it evidently wished to extend the study to touch on every aspect of OCP. The Panel had suggested that partici- pating countries should be helped to undertake monitoring studies themselves, but at Present they lacked the necessary equipn,ent. One representative appealed for funds so that such work could be done by national staff. 7.9 A representative found it inappropriate for the Panel to make recornnendations to Participating Governments regarding organized or technically assisted resettlement of oncho- freed lands. Such decisions lay entirely within the prerogative of the countries as sovereign States. The nature of such technical assistance also gave rlse to misgivings. rccfs Page 10 7.lO It was noted from the cover page of the report that LIHO believed that in the real absence of onchocerciasis the tector could be allowed to return without hampering settlements, though i-t was not clear whether that applied with or without extensions to the OCp area. On the other hand, the economic evaluation report (document JcC5.7, part II) referred to the nuisance the flies would cause, whether or not infective. It was pointed out that if the disease remained in the population it would be unsafe to a11ow the flies to return, so that WHO's statement referred to a time in the future beyond the 2O-year life of OCp. Clear criteria would eventually be needed to determine when the disease had been eliminated. 7.lL I,IHO had suggested that settlements should not be located in the vicinity of breeding sitesl yet the flight range of Sirrulium was over 3OO krn, and in Niger, for example, no twopoints in the OCP area were more than 2OO km apart. The Panel had referred (paragraph 41) to the improvement of domestic water supplies as a means of reducing visits to rivers and exPosure to the nuisance of biting f1ies. In countries short of water, such measures might also have value in reducing.infection and in assisting overall development. 7.12 The World Bank representative explained that its questions to the panel had reflected its concern whether measures should be taken nor.r to protect settlements against future health risks. Because the Panel might have misunderstood the queries, they had been posed again to WIIO in the Steering Conrnittee. The panel had not met since. 7.L3 The Chief of the oCP Vector Control Unit said that in West Africa the nuisance causedby S. damnosum was rarely enough to threaten development; thus, if there was no chance ofdisease transmission, the fly population could with safety be left uncontrolled. C1early, with a large human reservoir of disease, all the Prograrrne's efforts would have been wasted if control operations stopped now. If the parasites were eliminated in the human population, however, and flies arrived without infection, they would be no threat when feeding on people without the disease. With regard to the positioning of human settlements, certain riverlocations were particularly attractive to the migrating flies as breeding sites. They concen- trated near these sites, laid their eggs and then, probably because their food reserves tere exhausted, had to take a blood meal nearby. As a planning guide, it was therefore wise to keep settlements 5-1O hr away frmr such sites. 7.L4 In reply to a question on paragraph 12, he explained that S. sanctipauli was a forestform of the simulium complex. work done by rRo, Bouak6, "na ocp-tlEhournE]t it p1-ayed nopart in migration into treated areas. S. sarrctipauli appeared to be a poor vector of thedisease, which was not a major problem where this species r^ras dominant. OCp concentrated on the savanna zotte, where there was a clear epidemiological need, and on S. damnosum s.s. andS. sirbanum , which were serious threats. Regarding paragraph 13, the phrase rrborder treatmentrl was intended to convey the idea that once the disease had been reduced in the human population, active control would not be needed over the ld:role OCP area; nonetheless, an active control zone would sti11 be necessary as a barrier round the area in the maintenance period. 7.L5 The FAo rePresentative said that the JCC's coments would be transmitted to the panel and to the Steering Comnittee. He explained that the paper prepared by the Chairman had beenpresented as a draft requiring completion by the Panel. It would be examined again at thePanel's next meeting before being passed on for action. 7.L6 The Jcc accepted the Independent Chairman's suggestion that the Steering Corunittee should be asked to PrePare a clear definition of the Panel's role and its relationship with all other OCP bodies in time for the JCC,s next session. 8. REVIEW OF THE PLAN OF ACTION AND BUDGET FOR 1979: AgCNdA iICM 9 8.1 Introducing the Pl-an of Action and Budget EstimaEes for L979 (document JCC5.8), the Prograrrne Director said that the inclusion of the whole of the lvory Coast extension in the Plan of Action brought the Prograrmne area to 764 OOO hl2 and the river length protected to 588 648 krn in 1979. The estimates provided for 6430 helicopter hours and 1583 fixed-wing aircraft hours; the cost of the former would be reduced from $ 394 to $ 3lZ and of the latterfrom $ 185 to $ 146.50. Sone 25o ooO litres of insecticide would be used, or about 7% lessper lcn of river than in 1978. JCC/ 5 Page 11 8.2 The Epidemiological Evaluation Unit would tackle some 120 villages in which it would examine 30 OOO people. While the work of the Economic Development Unit would be influenced by the JCC's subsequent discussions on development qLrestions, he did not exPect them to affect the budget estimates. Similarly, the direction and volume of research and training would not change markedly it L979. 8.3 The cost of implementing the Plan of AcEion was nov estimated at $ 13 895 2OO, of which 65.4% was for the Vector Control Unit, 15.2% for administrative support in Ouagadougo't,7.9% for research and training, 5% for epidemiological- evaluation and 2.7% for the Economic Development Unit; the remaining 4% was divided between administrative support in Brazzaville, Geneva and FAO, meetings, and the Office of the Independent Chairman. Apart from support in Brazzavj-1le and Geneva, which were 7% higher, all budget items were either unchanged or reduced in relation to the December 1977 estimates for 1979. These reductions totalled $ 1 818 4OO, the main components of which were $ I 2O3 4OO attributable Eo the Vector Control Unit, $ 262 5OO to the Epidemiological Evaluation Unit, and $ 282 85O to administrative support. The reasons for the reductions were described in the document. 8.4 While final accounts were not yet available, it was hoped that Ehe actual 1978 expendi- ture would be some $ 11 5OO OOO, or $ 2 3OO OOO lower than the figure estimated in December 1977. 8.5 The JCC, in reviewing the Plan of Action and Budget, congratulated OCP on the clear presentation in the document. 8.6 A representative inquired if the reduction in the ratio of vector collectors to river di-stance (page 5 of the document) would permit the capture teams to maintain their Present leve1 of effectiveness. He was informed that it had been found possible to reduce the number of capture points in the Phase III area now that it was better known; similarly in the Phase II area, the dense network of points had been reduced in view of the excellent control results. Such decisions were Laken with great care; a maximum of information was desirable, but the work was very expensi-ve. Another representative noted that it was anticipated (page 4) that in 1979, as in previous years, 15-2C/" of weekly larviciding treatment circuits could be safely suspended, and asked what were the criteria for such interruptions. He was told that in certain areas where the catching teams showed that there were no flies, and at times when weather conditions prevented irmnigration, it was safe to suspend treatment. However, the situation was constantly monitored, so that if flies should reappear treatment could be reintroduced innnediately. 8.7 With regard to epidemiological evaluation, the fear r^7as expressed that if in each river basin and epidemiologicalfecological zone only the most representative hyper- and mesoendemic villages were selected for examination, taking accessibility and socioeconomic future into account (page 5), the poorer and more inaccessibl-e villages would be at a disadvantage. It was explained that the most important short-term question was whether transmission continued or not. In hypo- or mesoendemic villages the level of transmission was so 1ow that it was very difficult to detect. The Epidemiological Evaluation Unit would therefore concentrate on hyperendemic villages where residual transmission could be diagnosed if it occurred. Never- theless, the hypo- and mesoendemic villages remained on record and would eventually be important to the Progranmre's success. The OCP staff would do their utmost to overcome difficulties of access. 8.8 A representative asked for further information on the studies of patients being treated wi.th suramin in Upper Volta (page 6). He was informed that under an agreement between OCP and the Ministry of Health, the Programme was to assist in the scientific supervision and evaluation of a treatment campaign undertaken by a Public Health Department team in the Ti6b616 region. 8.9 In answer to questions, the JCC was informed that the 1979 volume of research under OCP would be similar to that in 1978. The research was designed to support the Programne's operations, and was kept under constant revierr. The main change in emphasis in 1979 was from vector cytotaxonomy to helminthology. In the past much research had been done under contract by institutions, but in 1979, because the work had to be done in the field, more use would be rccf5 Page 12 made of consultants. The funds in the budget were adequate for all the research envisaged. The Prograrmne Director welcomed a suggestion that since some research work related to oncho- cerciasis was being taken over by TDR, each year's budget document should indicate what this research was and how it related to the rest of OCP's research. 8.10 A representative noted that the budget provided only $ 15O OOO for environmentalprotection. He was assured that this sum would enable the data requested and recomended to be obtained and made available. 8.11 Two representatives noted that administrative costs accounted for some 19% of the 1979 budget estimates; that figure should be regarded as a ceiling. Another representative felt that in view of OCP's circumstances the present costs were reasonable. He pointed out that the various groups and cormnittees made heavy demands on the Prograrmne's resources. Moreover, many of the JCC's suggestions had implications for funds and staff time. In the case of particularly expensive proposals, the -Conrnittee should perhaps ask for a prior statement of the cost implications. 8.L2 The Prograurne Director said that administrative costs were a constant concern; the Present proportion was indeed expected to be a ceiling. Those incurred in the OCP area rePresented 15,4% of the budget, accounted for as follows: transport, 2l%; typing pool, 3%; finance, l:O%; personnel, '10%1 general services, L3%; chief administrative officer, 4%; supplies, 8%; Director's office, 31%. These costs permitted the administration of a large quantity of equipment, a staff of some 7OO, 3OO vehicles, and an air services contract, all distributed over seven countries, in an expanding ProgratrEre area, He stressed that all these costs were closely linked to field operations, and that the output of the Progranrne depended on the quality of its administration. 8.13 A representative suggested that the budget should include provision for JCC members to visit field areas where experimental work was being done, to enable them to take part in the Comrittee's discussions in ful1 knowledge of the facts. The Prograrmne Director said that he was prepared to organize such visits ir, the OCP areal he would try to absorb the additional demands on sEaff time, aircraft, etc., within the present budget. 8.14 A representative observed that when vehicles broke dor"m replacements r^rere sent from OCP headquarters, and asked if studies had been carried out of possible alternative systems. In Niger, for example, the Government would be prepared to provide temporary replacements for vehicles out of service. The Comnittee was informed that vehicles were distributed at a rate of one per mobile unit, with a 2tr4 reserve in case of breakdowns. In the past these had been assigned at subsector Ievel, but it had since been found that centralization in fewer locations gave greater flexibility and control. The Prograrmne Director thanked Niger for its generous offer of assistance, which had always been forthcoming on past occasions. 8.15 The WHO Regional Director for Africa felt that national staff did not play suffici-ent part in executing the Progranmre. He suggested that further logistic support should be given to strengthen the activities of the National Onchocerciasis Comnittees. He also considered that epidemiological evaluation r^ras not enough. It shoul-d be followed up with the delivery of health care where structures were now missing. 8.16 The JCC approved the Plan of Action and Budget of the Progranune for L979 9. FINANCING OF THE ONCHOCERCIASIS CONTROL PROGRAI'IME FOR 1979: Agenda item 10 9.1 For the discussion of this item, the Cormnittee had before it a cumulative statement of contributors to the Onchocerciasis Fund for the period L974-1978. The Wor1d Bank representa- tive said that after making quarterly advances totalling $ 12 rnillion to WHO for 1978, the Fund had a balance of some $ 4.8 mi1lion, which was sufficient to meet the first quarterly advance for L979 of $ 4.2 million to be made to WI1O later in December 1978. The total advances for 1979 were now estimated by WHO at $ 13 mi1lion. Taking into account the need for an advance at the end of 1979 for the first quarter of 1980 of $ 5.2 million, assuming that OCP continued, the total financing requi-rement for L979 vas estimated at $ 14 million. rccfs Page 13 9.2 To help meet that need, the World Bank had authorlzed a contribution of $ 1.75 million for L979, bringing its total contribution for the first stage to $ 6 mlllion. He was also glad to announce that during 1978 two new donors had expressed their intention of contributing to the Progranrne. Saudl Arabia had indicated that it planned to contribute $ 5 million over a three-year period, and had already made a payment of $ 1.67 million in 1978. Secondly, the Sabah Al-Salem A1 Mubarak Al-Sabah Foundation of Kuwait had indicated its intention of contri- buting $ 1OO OOO. He expressed his gratitude to these new contributors. 9.3 The United Kingdom representative said that, as the Connnittee had approved the Plan of Action and Budget for L979, his Government would again be glad, subject to parliamentary approval, to make 107. of I{HO's drawings on the Fund available in 1979. 9.4 The representative of France confirrred that in 1979 his Government would contribute FF 5 million, representlng the balance of its total pledge of FF 26 million for the first s tage. 9.5 The representative of Canada said that despite delays in the national budgetary Process, he expected that his country would be in a position to fulfiI its earlier statement of general intent in 1979. 9.6 The Belgian representative said that in view of irmninent Political changes she could not conunit her Goverrnnent. However, the budget estimates stipulated a lO"/" increase in the con- tribution for 1979, which, subject to parliamentary approval, would be of the order of BF 20 mil1ion. 9.7 The Netherlands representative said that as the last part of its total contribution for the first stage had been paid in 1978, in consultation with the World Bank, it would not make a further payment for L979. 9.8 fhe representative of Kuwait said that his Goverrsrent had pledged $ 6 million for the first stage; in L979, it would make the final annual contrlbution of $ 1 million remaining from that totaL. g,g The Japanese representative said that his Goverrrnent had so far contributed $ 3.5 million to the Progranme. Its contribution for 1979 would not be lower than that for 1978, and it hoped to reach a total of $ 5 million for the first stage. 9.10 The United States representative said that his Government had originally pledged $ 6 million for the first stage. In 1978, as a result of a congressional visit to OCP head- quarters, Congress had earmarked $ 2 million, representing an additional $ 1 million, so that the total pledge had already been paid. However, subject to the availability of funds, his country planned to contribute a further $ 1.7 million for L979 to help meet increased costs due to inflation. 9.11 Sunrning up the position, the World Bank representative said that in addition to the contributions already announced for 1979, Norway would provide $ 5OO OOO, representing the balance of its pledged contribution of $ 1 mi11ion. The total of sorne $ 14 million would be adequate to meet costs for the final year of the first stage of OCP and the first quarterly advance for a second stage, should thus be approved by the CorEnittee. There might also be a sma1l surplus which could be carried for:r.rard inEo the second stage. In response to a request, he agreed to circulate in L979 a statement showing the balance of contributions due to the Onchocerciasis Fund and the totals paid so far. 9.12 The representative of Upper Volta said that his country was in a special position as OCP was based there. It had been directly involved in Phase I, and 90% of its territory was covered by the Progranure. It had adopted the framework agreement and signed other agreements with OCP. Responsibility for the Progranune, however, had not always lain with the Ministty of Health. Now that responsibiLity for the Progranure came directly under the Minister for Health, who was also Chairman of the National Onchocerciasis Comnittee' any difficulties should be solved. Though Upper Volta was in arrears with its contributions, the impression that it could not fu]fil iEs undertakings was no doubt due to administrative shortcomings. rcc/s Page 14 Upper Volta was fully conmitted to OCP and would fuIfil its obligations. Before the session, Upper Volta had issued a payment order for 20 million CFA francs to cover its participation in OCP. He invited the Progranrne Director to contact the National Cormnittee to iron out certain questions regarding the amount of Upper Volta's contribution and to determine which costs were attributabl-e to the national authorities and which to OCP. 9.13 In accordance with the Steering Conurittee's decision of October 1978, the Progranune Director reported on the status of contributions of the Participating Governments. He first thanked the Upper Volta representative for the contribution he had just announced; the amount did not correspond to that in OCP's accounts, but tl"re discrepancy could be dealt with in Ouagadougou; Ghana, Ivory Coast and Niger were up to date with their contributions. No banker's notification had been received of payments by Benin, Mali and Togo. Mali had con- siderable arrears but had made an effort to pay its 1978 contribution. The unpaid contributions totalled 7 25O OOO CFA francs for Benin; 8 703 OOO CFA francs for Togo; and 25 9L3 OOO CFA francs for Uppet' Volta, not counting the 20 million CFA francs payment just annouoced. 9.L4 The representative of Mali said that before coming to Lom6 he had attempted to settle Mali's arrears and thereby show its firm support. for OCP. Through a misunderstanding, however, the arrears, which represented the pay of Mali nationals working for OCP, had not been settled. A payment of 15 381 605 I"Iali francs had been made in November, so that contri- butions for L978 were up to date. Henceforward the Treasury would pay Mali's share of staff costs monthly. 9.75 lhe representative of Togo said that at the 1977 meeting of National Onchocerciasis Comnittees in Abidjan, his country had been reminded that the pay of some Togolese nationals working for OCP should be paid by the Goverrrnent. Armed only with the existing agreements, the Ministry of Health had found the Ministry of Finance difficult to convince. However, in November 1978 Togo had paid the sum of 8 266 755 CFA francs it considered to be due, while the Prograrmne Director had referred to a larger figure, perhaps because different scales of pay were used. He suggested that the existing agreements should be reviewed so that each party knew exactly what its obligations were. 9.L6 The Independent Chairman emphasized the value of the information on the status of con- tributions of the participating countries, whose continued support for the Progranune he welcomed. 9.L7 lhe representative of the Federal Republic of Germany said that two officials from his country had taken part in the World Bank's econornic evaluation mission in March - April 1978. They had been struck by the importance of setting up an efficient health infrastructure in the oncho-freed areas. He therefore welcomed the proposals in the evaluation report for making use of OCP's infrastructure for the health sector. He also supported the proposals for Erying out simpler and less expensive technology for vector control with a view to possible cost reductions in the second stage of the Prograrmre. He welcomed the plan to have OCP evaluated by an independent corunission. The results should be available by mid-1979 to allow them to be fully discussed by contributors, together with proposals for the financing of the second stage, before the JCC| s L979 session. He was glad to note that his remarks regarding a clear delineation between OCP and TDR in the financing of research had been taken into account, and that the Ernst Rodenwaldt-Institut in Lom6 - supported bilaterally by his Government - had been assigned research work under OCP. 9.18 The IINDP representative observed that IINDP had contributed to both OCP and TDR since their inception. Its contribution to the first stage had been fixed at US$ 2 O4O OOO. The remaining balance of $ 460 OOO to be paid directly to the Fund, would be its contribution for 1979, and possibilities for subsequent years would be reviewed at an appropriate stage. 9.L9 The representative of Niger asked, if, assuming that his Government paid their salaries, OCP would be prepared to employ both the technicians from Niger now in training at Bouak6. It was understood that one would become Niamey subsector chief, and it was desirable that the other, with equal qualifications, should continue in onchocerciasis work. The Progranrne Director said that such cases raised certain problems, because OCP had to supplement the JCC/ 5 Page 15 workers' 1ocal pay frour Progranrne funds. Tf Niger had no structure w'ithin which to employ trained staff, it might be possible to employ them on loca1 salaries in connexion with OCP's work in thaE country. I{e emphasized that the training of national- staff did not imply that they could then be absorbed by OCP. 9.2O Other members of the JCC stressed that the objective of training hTas not for the staff to be employed by OCP. On the contrary, the intention had always been that they should be selected with a view to returning to T./ork in their national services. Efficient national health infrastructures should be built up nor"r, and the trained staff would play an imPortant part in maintaining what OCP had established. 9.21 After the conclusion of the discussion, the Progrartrne Director announced that he hadjust received notification of payment of Togo's contribution. 10 STIJDY OF fiIE EVAIUATION REPORT AND TUTURE OF TIIE PROGRA},IME: OPERATIONAL ACTIVITIES: Agenda item 11(a) 10.1 The Progranrme Director introduced part I of the evaluation report (documenE JCC5.7), which dealt with operational activities. In September 1977 t}:,e Steering Conurittee had pro- posed that a comprehensive review of OCP be undertaken to lay the basis for the financing of the second stage. WIIO had been made responsible for the operational aspects and the World Bank for the economic developnent aspects of Ehe review. A first draft of the WHO part had been ci.rculated in lularch and April 1978 and reviewed by a group of STAC members in May. A revised draft had then been examined by the meeting of the National Onchocerciasis Cormnittees in Cotonou in June and by the STAC in Brazzavill-e in August. In September the Steering CoflErittee had reviewed a draft with further revisions, also taking into account the World Bank's comnents. That version had been accepted as adequate for fund ralsing and \^ras nos/ before the JCC. LO.z ldeally, OCP would have preferred to take part in the evaLuation at a sorer,fiat later stage in operations. Activities had been expanding phase by phase up to L977 to cover all the original OCP area, and 1978 should have been the first year of consolidation. In L977, hovever, the JCC had asked for the extension of control into the southern Ivory Coast and the beginning of studies in the south of Benin, Ghana and Togo. 1O.3 The report covered the period from OCP's launching in L974 to L978, It confirmed that the structures initially conceived for the prograrmne had been suited to its needs. They had enabled problems to be solved, and had been flexible enough to permit additional investigations in the course of operational activities. Ihe methods used had been shorrn to be adapted to the OCP area as a wtrole and to be sufficiently sensitive to meet the Programne's changing needs as it moved from the vector attack phase to a maintenance phase. 1O.4 The research support had been planned primarily to meet operational needs. Much of the research work had been done in close coordination with other parts of WHO; for example, insecticide developrnent with the Division of Vector Bio1ory and Control and chemotherapy studies with TDR. Training of national staff had expanded to meet first OCP's and then the countries'needs. 1O.5 Thus a soLid foundation had been laid for OCP's continuation in the second six-year stage. The medical e'ridence indicated that the vector control strategy used and the results so far obtained should enabl-e the Prograrmne's objectives to be realized within the 2O-year period. 10.6 Nevertheless, the operation was costly and based on sophisticated techniques. The aircraft represented the only appropriate technology now available for a programme of OCP's type and size. It was intended to use the second stage, when it was hoped that the pressure for expanding operations would not be so greaL, to find alternative strategies, assess nationally-oriented structures, study integrated methods of control, seek acceptable means of chemotherapy, reduce costs, and permit greater national participation. rccf5 Page 16 1O.7 The total cost of the second stage was now estimated at some $ 133 million, an increase of sonre $ 77 mil]-ion over L974-1979, of which 64% was due to inflation and 36% to increased activities. This projection was based on certain assumptions: 8% annual- inflation combined with exchange rate fluctuations; an 11.5% yearly increase in staff costs; activity at a constant 1979 leve1; replacement of one-Ehird of the vehicle fleet each year; aerial contract increasing at 10% a year starting from the average losing bid in 1976. These tentative assr:rnptions would have to be confirmed by experience. For example, the level of activity might decrease, wtrile the rate of inflation and exchange rates could go up or down. The Progranme would adjust its budget estimates each year as experience indicated. 10.8 The JCC expressed its appreciation of the comprehensive and informative report prepared by WIIO, which provided a valuable history of the operational aspects of OCp. It was recog- nized that the inclusion of more detail would have made the report unwieldy. The Comtrittee considered that the document showed that the Prograrune was achieving its objectives and that its structures were suitable. Some regret uras expressed that the report did not look more into the future; it was noted, for example, that the statement in the Plan of Action and Budget 1980-1985 (Chapter VIII, page 60, first paragraph) that the stratery of OCP would remain essentially as originally planned was hardly calculated to persuade governments to contribute to the second six-year period. l-0.9 Io answer to questibns, the JCC was informed that the only wild animal, ever found naturally infected with O. vol-vuIus was the gorilla. Chimpanzees had been infected experi- mentally but their use was obviousLy l-imited. Work was continuing to transmit or to transplant the parasite to other animal-s and to grow it in vitro. Studies on closely related Onchocerca species were also be ing pursued, especially in cattle, and the specific identity of erca larvae found in wild S damnosum s.1. was be ing studied, using such new techniques as histochemical staining. 10.10 While the report did not mention the point specifically, the criteria for declaring an area safe for econornic developnrent based on the annual biting rate (ABR) and annual transmis- sion potential (ATP) were still- intended to be met over a two-year period. Indeed, over 6O% of the oCP area had already held the recorunended tolerable levels for two years, including nearly all Upper Volta. 10.11 A representative suggested that the difficulties caused by reinvasion, and its effect on future strateg'y, had been inadequately dealt with, and that estimates as to the proportion of the OCP area subject to reinvasion appeared to vary from 20% to 3t/". I{e was told that the ProPortion of the original OCP area affected was 25-27%, but would be reduced if the Ivory Coast extension was taken into account. The choice of the correct boundary to the south should reduce the impact of reinvasion, since the flies invoLved were savanna cytospecies; the forest flies appeared to play no part in these migrations. As to the flight range, flies had been known to migrate as far as 27O krn. Much had been learned in the first five years, and it was j-nevitable, as more knovledge accurm:lated, that control would become more easy and cheaper. The view was expressed that the various extensions requested were justified in themselves on humanitarian grounds, and not simply to safeguard the present area from reinva- sion; it was therefore not satisfactory to say that they were too expensive. LO.L2 It was the STAC's opinion that more funds shouLd be earmarked in order to expand research. Among the principal objectives of future entomological research, it was suggested that it woul-d be more appropriate to find a series of alternative larvicides and formulations to "supplementrr or rrcomplementrr, and not to ttreplacerr, Abate (page 65, second paragraph, (i)). The need for formalizalion of the present good working relations betrreen TDR and OCP was emphasized. 10.13 Attention was drawn to studies in Canada, where a simple United-States-designed fibre- glass panel trap to catch adults was being evaluated against Simulium, w'ith promising first results. Ihe natural-fibre ropes being used at 1arval evaluation sites appeared to be so attractive to the larvae that the possibility of a related control technique was being investi- gated. OCP would foL1ow those studies closely and possibly try the new traps; the ropes mentioned had not so far proved successfuL against S. damnosr.rn. The trials of the insect- growth regulators Dimilin and Altosid (page 43, last paragraph) were being carried out chiefly at Bouak6 by ORSTOM. rccf5 Page 17 10.14 In view of ttre importance of environmental consideration, it was suggested that the report might include an anlysis of research in biological control methods. However, the JCC was i.nformed that no firm prospect of a biological control agent had been uncovered, though work had been done on a parasite of S. damnosum larvae and on Bacillus thur tensl-s var. israelensis which also readily ki11ed Sirmrliicl larvae. Biological control agents, if released before their effects were known, could have a far more serious effect on the environ- ment than insecticides, and were not necessarily cheaper. Ihe JCC was also told that the filarial skin paras ite Dipe talonema streptocerca , which was prevalent in the Vol-ta Region of Ghana (page 44, seventh paragraph), had been studied at the request of the STAC as a possib1e source of error in epidemiological surveillance, First, the parasite was not pathogenic for man, so no control method was neededl secondly, the vector was not a Simuliid; thirdly, the parasite was not found north of the 8'N para1le1, and thus could only cause problems if the OCP area was extended in the south. The parasite had never been found aLone, but only in association with O volvulus. 10.15 A representative regretted that there was no section on public health in the rePort. Although OCP had a public health post, there was no indication of what had been done or what was planned. Perhaps OCP should be examining disease paEterns in the valleys and possible approaches to deal with them. It was not clear if OCP thought that it should be the focus for the health infrastructure, or if onchocerciasis surveillance should be a part of the over- all health system. In reply, it was pointed out that the STAC rePort menti.oned the rmrlti-disease use of the OCP structure, certainly for trypanosomiasis and schistosomiasis. Such a decision would have many implications, for example in research on control, since trypanosomiasis was also carried by a biting fly. 10.16 The decision would also have implications for training, wtrich it was also suggested had not been adequately dealt with. If OCP was to last 18-20 years, the document should reconrnend specific fonrs of health infrastructure which governments could consi.der developing in order to maintain the Progranrne nationally. 10.17 Referring to the statement that the role of the JCC was to exercise general supervision over the policies to be adopted in OCP (page 3, first paragraph), a rePresentative asked where policy was in fact made. The Prograrrme Dj-rector said that policy was determined by the JCC through its function of annual review and approval of the Plan of Action and Budget. 10.18 The Coumittee voiced its preoccupation with OCP's future strategy. The Progranrne's objective, as defined by the STAC (page iv, first paragraph) gave no ending date for OCP and yet referred to maintenance and control, with the implication that national Prograrmes would later undertake maintenance operations. fhe Prograrrrne Director said that the Progranrme could be justified by its health and economic benefits. That did not mean ignoring possible alternatives to the present costly and complex control methods. The Prograrmne had started on the assumption that after 20 years larviciding could stop and the blackfly be allowed to return, because transmission would have ceased. In August 1978, however, the STAC had con- cluded that some l-arviciding would have to continue after year 20, though the methods to be used were unclear, as the new technology was lacking. It was not certain, at the present rate of cost increases, in what form the Prograrure could eventually continue. 10.19 Thus research was needed on cheaper alternative technology and new approaches. Extensions should be studied, not only in themselves, but as a means of strengthening OCP and reducing its costs. Other studies might relate to localized larviciding, manipulation of the environment, better siting of settlements, the possible use of the OCP structure for other health care training, and whether the right research was being conducted correctly. 10.20 Such a review might be carried out by an independent multidisciplinary conrnission of 8-10 members. It might last for one or two years; by 1980-1981, the JCC would then have far more information as to OCP's long-term future. ]1O.2l The STAC representative warned against expecting definite statements regarding OCP's future after only a few years of operations and before further research had produced sufficient data on new technologies. The Prograrmne's objective was to reduce the disease, and this was reflected in the need to control- the vector, Clearly to eradicate the vector was impossible, rccf5 Page 18 and since transmission might be resumed through migration of people with survival of pockets of the disease, it seemed reasonable to indicate the of both the vector and the disease - though at a 1ow leve] - over a long noutd need to plan for this, and control activities would be adjusted to a tolerable level. A11 this would require further research. onchocerciasis or the need for surveillance period. Countries keep transmission at LO,22 Representatives of the participating countries fuIly tecognLzed the importance of maintenance so that the results achieved were safeguarded and new developrnent projects would not have to be abandoned. Ihe exanrple was quoted of a cement works on the untreated Senegal river, where over 80% of the more than 2OO workers had onchocerciasis. The solution to the maintenance question and to the treatment of new areas might be found by returning to earlier methods of ground application of larvicides from river banks, no doubt with improved equiprent. Certainly elaborate operations with aircraft would not be feasible once OCP ended. LO.23 An essential factor would be to inform the people and involve Ehem in contributing positively. The origin and features of onchocerciasis and the existing possibilities of treatment should be expl-ained. Larval breeding sites and larviciding could be demonstrated. OnIy in this way, using techniques within the reach of the people and as part of other simple heal-th measures to improve the qualiEy of life, could Progress be made. People would continue to live near the water, because in dry areas r^7ater rilas 1ife. Other diseases too could be tackled by associating the people in control and prophylaxis. LO.24 It was pointed out that the proposed 2O-year duration of OCP was linked to the aPParent 1-ife-span of the parasite; however, if the actual life-span would not be known for some 15 years, the duration might have been underestimated. Judging the Progranure's success rnight wel-l prove difficult until the end of the 2O-year period. It was unlikely that the Contri- buting parties would endanger everything achieved by withdrawing suPPort, but consultations on cutting costs might be necessary. Ihe JCC was informed that little definite was known of thb life-span of 0. volvul.us. and research was continuing. In Kenya, live parasites had been found 11 years after the interruption of transmission, but not seven years later. Twelve years after the start of control operations in a canpaign in Mali, the incidence of the disease had faLlen fron 7ff/" to 3-5%. Thus 12 years appeared to be the maximum life-span there, while the mean might be much lower. 10.25 The JCC concluded that ways rm,rst be found of enabling the Participating Governments to maintain the Progranune relatively independently, with consequent implications for the organiza- tional structure, international cooperation, training, technology, and so on. No fundamental decisions could be taken without bearing in mind the ultimate need for national self-reliance. LO.26 The Independent Chairman said that the Conrnittee's conrnents should also be taken into account when discussing the econornic aspects and Long-term future of OCP. 11. ECONOMIC ASPECTS OF IIIE PROGRTIO,IE 1l-.1 In accordance with its decision at its fourth session, the JCC devoted an entire day to the economic aspects of the Progranune. Study of the evaluation report and future of the Progreme - Econornic aspects: Agenda item 11(b) ll.2 Ihe item was introduced by the World Bank representative, Mr B. Alisbah. In its earlier forms, part II of the evaluation report (document JCC5.7, part II), which had been prepared by a World Bank economic review mission, had generated considerable controversyr ro doubt because the positive aspects of OCP had been insufficiently accentuated. The many corments voiced on previous occasions had resulted in the much-changed version now before the Comrittee. 11.3 The Bank in no way fel-t that economic development of the areas affected by onchocercia- sis was not an economic proposition. The betterment of the lives of those rfto lived in poverty in the OCP area was the only acceptable goa1. The report emphasized the difficulties inherent in that task, which did not end with control of the vector. rccf5 Page 19 LL.4 Under its terms of reference, the mission had been obliged to quantify factors that were very difficult to quantify. Nevertheless, an attemPt at quantification was a first step torrards finding least-cost solutions. The mission had drawn attention to the issues that had to be tackled in the development of the OCP area. There was no quick and simple solution, and many alternatives must be explored. 11.5 In this work, all had obligations. The implementing agencies must be alive to 1ow- cost techniques and alternative strategies. The Participating Governments mrst PrePare comprehensive development plans and prograrrnes providing for measures to raise productivity. Ihe contributors, bilateral and international, must recognize that efforts to assign costs and benefits to OCP were intended, not to judge the value of the Progranrne, but to help in forrmr- Lating effective least-cost solutions to a problem that must be solved. 11.6 It would be unproductive at the present stage to query specific technical points in the report, which was bound to be only a first approximation. The margins of error, which were inevitably large because of the paucity of data, could no doubt be progressively reduced. Ihe improvement of the data base for economic planning in the area should be a Priority. Even more important would be countries'efforts to formulate and implement balanced developrnent programnes. The Bank would provide technical cooperation, as requested, for the preparation of such programnes and financing, within the limits of its resources, for the developnent schemes that emerged. No doubt other donors too would be interested in financing well- prepared schemes. He would welcome advice, both during the discussion and wtren individual countries were contacted in L979, on how best countries might be assisted in formulating their longer-term developrnent efforts. lL.7 The report was introduced by the leader of the economic evaluation mission, Professor E. Berg, who began by underlining the difficulty of evaluating health prograrmnes in narrow economic terms when better health was an end in itself. 11.8 The mission had found that the accepted paradigm in which the OC? area was typified by abandoned river valleys surrounded by crowded plateaux was applicable to sorne but not all of this diverse area. 11.9 The original economic justification of OCP had been based on settlement projects in oncho-freed zones, but five years of experience had shor^rn that such projects were few outside Upper Vo1ta. Other economic benefits had not been accounted for in that justification. The mission had therefore made estimates of two sets of conventional economic benefits: (a) the improvement in the quantity and quality of labour; and (b) the land that control would make availabl-e for more intensive cultivation. For (a), in the absence of data, the mission had suggested the possible size of benefits under various assumptions about effects on labour productivity. For (b), a study of the scarce information on population distribution and land use had 1ed to the tentative conclusion that OCP could help to make'some 275 OOO km2 available for further cultivation. When these factors were added together, the assessment was satis- factory even on narrow economic tems. 11.1-O As to developnr.ent strategy, the mission had concluded that rehile Ehe new lands would be extremely va1uab1e, they could not absorb more than a- small proportion of the region's population growth. Agricultural develop,rnent of existing lands should therefore have priority. At the same time, the high-input technolory on which the rrgreen revolution" had been based was not suited to semi-arid areas; more attention should be given to the new techniques described in Appendix IV and pilot projects should be started in West Africa. 11.11 The report also discussed the FAO/IBR-D planning method.ology, which was intended to provide guidelines for planning the area's developrnent. The mission had accepted the general view that planning rr/as a national responsibility and that the Local OCP-related planning bodies should be integrated as much as possible into the overall national planning institutions. Ll.Lz The mission had examined the issues of appropriate technology and recurring costs. The existing technology, excellenE as it was, appeared unsuitable in the long run in terms of manPor^rer, organizatLon and costl in particular the OCP countries' current budgets could not be expected to absorb the expense of such a prograrrEne. Thus technologicall-y and economical-ly more appropriate systems of vector control must be found. rccfs page 20 11.13 Asked to provide guidance on the economic justification of the proposed extension of the OCP area, the mission had hesitantly suggested sorne guidelines. The main criteria proposed were the size of the at-risk population, the intensity of exposure, and the extent to which access to new lands was increased. Annual report of the Economic DeveloDment Advi sory Panel Agenda item 7 7L.L4 fhe Chairman of the Economic Developrnent Advisory Pane1, Professor G. Camus, introduced rhe report on EDAP's fifth meeting, held in Paris in September 1978 (document JCC5.5). The World Bank, in consultation with the other Sponsoring Agencies, had decided that in 1978 the Panel should concentrate on the draft report of the economic evaluation mission in order to determine rdrether it constituted a sound analysis of OCP's economic developurent impact. Ihis draft had already been reviewed informally by the Participating Goverrunents at a meeting in Ouagadougou. As a result of the various corunents, the l-eader of the mission had edited, shortened and modified the draft, and-particularly the chapter on emPty lands, to produce the present version. 11.15 The Panel had not met again to examine the final version of the rePort. However' he attempted to sunmrarize its reactions to the earlier version, many of r,fiich were stil1 relevant. The mission had produced a valuable report r,rhich drew attention to a rnrmber of important points. For example, it'had demonstrated the diversity of developur.ent experience and needs; the model- of empty fertile valleys and crowr:led plateaux was by no means true of the whole OCP area. 11.16 EDAP had supported the mission's emphasis on the need to use new agricultural and animal husbandry technologies in both old and new lands, and on the importance of substantial and continuing external financing. The report also provided a systematic analysis of OCP's econornic benefits. However, the PaneL considered that it tended to underestimate the area's development potential and the Progranure's economic benefits, and those criticisms remained in part true of the later version. In its amended forrm:lation, the chapter on emPty lands would no doubt have been accepted by EDAP; similarly, the Panel's corurents in paragraphs 22-25 of its report on the lack of integration of agriculture with other sectors of the economy had been taken into account. 11.17 On the other hand, the report might have adopted a broader viewpoint. The stress on agriculture had masked other devel-opment possibilities, lrhile in agriculture dryland farming had been stressed to the detriment of irrigation and livestock, to vftich the governments concerned attached high priority. l-1.18 It should be remembered that the mission had attempted to carry out very broad terms of reference in a limited time, even though sonre disciplines were not rePresented and informa- tion was scarce or absent. On balance, EDAP considered the report a valuable franework for the further analysis of the Points raised. 11.19 A member of EDAP, Mr R. N'Daw, endorsed those cournents. However, he considered that OCP's permanent structures (the Panel, the Economic Developn,ent Unit) could themselves have prepared the mission's report if they had worked in a different way and kept the area's developn,ent under constant scrutiny. Regrettably, OCP was not monitoring its own economic benefits, which were insufficiently emphasized in the rePort. More stress should have been laid on socioeconomic developm.ent, and the mandate of the Prograrmne's economic entities should be reviewed. lL.zO With regard to paragraph 16 of the Panel's report, he underlined the need for cooPera- tion to free the participating countries fronr the constraints caused by lack of data in preparing development programnes, Better knovledge of soil and water resources were the key to proper planning. Another important point was migration (paragraph 18), whether across national borders, organized or unorganized, or to meet regional policies by contributing to an equilibrium between population and the 1and. In this sense, OCP's cost was justified simply to improve the area peopLe had to move to. He welcomed the STAC's suggestion to link Simulium control with tsetse f1y control, since some countries could not live r,rithout cattle; OCP's infrastructure could well be used in this way. rccf5 Page 2l General discussion--on items 11(b) and 7 1-1- .2l A number of representatives expressed satisfaction with the final version of the review mission's report, which showed great improvement over the earLier drafts examined by EDAP and the participating countries" It was suggested that these countries might have been given an opportunity to comenL officially, and that the mission and OCP's economists should have worked more closely with tire goverrments Lrr order to understand their problems better. 11.22 The report was criticized as beirrg too theoretical and not containing enough detail on the countries' economic develognrent policies. The WHO Regional Director for Africa felt that complex econometric studies might distract OCP from its twin goals of conLrolling onchocercia- sis and prornoting socioeconomic development. It was no[ p<-rssi-bIe to assess human suffering in figures. The crux of the problem r^ras how to cooperate r^rith the countries to further their developnrent - perhaps by offering experts to work with the national planners, but not by sending missions for a few days. 7L.23 It was pointed out that, although there was considerable diversity in the OCP area as the mission indicated, the basic facts, the quality of life, and the human problems were much the same in all the countries. fhe contributors should not lose sight of those major problems. LL.24 Several representatives ruould have preferred the evaluation study to have been carried out by OCP's permanent econcrmic structures (mAP, EDU), which knew the area wel1, and not a visiting mission with limited time at its disposal. The National Onchocerciasis Conrnittees could also have played a larger role. It was considered that development planning groups for the oncho-freed areas should if possible be int.egrated into the national planning machinery. If not, at least frequent consultations and joint meetings should be he1d. Countries that had not yet set up planning groups should go ahead, and not wait for the outcome of other countries' experiments. LL.25 Clne representative said Lhat his country's criticisms of the mission's draft rePort at the unofficial meeting at Ouagadougou had not been taken into account; in view of their substantive nature, this would no doubt have been impossible in the time available. Examples of the report's weakness were its treatment of such questions as national planning structures, exploitation of the land, methods of cultivation, and stockbreeding. Although it had been amended, the report \"/as stil1 unacceptable. He therefore suggested that it should be re- written to give a better picture of what was being done and planned in the countries in the OCP framework. The report's shortcomings reflected both the conditions in which the mission took place and the way in which countries' contributions were obtained. It could be done again either by EDU or by a mission with more time and resources. 7L.26 The JCC took the view that the mission's report tended to understate the economic benefits of OCP. For exampLe, the mission had not agreed (Appendix II) with the PAG mission as to the product of migrants. In fact, however, the marginal output of Potential migrants in the overcrowded o1d lands could be regarded as zero, so that the only element to be con- sidered was the additional production in the new lands, A higher value should be attributed to the social cost of blindness, since blind people not only were unable to contribute but were also a charge to society. There was also a tendency to confuse production with productivity. Moreover, if the mission had thought discount rates of lO% or 15% too high for its projections, it should have used lower figures, with a consequent large increase in the estimated economic returns. The analyses of migration and income were too theoretical. 1L.27 Among the constraints noted by the mission were low income and land tenure systems. However, income was often understated because food grown for domestic consumption was not taken into account. As to land tenure, that was a matter for each country to settle; OCP would be better occupied examining such topics as infrastructure, corrnunications and health services. LL.28 It was considered that the participating countries were fulIy able to adapt their health systems to cover the oncho-freed areas; after all, if specific diseases became a serious problem, WHO's help could be relied on. Several speakers said that the use of OGP structure to deal with other diseases, e.g. trypanosorniasis, was worth careful study. rccf5 Page 22 LL.29 One representative thought this would be difficult; however, he suggested that national staff carrying out economic developnrent surveys should be allowed to travel as passengers in OCP vehicles. His country had adopted the FAO/IBRD planning method.ology in L975, and was anxious to gather data to plan its development properly. It had found this undertaking difficult because of a lack of vehicles, equipment and manpov/er. Outside help would certainly be needed. 11.30 One representative expressed her dismay at the negative tone of sorne of the conunents. On the eve of the second stage, she wished at least to be able to tell her Government that the participati-ng countries wanted OCP and, despite inevitable problems, were in general satisfied. She was assured that the Participating Governments' conrnents shor{ed their deep interest in the Prograrmne and their concern for its complete success. 11.31 Responding to the discussion, the World Bank representatj-ve agreed that little progress could be made with the report unless the right input was received frorn the countries. Trying to re\^rrite it would not he1p. He felt that while no contributor had yet made a conmitment for the second stage, many realized that they had a long-term corunj-Enent to OCP, and that would not depend on the mission's preliminary attempts to define economic factors. They v/ere not concerned, for example, with the precise rate of economic return indicated by the mission, which was based on uncertain data and was in any case quite favourable. More important were such questions as aI-ternative strategies and cheaper methods. 71.32 Professor Berg recognized that the mission's report had many limitations. OCp had seven participating countries, their oncho zones were often remote, and transport was diffi- cu1t. The mission's members had different skills and were available at different times. Thefinal version of the report had taken account of many of the criticisms of earlier drafts. As an example of the logistic problems, the mission had never received Benin's cor6rents and so had been unable to take them into account. 11.33 He ful1y agreed that locally-based structures were a better approach to such reviews. For example, the report did not include country studies because the mission could hardly make Pronouncements on national developurent sErateg'y after a weekts visit. Broader issues could be tackled, however, with the help of local knowledge. As the report recornended, the EDU could well be strengthened to serve as the agent for economic anal-ysis. 11.34 With regard to the Contributing Parties, he pointed out that the projected economic return was satisfactory. Yet, as the report stressed, health projects could not be evaluated so1e1y on that basis. OCP was a humanitarian project with an irrnense impact on a specificpopulation very rmrch in tune with the international donor cormnunity's development strategy. 11.35 In conclusion, he emphasized that oCP's benefits varied between countries. If carried out only in individual countries, it would be more favourable for some than for others. However, the benefits \,rere sometimes external to individual countries, because control in one country could Prevent reinvasion in another. Thus there were important regional benefits, and it was only through international financing that programnes such as OCp could be financed. 11.36 Speaking at the invitation of the Independent Chairnan, the observer from the Inter-State Permanent Comnittee for Drought Control in the Sahel (CILSS) referred to the commoninterest of oCP and CILSS in combating human affliction. Ihe two organizations were activein the same Part of Africa, and four OCP Participating Governments were members of CILSS.CILSS's objective was to control desertification, which reduced the land's productive capacity at a time when the annual increase in food production in the Sahel (less than 1%) fe1I short of the popul-ation growth rate (2.5%), while OCP sought to make large areas of fertile land fit for resettlement. Close collaboration between CILSS and OCP could greatly improve development strategy in West Africa with the aim of recovering needed land and increasing food crop produc- tion. The solidarity of the international conrnunity could do much to assist the two organizations in their fight against the twin calamities of disease and drought. rccf5 Page 23 Soc ioeconornic deve loPrnent aspects of the Prograrure: Agenda item 8 LL.37 Introducing the item, the Progranrne Director said that the rePort (document JCC5.6) was of an interim nature. It did not seem useful to reproduce each year a fu1l list of developnrent projecEs in the OCP area, as the L977 report had done, though the earlier informa- tion could be updated. Moreover, the future direction of the Economic Developrnent Unit would depend on the proposals not only of the economic evaluation mission and the Cotonou meeting of National Onchocerciasis Conrnittees, but also of the JCC at its Present session. 11.38 The report had been prepared in close cooperation with goverffrents. It consisted of two main parts, one on general development activities in the area and the other on specific developrnent projects. The general section drew attention to the trend in the participating countries towards regional planning, as the details under each country indicated. l1ali and Niger had now appointed national coordinators for the develoPment of onchocerciasis areas. 11.39 The Progranure Director outlined the development of the countries' onchocerciasis zones against the background of their national devel-opment plans and budgets. In Benin, activities in the OCP area were centred on agriculture, and particularly agricultural credit. Ihe main problem appeared to be the need to improve cultivation practices. Ghana, wtrere estimates were difficult because of the high rate of inflation, had many projects in agriculture, forestry and water supply. Ihe lack of r^7ater and power remained serious constraints. Ivory Coast was supplementing traditional crops with sugar, fiaize, fruit and vegetables, particularly in the centre and north. Problems included shortage of labour and of meat and fish, while a new factor was the discovery of oil, which would lighten the agricultural sector's burden. 11.40 In Mali the S61ingu6 Dam remained the key developrent project in the onchocerciasis zone. The world's largest solar electric power station (8O kW) had come into service at Dir6 as part of the rrOperation Sahel-New Energyrr project. Ihe road network and the primary health care system srere being expanded. The main problems were to strike a balance between produc- tion for internal consumption and export, and to protect soil and water. Niger had large phosphate and iron-ore deposits in the oncho zone. Its development problems included the need for security in food stocks and supplies, the lack of qualified manpower to plan and implement projects, and the need for regional economic integration within the country and with its neighbours. 11.41 Togo was developing agricultural and mineral production. It too sought to redress regional imbalances within the country and to promote regional integration in West Africa. Problems in the oncho zone included variations in soil quality, uneven population distribution, variations in land tenure systems, and inadequate socioeconomic infrastnrcture. In Upper Vo1-ta, the AW !/as an important element in devel-oping the oncho zones. The major problems continued to be the protection of soil cover and water resources, the proper adjustment of the human population and livestock to avaiLable resources, and the provlsion of basic health, transport and conurnrnications i.nfrastructures. LL.42 Representatives expressed satisfaction with the report, whi-ch also had the function of supplementing the economic review mission's r:eport. In response to the criticism t-hat the information on Benin was unduly scanty - for example, in the references to agriculture where the role of the CARDERs and the developrnent of agriculture were incompletel-y described - it was pointed out that each section was contributed by the country concerned, and that the document had already been reviewed at Cotonou by the meeting of National Onchocerciasis Conrnittees. Nevertheless, the methods of collecting the data shor-r1d be re-examined to ensure that OCP obtained accurate and up-to-date information. 7L.43 A representative expressed the view that vector control operations could not bear the extra burden of general public health activities. OCP's ultimate success could only be ensured by a sound public health infrastructure in the oncho-freed areas. In reply, the representatives of Mali and Ivory Coast explained that these areas \"rere treated in the same way as other parts of their countries, as part of the overall developrnent effort. Effective primary health care systems were being constructed with emphasis on conrmrnity participation and, where appropriate, the use of traditional health workers and medicines. Due attention was being given to training of staff, logistics, funding, drug supplies, sanitation, health rccf5 Page 24 education, the use of mobile health teams, and indeed the need to reach the whole population with polyvalent heaLth services. It was felt that, to protect their own health, the cormnuni- ties might also play a role in vector control, and there was no doubt as to the participating countries'ability to provide adequate health care in the freed areas. 11.44 The WHO Regional Director for Africa added that at the Regional Conrnittee for Africa's 1978 session, all States had conrnitted themselves to WIIO's target of health for all by the year 2OO0. Each country would fo1low its own approach to this target; the representatives of Mali and Ivory Coast had described two equally valid experiments. He agreed that there should be no distinction between the heal-th care delivery systems in the OCP area and at national leve1. Clearly, too, the economic and social sectors were intimately linked. As to the EDU, he believed that the unit should not simply continue its functions of information coordination and advice, but should play a more active stimulatory role at national leveI. 1L.45 A representative said that there had been a request at the JCC's last session for more complete statistical data and the stre-ngthening of EDU's staff to enable it to do the necessary work. A study on migration had also been requested. He wondered how the Unit's future was seen now that its previous chief had left OCP. He believed that it should be more dynamic, and perhaps FAO or IINDP couLd play a larger part. Certainly EDU should itself have been able to carry out the evaluation done by the economic review mission, The Progranrne Director said that EDU had a competent staff and that a nerrr chief would be appointed in due course; the previous chief had left only a month earlier. As to the proposal concerning migration, there had already been many studies on this subject, notably by ORSTOM, and the World Bank was hol-ding a seminar based on a further substantial study in Ouagadougou in January 1979. Ile doubted if OCP should use its slender resources to repeat what was already known. In the representative's view, however, the ORSTOM study had not been done along OCP lines; r,rtiile he attached importance to the Progrannne's independence, he considered that the w'ishes of the JCC members should be respected. LL.46 Representatives asked whether the EDU would be given the function of following States' development policies and anal-ysing OCP's economic impact instead of ad hoc missions. Its mandate would perhaps have to be changed, and additional- staff and resources provided. It was noted that the agreement governing the first stage had related chiefly to vector control, with WHO as executing agency. Ihe economic aspects had been secondary and were in any case outside W[10's competence. The Progranune's future economic structure and the organization responsible would need further thought in the Steering Corrnittee and at forthcoming meetings. L7.47 Ihe Independent Chairman pointed out that the 1973 Accra Agreernent and the memorandum of understanding approved at the JCC's first session provided for an EDU, whose chief had been proposed by FAO, the Associate Agency, but nothing specific was stated as to how the question of economic developnrent shouLd be tackled. The JCC accepted his suggestion that the Steering Conrnittee shouLd be asked to examine the whole matter and present a clear proposal as to the future economic structure during the coming year. Landsat-related study for regional p lannine of onchocerciasis-free areas I1.48 Ihe JCC heard a presentation describing, at the half-way stage, this 18-month project undertaken by the African Developrnent Bank (ADB) with USAID funds. The study covered some 225 OOO lsn2 in Upper Vo1ta, Ghana and Benin, and was designed to assist the countries in planning the devel-opment of oncho-free areas by providing data, through satellite imagery, on geology, mineral and water resources, vegetation, climate, human settlements and land use. The use of resource inventories and accurate maps derived from saLellite images combined with conventional planning techniques was expected to enhance the planning process substantially. The training of national counterparts in the methods of resource mapping and analysis used was an important part of the project. 11.49 The ADB representative said that in addition to resource inventory overlays, prepared at a scale of 1:2OO OOO, resource development potential overlays would show agricultural, rangeland/livestock, r4Tater resource, and fisheries, forest and wi1d1ife, mineral resources, and resettlement and lnfrastructure potential. Similar more detail-ed maps, covering an area of 8OOO krn2 would be prepared at 1:50 OOO. A11 this information would assist in the rccf5 Page 25 development of both oncho-freed new lands and old lands. The project would be completed before the JCC's next session, at which time it might be possible to Present a document on the results. 11.50 The WI{O representative emphasized the value of the survey in plnpoinEing water courses' breeding sites and river flow rates, identifying the vegetation cover used by adult Simulium and tsetse flies, and studying meteorological factors in relation to relnvasion. The methods used, though expensive, would provide knowledge that could not be obtained otherwise, and should help to flnd a more aPPropriate technology for the future. 11.51 In answer to questions, the JCC was told that the project's all-in cost for the 18 months was $ 1 537 OOO. Every attempt would be made to finance extensions of the survey to those parts of the oncho zones of Ghana and Benin that were not at Present included. Coopera- tion with the similar project to start in MaIi it L979 should be possible. The delay in project missions to Benin should not affect the work there. |L.52 It was explained that topographic mapping from satellite images was not possible. As to the relative importance of work on the ground, this was sti1l needed, for example, to check soil depth, provide water analyses, and determine plant species and density. In comparison to aerial photography at 1:20 OOO, satellite imagery was much cheaper, with an overall view that showed features such as fault llnes which were not visible at ttre larger scale; however, for more detailed work the photographs had obvious advantages. Ihe training at the Ouagadougou centre was financed by Canada, France and the United States of Amer:ica, with a contribution from Upper Volta. Counterparts of a high technical level were being trained and working successfully wlth the project. Long-term future of the Prosragure 11.53 The World Bank representative said that the question of OgP's long-term future had been well covered during the JCC's di-scusslon on economic maEters. He had been particularly encouraged by the points emphasized by the Director-General of WIIO at the inaugural meetinS. The discussion on financing for L979 had been satisfactory. The Bank now wished to starE organizing the funding of the second stage; this it proposed to do by holding two meetings of contributors, to give time to feed back the results of the first meeting to the participating countrles. 11.54 The first meeting was tentatively scheduled for 3O-31 January 1979 in Paris. This would give contrlbutors the opportunity to exarnine: (1) the evaluation report in relation to the second stage; (ii) infomration on the financing of the first stage and how it had been shown; (iii) a document on financial requirements for the second stage; and (iv) draft agreemenEs for the second stage. It was not intended Ehat a cmrplete financing Programne should be agreed at the first meeting. Arrangements could be formalized al the second meeEing, perhaps in May 1979. 11.55 Ihe United States representative said that the review of parts I and II of Ehe evalua- tion report had brought out certain points of concern that would require attention in the future, e.g., reinvasion, alternative technologies and the develoPment of health cadres. He was satisfied with part I of the report, and he believed that part II, in which the mission had concluded that OCP was economically sound, would be accepted by his Government. He had already asked approval for his country to particiPate in the next six-year stage. It was clear that OCP was tackling a serLous health problem to which the Participating countries attached importance, and his country would continue to discuss its participation in a favourable way. 11.56 The Netherlands' representative said that it was evident from the Conrnittee's discus- sions that there were sti11 many unknown factors: it was not possible to state the duration of OCP or assess the Level of maintenance of vector controll it was not known if there were aPPro- priate technologles that would enable the populatlon to ParticiPate; the economic benefits could not be assessed, especiaLly since the disease was not the only develoPment constraint; and it rdas not knor,m when the participating counEries would take over. However, iE was known that the disease couLd be controlled. OCP had only come into fu1I operation in 1978, and more rccfs Page 26 time was needed to answer the questions. The second stage should be used to collect more information, particularly on alternative technologies. A11 this would involve much work; care should be taken that OCP remained manageable in size and that the effectlve execution was secured. Her country had confidence in OCP and would continue ln the second stage to contri- bute substantially to the Prograrmne in its present form. L2. FEASIBILITY OF AN ONCITOCERCIASIS COMROL CA},IPAIGN IN THE SENEGAI RIVER BASIN AREA (REPUBLICS OF GUINEA, MALI AND SENEGAL): Agenda item 12 L2.L The WIIO representative introduced a report (document JCC5.9) prepared in accordance with the JCC's request at its previous session. Ihe report began by describing the measures taken by WIIO in connexion with the prefeasibility study in Guinea, Mali and Senegal, including the provision of funds and establishment of a study team. Technical stePs had included reports by Dr Philippon on onchocerciasis and its vectors in Mali and Senegal, a study of the disease's possible limits in Guinea, and studies by ORSTOI'I and OCCGE exPerts of the Senegal river basin in Mali and the Gambia river basin in Senegal. TVelve workers from Guinea and three from Senegal were being trained at IRO, Bouak6, and Malian candidates would shortly be interviewed. 12.2 Section 2 of the report described the onchocerciasis situation in Senegal, Western Mali, Guinea and Guinea-Bissau. The 1evels of endemicity and transmission were as high as in the OCP area; the highest transmission potential recorded in West Africa for one month was on the Niokolo Koba, a tributary of the river Gambia. 1,2.3 lhe proposed strategy reflected that of OCP, and was based on the distance flown by the vector (which called for a regional canpaign over a large area), the long life of the Parasite, and larviciding, the only control method yet available. This suggested a minirmrm area of sone 2OO OOO kn2, and a manageable maximum of perhaps 1 million km2 under present circumstances. 12.4 The area involved was shown in },lap 1. The objective was to clear the'rrestern pocket of savanna onchocerciasis; its boundaries were: to the north, the limits of the vector, the parasites and infected people; to the east, the present OCP (a big advantage); to the west, a line stil1 to be defined, passing through Senegal and possibly Gambia, through Guinea-Bissau and into Guinea, where the problem of delimiting savanna and forest vectors and disease arose; and to the south, through Guinea and possibly northern Sierra Leone and Liberia. Ihe precise technical, logistic and financial benefits, including the prevention of reinvasion of the OCP area, remained to be quantified. 12.5 The campaign's tactics would follow OCP's pattern of larviciding, backed by entomologi- cal, epidemiological and hydrobiological evaluation. Difficulties might be encountered in mountainous areas, but first results suggested that the blackflies present there were not of the dangerous savanna type. 12.6 It was proposed, as the next step, that a preparatory assistance mission to goverrments should be organized, with the terms of reference outlined in pages 5, 6 and 7 of the report. These would be: (1) the collection of existing entomological, epidemiological, socioeconomic and hydrological data; (ii) the analysis of the data; (iii) the initiation or completion of work in entomology (delimitation of prograflrme boundaries and aerial- surveys of breeding sites, estimates of transmission dynamics), epidemiology, hydrology, hydrobiology, and Eraining;(iv) planning of the control campaign. Ihe mission would last two-and-a-ha1f years, at an estimated cost of $ 1 O24 OOO. Annex 2 of the report contained a framework for the economic appraisal of the proposed programne. 12.7 Every effort was being made to simplify existing control technology, which was highly effective but complex and costly. One advantage of adulticiding, should it prove feasible, was that it might have a beneficial effect in relation to the control of the vector of human trypanosomiasis. OCP was the fruit of many years of research, in which scientific progress was being matched by socioeconomic benefits. In four years, more progress had been made in respecE to the biology of sis than ever before. s. d methods of control and the epidemiology of onchocercia- rccfs PaEe 27 L2.8 The representative of l.{ali said that in March 1978, following the JCC's L977 session, it had invited the Governments of Guinea and Senegal to a meeting in Bamako at the outcome of which the three countries had submitted a joint request to WIIO. A study had since been made of the wtrole of the onchocerciasis zone of west Mali, east Senegal and north Guinea, following which the report now before the Coumittee had been prepared. He asked the Participating Governments, Contrlbuting Parties and Sponsoring Agencies to support the implementation of the proposed feasibility study, after which the health work desired by the three goverrments and peoples could begin. Ihe Senegal and Upper Niger basin region had substantial economic potential and a regional prograrme for the development of infrastructure in power, water resources, irrigation, navigation and industrial-jzatiot had already begun. Onchocerciasis control in the area would help to overcome the age-old problems of l-ack of water to the north and disease to the south. He hoped that the JCC would accept the proposals without reservations. 12.9 The observer from Guinea, speaking at the invitation of the Independent Chairman, welcomed the prompt preparation of the report before the JCC. As the previous speakers had already described the purpose and contents of the report, he would simpl-y reply to a question concerning his country's health services. Guinea's health policy lras direcEed towards preven- tion and based on volunteer health brigades. Guinea considered that prevention supported by health education, so that the people participated actLvely, hras the best means of alleviating possible shortcomings in health care at the sma11 village leve1. Multidisciplinary mobile preventive teams were an essential component of the Government's policy. A11 this was integrated in village health centres and distrlct and regional dispensaries, under the authority of a nurse or physician. Regular health plans were prepared and integrated in the national five-year developnrent p1an. The intention was to reduce the need for health care and to seek instead of waiting for the patient. L?.LO The observer from Senegal said that considerable progress had been made with extensions both within the participating countries and elsewhere. Ihis progress should nors be consoli- dated with a view to social and econornic developrnent of the areas freed. lhe fact that an extension to the west would help to prevent reinvasion was a solid argument. For the countries concerned, however, the campaign was essential; they had suffered from drought for many years, and the success of the projects for the development of the Senegal and Gambia basins and the exploitation of mineral resources depended on the control of endemic diseases, particularly onchocerciasis. In east Senegal, the onchocerciasis prevalence (over 6O7.) and blindness (11%) rates were very high and seriously hampered the large developtnent projects planned or under way. The overall develop,nent plan provided for studies and control of the major diseases. A11 the countries concerned had conrmrrrlcable disease control services and plans for the developn,ent of basic health services. Senegal followed an integrated health policy with priority to rural, conrnunity and educational medicine. The regional- health structures consisted of a hospital with pha:macy and laboratory, health centres, health posts, and primary health care through 1ocal cormnrnities. Ttre question of the proposed progranrne's relationship to OCP could be dealt with at a later stage. He thanked WHO for the report, which it had prepared in record time. 12.11 The UNDP representative welcomed the WIIO report. Ihe question of the new progranme's relationship with OCP was important in view of the possfbility of administratLve duplication and, on the other hand, the logistic and management problems referred to during the discussions. He agreed with the proposal for a preparatory mission to provide the JCC with fulI i.nformation particularly on the advantages and disadvantages of establishing a separate prograxme. 1'he terms of the mlssion should therefore be designed accordingly. However, agreement to the mission should not be taken as a cosuritment to fundlng the prograrune; moreover, it was Premature to discuss wtrether it should be separate or part of OCP until the mission,s findings were available. As the document had been circulated only a short time earlier and governments had not had Eime for consultations, he suggested that WHO should contact them directly, for funds. UNDP would participate in financing the missi.on, wlthin the framework proposed, and hoped others would do likewise. L2.12 The representative of the STAC said that his Comnlttee had not been asked to consider WIIO's proposal for studies in the Senegal river basin. However, he believed that the STAC was in favour of the new programne. He assumed that if the JCC approved the proposal in JCC/ 5 Page 28 principle, the STAC would be asked to coment on it Ln 1979; if so, it would probably be in favour on technical grounds, because of the benefit to the present OCP. 12.73 The World Bank representative paid tribute to WHO for preparing the report in time. Looking at the present OCP and the new proposal, he wondered why the OCP area had been defined as it was. I,Ihile the report showed the essential steps, he agreed that the study should be wider, in order to examine such questions as the importance of onchocerciasis in relation to other dieases, the priority countries gave to onchocerciasis as opposed to other diseases, the structure of health services, and the anount of land that woul-d be made available. The study should also examine the advantages and disadvantages of starting a separate programne, and the extent to which it would reduce OCP's costs. The fact that WHO was trying to develop new technologies had impllcations both for OCP and for the new study, which should recognize that present techniques rrere too expensive and consider other strategies. It should be understood that support for the study dld not necessarily imply support for the prograflrme. He suggested that WIIO should circulate a document revised in line with the Steering Comnittee's coxmnents, together with the mission's terms of reference, to all contributors. The study could then be very valuable. 72.L4 The representative of the Ivory Coast asked the JCC to give the proposed study its full support. Ihe need rdas to, eradicate what was a hazard to man and an obstacle to developmr.ent; aLl- structures, operations and research should be designed to achieve that goa1. He caIled on the Contributing Parties to continue their health cooperation to reach a solution. L2.15 The JCC was in prtnciple in favour of the proposed study mission. It recognized that a campaign to the west of the OCP area could have technical benefits in reducing reinvasion and could also produce loglstic and administrative economies. The United States representative maintained his earlier offer to assist the mission if other countries agreed. However, a number of representatives were unable to conrnit their goverrunents to financial support for the mission because the report had been received too near the session to permit discussion before- hand. It was emphasized that agreement to the study did not iurply a corrnitment to carry out the campaign; that could be decided only when the mission's report was available. 12.L6 It was accepted that onchocerciasis was a serious problem in the Senegal river basin area. It was considered that the scope of the study shouLd be broadened to cover the poinEs raised by the Steering Cormnittee on the cover page of the report. Specifically, representa- tives referred to the significance of onchocerciasis in relation to other diseases in the area, the potential benefits for econo'mic developnent, and the advantages and disadvantages of setting up a separate programne. A representative suggested that the tetms of reference should be revised to put greater emphasis on simpler and cheaper control technolory, the integration of epidemiol-ogical and entomological work into the existing national health structure, health education, reduction of transmi-ssion to a tolerable leve1, and operational research. The mission might include a logistics expert and a river modification engineer. L2.L7 Other representatives were doubtful whether the mission was the correct body to do that work. Since TDR was tackling the question of appropriate technol-ory, the links between such a broader study, OCP and TDR would have to be carefully defined. It was suggested that the study should be so designed that it was of value to the countries concerned whatever decision the JCC eventually reached regarding financial support. In the oPerational research phase of the study, use might be made of Canada's experience in both airborne and ground control techniques and with adulticides (Azemethophos was promising), alternative larvicides (including methoxychl-or), and larva1 growth control compounds (Altocid and Dimilin). L2.LB Ihe preliminary report stated that the proposed prograrrEne should be related to OCP but separate, because OCP had already reached maximum size and was in the maintenance phase. However, it was considered wiser to decide on the precise relationship between the two Programmes only when the misslon's report was available. The maximum desirable slze would depend on the technolory used. 12.19 Representatives also questioned the JCC's rel-ationshlp to the proposed programne. Certainly the Cormrittee could not be expected to act as the governing body for all onchocercia- sis control progranres in Africa. At the present stage, however, and since the JCC had asked rccfs Page 29 WHO to carry out the preliminary study, it was reasonable for WIIO again to be responsible for the mission, and to make use of OCP's structures, including the JCC and the STAC. 12.20 The JCC's main objective unrst be the success of OCP, whose execution rmrst be ensured from the financial, logistic, personnel and management viewpoLnts. As OCP was already having staffing problems, csmpetent manpower might be a serious constraint for the suggested proSramme. L2.21 Responding to the discussion, the WHO representative explained that the present OCP area had been chosen, not because it was isolated or the worst afflicted region, but because it was the best known. As to the size of OCP, he thought that 1 million km2 was the maximum wiEh present methods and cornnunications. If those structures could be simplified, the area might be larger. Time had not permitted a more detailed preliminary rePort. Undoubtedly the proposed study would include a justification of the prograrrrne in the light of the Steering Conrnittee's recoEnendations, including the question of appropriate technology. L2.22 The JCC's remarks on the relationship between OCP and the proposed campaign also reflected the Steering Cormittee's comnents. It seemed thaE onchocerciasis control in general might be covered by five structures: (i) the present OCP suPerstructure (JCC, STAC, EDAP, etc.); (ii) OCP itself as an executive body; (iii) the proposed mission with its own terms of reference; (iv) the group on appropriate technologies Eo be set up by WHO, in collaboraLion with TDR, OCP, and the mission; and (v) a structure in which all parties involved would be represented, to study wtrether to operate only the present OCP, two seParate Programnes, or an enlarged OCP. 72.23 He noted that the staff necessary for the mission were already available or in training. I'loreover, close contacts were being maintained with regard to the methods and cornpounds tested in Canada. He agreed that the study should in any case be useful to the countries; that question was linked to the eventual transfer of operations to the participating countries, and might be examined by the grouP on aPProPriate technologies. L2.24 The WIIO Regional Director for Africa emphasized that as the JCC had asked for the study in the Senegal basin area it should logically continue to follow up the matter. Time could be allowed for further review of the preliminary report, but that did not mean that the Comittee could not take a decision of principle. The reinvasion of Parts of the OCP area originated in neighbouring untreated areas. To Protect OCP's investment and the results achieved so far, control in the area to the west was surely highly desirable. L2.25 While funding was important, it was not the vital question. It was not only the participating countries that benefited from OCP, but also the developed countries that provided the equipment. WIIO had taken note of the JCC's wishes for the study and would do the necessary work. As to where operations would be directed frorn that was unimportant, since WHO was a single organization; each Level performed its appropriate functions, and certainly the regional onchocerciasis prograure woul-d come under himself. As to the relations between OCP and the proposed prograrrrne, firm proposals could only be made after more detailed study. L2.26 The Independent Chairman expressed the JCC's thanks to WIIO'for the preliminary study. He suggested that WIIO be asked to carry out the further study in the light'of the JCC's cofiEnents, and to approach governments for the necessary resources; it appeared that the Contributing Parties would take a positive attitude to a request for funds. He would inform WIIO officially so that. action could be taken. L2.27 The JCC decided that the revised terms of reference of the study mission should be annexed to the Independent Chairman's report on the session (Annex 7); that the total finan- cial requirements and timetabl-e should be indicated, together with funds known to be available; that the study mission should be responsible to Ehe Director-General of WI{O, who could then make appropriate arrangements within WHO; and that it should receive an interim report, with the STAC's views for 1980. rccf5 PaSe 30 13. STuDy OF AN ONSHOCERCIASIS CONTROL PROGRAI'II,IE IN NIGERIA: ASenda item 13 13.1 The study of an onchocerciasis control progranrne in Nigeria prepared by WHO as a result of the JCC's discussion at iEs fourth session (document JCC5.10) was submitted to the CorrnitEee for information. L3.2 The IrrHO representative noted that since the 1977 session the Government of Nigeria had decided to operate its own progrErme. It had been agreed in meetings between the Nigerian authorities and WHO that WHO would provide a plan of action for such a Programne, the primary objective being the protection of the Federal Capital Territory. The study now before the JCC outlined the action taken by WHO since the Corurittee's fourth session and also the activities to be undertaken by the Nigerian Government. It then described what was known of onchocercia- sis and its vectors in Nigeria, and the strategy and tactics to be applied in the national campaign (based on those of OCP). As the plan of action indicated, Phase I of the campaign would concentrate on an area of some 2OO OOO lqn2 centred on the Federal Capital Territory, while the phase II area woul'd be that lying between phase I and OCP. Further tasks included the delimitation of the prograrEne to the south, mapping of breeding sites, studies of Sirm-rlium population dynamics and onchocerciasis transoission, epidemiological surveys and the detailed planning of a control progranrne. 13.3 I[HO's future cooperation would be provided partly through the Vector Biology and Control Research Unit at Kaduna; the Unit's staff had been strengthened and additional training for studies on onchocerciasis had been given. Nigerian institutions that rright collaborate ldere also indicated. Annex 1 of the report contained a bibliography of onchocerciasis in Nigeria' Annex 2 showed the proposed structure of the carnpaign, wtrile Annexes 3 and 4 listed staff and equip,ment needed for headquarters and phase 1. The study concluded with maps showing known S. darmosum s.1. breeding and capture sites, the distribution of onchocerciasis, and the location of preliminary studies and control- areas. He had no infor:rration on what steps the Nigerian authorities had taken in response to the proposed plan of action. L3.4 The JCC took note of the study and expressed its thanks to WtlO for producing the rePort. L4. OII{ER MATTERS: Agenda item 14 Arrangements for the sixth session of the JCC 14.1 The Comnrittee noted that according to the customary rotation, the host to its sixth session would be either a Contributing Party or a Sponsoring Agency. It decided to hold the session around the beginning of December 1979; the precise dates and the place of the session would be arranged by the Independent Chairman following the necessary consultations. 15. CLOSIIRE OF THE FIFTII SESSION: Agenda item 15 15.1 The Independent Chair:rran expressed his gratitude to the Vice-Chairman for his support during the session and to the Government of Togo for its outstanding hospitality and the excellent facilities it had provided. He thanked all the participants for their cooperation in the exercise of his functions. 15,2 Representatives expressed their thanks to the Independent Chairman for his conduct of the meeting and to the President and the people of the Republic of Togo for their warm hospitality. 15.3 The Independent Chairman declared the fifth session of the JCC closed. rccfs ANNEX 1 Page 1 AGENDA 1. Opening of the session 2. Election of the Vice-Chairman of the session 3. Adoption of the agenda 4. Progress Report of the World Health Organization for 1978 5. Annual Report of the Scientific and Technical Advisory Committee 6. Report. of the Ecological Panel 7. Annual Report of the Economic Development Advisory Panel 8. Socio-economic Development Aspects of the Prograrrne 9. Review of the Plan of Action and BudgeE of the Prograrnme f.or 1979 10. Financing of the Onchocerciasis Control Progranrne for 1979 11. Study of the Evaluation Report and future of the Programme a) Operational activities b) Economj-c aspects 12. Feasibility of an onchocerciasis control campaign in the Senegal River Basin Area (Republics of Guinea Mali and Senegal) 13. Study of an onchocerciasis control programme in Nigeria 14. Other matters 15. Closure of the fifth session rccf5 ANMX 2 Page 1 LIST OF PARTICIPANTS Dr M. G. Candau Independent Chairman PARTICIPATING COVERNMENTS Peoole's Reoublic of Benin Dr Jean Enmanuel Akinocho Directeur des Etudes et de Ia Planification MinistEre de la Sant6 publique Mr Nicolas Ahouansou-Amanon Conseiller Permanent du Projet de D6veloppement 6conomique des Zones lib6r6es de I 'Onchocercose Ministdre du Plan, de la statistique et de la coop6ration technique Mr Pascal Crecet Planificateur, Groupe de Planification de D6veloppement du Projet Onchocercose MinistEre du Ddveloppement rural et de 1'Action coop6rative Ivorv CoasE Son Excellence Monsieur Jean-Baptiste Mockey Ministre d'Etat charg6 de la Sant6 publique et de la Population et des Affaires sociales Dr lbrahim Kone Directeur des Relations r6gionales et internationales MinistEre de la Sant6 publique, de la Population et des Affaires sociales Ghana Colonel (Dr) J. B. B. Asafu-Adjaye Executive Director National Onchocerciasis Secretariat Ministry of Economic Planning Dr E. G. Beausoleil Director of Medical Services l4inistry of Health Mr N. S. Belo-Giwa Permanent Secretary, National Onchocerciasis Conrnittee Ministry of Economic Planning Mr H. E. Voelkner Planning Coordinator National Onchocerciasis Cormnittee Ministry of Economic Planning rccf5 Annex 2 page 2 Ma1 i Son Excellence Monsieur Le Lieutenant-Colonel Missa Kon6 Ministre de la Sant6 publique et des Affaires sociales Dr Abdoulaye Dia11o Directeur g6n6ral de 1a Sant6 publique MinistEre de la Sant6 publique et des Affaires sociales Dr Souleymane Sow M6decin-Chef, Division de la M6decine socio-pr6ventive et des Maladies transmissibles Ministdre de la Sant6 publique et des Affaires sociales Mr Robert N'Daw Ing6nieur, Conseiller permanent de la Cellule Onchocercose MinistEre du PIan Niger Son Excellence Monsieur 1e Docteur Yahaya Tounkara Ministre de Ia Sant6 publique et des Affaires sociales Dr Ibrahim Alfa Ciss6 Docteur en M6decine Ministdre de 1a Sant6 publique 9t des Affaires sociales Dr Lazare Loco Dj-recteur Adjoint de 1'Hygidne et de 1a M6decine mobile MinistEre de la Sant6 publique et des Affaires sociales Mr Ibrahima Tanko Chef du Service de Vulgarisation agricole Ministdre du D6veloppement rural Mr Gado Boureima Coordonnateur du Projet SAY MinistEre du Plan Togo Son Excellence Monsieur H. Bodjona Ministre de Ia Sant6 publique, des Affaires sociales et de 1a Promotion f6minine Dr T. Houenassou-Houangbe Directeur g6n6ra1 de la Sant6 publique MinistEre de 1a Sant6 publique, des Affaires sociales et de la Promotion f6minine Dr Adj6t6 Prince Agbodjan M6decin-Chef du Service national des Grandes End6mies MinistEre de la Sant6 publique, des Affaires sociales et de 1a Promotion f6minine Mr Adj6 Wilson Directeur d'Ecole Ministdre de I'Education nationale et de la Recherche scientifique Mr Viwa16 Adigo Chef de la Division du D6veloppement rural Ministdre du Plan rccfs Annex 2 page 3 Mr Ekou6 Assiongbon Division du D€veloppement rural MinistEre du Plan Dr Tchasseu Karsa Directeur de la Division de 1'Epid6miologie MinistEre de la Sant6 publique, des Affaires sociales et de Ia Promotion fdminine Mr Dogbeci Ehlan Chef du Service de I'Education sanitaire Miss S6popo Santos Radio Lom6 Mr Komi Tsogbe MinistEre de 1'Int6rieur Mr Kokou Nodzro MinistEre des Finances et de I'Economie Mr Adodo Directeur de Ia Coop6ration internationale, I'linistEre des Affaires 6trangEres Mrs Traore Direction des Affaires sociales M6decin-Capitaine Bruce MinistEre de la D6fense nationale Upper Volta Son Excellence Monsieur le Docteur Douamba Tinga Ministre de la Sant6 publique et de la Population Mr Simeon Sorgho Secr6taire permanent du Comit6 national pour 1'Onchocercose MinistEre du Plan et de la Coop6ration CONTRIBUTING PARTIES African Development Bank (ADB) I'tr Mohamed Bouzid Division Chief 1'1r Niels L. Martin Consu ltant Belgium Mrs Suzanne Vervalcke Directeur d'Administration, DirecEion de la Coop6ration multilat6rale MinistEre des Affaires 6trangEres, du Cormnerce ext6rieur et de la Coop6ration au D6veloppement rccf5 Annex 2 page 4 Canada Mr Douglas Lindores Director, United Nations Prograrmnes Division Canadian International Development Agency (CIDA) Mr Ian Lindsay Scientific Adviser Research Establishment, Ottaura Mr Michel Roy First Secretary in the Office of the Embassy of Canada in Ouagadougou Federal Republic of Germany Dr Winfried Pulst Deputy Head, Department of Health, Nutrition and Population Policy Federal Ministry for Economic Cooperation France Mr Robert Thil Sous-Directeur des Affaires g6n6ra1es et financiEres Direction de 1a Coop6ration culturelle et technique MinistEre de 1a Coop6ration Dr Henri HeliEs Chargd de Mission ts la Sous-Direction de la Sant6 publique et de 1'Action sociale Direction de 1a Coop6ration culturelle et technique MinistEre de Ia Coop6ration Japan Mr Osamu Yoshihara Multilateral Cooperation Division Ministry of Foreign Affairs Kuwait Dr Abdul Karim Sadik Economic Advi-ser Kuwait Fund for Arab Economic Development Dr Talaat Zaghloul Scienti s t Ministry of Health Dr Rashed A1 Awaish Physician, Head of Quarantine Division Ministry of Health The Netherlands Miss A. Hofstede General Progranrnes Bureau Financial and Economic Development Co-operation Department Ministry of Foreign Affairs rccf5 Annex 2 page 5 Saudi Arabia United Kingdom Mr W. Denis Maniece Assistant Secretary Ministry of Overseas Developnrent Dr Peter Haskell Director, Centre for Overseas Pest Research Ministry of Overseas Development Dr A. Murray Baker Medical Adviser Ministry of Overseas Development United States of America I"1r E. Dennis Conroy Director, Office of Regional Affairs Bureau for Africa Agency for International Development Dr Alfred A. Buck Tropical Disease Adviser Office of Health Agency for International Developnent Mr Howard lhomas USAID Liaison Officer, Onchocerciasis Control Prograrmne, Ouagadougou Mr Cyril G. Groom Senior Officer, Policy and Planning Unit Agricultural Services Division World Bank (IBRD) Mr Bilsel Alisbah Director, Progranrnes I Western Africa Region Mr Stephen Denning Division Chief, Prograrmnes I Western Africa Region . Professor Eliot Berg Leader of Economic Evaluation lriission SPONSORING AGENCIES Food and Agriculture Organization of the United Nations (FAO) JCC/ 5 Annex 2 page 6 United Nations Develop,ment Prograrmne (UMP) I'1r Salif N'Diaye Chief, Regional Project Division Regional Bureau for Africa World Health Or tzqtro4 (WHO) Dr H. Mahler Director- General Dr Comlan A. A. Quenum Director of the Regional Office for Africa Mr l"larc Ls. Bazin Director of the Onchocerciasis Control Progranrne WlO Secretariat Mr A. Groenendijk Director, Division of Budget and Finance, WIIO HQ Dr A. O. Lucas Director, Special Progranrne for Research and Training in Tropical Diseases, WHO HQ Dr J. A. Mahoney Director, Conrnunicable Diseases and Environmental Health Regional Office for Africa Dr C.-H. Vignes Director, Legal Division, WHO'HQ Dr John Davies Chief , Entomological Evaluation Onchocerciasis Control Progranrne Dr F. Grant Medical Officer Onchocerciasis Control Progranrne/Regional Office for Africa 1"1r Robert Helmholz Chief , Administrative Services, Onchocerciasis Control Progranrne Dr Ren6 Le Berre Scientist, Division of Vector Biology and Control, WHO HQ Dr Brian Duke Chief , Eilarial Diseases, I^rHO HQ Mr J. Douglas M. Marr Entomologist/Biologist, Onchocerciasis Control Progranrne Dr Andr6 Prost Epidemiologist, Onchocerciasis Control Progrannne Mr James Walsh Scientist, Onchocerciasis Control Progranrne rccf5 Annex 2 page 7 o Mr Andr6 Rougemont Chief Epidemiology, Onchocerciasis Control Prog::armne Mr Samuel A. Sowah Entomologist, Onchocerciasis Control Programme Mr A. T. B. Ndiaye Chief, Information Regional Office for Africa Miss Margaret Desbois Administrative Officer, Onchocerci-asis Control Progranrne Miss Rosemary Villars Administrative Officer, Onchocerciasis Control Progranrne EX OFFICIO PARTICIPANTS Professor G. Camus Representative of the Economic Development Advisory panel (EDAp) OBSERVERS Guinea Dr Gabriel Sultan Directeur g6n6ral des Services de Pr6vention et des Brigades sanitaires MinistEre de la Sant6 S6n6gal Dr Alassane M'Baye Conseiller technique MinistEre de la Sant6 publique Organisation de C oordination et de Coop 6ration pour 1a Lutte contre les Grandes End6mies (OCCGE) M. Bernard Philippon Directeur de 1'rnstitut de Recherches sur I'onchocercose de Bouak6 ce de la Recherche s et techni -Mer M. Bernard PhiLippon Directeur de I'r:rstitut de Recherches sur 1'onchocercose_ de Bouak6 fnter-State Permanent Comnittee for Drought Control in the Sahel Dr Mady Keita Expert economiste analyste Commission of European Conrnunities Mr Ren6 Teissonnidre Delegate of the Conrnission in Lom6

rccfs ANNEX 3 Page 1 ADDRESS BY His Excellency Mr H. Bodjona Minister of Public Health Social Affairs and the Advancement of Women Right Honourable member of the Political Bureau, Personal Representative of the Founder President of the Ral1y of the Togolese People and President of the Republic, Members of the Central Corunittee, Right Honourable Ministers, Your Excellencies the Ambassadors, Mr Director-General of WHO, Mr Independent Chairman of the Joint Comrittee, Honoured guests, Ladies and Gentlemen, Men and Tromen Militants of the Togolese Revolution, It is to the abiding interest taken by Ehe Founder President of the Rally of the Togolese People and President of the Republic, General Gnassimgb6 Eyad6ma, in the protection and promotion of the health of the populations of Togo and in the organization of our country's public health system, that is to say in Ehe Eotal development of Togolese man, that we owe today the single honour he has done us in designating a member of the Political Bureau to preside as his representative over the opening meeting of the plenary session of the JoinE Coordinating Coumittee for the Onchocerciasis Control Programne in the Volta River Basin Area. It is accordingly on behalf of all my colleagues, the participants, that I have the honour to convey our sincere thanks, with the assurance of our most respectful and whole- hearted devoEion, to the Founder President of the Rally of the Togolese People. Mr Director-General of WHO, Your presence among us at Ehis plenary session of the ConrmiLtee is an invaluable encouragement and incentive to perseverance, both for the executing and sponsoring agencies and, above all, for the donor countries thanks to which this programme has been launched and will conti-nue until the results we count on are achieved. It is an encourage- ment for all those who are helping in the fight against Ehis scourge of river blindness, but also an adequate guarantee for the donor countries which need some assurance that the financial aid they have agreed to provide is used wisely to liquidate Ehe scourge and alleviate the physical and moral sufferings of those afflicted by it. I should therefore 1ike, on behalf of the National Conunittees, to express to you, and also through you to WHO, our deep gratitude. We also owe a debt of thanks to Dr Quenum, WHO Regional Director for Africa, for the solicitude he has always displayed where the problems of the Region are concerned. As for you, Dr Candau, Independent Chairman of the onchocerciasis project, by the very fact of agreeing to take on that responsibility you have reaffirmed the interest which you have never ceased to take in the health problems of the world. For that, please accept our thanks. rccf5 Annex 3 page 2 Your Excellencies, Ladies and Gentlemen, It is for me a source of deep gratification and a great honour to have the duty of greeting our distinguished guests in this great Meeting House of the Rally of the Togolese People, symbol of national unity. Allow me, on behalf of the National Onchocerciasis Control Conrnittee, to wish you all welcome on Togolese soil. We should also like to offer you our sincere thanks for having kindly accepted our invitation. As for the rr,aterial arrangements, everything possible has been done to ulake your stay among us pleasant. But if by any chance you were Eo note certain shortcomings, we beg you kindly to excuse us. May the few days that you will be spending here enable you to get to know and esteem our people better and leave you, when you return to your respective countries, with a happy memory of Togolese hospitalityl I will conclude by expressing my fervent wish that our conference may be an unqualified success. Jccfs ANNEX 4 Page 1 ADDRESS BY Dr M. G. Candau Independent Chairman Right Honourable Representative of the Founder President of the Rally of the Togolese People and President of the Republic, Right Honourable Minister of Health, Your Excellencies, Mr DirecEor-General of WHO, Members of the Joint Coordination Comittee, Ladies and Gentlemen, Allow me to convey to you, Right Honourable Representative of the President of the Republic, on behalf of the Committee and in my personal capacity, our thanks for doing us the honour of presiding over this inaugural meeting of the fifth session of the Joint Coordinating Comnittee for the Onchocerciasis Control Programme in the Volta River Basin Area. This demonstration of the interest which His Excellency the Founder President of the Rally of the Togolese People and President of the Republic takes in the Programme is an invaluable encouragement.for us. I am voicing the feelings of the members of the Committee in asking you to convey to His Excellency our appreciation and gratitude for the hospitatity generously afforded us here in your country's capital. My very warm thanks go also to Ehe Togo authorities, members of the Diplomatic Corps and guests who are here this morning. I should like to hail the presence among us of Dr Mahler, Director-General of the World Health Organization, and to te11 him how greatly our Comnittee appreciates the way in which the activities of the Programme are being conducted under the responsibility of wHo. I should also like to welcome all the Members of the Committee and Observers This year 1978 - vftich has been marked by the consolidation of the activities of the Programme in the whole of the area initially selected - has also seen an extension of those activities noEably in the lvory Coast and the commencement of studies wiEh a view to an extension for Benin, Ghana and Togo. The agenda for our meeting this year is heavier than usual. In addition to the annual reports of the different Advisory Groups and of WHO which are submitted to you each year, you will have to consider reports concerning the extension of activities to Western Mali, to Guinea, to Senegal and to Nigeria. To these many subjects will be added that of the evaluation of our Progranrne, in its technical and economic aspects, and the continuation of its activities in the second phase of operaEions, from 1980 to 1985, during which it is hoped to see not only the consolidation of the results achieved but also the working out of a new strategy for the future. Our Programme was planned at the outset in the light of the knowledge available at that time concerning the epidemiology of the disease and the biology of the vectors. The experience and the new data which \./e now possess on the subject warrant an evaluation of the activities of the Progranrne and a study with a view to refinement of our onchocerciasis control strategies. The phenomenon of reinvasion and its geographical sources must also decisively influence future strategy. rccf5 Annex 4 page 2 Let us hope that soon studies will be extended to the natural limits of the distribution of the main vectors, not only in the Participating Countries but also in neighbouring countries. We must not remain content with the knowledge already acquired. On the contrary, there is an urgent need for a stil1 greater research effort in order to find simpler and less costly methods of vector control and extend our knowledge of the disease and its treatment. In the long run the success of our Progranune and the benefits it brings the Participating Countries will depend largely on the development of the permanent health services - an integral part of the countries' social and economic infrastructure - on whi.:h wi11 lie the responsibliEy for the promotion of health, for the prevention and control of diseases, and more particularly for controlling the corununicable diseases of importance in the Region. On the termination of Ehe activities of our Prograrrne, those health services will have to be ready to take over the responsibility for any continuing onchocerciasis control activities. The understanding and the close cooperation that exist among the Participating Countries, the Contri'buting Parties and the Sponsori-ng Agencies give us the assurance that the activi.ties of the Programme will help the economic and social development of the Region and that its population will enjoy in the future a healthier and more prosperous life than today. In conclusion allow me, Right Honourable Representative of the Founder President of the Rally of the Togolese People and President of the Republic, to reiterate our thanks to you for having consented to honour by your presence this inaugural meeti-ng. rccf5 ANNEX 5 Page 1 ADDR-ESS OF Dr H. Mahler Director-General of the \rrorl"d iiealth Organization Right Honourable Minister, Mr Independent Chairman, Delegates, Ladies and Gentlemen, I should like to say before 1 go any further how graEified I am that my firsr contact with the JCC shotrld be taking place in this very flourishing city of Lom<!, sPear- head of the progress of a vigorously developing Togoland whose destinies the President of the Republic is guiding with faith, determinaEion, and a keen sense of African uniry. This programne represents a concerted effort to attain a conmon goal: the control of a parasitic disease that afflicts, sometimes to the point of causing blindness, millions of people living in rhis part of West Africa. WHO is happy to be able to confirrr tfre excellence of the results obtained in the entomological sphere. This indubitable success is due to the continuous cooperation of every one of the governments and organizatiorts represented today in this ha11. As you know, operati-ons are proceeding acccrding Lo plan, and to date 75 per cent.of the operati-onal zone j.s under control. Just one year ago your Cormnittee authorized an extension of the operations i-n the Ivory Coast and asked for preliminary studies to be insEituted with a view to a possible extension in Benin, Togo and Ghana. The activities of the programme have accordingly increased, but it-s effective- ness has not diminished. This is beyond all doubt the result of sound management and also of cooperation between the seven States in pursuit of the common objective: the elimin- ation of what constitutes a danger for human beings and a brake on the economy, The National Onchocerci-asis Control Conuni.ttees are beginning to play the important role assigned to them and we cannot overpraise the excellent move that was taken with the holding in Abidjan, in June 1977, of the first joint meeting of those Committees. The Cotonou meeting in June 1978 was also a very constructive one and we have high expecrations of the one scheduled to be held in Bamako in June 1979. The role of these Conrnittees wili certainly increase in years to come with the progressive and desirabie integration of the activities of the Progranrne into the programrnes of the individual States. I should also like to pay tribute to the advisory bodies and to the work they perform. To the STAC, in particular, we are beholden for its many suggestions, always framed in a constructi-ve spirit. The ecological fact t.hat so far the rivers have not been affected augurs well for the future of the Progranure. The STAC has nevertheless stressed that the present dependence of the Prograrmne on a single insecticide witl need to be reduced. It is therefore important now to step up research aimed at finding alternative solutions, and some progress is being made. Thus, during a meeting held in Geneva this year on the development of insecticides for the Progranrne, the representati-ves of industry, who were participating, reacted favourably to the idea of producing new substances for testing. As regards chemotherapy, the TDR Programme is stepping up its research effort and the pharma- ceutical firms have latterly been producing a larger number of drugs for testing. The STAC has, moreover, expressed the view that it would probably be necessary to maintain a certain level of control even after 2O years. What will this level of control be? What methods will be used? The real challenge facing us is how to find a control technique that is less complex but equally efficacious, less expensive and therefore more cost-effective. L have already asked the Programe to set uP a \^rorking group of inter- nationally known scientists that could study Ehe problem of the long-term future of the rccfs Annex 5 page 2 Programme and in particular answer the following questions: 1. Does there exist a simpler and less costly technique for larviciding? 2 Could a combination of environmental modification, Localized larviciding, and siting of villages keep the prevalence of the disease down to an acceptable leve1? What recourse might be had now or later to other methods for controlling the vector, e.g. control of adult f1ies, biological control, etc.? 4. Would the extension of the Prograrmte reduce the logistic costs? . Another important question to be settled is whether, and if so how, the OCP organization could be used to combat other diseases and thus increase the cost-effectiveness of the Programme. Though i-nvolvement of the Programme in other spheres is for the moment outside its strict terms of reference, I should like today to put frankly the question whether it is rational in economic terms that this programure, whJ-ch has proved so dynamic and effective, should confine its future activities to solving only one of the problems of this region which is beset by so mFny others in the public health field. You wi11, I am sure, agree Ehat this question urgently needs consideration. WHO's objective is to attain for everyone by the year 2OOO a level of health conducive to the grorrth of social and economic productivity. According to the Alma Ata declaration all governments should already now be mobilizing their resources to develop their own national systems of primary health care. Within this framel/ork it will be the responsi- bility of each of the participating Governments to incorporate into its primary health care system a suitable structure for keeping the country free from onchocerciasis. The establishment of these structures should begin as soon as possible. In this connexion, it is with very great interest that I have noted the viewpoint repeatedly expressed by the NaEional Onchocerciasis Control Cormittees as to the exclusively national relevance of the economic development aspect, on which the report of the World Bank and that of the EDAP are awaited this year with particular interest. Part of your session at Lomd will be given over to economic questions. The challenge facing theNational Committees is accordingly to launch, as expeditiously as possible, clearly identified and carefully prepared development projects such as will enable each country to derive optimum profit from the huge investments of the Control Prograuure, and it is my fervent hope that chis challenge will be taken up. 3 rccf5 ANNEX 6 Page 1 ADDRXSS OF The Representative of the Founder President of the Togolese People's Ral1y and President of the Republic Mernbers of the Political Office and the Central Committee, Ministers, Your Excellencies the Ambassadors, Mr Director-General of WIIO, Mr Regional Director of WHO, Mr Independent Chairman of the Joint Coordinating Committee, Distinguished guests, Ladies and Gentlemen, Militants of the Togolese Revolution, I have the honour of representing the Chairman and founder of the Togolese People's Party and President of the Republic, General Gnassimgb6 Eyad6ma, aE this opening meeting of the Joint Coordinating Comnittee for the Onchocerciasis Control Progranrne in the Volta River Basin Area. It is for me both a privilege and a great responsibility. I should like to take this opportunity to reaffirm the wholehearted and active supporE of the Togolese Government and people for the valuable work you are carrying out in our sub-region to control onchocer- ci-asis, otherwise known as river blindness; because of its complications, this very serious disease is a fearful public health problem of great complexity. An estimated 2O million people, for the most part Afri-can, are suffering'from it. It is present in all the West African States, and the savanna zone harbours the largest foci in the world. In Ma1i, Upper Vo1ta, Niger, Benin, Ghana and the Ivory Coast, some 6O0 OOO people have onchocerciasis, and about 60 OOO of them have been blinded as a result. My own country, Togo, has not been spared. The fight we have conrnenced against this disease is planned to cover a period of 20 years. AE present it is not possible to use mass drug treatment for the control of onchocerciasis. The only way to reduce transmission Eo zero, and ultimately cause lhe disease to disappear completely, is to eradicate the flies. In view of our experience with sma1lpox, we are entitled to hope for success. Our regional smallpox eradication and measles control programme was carried out with the help of WHO and USAID; as a result of this project there is no longer a single case of smallpox in Togo. It is this achievement which encourages us to persevere with a campaign of regional, progranrned and concerted work. The Togolese Government joins with the governments of the Ivory Coast, Benin, Ghana, and Mali in requesting the geographical extensj-on of the Onchocerciasis Control Programme and notes that the governments of Senegal, Guinea and Nigeria have also requested that the operations of the Progranrne be extended to their respective territories. The Onchocerciasis Control Programme is now fully under way, and in a few months will have been operating for six years. While I have neither the time nor, I fear, the quali- fications to speak in detail about the Programme's activities, I can say that the results at the end of Ehese firsE years are positive. I firmly believe that Ehe evaluation reports to be presented by your experts will attract the necessary resources so that the second stage of the Progrartrne can be tackled wiEhout any major difficulty and to the satisfaction of us a1I. Your campaign is in the interests of Africa's destiny. It is promoting the regional regrouping of our States. After much hesitation we have finally understood that the rccf5 Annex 6 page 2 development of our respective states will come about through joint action, partly indeed, through this jointly operated Programme. At a time when we are progressing towards more carefully defined aims in the political field, it is useful to bear in mind and stress those areas in which we have already achieved great success, in particular public health, the health of our populations and the protection of our friends. Admittedly, as r^re very soon realized, flies do not respect the geographical limits of our national territories. We thus have a sacred duty to thank all those who first pointed out this phenomenon and who patienLly helped us to overcome our particularist attitudes and bring into being this vast regional Prograuure which is now endeavouring to expand to cover all the countries of the community of West African States. This Prograrnme also offers an example of international cooperation. It is by pooling the financial resources provided by Belgium, Canada, the Federal Republic of Germany, France, Japan, Kuwai-t, the Netherlands, the United States of America and international bodies such as the World Bank, USAID, and the African Development Bank that we can carry out this jointly planned Control Progranme. It was to give the populations of these countries a feeling of involvement in this joint campaign that rre decided to hold the Joint Coordinating Conmittee alternately in one of the participating African countries and in one of the contributing countri-es. On behalf of the Togolese Government, I should like to welcome the respected representatives of all the contributing countries present here. I wish to assure them of our gratitude and ask them to kindly transmit to their respective governments the warm thanks of our populations for the material support they are providing for the operation of this vast Programe wtrich, in our eyes, represents - as others have seen fit to emphasize elsewhere - an example of rea1, disinterested, humanitarian cooper- ation between participating 3nd contributing countries. The economic and social development of the African States is today the prime objective of our governnents. For this reason we seize any opportunity to promote production and encourage such development. To this end we need to make good use of all the fertile lands first of all, and then of allother available areas in our countries. Unfortunately, the ever-increasi-ng abandonment of these fertile lands on account of the intolerable harm done by the vector f1y and the terrible complications of the disease it transmits, is a serious handicap to our States in their development efforE. The exploitation of our land and water resources for development progra[mes is feasible only if we can successfully control onchocerciasis. We believe that the objectives of our Progranme will be achieved. In the long term, the significant development of applied research and m2npower training at all 1evels will ensure that future uraintenance activities are earried out with maximum efficiency. The fact that this meeting is being held in the Togolese capiEal is proof of the great interest taken by ry country in man's development, in his full development. The end purpose of this Prograume, of our work, is man: to save man from this degrading scourge and to liberate him for the work of development, for great acts of dedication. I cannot mention this aim without thinking of those outstanding men of the World Health Organization who provide us every day with examples of dedication to the cause of humanity. Firstly I should like to mention those who spoke before me from Ehis rostrum, in particular Dr Candau whose enormous experience gained over many years enables him to preside over this joint undertaking wiEh authority and efficiency. Dr Mahler, Director-General of WHO, and Dr Quenum, MIO Regional Director for Africa, in spiEe of their numerous and onerous commitments, have both been willing to accept responsiblity for running the technical operations of the Prograrme. We are also grateful to the indefatigable staff of the United Nations Development Prograuure, the Food and Agriculture Organization, the World Health Organization, the European Development Fund, the World Bank and Ehe African Development Bank. Neither will I forget, before I end, to pay the tribute they deserve to all those - doctors, research workers, administrators and technicians - vrho, at different 1eve1s, in the field or in laboratori-es, devote each day to the efficient performance of their duties. They all have a right to our gratitude. rccf5 Annex 6 page 3 It is now nearly 12 years since the Chairman and Founder of the Togolese People's Party, General Gnassimgb6 Eyad6ma, courageously undertook to ensure the fu11 development of the Togolese nation and to restore their dignity to the people of Africa; this explains his constant interest in and his vigilant work on behalf of the protection and promotion of the health of the Togolese people. Immediately following independence the health situation of our country was characterized by a high prevalence of cornmunicable diseases, high mortatity and a short life expectancy. The shortage of drinking water in rural areas, the absence of environmental health measures, and malnutrition all contributed to the high incidence of infectious diseases. To cope with this situation, the health policy of the Government under the enlightened guidance of General Gnassimgb6 Eyad6ma was to integrate preventive and curati.ve medicine, to bring health care nearer to the rural populations, to provide virtually complete coverage for the population, to improve the quality of care provided and hence avoid transporting the seriously sick over long distances. Great efforts were put into the development and strengEhening of the health infrastructure by increasing the number of health care units in urban and rural areas. AE the same time, a great effort was made to step up manpohrer training so as to provide the best possible condiEj-ons for the implementation of a prograEme which, by virtue of its nature and scope, determines the economic development of our country. The Togolese Government is resolutety pursui-ng its programre of social and economic development for the entire country; the same can be said of all the Participating Countries of the Prograrrne. I Eherefore feel I can speak on behalf of all the countries concerned in expressing to the Joint Coordinating Cormnittee our special gratitude for future work. We are convi-nced that a sati-sfactory solution in keeping with the wishes of all our countries will be found during thi-s session. It is with optimism that we address our constant friends and convey to them the hopes we place in acEive cooperation and in the prograllmes of work so generously provided for the greater good of our populations. On behalf of the Chairman and Founder of the Togolese People's Party I wish this meeEing every success. It is with great confidence thaE I declare the fifth session of the Joint Coordinating Conrnittee for the Onchocerciasis Control Programme in the Volta River Basin Area open. May regional and international cooperation long continue in the victorious fight against onchocerciasis.

(vBcf7e.L) INTERCOUNTRY PROJECT FOR THE FEASIBILITY STUDY OF AN ONCHOCERCIASIS CONTROL CAMPAIGN IN THE SENEGAL RIVER BASIN AREA (Governments of Guinea, Guinea-Bissau, Mali, Senegal) 1, INTRODUCTION The Governments of Guinea, Mali and Senegal have, for many years and on many occasions, requested that the Onchocerciasis Control Prograrmne in the Volta River Basin Area (OCP) at present being implemented in seven countries of West Africa should be extended to the areas of these countries where onchocerciasis is known to be as serious a health problem as it is in the OCP zone. The last official request was made at the 4th session of the Joint Coordinating Conrnittee (JCC) of the OCP (Kuwait, December T977) where Senegal and Guinea were invited.,as observer, Mali being already one of the OCPrs seven countries for its south-eastern foci^. The decision of the JCC was (Indepe-ndent Chairmanrs report, page 13) 6.26 "hH0 should be asked to conduct joint studies in Guinea, Senegal and western Mali where technical considerations indicated a combinated approach. The JCC noted with satisfaction the Regional Directorts offer to carry out these joint studies and expressed the hope that WHO would find the necessary funds as soon as possible. In that way, the necessary information would be available for the JCCrs next session and no time would have been wasted...". 6.27 "The JCC accepted this proposal". 6.28 "The United States representative said that if WI{O wished to carry out the joint studies in the Senegal River Basin, his Government would be willing, entirely outside the Progranure, to consider making a contribution in the form of consultants or other assistance that might be needed". Since December 1977, in accordance with the instructions of the JCC, WHO has undertaken the following actions: - The Regional Director made available US$ l5O 000 from his Development Fund for supporting activities in 1978. This sum is in addition to US$ 30 O0O contributed by the Director-Genera1. - A conrnittee, composed of Regional Office and Headquarters specialists, in charge of the preliminary studies and planning, has been set up. 1 -During the last World Health Assembly, the Government of Cuinea-Bissau officially requested to be included in the Project for a Feasibility Study. WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE JCC/ 5 ANNEX 7 Ce document ne constitue pas une publrcatron. ll ne doit farre l'objet d'aucun compte rendu ou r6sum€ nr d'aucune citation sans l'autorisatton de I'Organisatron Mondiale de la Sant6. Les oprnrons exprim6es dans les artrcles signes n'engagent que leurs auteurs. Tho rssue of thrs document does not constrtute formal publication. lt should not be reviewed, abstracted or quot6d without the agreement of the World Health Organrzatron. Authors alone are responsrble for views expressed rn signed articles. vBc/79.t Page 2 - A field team, composed of an epidemiologist and an entomologist in charge of collecting the existing data and organizing some preliminary surveys, has been created. - Missions of specialists from Headquarters and Regional Office for discussions with the national authorities and coordination of the activities. - Interviews of candidates in the countries and organization of their training in the different disciplines and at different leve1s (12 Guineans, 3 Senegalese). - Recruitment of a temporary adviser in charge of producing a synthesis of the available entomological and medical data in Senegal and Ma1i. - Recruitment of a temporary adviser in charge of producing a synthesis of the socio-economic data available in the three countries. - Organization and implementatiori (September 1978) of aerial surveys of the entire areas of western I'Iali and Senegal . 2. ONCHOCERCIASIS IN SENEGAL, WESTERN MALI, GUINEA AND GUINEA-BISSAU The studies already made in these countries, if far from.being sufficient for a control campaign to be planned and implemented, give a clear indication that onchocerciasis is, in the savannah areas as serious a health problem as it is in the OCP area. The prevalence of the lLlseeEe reaches its hyperendemic level (more than 6OZ) along all Ehe main rivers and tributaries except on the Senegal s.s. (Kayes area), the lower-Bafing and the lower-Bakoye which represent the northern limit of distribution of the disease and its vector in this region of West Africa. Ocular lesions and blindness due to onchocerciasis are thus widely distributed in the hyperendemic areas. In his synthesis for- Senegal, Dr B. Philippon writes (page 12): "In practice, the entire population (more than 9OZ) more than 15 years o1d carries O. volvulus microfilariae... The first cases of blindness due to onchocerciasis appear after the age of 15 years and affect one person in five in the adult population. In the Gambia Basin, the maximum rate of blindness reaches LL?...". The transmission levels can be extremely high in the hyperendemic area and, to give an example, the maximum transmission potential knom in West Africa (including that of the OCP :) has been found on the Niokolo Koba, a tributary of the river Gambia, where, in one month, the transmission reached 3 000 larvae (tolerable leve1: 100 larvae per yearl). Our knowledge of the distribution of the breeding-places of S. damnosum s.s. (mainly obtained during the recent aerial surveys implemented by OCCGE and WHO in September 1978), although incomplete, shows that these places are widely distributed on the main rivers and on most of the permanent or non-permanent (rainy season) tributaries. In the savannah area, the cytospecies involved in the transmission are the same as those in the OCP zones (S. damnosum s.s. _q . sirbanum . With the exception of the northern zone in Mali (Kayes), where a high per- centage of the flies are zoophilic, the dynamics of f1y populations show no difference from what is already known from other savannah areas, including the OCP. One aspect of the vectors I population dynami cs has to be emphasized: the problem of reinvasion. In the OCP area, the periodic reinvasion of some of the treated areas, princip- a1ly the western and south-western zones in Mali and Ivory Coast, has been the main technical problem from the beginning of the Progrannne and the main concern of the recipient and donor countries. The extension of treatments in Ivory Coast has greatly reduced this problem vBcl79.L Page 3 but some of the newly treated areas are sti1l reinvaded during the rainy season, the f1ies, belonging to savannah cytospecies, coming from non-treated savannah zones located westward or southward, i.e. in Guinea and possibly western Ma1i. For the ner/ zone presently under consi- deration, this problem will not exist as the area will have to be designed so as to include the entire zone where S. damnosum savannah cytospecies are breeding; (the western, south-western and sorrttern flillIs of the proposed areas are presently under study but they can be expected, from already available data, to be as shovm on the maps attached). This zone will present the following advantages (see maps 1 and 2): (i) The northern limit of the vector and disease distribution is well knovm, as it was for the OCP. (ii) The programme will be conriguous with OCp, then: - OCP will be protected from reinvasion from the west and south-westl - this Programme will also be protected from possible reinvasion from the east. (iii) This programme area will not be subjected to reinvasion from the west, south-west and south for the reason already described. This progranrne will thus be very isolated from any reinvasion and wi11, moreover, improve the results obtained in the western areas of the OCP. Socioeconomics: !1r N. Prescott, WHOfs temporary adviser, who made an analysis of the documents so far available writes: "The proposed control prograumre will bring benefits both to the participating countries and to the countries threatened by vector reinvasion on the \,restern border of OCP. These benefits will be of three kinds: aggregate health benefits; aggregate income benefits, resulting from an increase in the quantity and quality of labour and land resourcesl and distributional benefits reflecting the fact that the prograrmnets beneficiaries are among the worldrs poorest. A framework for analysing these benefits hras presented to the JCC in Lom6, Togo (December 1978). In the following section, insufficient information is presently available to provide a basis for evaluating, even crudely, the size of the potential benefits of the proposed progranrne, and no attempt will be made to do so here. Recommendations for collection and analysis of relevant data were submitted to the JCC in Lom6, Togo (December 1978). The only information avialable for each of the three participating countries related to the progranmets possible impact on the development of land resources. Eastern Senegal A list of four development projects, including two settlement schemes, planned for imple- mentation in areas of known onchocerciasis transmission. The extent to which the viability of these projects is endangered is not knor.m. Western Mali A list of agricultural and other development projects planned or in progress in the programe area. The extent to which onchocerciasis may affect the productivity of any of these investments is not known. wc/79.t Page 4 Guinea The relative unoccupation of some of the river valleys in Upper Guinea has been attri- buted to the presence of the disease vector, The size and potential productivity of this underutilized area is not knownr'. 3. STRATEGY AND TACTICS TO BE APPLIED IN THIS PROGRAMME 3.1 General strategy Despite its isolation, this programne will have to adapt the strategy on which the OCP is based. - "The extent of flight of the female vector makes it necessary to treat fairly large areas". In the present situation, the northern and eastern limits being known (see above), the first objective is to determine the other limits in Senegal, Guinea, Guinea-Bissau, possibly the Gambia (no onchocerciasis focus is presently known in this country) and Sierra Leone (northern region), in order to cover the entire distribution area of the savannah cytospecies of S. damnosum. Three countries (Guinea, Mali, Senegal) have already agreed, at the highest 1evel, on the principle of joint action. - "The longevity of the parasite in man (15 to 20 years) and the lack of therapeulic means of control make it necessary to pursue an entomological control campaign over a very long period". Two questions can be raised about those principles being applied to this new area, vi-z: (i) Since the area is described as "isolated", why not aim at the "eradication" of the fly which would considerably reduce the period of treatment and definitely solve the problem? Unfortunately, it is not realistic to expect that all S. damnosum savannah cytospecies foci in this difficult area could be discovered and correctly treated during the first phase of the campaign. Thus, those who will be in charge of this Progranme will have to have at their disposal the means of facing any difficult control situation during a sufficiently long period. (ii) What will happen after 15 or 20 years? This question, already raised after the first four-year period of the OCP, can be answered this way: the isolation of this area and its contiguity with the OCP will certainly lead to an extreme reduction of the para- site in the human population as well as suppress the problem of circulation of parasites due to fly migration between the treated areas of the ocP and the \^Testern zones under cons idera t ion. 3.2 Tactics The structures of the OCP, the methods and techniques used in this progranrne could be adapted to the new areas as they have proven to be va1id, especially as concerns: - direction and technical unitsl - methods of treatment (aerial applications); - insecticide selection and efficacy; - methods and structures of evaluationl - entomology: sect.ors, sub-sectors, radio-communications' etc. ; - epidemiology: simple and detailed evaluation; - hydrobiology vBc/79.L Page 5 However, for the sake of economy and to make it easier for the countries concerned to carry on the operations, it is reconrnended that emphasis be placed on the advisability of developing simpler and less expensive control techniques, on the integration of epidemiological and entomological activities within the existing national health structures, and on health educat i on . The advantages and disadvantages of establishing a separate prograrrne from the OCP inclu- ding possible economies of sca1e, duplication of management structures and possible dilution of scarce expertise should also be evaluated. 4. PLAN OF ACTION 4.L An intercountry project will be organi-zed to study the Feasibility of an Onchocerciasis Control Campaign in the Senegal River Basin Area. Its terms of reference will comprise: 4.1.1 Collection of data and information on A. Epidemiology - entomol o8y (a) Boundaries of areas free from onchocerciasis. (b) Endemicity 1eve1 and severity of the disease in selected vilrages. (c) Determination of the western, south-western and southern boundaries of the project by epidemiological surveys. (d) Determination of the western, south-western and southern boundaries of theproject by a study of the distribution of the savannah vectors of onchocerciasis. (e) Distribution of the larval sites of the vectors at different seasons. (f) Estimation of transmission dynamics. (g) Information on the non-target aquatic fauna, selection of monitoring points. (h) Participation in the study programne on the possibility of introducing new control techniques, such as ground-1eve1 treatment, envirorunental manipulations, and chemotherapy. For this purpose it may be necessary to use the services of design and environmental engineers. B. Hydrology (a) Distribution of hydrometric stations, evaluation of the up-to-dateness of the hydrological data. (b) Evaluation of additional needs. C. Radio-conrnunications In order to ensure rapid conrnunications between the various operational centres of a control progrEume' a system of radio-cormnunications will need to be set up. The project will study the various possibilities. It will get in touch with the appropriate national autho- rities and with the rnternational Teleconununications union. D Training Continuing the efforts already undertaken, the project will evaluate Ehe needs for specialist staff and the training or specialized training they need to be given. vBc/79.1. Page 6 E. Infrastructure for aerial operations Evaluation of the available facilities, prineipal and secondary airfields, possibilities of using them at different seasons, control of aerial navigation, fuel supplies. F. Onchocerciasis and other diseases The importance of onchocerciasis by comparison with the other causes of mortality and morbidity in the region will be determined. G. Health infrastructure Current public health programnes, including the 1eve1 of expenditure and type of services, and the national health strategies of the participating countries, including the priority to be given to onchocerciasis control' wilI be examined. H. Agric.rl!,rrel_ 3e!s The crop-groning and livestock production potential of the reclaimed areas will have to be determined, and projects now under way or which could be implemented after an onchocerciasis control campaign should be indicated. Regions with the best prospects for developing agri- culture should be identified. AlI these data will be compiled in such a way that the impor- tance, role and priority in each country of increasing land availability in the context of national development strategies can be clearly identified. I. Geographical data An inventory of pedological, climatic, hydrological, botanical and topographical data, together with information on roads, will have to be dravm up. Maps and aerial photographs of the region will be listed. J. Demograph ic and sociological data The movements and dynamics of human populations will be studied on the basis of existing documentation. The knowledge, attitudes and practices of people of the area with regard to onchocerciasis will be studied to assess their possible participation in control efforts ' Therefore, services of a behavioral scientist would be needed. 4.L.2 Analysis o f data - limits of operatlon zone Tife ltgje.t A. It will determine the state of knowledge in each focus about entomology, epidemiology and chemotherapy, and record the information on maps' B. Ir will determine the limits of the zone in which action is desirabl-e. C. Tt will determine the most appropriate methods for the control of onchocerciasis in this zone, taking into account the rlsults obtained in the studies referred to in section 4. 1. 1, A, (h) . D. It will collaborate with national authorities in determininB the priorities to be given in the fields of public health and of development activities. vBC/79.1 Page 7 E. It should analyse and present the results in such a \^7ay that they can be directly used for the study of the pros and cons of integrating the campaign in the Senegal River Basin with the programne in the Volta Basin with particular attention to the possible operational bene- f its \,rhich could accrue to the latter. F. The data collected should be suitable for use by the countries concerned even if the onchocerciasis control campaign should not take p1ace, 4.1.3 Compilation of an interim report for the JCC in 1980 An interim report on the progress of the feasibility studies will be subrnitted to the OCP Scientific and Technical Advisory Connnittee in 1980 for study and transmission to the Inde- pendent Chairman for the 7th session of the JCC in December 1980. 4.1.4 Establishment of a plan of work for Onchocerciasis Control in the Senegal River Basin Area The report will comprise the following sections: A. Obiectives of the Onchocerciasis Control Pro gramme This section will deal with the health and economic objectives of the programme. B. Management structures The responsibilities and lines of cormnunication for ensuring the smooth running of the prograrune will be defined. C. Intercountry coopela!ion An intercountry cooperation is essentiaL in a programne of this kind, the project will indicate the means to be used to bring about such cooperation. The setting-up of National Onchocerciasis Committees and periodic meetings of the various national committees should be considered in this connexion. D. Control activitles The control methods will be defined and the plans of operation indicated. logical and epidemiological evaluation activities and environmental surveillance rai11 be described in detail, with timetables for their implementation. The entomo- activities E. The year of I. Economic development activities anticipated health benefits, income benefits and distributional benefits during each programne implementation should be assessed. Presentation of a draft budget for the coItlrol ?Iqgralmre The budget will include personnel, equipment, operations (including computer tirne and the cost cf technical meetings), training, and associated research. It will take the ccntrib- utions of participating countries into account. vBC/79.7 Page I G. Cost-effectiveness of a control campaign This section will compare the anticipated benefits of section E plus the possible ,rpr,ra- r,ir,ai and financial benefits for the present OCP to the cost of the campaign as descriired j-Lr ;ccrion F, will discuss the suitability of a control campaign in the Senegal River Basir, .lrei and ruil1 make recommendations for future action. 4 Duration and cost of the Feasibility Study The duration of the Feasibility Study is estimated at tvo-and-a-ha1f years The cost per year is estimated (see Annex L) at 1st year 2nd year 3rd year TOTAL us$ 1 252 000 The increase with reference to the report 78.5 presented at the JCC in Lom6: is ior by the need to engage the services of consultant engineers and sociologist for :J new technologies and by the need to train personnel. us$ 604 ooo us$ 417 600 us$ 170 4oo ac ilountr--ri the s ruri;, 4.3 Project requirements Personnel - an entomologist (Project Manager) - an administrator I medical officer and 1 operations officer are alrcady composing the IrtlO international staff - staff (c1erks, drivers, etc.) - national teams, working under national status, in order to collect further data(1 team in each eountry) - consultants fraining means Means necessary for the study of new technologies Equipment - 8 cars - provision for medical and entomological equipment 14aintenance - travel for staff and Headquarters and Regional Office experts - provision for flying time 4.c Headquarters location The best site for the Headquarters of this project would appear to be Bamako, Maii, li,,:ti r!tiere liaison inside and outside the programme (including the OCP, the 0CCGFI/ORSTOI1 tr.'in ,' Lentre, etc.) appears to be the best. BUDGET vBC/79.t Page 9 Annex I TOTAL L979 19 80 1980(6 months) 1. PERSONNEL a) International staff - Entomologist (Project Manager) - Administrator - Consultants (USg 4500 per month) . Entomology . Epidemiology . Socioeconomics . Hydrology . Hydrobiology b) Local staff (clerk, typist, driver) Sub-tota1 - Personnel 2, DUTY TRAVEL - Travel r"rithin project area - International travel Sub-total - Duty Travel 3. TRAINING 4 5 6 AERIAL SURVEYS (US$ +OO per hour) STUDIES ON NEW TECHNOLOGIES SUPPLIES AND EQUIPMENT - Vehicles . 3 small cars (5O4 type) . 2 four-wheel drive (Land Rover type) . 3 W\I camping cars - Lab. - field equipment (incl. maps) - Office equipment Sub-total - Supplies & Equipment 7. OPERATION AND }{AINTENANCE 1 - Vehicles (8 x 25 0OO km x 0.25) - Office equipment - Lab. + field equipment Sub-tota1 - Operation & Maintenance 8. REPORTS Sub- t ota 1 9. PROGRAMME SUPPORT COSTS TOTAL US$ 125 000 110 000 40 500 40 500 58 500 9 000 18 000 25 000 US$ 50 000 44 000 18 000 18 000 18 000 4 500 9 000 10 000 US$ 50 000 44 000 13 500 18 000 27 000 9 000 10 000 US$ 25 000 22 000 9 000 4 500 13 500 4 500 5 000 426 500 171 500 171 500 83 500 25 000 37 500 10 000 15 000 10 000 15 000 5 000 7 500 62 500 25 000 25 000 12 500 50 000 25 000 25 000 IO4 000 60 000 40 000 4 000 150 000 75 000 75 000 23 IOO 24 200 24 800 13 200 5 500 23 100 24 200 24 800 13 200 5 500 90 800 90 800 137 500 13 700 4t 200 55 000 5 500 15 500 55 000 5 500 16 500 27 500 2 700 8 200 192 400 77 000 77 000 38 400 22 000 5 500 5 500 11 000 1 098 200 529 800 419 000 149 400 153 800 74 200 58 600 21 000 I 252 000 604 000 477 600 170 400 IRent of Headquarters premises, electricity, telephone, water, watchman to be paid by the host Government. UJ E, / z o UJ o 5 a @ Ui U a @ ) o @ ! f o o z)o @ = o 2 @ o I LrJ J o6 o UE J *- / s a tlL lo0 f, oo U r Iz) Y MAP 1 THE SENEGAL RIVER BASIN AREA vBCfTs.L Page 10 Alnex lI UJ.7. ; f, o a a\ ) -=-< l o @o o F rQ o =I o oIfoo EU tV' o z o = o) o ;s5 I a z z o o t:'c z a 2 Iflo z @ ) rE I l o o E o 2'-T. .. E z'I ul 1 oE z o a j t EJ o N 6v$t @ oo )z 'o--F EL o UJ z ut oi)G z oo ti $ Eo Io z =0 N J I E =E c4 L,; OoC- o=^ 9a E {o - ili t t(tv)r J l 2 E .gl df' 0 0 CI; = or'. G Y o { t (1 (l Zl o0l o @ z Y o F -/ (, r. *,' -it -.\1 j L,! 3 ,i E ( ) o\ f I I I I ( ,.1,J,rt" Jril( ^tts '{- -\ ll\---- ------.,12--r! = - i:,a.- \,qv!l{ E; a E z q(J o I F2 3 F {_ ) r--l $ ,$ FJo rE '-- E ,d >l ) \ du 92 J4t(+] = = =G, I \9 ! ooo i \ I *, G E J E t^ i- z -o l \ I EUI - E c z '.\ z J I I I I ) u zu @ ,t -'(l i,= t (L o o ! z I l tt1{ s 9 o I ccitE,EJ< <z 23 , vBc,/7s.r Page 11 Annex II LU E. 4 O o LIJIF -t = F f(., Fz o O ul -F(, z = o -a N L t

) i JOINT COORDINATING COMMITTEE Onchocerciasis Control Programme in the Volta River Basin Area Ofice of the Independent Chairman c/o World Health Organization l21l Geneva 27, Switzerland Tcl. 346061 TclcxZES 27821 J.C.C..C.C.C. COMITE CONJOINT DE COORDINATION Cinquidme session Lom6, 5-8 d6cembre 1978 COMITE CONJOINT DE COORDINATION Programme de Lutte Contre I'Onchocercose dans la Rdgion du Bassin de la Volta Bureau du Prdsidcnt Indlpendant c/o Organisation Mondiale de la Sant6 l2l I Gendve 27, Suisse T.l 3il@61 T.lcx 2!rtD< 27821 JCC 5. 9 22 novembre 1978 Point 12 de f'ordre du jour provisoire Le Pr6sj.dent ind6pendant transmet au Comit6 conjoint de Coordination pour 6tude, i sa cinquidme session, 1e document "Faisabilit6 d'une campagne de lutte contre 1'onchocercose dans 1a R6glon du Bassin du Fleuve Sin6gat (R6pub1i-ques de Guln6e, du Mali et du Sin6gal-)", apr6s examen par Ie Comit6 d'Orientatron qui a formul6 les commentaires sulvants S'il s'agit d'examiner s'il est Justifi6 d'6tablir un nouveau programme de lutte, i1 faudrait examiner, outre les questions indiqu6es dans Ie PIan d'Action: a) f importance de I'onchocercose comparce aux autres causes de morbidit6 et de mortaliti dans Ia r6gion; b) les programmes actuels de sant6 pubtique y compris Ie niveau des dipenses et le genre de services; les strat6gies sanltaires nationales des Pays particlpants, y compris la priorit6 a accorder i la lutte contre I'onchocercose; c) sur le plan des avantages pour Ie d6veloppement 6conomique, I'importance, le 161e et Ia nature prioritarre d'un accroissement des superficies utilisabfes dans Ie contexte des strat69ies du di'veloppement national ; d) les avantages et les inconv6nients de Ia mise au pornt d'un programme distinct du Programme OCp y compris les 6ventuelles economies d'6cherre, ra dupticatron des structures administratives et fa possible dilution des ressources en sp6cralistes. II Quant aux effets possibles du programme sur OCp, Ie Comlt6 d'orientation consi.d6re que ]a questi-on doit 6tre examin6e plus avant et qu'i1 faudrait 6tudi-er notamment : a) Ies effets possibles des quantit6s de produits larvicides n6cessaires pour le Programme OCp; b) res incidences financi6res probables du nouveau programme sur OCP; c) 1es autres moyens possibles de soutenir Ie programme OCp(par exemple par ra destruction des vecteurs adultes ou l'extension partielle du Programme vers I'ouest ). " I at tWORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE vBcfTe 5 FAISABILITE D'UNE CAMPAGNE DE LUTTE CONTRE L'ONCHOCERCOSE DANS LA RXGION DU BASSIN DU FLE'IIVE SENEGAI (REPUBLIQUES DE GUINEE, DU MALI, DU SENEGAI) ORIGINAL : ANGLAIS Ce document ne constttue pas une publtcatton. ll ne doit farre I'objet d'aucun compte rendu ou r6sumd ni d'aucune citation sans l'autonsation de l'Organisatron Mondiale de la Sant6. Les opinions exprim6es dans les artrcles sign6s n'engagent que leurs auteurs. I The issue of this document does not constitute formal publication. lt should not be reviewed, abstracted or quoted without the agreement of the World Health Organization. Authors alone are responsible for views expressed rn signed articles. vBcfT 8. s Page 2 I. INTRODUCTION Les R6publiques de Guin6e, du Mali et du S6n6ga1 ont, depuis de nombreuses annEes et i de mrltiples occasions, demand6 que le Progranrcre de Lutte contre 1'Onchocercose ex6cut6 pr6sen- tement en sept Etats d'Afrique de 1'Ouest (Onchocerciasis Control Program = OCP) soit 6tendu aux r6gions de ces trois pays of lronchocercose est connue pour repr6senter un problErne de sant6 publique aussi s6rieux qu?i1 lrest dans la zone du Prograrme r6giona1. Le derniEre requ6te officielle fut faite lors de la quatriEme session du Comit6 conjoint de Coordination drOCP (Kcruelt, d6cembre L977) e laque11e 1a Guin6e et le S6n6ga1 furent invit6s en tant qurobservateurs, 1e Mali 6tant d6ji inclus dans ce prograume pour ses foyers du Sud-Est.'1- La d6cision de CCC fut la suivante (Rapport du Pr6sident ind6pendant, p. L4) 6.26 t ilIl faudrait demander i 1'OMS de conduire des dtudes concert6es en Guin6e, au S6n6ga1 et au Mali occidental of une approche combin6e 6tait indiqu6e par des consid6- rations d'ordre technique. Le CCC a not6 avec satisfaction l'offre du Directeur r6gional d'ex6cuter ces 6tudes concert6es et a exprim6 1'espoir que 1'OMS trouverait dEs que possible 1es ressources suppl6mentaires. De ce fait, les informations indispensables seront pr6tes pour la prochaine session du CCC, et i1 n'y aura pas eu perte de ternps...tl 6.27 : r'Le CCC accepte ces propositions." 6.28 z "Le Repr6sentant des Etats-Unis a d6c1ar6 que si 1'OMS souhaitait ex6cuter 1es 6tudes concert6es dans le bassin du S6n6ga1, son Gouvernement pourrait envisager, ind6- pendarrnent du Progra.nme, de fournir des consultants, ou toute autre contribution qui pourrait 6tre n6cessaire. tr Depuis d6cembre 1977 et selon les instructions du CCC, 1'O}.(S a entrepris les activitds suivantes : - Le Directeur r6gional a rendu disponible une sortrne de 150 OOO dollars US provenant de son fonds pour le d6veloppement afin de permettre la r6alisation des activit6s en 1978. Cette sormne vient en addition des 30 OOO dollars US constituant La contribution du Directeur g6n6ra1. - Cr6ation d'un comit6 compos6 de sp6cialistes du Bureau r6gional et du Sidge, charg6 des 6tudes pr6liminaires et de 1a planification. - Cr6ation d'une dquipe compos6e d'un 6pid6miologiste et d'un entomologiste devant collecter les donn6es existantes et organiser quelques travaux pr6liminaires, - Des sp6cialistes du SiEge et du Bureau r6gional se sont rendus dans les pays afin de discuter avec les autorit6s nationales et de coordonner les activit6s. - Des candidats nationaux ont 6t6 s6lectionn6s et leur formation a 6t6 organis6e dans les diff6rentes disciplines et aux diff6rents niveaux (12 Guin6ens, 3 S6n6galais). - Un conseiller temporaire charg6 de synth6tiser les donn6es entomologiques et m6dicales au S6n6ga1 et au Mali a 6t6 recrut6. - Un conseiller temporaire charg6 de synth6tiser les donn6es socio-6conomiques existantes pour les trois pays a 6t6 recrut6. - La prospection a6rienne de 1'ensemble des zones du Mali occidental et du S6n6ga1 a 6t6 organis6e et r6a1is6e en septembre 1978. Au cours de 1a derniEre Assembl6e mondiale de 1a Sant6 (mai 1978), 1a R6publique de Guin6e-Bissau a officiellement demand6 i 6tre incluse dans ce Progranme. I vBcf 78.s Page 3 2. L'ONCHOCERCOSE AU SENEGAI, AU MALI OCCIDEMAL, EN GIJINEE ET EN GUINEE.BISSAU Les 6tudes d6jA r6a1is6es dans ces pays, bien qu'insuffisantes en vue de la planification et de 1'ex6cution d'une c.ampagne de lutte, indiquent clairement que 1'onchocercose constitue, dans les zones de savane, un problEme sanitaire aussi s6rieux qu'iI l'est dans La zone d' ocP. - La pr6valence de la maladie atteint 1e niveau hyper-end6mique (plus de 6O %) 1e long de toutes les riviEres principales et de leurs affluents i 1'exception du fleuve S6n6gal au sens strict (r6gion de lGyes) et des bassins inf6rieurs du Bafing et du Bakoye, qui repr6- sentent 1a limite septentrionale de distribution de la maladie dans cette r6gion de 1'Afrique de 1'Ouest. - Les l6sions oculaires et la c6cit6 dues ) I'onchocercose sont donc 1a rgement distribu6es dans 1es zones hyperend6miques. Dans sa synthEse pour le S6n6galr le Dr Philippon 6crit(p. L2) : "Pratiquement toute la population (plus de 90 %) ig6e de plus de 15 ans est porteuse de microfilaires d'O. volvulus ... Les premiEres c6cit6s onchocerquiennes apparaissent aprEs I'Age de 15 ans et affectent un individu sur cinq chez les adultes de plus de 30 ans. Dans 1e bassin de Gambie, les taux maxirnrms de c6cit6s onchocerquiennes atteignent LL 7" ...'t. - Les niveaux de transmission peuvent 6tre extr6mement 61ev6s dans les zones d'hyper- end6mie et, Pour donner un exemple, 1e potentiel de transmissionmaximum connu en Afrique de 1'Ouest (incluant OCP) a 6t6 mis en 6vidence sur le Niokolo Koba, affluent de Ia Gambie ot, en un mois, la transmission a atteint 3OOO larves (niveau de tol6rance : 1OO larves par an). - Nos connaissances de 1a distribution des gi tes de S. damnosum (principalement obtenues au cours de 1a recente prospection a6rienne r6alis6e par 1'OCCGE et 1'OMS en septembre 1978), bien qu'incomplEtes, montrent que ceux-ci sont largement r6partis sur les cours d'eau princi- paux, ainsi que sur 1a plupart des affluents, permanents ou non. Dans les zones de savane 1es espEces cytologiques impliqu6es dans la transmission sont les m6mes que dans celles d'OCP (S. damrosum s.s., S. sirbanum). A 1'exception de la zone s eptentrionale du Mali(Kayes), of une proportion 61ev6e des simulies sont zoophiles, la dynamique des populations vectrices ne montre aucune diff6rence avec ce qui est connu des autres zones de savane, oCP y compris. - Un des aspects de 1a dynamique des populations vectrices doit 6tre mis en exergue : e roblEme de la r6invasion Dans la zone d'OCP, 1a r6invasion p6riodique de zones sous trai- tement, principalemenE celles situ6es i 1'ouest et au sud-ouest, au I'1ali et en CAte d'Ivoire, a constitu6 Ie principal problEme technique depuis le d6but des op6rations ainsi que le souci majeur des pays participants et des instances conEribuant au fi.nanceuent et a 1'ex6cuEion. L'extension des traitements en C6te d'Ivoire a r6duit consid6rablement ce probldme mais cer- taines des zones nouvellement traitees sont r6envahies durant la saison des pluies, les simulies, apPartenant aux espEces cytologiques savanicoles, provenant des zones de savane non trait[es situ6es A 1'ouest ou au sud-ouest, par exemple en Guin6e et 6ventuellement A 1'ouest du Mali. Pour la r6gion faisant 1'objet du pr6sent rapport, ce problEme ne se pr6sentera pas car la c,mPagne sera congue de maniEre A inclure 1'ensemble des zones de reproducti-on des espEces cytologiques de savane (les limites ouest, sud-ouest et sud de la zone sont actuellement i 1'6tude mais on Peut estimer qu'eIles correspondent A celles qui figurent sur les cartes 1 eE 2). Cette zone pr6sentera les avantages suivants (Cf. cartes 1 et 2) i) La limite septentrionale du vecteur et de la maladie sont bien connues, comme ce fut le cas pour OCP. ii) Le Progreme sera contigu A OCP : - celui-ci sera donc prot6g6 des r6invasions provenant de 1'ouest et du sud-ouest; - le Progranrme occidental sera 6galement prot6g6 de r6invasions possibles provenant de 1' est. 8.5 4 vBcfT Page iii) Ce progralure ne sera pas 1ui-m6me sujet aux r6invasions provenant de l'ouest, du sud-ouest ou du sud pour les raisons 6voqu6es ci-dessus. Ce prograurne sera donc i l'abri de toute r6invasion et, de plus, se traduira par une am6lioration des 16sultats dans les zones occidentales drOCP. - Aspects socio-6conomiques : M. N. Prescott, conseiller temporaire de ltOMS, qui a analys6 les documents disponibles, 6crit (Cf. 6galement annexe 2) ttCe progranrne de lutEe sera b6n6ficiaire i la fois aux pays participants et i ceux des dtOCP qui sont soumj-s aux r6invasions sur le flanc occidental. pays Ces b6n6fices seront de trois ordres : b6n6fices au plan sanitaire; b6n6fices au plan des revenus, r6sultant dtune augmentation de la quantiE6 et de la qualit6 du travail et des ressources en so1; b6n6fices au plan de 1a distribution, 1es populations b6n6ficiaires drun te1 programme comptant parmi les plus pauvres du monde. Un programne permettant dranalyser ces b6n6fices figure en annexe 2. Dans le paragraphe ci-dessous et pour cette annexe 2, il apparait que les informations disponibles sont actuellement insuffisantes et ne permettent pas, m6me sotrEnairement, dr6valuer 1e b6n6fice potentiel drun teI prograrrne. Des recomnandations concernant 1a collecte et lranalyse des donn6es figurent en annexe 2. Les seules informations dispo- nibles pour chacun des pays participants traitent de ltinfluence du Programme sur la mise en valeur des ressources en so1. S6n6ga1 oriental Quatre projets de d6veloppement, incluant deux prograrunes de r6installation de populations sont pr6vus en zones de transmission de lronchocercose. Ia vuln6rabilit6 de ces projets eu 6gard a cette maladie nrest pas connue. Mali occidental Une liste de projets de d6veloppement, agricoles et autres, a 6t6 fournie. Ltinfluence de lronchocercose sur la productivit6 de ces investissements ntest pas connue. Guin6e La d6sertion relative de certaines va116es de la Haute Guin6e a 6t6 attribu6e d 1a pr6- sence du vecteur de ltonchocercose. La superficie et la productivit6 potentielle de ces zones sous-utilis6es nrest pas connue.'l 3. STRATEGIE ET TACIIQIIE DEVANT ETRE APPLIQIIEES DANS CE PROGRAMME 3. 1 Strat69ie g6n6ra1e En d6pit de son isolation, ce programme devra adapter la strat6gie sur laquelle OCP est bas6 (Le Berre et a1., L978, p. 72) : -"L',5tendue de vol des femelles vectrices n6cessite 1e traitement de larges zones.t' Dans la pr6sente situation, 1es limites septentrionales et orientales 6tant d6termin6es(Cf. cl-dessus), le premier objectif sera de pr6ciser les autres frontiEres au S6n6ga1, en Guin6e, en Guin6e-Bissau, 6ventuellement en Gambie (aucun foyer dronchocercose nrest actuellement connu dans ce pays) et au Sierra Leone (r6gion nord),-de maniEre ) couvrir toute 1'aire de distribution des espEces cytologiques savanicoles de S. damnosum. Trois pays (Guin6e, Mali, S6n6ga1) ont d6jd accept6, au niveau le plus 6lev6, 1e principe d'une campagne conjointe. -"La long6vit6 du parasite chez lrhonrne (15 a 20 ans) et lrabsence de th6rapeutique rendent n6cessaire la poursuite de la campagne de lutte entomologique sur une longue p6riode.t' Deux questions peuvent etre pos6es au sujet de lrapplication de ces principes d cette nouvelLe zone : vBcf78.5 Page 5 i) Puisque la zone a 6t6 d6crite comme 6tant rrisol6ert, pourquoi ne pas viser I lr"6radicationil du vecteur, ce qui r6duirait consid6rablement 1a p6riode de Eraitement et r6soudrait d6finitivement le problEme ? I1 nrest malheureusement pas r6alisEe dresp6rer que la totalit6 des foyers drespEces vec- trices savanicoles de cette r69ion difficile pourraient 0tre d6ce16s et correctement trait6s durant la premiEre phase de la campagne. En cons6quence, ceux qui auront 1a responsabilit6 de ce programme devront avoir A leur disposition 1es moyens de faire face d quelque probldme que ce soit durant une p6riode suffisamment longue. ii) Qu'adviendra-t-i1 aprEs 15 ou 20 ans ? A cette question, d6ja pos6e A f issue de la premiEre p6riode de quatre ans du Progranrne r6gional, i1 peut €tre r6pondu comme suit : f isolement de cette r6gion et sa contigutt6 avec celle drOCP conduira certainement A une extrame r6duction du parasite dans les popu- lations humaines ainsi quri lrannulation du problEme pos6 par Ia circulation des vecEeurs et des parasites entre 1es deux zones. 3.2 Relations avec OCP En d6pit de sa contigult6 avec OCP, le pr6sent projet ne peut 6tre, pour de simples raisons de logistique, envisag6 corure une extension du premier : - Celui-ci a d6ji, avec les extensions m6ridionales en cours drex6cution ou de planification en C6te drlvoire, au Ghana, au Togo et au B6nin, atteint sa taille maximum en ce qui concerne la circulation des donn6es, des directives techniques et administratives, du personnel, etc. - OCP a d6j} atteint sa p6riode de maintenance, les zones de 1a phase III 6tant sous traitement depuis deux ann6es. 11 peut cependanE Otre envisag6 que lrexp6rience acquise dans OCP sera transmise au nouveau projet (formation d6jh en cours, m6thodes et techniques nouvelles, expertise de tout ordre, 6change de donn6es, etc.). 3.3 Tactique Les structures drOCP, les m6thodes et techniques utilis6es ayant prouv6 leur bien-fond6 pourront 6tre adapt6es d 1a zone nouvelle, particulitsrenent dans les domaines suivants : - Direction et diff6rentes unit6s; - M6thodes de traiEement (voie a6rienne); - Choix de lrinsecticide; - M6thodes et stnrctures de lr6valuation; - Entomologie : secteurs, sous-secteurs, radio-conrnunications, eEc. ; - Epid6miologie : 6valuations simple et d6tai116e; - Ilydrobiologie. 4. PId,N DIACTION Le plan suivant est envisag6 : 4.1 Une Mission dtAssistance pr6paratoire aux Gouvernements (Mission APG) sera organi-s6e, avec les termes de r6f6rence suivants : i) Collecte des donn6es existantes : - Entomologie - Epid6miologie (pour ces deux disciplines, cette collecte est d6jA bien avanc6e) vBcf78.5 Page 6 - Socio-6conomie - Hydrologie ii) Analyse de ces donn6es. En ce qui concerne le volet socio-6conomique, cette analyse concernera 1es projets de d6veloppement existants ou en cours de planification et leur relation r6e1le avec ltonchocercose (Cf. annexe 2). iii) D6oarrage ou finalisation des activiE6s dans les domaines suivants : a ) Enromologie : 'D6tennination exacte des limites du Programme h lrouest, au sud-ouest et au nord (aires de distribution des espEces cytologiques du vecteur); Prospection par voie a6rienne des zones inconnues en vue de la localisation des gites des vecteurs aux diff6rentes saisons; Estimation de la dynamique de transmission. b) Epid6miologie: D6termination des niveaux drend6micit6 et de la s6v6rit6 de la maladie dans 1es villages s6lectionn6s; D6termination des linites du Programme h Itouest, au sud-ouest et au sud(Cf. entomologie). c) Hydrologie: Contacts avec les Etats en vue des am6liorations i apporter aux r6seaux de base (densit6, qualit6 des donn6es). d) Hydrobiologie : Collecte des donn6es de base dans les diff6rents bassins; S6lection des points de surveillance. e) Formation : Organisation de la formation de personnel dans les diff6rents domaines. iv) Planification de la campagne de lutte, incluant une p6riode pr6liminaire d'installa- tion et de compl6ment d'6tudes. 4.2 La dur6e de cette Mission APG est estim6e i deux ann6es et demie. Le coOt par ann6e est estim6 d : lEre ann6e 2Eme ann6e 3Eme ann6e Tota I us $ 49o ooo us $ 363 7OO ur $_ ,ro ,* us $1 024 ooo 4 .3 Les structures de cette Mission APG peuvent etre envisag6es de la maniEre suivante Personne I - Un chef de Mission - Un administrateur(1 m6decin et 1 officier des op6rations composent d6ja 1'6quipe OMS) - Personnel drex6cution (secr6taire, chauffeurs, etc. ) - Equipes sous statut national charg6es de collecter les donn6es suppl6mentaires (une 6quipe dans chaque pays) - Consultants. vBcf 7 8.5 Page 7 Equipement - 5 v6hicules - Heures de vol - Equipement m6dical et entomologique. Fonctionnement du personnel et du mat6rie1. 4.4 La meilleure localisation du Quartier g6n6ra1 de cette Mission APG serait Bamako, drot les liaisons vers lrint6rieur ou ltext6rieur du Prograrmre (incluant OCP, le centre de forma- tion, etc.) apparaissent corrte 6tant les plus favorables. vBcf78.s Page 8 ANNEXE 1 BT]DGET POI'R LA }fISSION APG ANME 1 ANNEE 2 ANNEE 3+ TOTAL 50 000 44 000 10 000 4 h/mois US$ 4 4 1 2 tt tt tt tt 50 000 44 000 10 000 3 h/mois 6 It2 tl us$ 4" 2 infnois 5 000 US$ 1 3 1 25 000 22 0@ il il It 125 000 110 000 25 000 166 500 25 000 37 500 104 000 23 LOO L3 200 5 500 137 500 13 700 4L 200 22 000 us$ 24 24 200 800 10 000 15 000 55 000 5 500 16 500 5 500 67 500 60 000 23 LOO 24 200 24 8oo L3 200 5 500 10 000 15 000 55 000 5 500 16 500 5 500 67 500 40 000 31 500 4 000 5 000 7 500 27 500 2 700 8 200 11 000 898 200 125 800 429 800 60 200 319 000 44 700 L49 400 20 900 170 300 1 024 000490 000 363 700 PERSONNEL - 1 Chef de projet - 1 Administrateur - Personnel loca1 ( entomologis te) (secr6taire, dactylo, chauffeurs) Consultants : (g4soo x ty'nois) - Entomologie - Epid6miologie - Socio-6conomie - Hydrologie - Hydrobiologie VOYAGES - }fISSION - Entre Pays - Visites de 1'ext6rieur ou A f intErieur FORMATION (Contacter le PNUD) PROSPECTIONS AERIENNES ($4OO par heure) EQUIPET,IENI* - V6hicules 3 voitures l6gEres (5O4) 2 voitures tout-terrain (Land-Rover) 3 W camping - Lab. * 6quipement de terrain (incluant 1es cartes) - Bureau FONCTIONNEMENT - V6hicules (8 x 25 ooo km x o,25) - Bursau - Lab. * 6quipement de terrain RAPPORTS DEPENSES DE SOUTII4N DE PROJET + 14 % TOTAL 6 7 * Location des batiments, 61ectricit6, t61€phone, eau, gardien pay6s par 1e Gouvernement 1 2 3 4 5 vBcf78.s Page 9 ANNEXE 2 EVALUATION ECONOMIQIIE DU PROGRAMME DE LUTTE CONTRX LToNCHOCERCOSE DANS I,A REGION DU BASSIN DU SENEGAL Nicholas M. Prescott Magdalen College Univers it6 d rOxford Ang leterre Consultant de IrOMS 1. INTRODUCTION La pr6sente annexe expose le cadre de base drune 6valuation 6conomique du progranme de lutte, suivi de recomrandations concernant 1a collecte et ltanalyse des donn6es pertinentes. 2. LE CADRE Ltobjet de lt6valuation 6conomique est dtappr6cier la contribution du prograrrne de lutte i 1a r6alisation des principaux objectifs des pays participants. Ltapproche fondamentale consis- tera i estimer et a comparer les b6n6fices et 1es coOts associ6s h lrex6cution du projet au cours de p6riodes h venir. 2.1 Les b6n6fices Le prograrme propos6 apportera des b6n6fices non seulement d lrint6rieur mais aussi i lrext6rieur de lraire du prograune. A ltext6rieur, les b6n6fices r6sulteront de 1a r6duction du risque de transmission de ltonchocercose sur un dixiEroe environ de ltaire de 1tOCP, ce risque 6tant d0 i 1a r6invasion par des vecteurs venant des limites occidentales de lraire. Ils seront de trois ordres : b6n6fices au plan sanitaire, b6n6fices au plan des revenus et b6n6fices au plan de la distribution. Ltimportance de ces b6n6fices d6pendra essentiellement de ce que seraient Ia pr6valence et la gravit6 de ltonchocercose i ltavenir en lrabsence du programme de lutte, de ce que serait la r6duction de 1a pr6valence et de Ia gravit6 de la naladie obtenue gr6ce au programe, eE de 1a rapidit6 avec laquelle se produirait cette r6duc t i on. 2.1.1 B6n6fices au lan sanitaire Ces b6n6fices repr6sentent 1a future r6duction de la morbidit6 due ir ltonchocercose, quelle que soit 1a gravit6 clinique des cas, frappant les individus de tous les groupes dtAge. En gros, i1s peuvent etre exprim6s en termes de r6duction du nombre de cas de c6cit6, drinca- pacit6 visuelle ou dtinfections sans incidence oculaire, au cours de chaque ann6e b venir, qui sera obtenue grAce au prograrme de lutte. Ces b6n6fices favorisent 1a r6alisation des objectifs des gouvernements concernant lram6lioration du niveau de sant6, et leur valeur est ind6pendante de la contribution du prograflme i la r6atisation dtautres objectifs. Leur valeur sera fonction de la priorit6 respectivement accord6e i lram6lioration de Ia sant6 dans chacun des pays Parti- cipants et pourra diff6rer de ltun i ltautre. 2.L.2 B6n6fices au plan des revenus Ces b6n6fices, de deux sortes, traduj.ront lreffet du prograrme sur les ressources futures en facteurs de production dans 1es pays participants : i1 y aura les b6n6fices dus d 1 raccrois- sement des effectifs et de la qualit6 de la main-d'oeuvre et 1es b6n6fices dus i lraugmentation des ressources en terres effectivement disPonibles. vBCf 7 8.5 Page 1O Annexe 2 a) Accroissement des effectifs et de la ua1it6 de la main-dtoeuvre. Ce b6n6fice r6sultera de deux facteurs i) Ltaugmentation de lreffectif de la main-dtoeuvre gr1ce 1 la r6duction du nombre de travailleurs atteints drincapacit6 complEte pour cause de c6cit6 onchocerquienne. ii) L'am6lioration de 1a qualit6 de la main-dtoeuvre, ltefficience du travail augrnentant avec 1a diminution des cas drinvalidit6 visuelle ou drinfection sans incidences oculaires chez les travailleurs. Ce b6n6fice peut sfexprimer en termes de r6duction du nombre de travailleurs atteints de c6cit6, dtincapacit6 visuelle ou de d6bilitation sans incidences oculaires au cours de chacune des ann6es i suivre. Sa valeur d6pendra en partie de la production marginale de la main-dtoeuvre et de la mesure - inconnue mais variable - dans 1aque1le lrincapacit6 visuelle ou lrinfection sans incidences oculaires compromet lteffi- cience du travail. I1 convient de souligner que 1e b6n6fice d0 a lraccroissement des effectifs et de 1a qualit6 de la main-dtoeuvre ne fait que refl6ter la part des b6n6fices au plan sanitaire int6ressant 1es individus en Age de travailler et que lrestimation des deux cat6gories de b6n6fices repose sur une base 6pid6miologique commune. b) Lrausmentation effective des disponibilit6s en terres Ce b6n6fice repr6sente la valeur de lrutilisation de sols potentiellement productifs dont le d6veloppement est entrav6 par le risque dronchocercose d0 i la pr6sence du vecteur de 1a maladie dans 1es zones int6ress6es. La nature de lfentrave peut Otre de trois sortes. 11 peut stagir drune entrave absolue, telle que les populations locales refusent de sri-nsta11er dans 1es zones affect€es par crainte de lroncho- cercose, i cause peut-Gtre drexp6riences pass6es de peuplement et puis drabandon des so1s. Ou il peut stagir dtune entrave relative, quand la pr6sence du vecteur ne suffit pas i empOcher le peuplement, mais en menace le maintien h la longue i cause du danger de voir apparaitre une hyperend6mie onchocerquienne. Dans dtautres circonstances, 1a pr6sence du vecteur dans des zones non peupl6es peut ne repr6senter qurun obstacle parmi drautres, alors que tous les obstacles devraient 6tre surmont6s pour qurune bonne exploitation des sols soit possible; on peut citer, comme exemples de te1les entraves, 1e manque dtinfrastructures (routes, 6coles, services de sant6), lrinondation des va116es fluviales et la pr6sence de vecteurs drautres maladies, notanmlent de la trypanosomiase eE de la shistosomiase. Ce qui importe, c?est de reconnaitre que lrendiguement du vecteur de lronchocercose ne suffira que rarement i assurer un peuplement durable des terres recouvr6es, bien quril puisse en €tre lrune des diverses condi.tions n6ces- saires. Les b6n6fices ir escompter de lrexploitation des terres nouvelles d6pendront probablement non seulement de leur potentiel agro-6conomique de base, mais aussi de la rDesure dans laquel1e la lutte antivectorielle aura 6t6 int6gr6e dans un programe plus g6n6ra1 de d6veloppement rural exigeant des investissements additionnels, et notamment d?investissements en infrastructures essentielles. IIs d6pendront aussi pour beaucoup du rythme auquel les sols potentiellement disponibles seront mis en valeur. 2.L.3 B6n6fices au plan de Ia dirt11lg1ig4 Ces b6n6fices srajoutenE, sous forme de bien-6tre, d ceux que les populations des zones rurales, b6n6ficiaires directes du prografime de lutte, reEoivent aux plans de 1a sant6 et des revenus. Deux des pays participants, le Mali et la Guin6e, figurent parrni les 20 pays 1es plus pauvres du monde, avec respectivement des revenus par habitant de US $1OO et US $150 (fSZ0). Le revenu par habitant du S6n6gal est plus 61ev6, soit environ US $39O (1976), mais 1e revenu moyen de sa r6gion orientale ne repr6sente que la moiti6 de la moyenne nationale. Les popula- tions qui doivent b6n6ficier du programre sont pr6cis6ment de ce11es que devrait viser en premier lieu lraction, actuellement pr6conis6e, pour satisfaire Ies besoins fondamentaux des pauvres du monde. 2.2 Les co0ts Les co0ts du progranrme de lutte correspondenE b la valeur des ressources absorb6es par le programne chaque ann6e durant son ex6cution. La plus grande partie de ces cotts sera repr6sent6e par des apports en devises 6trangEres. vBcfT 8. s Page 11 Annexe 2 3. RECOMMANDATIONS 11 faudrait cr6er un 616ment dr6valuation 6conomique au sein de la mission charg6e de lr6tude de faisabilit6 pour 6valuer les b6n6fices et les co0ts escompt6s au cours de chaque ann6e de lrex6cution du programne. Cet 616ment devrait 6tre dirig6 par un 6conomiste sp6cia- liste du d6veloppement, second6 par des consultants en agronomie, g6ographie humaine, socio- logie et agro-6conomie. I1 travaillerait en coop6ration 6troite avec les membres de 1a mission charg6s des enqu6tes 6pid6miologiques et entomologiques. 3. I Evaluation des b6n6fices 3.1.1 B6n6fices au plan de la sant6 GrSce aux donn6es 6pid6miologiques de base recueillies dans 1 rai.re du programre, on fera la projection, par 3ge et par sexe, du nombre de cas de morbidit6 de diff6rents degr6s de gravit6 qui pourront 6tre 6vit6s au cours de chaque ann6e du progranrme de 1utte. La projection devra comprendre : i) Le nombre de cas dronchocercose qui se produiraient au cours de chacune des ann6es D venir en I'absence du progralme, par 3ge, sexe et degr6 de gravit6 clinique. ii) Le nombre de cas dtonchocercose, r6partis dans 1es m€mes cat6gories, qui se produi- raient au cours de chacune des ann6es i suivre pendant 1 rex6cution du progranrne de lutte. 3.L.2 B6n6fices au plan des revenus Accroissement de lreffectif et de la qualit6 de la ,ain- Il faudra recueillir des donn6es concernant les taux de participati-on, par 3ge et par sexe, dans lraire du programre. Ces donn6es devraient 6cre utilis6es, en liaison avec Ia projection des b6n6fices au plan de Ia sant6 par 6ge et par sexe, pour obtenir lraugmentation escompt6e de la quantit6 et de la qualit6 de la main-dtoeuvre r6sultant du progranrme au cours de chacune des ann6es i suivre. On cherchera i 6valuer lrimportance de 1a r6duction de lreffi- cience du travail caus6e par les cas dronchocercose non incapacitante de diff6rents degr6s de gravit6 clinique, afin drobtenir une base r6aliste pour estimer ltam6lloration de la qualit6 de la main-droeuvre due au prograrme de 1utte. 11 faudra aussi recueillir des donn6es sur le niveau et le taux probable de croissance du produit marginal de 1a main-dtoeuvre non infect6e dans Ies parties concern6es de lraire du Programrne, afin drestimer lraugmentation probable de production qui r6sulterai-t de lraccrois- sement de 1a quantit6 et de la qualit6 de 1a main-droeuvre obtenu gr0ce h la lutte contre lronchocercose. Augmentation des disponibilit6s effectives en terres 11 conviendrait de pr6parer et analyser des cartes d6taill6es de la densit6 de la popu- Iation, de lrutilisation des sols et des caract6ristiques agro-6conomiques des sols de 1 ?aire du progranrne, afin de d6terminer 1a quantit6 eE la qualit6 des sols non utilis6s qui, grdce d la lutte contre l tonchocercose, pourront 6tre mis en valeur. On devrait analyser 1e potentiel de transmission de lronchocercose 6ur 1a base des taux dragressivit6 annuels dans 1es zones non exploit6es, afin de voir si, et dans que11e mesure Ironchocercose repr6sente un obstacle grave au potentiel de d6veloppement de ces zones. Il faudrait analyser les entraves autres que lronchocercose qui seraient de nature Ifreiner le d6veloppement des zones of lronchocercose a 6t6 identifi6e comme une entravepossible. On peut, parmi. dtautres facteurs, citer d cet 6gard 1e manque drinfrastructures(routes, 6ducation et services de sant6), la transmission drautres maladies, notanrment 1a trypanosomiase et 1a schistosomiase, ltinondation des va116es fluviales et les problEmes associ6s i lroctroi des droits droccupation des terres. t I vBcf 7 8.s Page 12 Annexe 2 En coop6ration 6troite avec les organismes comp6tents de planification des pays partici- pants, i1 faudrait entreprendre une 6valuation d6tai116e de la valeur de 1a production qui serait obtenue, au cours de chacune des ann6es i suivre, grAce 1 la mise en valeur de terres dont on peut penser que leur exploitation d6pend en totalit6 ou en partie dtune lutte efficace contre le vecteur, b part le co0t des ressources compl6mentaires qui seraient n6cessaires pour combattre 1es facEeurs adverses autres que 1 ronchocercose. 3.1.3 B6n6fices au plan de la distribution A la lumiEre des objectifs indiqu6s par 1es gouvernements et des politiques pratiqu6es dans chacun des pays participants, il faudrait chercher a appr6cier Ia valeur du b6n6fice de distribution interr6gionale et interindividuelle, i ajouter aux b6n6fices aux plans de la sant6 et des revenus, qui ira aux populations couvertes par 1e programe de lutte. 3.2 Evaluation des co0ts Une 6valuation d6tai116e des coOts i pr6voir pour le programe au cours de chacune des ann6es i venir devrait etre entreprise une fois le plan drop6rations mis au point. 3.3 Ressources requises Lr6quipe dr6valuation 6conmique se chargera de r6unir et dtanalyser les donn6es n6ces- saires au cours de la deuxiEme ann6e de lr6tude de faisabilit6, une fois termin6es 1es enqu6tes 6pid6miologiques et entomologiques pr6liminaires. Les ressources en personnel requises sont estim6es csme suit - un 6conomiste sp6cialiste du d6veloppement (chef dt6quipe) - un agronome - un sp6cialiste de la g6ographie humaine - un agro-6conomiste - un sociologue 5 mois/hc,mre 2 mois/hme 2 rnois/homre 2 mois/homne 2 mois/horrne , vBcf78.s Page 13 CARTE 1 LA REGION DU BASSIN DU FLEUVE SENEGAL a . ,,7. -- i./ i-\ llJ rQ () a -]=) o l.f' o o )o o =5 alo @ f o o E ) a ) o oz 9 o o )oI o @ foo ;.I Z o UO Z I o zZ:o o E 2 a I fo oE J = o I G rI o ---a f \ -it'l' i E u,r tlJ I z = J @ o G I I a @ f o - to x i =9 .Ja uJ e.J 8N ti 2oo l oI T \ \ >:O. >.3i I @ Ja ^1f o,it-I o ( oo I6 z \ / \ zI o E , t t I u UJ \\o I o \ t t E a i ) o o o ul o t\ 1t >' t f ! Zl o ltEI' :li 9ll C o rZ i It.l ur o =OE CLAsotE9ecE-g.:.: .E .E .E il! to1 Ia qt' \ ) 1t ,o 0 00 - -- CD. z G =-- t ) so G, o tlJ o z J o tl o Jtt t vBCf78.s Page L4 E I - , t I I \__ i Uf 9, 2 J =uoo o t E o) I E F I 3 9 - , I I d o o E! z 2 - +qIo zI(, ruJ cc (J UJ tt.l.l F :)(9 trz oo z G Fz o = c! lJJF CE o - o(, o /\___/-_/ \ i I 'f- o , oE I * Jo ul -1(_ o E @ I =tfrE >trrsU, Ju)O;> 2)el(,tt ul- c, Jo \ I \ t 4))h* \ 1 GU -J cI L'.*, '4.It/l, ./ K J 0[l2Uti F I kr -rl /, = -l I \,' \\ E o?o I I I I I tI I t I t f t @o z 'a c a .6 o -o l c ! E o ob 6 t t { I ( ) t I I I ,I \ I