Meeting of the country representatives of NGDO group for onchocerciasis control: 1-3 March 2010, Ouagadougou, Burkina Faso

World Health 0rganization MEETTNG OF THE COUNTRY REPRESENTATIVES OF NGDO GROUP FOR ONCHOCERCIASIS CONTROL 1-3 MARCH 2O1O Ouagadougou, Burkina Faso. INTRODCTION 1. The meeting for Country Representatives of the Non-Governmental Development Organizationi 61COOs) Group for Onchocerciasis Control, convened by the Africanprogramme for Onchocerciasis Control (APOC), was held from 1-3 March, 2010 at the APOC/HQ in Ouagadougou, Burkina Faso' Z. The meeting was attended by 27 NGDOs country representatives from 22 Afrien countries (Angola, Benin, Burkina Faso, Burundi, Cameroon, CentralAfrican Republic (CAR), Cote d'lvoire, DRC, Ethiopia, Gambia, Ghana, Guinea Bissau, Liberia, Malawi, Mali, Nigeria, Senegal, Siena Leorie, Sudan, Tanzania, Togo, and Uganda) and Yemen, representing, The Carter Center, Charitabte Society for Social Welfare (CSSW), Christoffel- Blindenmission, Helen Keller lnternational, lnternational Eye Foundation, lnternational Medical Association, Light For The World, Lions Club lnternational Foundation, Mission To Save The Helpless (MITOSATH), Organisation pour la Pr6vention de la C6cite (OPC), Perspective, United Front Against River Blindness, US Fund for UNICEF, UNICEF, Riseal, Schistosomiasis Control tnitiative (SCt), Sightsavers !nternational, World Vision and also the Mectizan Donation Programme (MDP). The HQ representaiives of the above NGDOs were also present. 3. Given the need to remain dynamic and respond to changing priorities in public health and the need to strengthen partnerships, especially for the control and elimination of onchocerciasis where possible and control of other NTDs, the meeting was intended to reinforce the APOC philosophy, principles, strategy of CDTI and emerging programme issues and emphasise the community-directed intervention (CDl) approach to be used as an essential tool for the detivery of multiple health interventions. The same network of community-directed distributors (CDDs) of ivermectin in APOC countries can be used for simultaneous delivery of other compatible health care services and commodities and to increase accessibility to poor and hard to reach communities. To ensure expansion of co- implementation, while remaining focused on reducing Onchocerca volvulus transmission in Africa, the meeting recommended: 4. At the initiation of the meeting, participants expressed concern that Govt representatives were not present at this meeting and urged that there should be a joint NOTF meeting in the future at which the recommendations listed below will be reviewed. (The NGDO coordination group should also report on these recommendations in a forthcoming meeting). 1 t CONCLUSIONS AND RECOMMENDATIONS 1) Back to basics of CDTI' i. Partners should continuously update themselves on the concept, philosophy and principles of CDTI (e.g. A Practical Guide for Trainers of Community-Directed Distributors; External Monetary lncentive Policies for Community Volunteers efc) ii. All partners should be encouraged to share experiences of successes of CDTI at every level. iii. APOC and NGDOs to re-orientate themselves for elimination of transmission of onchocerciasis where feasible iv. There should be joint monitoring and supervision by Government and NGDO partners NGDOs should be more proactive in monitoring implementation of activities at country level (NGDOS) 2l Motivation of GDDs - incentives and prevention of attrition - i. The meeting was concerned with the problems arising from different incentives from different programmes and call upon MoH to develop policies on incentives. The meeting requests WHO as the executing agency of APOC to take this forward. ii. Advocate for CDDs to be used for all community based health programmes; iii. Adopting innovative strategies for motivating CDDs at the community level e.g. 1. Provide School materials for family members 2. Facilitate income generation activities r.e. community gardens, farming cooperatives, micro enterprise loans3. Provision of infrastructure to community i.e. schools, health centres 4. Sponsorship of community members 5. Special recognition for long-serving CDDs iv. The Kinship structuie has worked well in some places and should be encouraged where aPPlicable v. There should be operational research on recognition of CDDs and their acceptance in communities 3) GDTI and other NTD control . APOC to provide guidelines on best practices for CDI; o There should be a focal person designated for Oncho/NTDs at all levels (especially at the FLHF level) (MoH, NGDOS, APOC); . lmprove involvement of village health committees in CDTI/NTDs by merging all these committees into one (MoH, NGDOS, APOC); v vi I -2- . Child feeding should be undertaken to determine if feeding school children before all drugs so as to decrease the likelihood of adverse events (MoH, NGDO, APOC); o Continue to advocate for the integration of CDTI into other PHC programmes such as Malaria and TB control, Vitamin A supplementation and other NTD controlthat could fit into this package to allow for effective and efficient use of available resources and strengthen links with PHC programmes (all partners) (see: A Strategic overuiew of the future of onchocerciasr's control in Africa, WHO,APOC); . ln line with co-implementation it is recommended that APOC consider funding activities required before MDA, particularly mapping, integrated baseline surveys and RApLOA assessment f LF in the remaining LGAs; lntegrated baseline surveys; RAPLOA assessment (APOC) 4l lmproving treatment coverage o The ratio of CDDs must be appropriate for the population, normally approximately 1 CDD: maximum 100 PeoPle, (MoH, NGDOs); . Ensure high quality training and supervision at all levels (MoH, NGDOs); o provision of bicycles for CDDs where possible - especially in remote areas (MoH, APOC, NGDOs); .'Mobilise financial support for coverage and M&E surveys (MoH, APOC, NGDOs); . ln view of different processes for procuring drugs for the various NTDs and the different methods for transportation and importation clearance, National CoordinatorS should plan well ahead to coordinate supplies for co-implementation of different MDA in consultation with all partners. (MoH, NGDOs); . Reinforce health education, sensitisation, advocacy and mobilisation (HSAM) to obtain better MDA comptiance for cinchocerciasis and NTD control (MoH, APOC, NGDOs); and . To ensure consistently high coverage by using WHO guidelines and the CDTI manual (MoH, NGDOs). S) Strengthening lnstitutional capacity and creating new partnerships with Universities and research institutions . Build capacity for Monitoring, REMO, Epidemiological, parasitological and entomologicalsurveys (APOC, NGDOs and MoH); and o Continue to incorporate the CDI curriculum in Universities, Medical and Nursing Schools (APOC, MoH). 6) Reinforcing advocacy and coordination at different levels o Ministries of Health should be pro-active in coordinating activities of all actors centrally to ensure prioritisation and maximum efficiency based on formalised contractual arrangements (MoH and NGDOS); o There should be advocacy to Governments to harmonise strategies adopted for NTD control (NGDOS, APOC); . Explore the option of having a "GoodwillAmbassado/' (APOC to fund); and -3- . Ensure each NGDO has an MoU in place with govemment (MoH and NGDOS) 7l Logistics and replacement planning' . ApOC,s pian for replacement 6f logistic supplies should be shared and agreed with MoHandNGDosandAPoCwillpromptlyimplementit. Gommunication . APOC communica$ions con|erning missions of NGDO partners should be copied to NGDoHQs/country-directorsorwhoeverappropriate... o Advocacy visits by APOC should involve NGDO partners in-country .ReportsofmissionsbyAPoCpartnersshouldbediscussedandsharedwithall partners 8. 9) Recommendations regarding participation of NGDOS in management of the APOC Trust Fund at country level' . ApOC ,"n"g"r"nt should communicate information on technical and financial management issues and fund disbursement to NGDOs in the four non APOC countrids (Ghana, Guinea Bissau, Cote d'lvoire and Sierra Leone)' o copies of transfer of funds should be forwarded to the NGDO project Partner in the field (APOC) . The NOTFs should involve and share information with all members includinginformationonAPoCTrustFundmanagement . ApOC member countries should have an active NOTF or similar structure and partners should strengthen weak NOTFs . ApOC should review and improve its financial system so as to avoid PotentialdelaYs . APOC should empower NOTFs on administration of projects physical resources , Apoc should share wlth all partners parts of financial reviews relevant to the NOTF of the countries on time . ApOC and partners should commit themselves to deadlines both for reporting, budgeting, and disbursement . NGDOs should assist projects in the early preparations of PAB in-country (Action: NGDO) . MoH and the supporting NGDO should endorse the final copies of PABs which should be submitted to APOC by 31 July of the preceding year (Action: MoH, NGDO) .MoU,programmedocumentsandAPoCfinancia]manualprovide guidelines on the roles and responsibilities of NGDO partners; Partners snouuupdatethemselvesontheseroles,especiallyregardingtheir involvement in the APOC financial management mechanism based on the 4 \language present in the MoU and cunent Direct Financial Cooperation (DFC's)/Letters of Agreement. (Action:APOC, NGDO) [Need to obtain legal advice on relevant doc? DFCs replace the LoA's in WHO's new GSM systeml APOC should send a letter to MoH and partners reminding them of the legal backing for NGDOs to sign financial documents (APOC mgt) Direct Financial Cooperation documents should indicate the involvement of NGDOs and should be shared with all partners (APOC mgt) NGDOs should be empowered to check use of vehicles and Guidelines should be provided on the use of vehicles and capital equipment (Action: APOC) . Project vehicles should have GPS tracking devices o There should be a time frame for the use of vehicles - Use of vehicles must be authorised - Log books should be provided and completed daily and reviewed on the 15s of every month along with the financial returns and servicing of vehicles (applicable to capital equipment) - lnclude maintenance contract (applicable to capital equipment) 'I.APOC should reinforce the training of Programme Managers and Finance Officers/accountant of NGDO and projects on the WHO financial/imprest system (Action: APOC) ii.Project partners should send advance copies of the covering transmission letter for imprest returns to APOC before official returns sent by WHO country office (Action: Project partners) iii.NGDO accountants should assist in ensuring that the financial returns of a previous month are ready by the 15h of the following month (Action: NGDO) iv.The WHO in-country accountant should prepare a summary of financial returns and share with all partners for identification of projects with late returns (Action: WHO Office in-country) v.Feedback from APOC on financial returns and other financial queries should made within one month of receipt (Action: APOC) vi.When funds are released for specific activities (e.g. REMO, RAPLOA evaluations or independent monitoring); the time frame should be specified in the contract (Action APOC) vii.APOC should advocate strongly to Ministries of Health to leave accountants in post for longer periods (e.g. minimum 2 years) and have a minimum of two accountants at the national level (Action: APOC) viii.Where possible, funds should be sent directly to project accounts (APOC mgt) t 5 I