African Programme for Onchocerciasis Control Programme africain de lutte contre I'onchocercose JAT'-FACJOINT ACTION FORUM Office of the Chairman JOINT ACTION FORLM Sixth session Yaounde. I l-13 December 2000 FORUM D'ACTION COMMLTNE Bureau du President JAF6.6 OzuGTNAL: ENGLISH July 2000 REPORT OF THE TENTH SESSION OF THE TECHNICAL CONSULTATIVE COMMITTEE (TCC) Ouagadougou,26 to 30 June 2000 I Ii (D CONTENT A. INTRODUCTION Paqe .l ..2B: REVIEW, CONCLUSIONS AND RECOMMENDATIONS OF TCC1O BI REVIEW OF THE TECHNICAL AND FINANCIAL REPORTS OF THE FIRST, SECOND AND THIRD YEAR IMPLEMENTATION OF CDTI AND VECTOR ELIMINATION PROJECTS, AND RECOMMENDATIONS ON THE RELATED SECOND, THIRD AND FOURTHYEARBUDGETS (item l0) . . . . . . . . 2 lntroduction: Summarybudgetofsubmittedproposals .....2 Bla Progress reports and budget proposals recommendedfor approval contingent on the submission to the APOC Management by the NOTFs concerned of additional information and/or clartficafionasandwhenrequiredbyTCC .......2 Cameroon ........2 National Secretariat Support (2d year technical and financial reports - 3'd 1'ear budget) Adamaoua Province (2d year technical and financial reports - 3'd year budget) North Province CDTI Project (2"d year technical report - 3'd year budget) Littoral [I Province CDTI Project (2"d year technical report) South West I Province CDTI Project (2"d year technical report - 3'd year budget) Centre III CDTI Project (2d year technical report and 3'd year budget) Chad Chad CDTI Project (2"d year technical report - 3'd year budget) Malawi Thyolo &MwanlaCnfl p-j"ct (3'd year technical report - 4d'year budget) . Nrgeria NOTF HQ Support (Z"d year technical report, 3'd year interirn report - 4d'year budget) Bauchi State CDTI Project (l"tyear technical report - 2"0 year budget) Benue State CDTI Project ( I't year technical report - 2"0 \,"u, budget) Enugu/Anambra/Ebonyi State CDTI Project (biannual progress report - 3'd year budget) FCT State CDTI Project (2d year technical report - 3'd year budget) Gombe State CDTI Project ( l't year technical report - Zno \,"u, budget) Imo/Abia States CDTI Project (2d year,6 month technical report - 3'd 1,ear budget) Kaduna State CDTI Project (3'd year technical report - 4ft y,ear budget) . . . . . Kebbi State CDTI Project ( l't year technical report - 2"d year budget) Kogi state CDTI Project (2"d year technical report - 4il'year summary budget) Kano State CDTI Project (2"d year technical report - 3'd year budget) Kwara State CDTI Project ( l " year technical report - 2"d year budget) Niger State CDTI Project (1"'year technical report - 2d year budget) Osun State CDTI Proje ct (2"d year technical report) PlateauA.,lassarawa States CDTI Project (2d year technical report - 3''r year budget) Taraba State CDTI Project (3'd year technical report - 4u'),"u. budget) Yobe State CDTI Project (1" year techrucal report - 3'o ),"u. budget) Zantfara Statc CDTI Project (2"d year technical report - 3'd 1'ear budget) . . . Central African Republic CAR CDTI Project (2"d year tcchnical report - 3"r year budget) 2 3 4 5 5 6 6 6 7 7 7 7 8 8 8 9 9 9 9 l0 l0 l0 1l 11 t2 t2 l3 l3 l3 t4 t4 (ii) Tanzania NOTF HQ Support (3'd year technical report - 4b year budget) Mahenge CDTI Project (3'd year technical report - 4ft year budget) Ruvuma CDTI Project (2d year technical report - 3'd year budget) Tukuyu Vector Elimination Project (2d year technical report - 3'o ),"u. budget) Tukuyu CDTI Project (l't year technical report - 2d year budget) Tanga CDTI Project (2d year budget) Uganda Phase I CDTI Proje ct (2d year technical report - 3'd year budget) Phase II CDTI Project (1" year technical report - 3'd year budget) Itwara Vector Elimination Project (2"d year technical report - revised budget) . . . Mpamba-Nkusi Feasibility Study (l't year technical report - 2d year revised budget) Liberia Lofa, Bong, Nimba & Montserrado CDTI Project (l't year technical report -2"d year budget) Equatorial Guinea Bioko Vector Elimination Project (2"d year technical report - 3'o ),"". budget) . . . B lb. Progress reports and budget proposals to be re-submitted to TCC Cameroon South West II Province CDTI Project ( I "t year technical report - 2"o \,"u, budget) REVIEW OF NEWNATIONAL PLANS AND CDTI PROJECTS (rtem t t) Cameroon CDTI Project Proposal for Haute Sanaga CDTI Project Proposal for Western Province Republic of Congo (Brazzavllle) National Plan . CDTI Project Proposal 83: UPDATE ON OPERATIONAL RESEARCH (rtem l2) ADDITIONAL SUBJECTS CONSIDERED BY TCC Item 4: Matters arising from the APOC Partners Meeting Item 5: Update on the APOC External Mid-term Evaluation Item 6: Update on the lmpact Assessment Studies Itern 7: The Elimination of Lymphatic Filariasis in Africa: role of APOC Item 9: Report on the financial management of APOC-funded projects . . . Itern 13: Other matters . . . Publication in the Lancet on APOC and OCP Tu,o additional CDTI Project Proposals for Nigeria (Akrvabon & Rrvers) REMO in Mozambique: update . . . . Issue relating to UNICEF support to onchocercrasis control rn Liberia . . . Communication by Professor A J Trees Prevention of HIV infection of newboms . . Organizationof TCC sessions. including documentation . . . Additional proposals Itcnr 14: Dates and places of TCCI | (ad hoc),TCCL} and TCC l3 sessions Item 15. Closure ANNEX I: LIST OF PARTICIPANTS ANNEX 2 AGENDA ANNEX 3 GUIDELINES FOR TCC MISSION TO CAMEROON t4 t4 l5 15 l5 l6 t6 t6 t6 t7 t7 l8 l8 B2 l8 l8 l8 19 19 l9 l9 19 19 20 20 20 20 2l 22 z2 23 23 23 24 24 24 24 24 25 25 25 26 26 26 z6 27 29 30 a JAF6.6 Page I THE APOC TECHNICAL CONSULTATIVE COMMITTEE Tenth session Ouagodougou, 26 to 30 June 2000 A. INTRODUCTION 1. Dr Azodoga S6k6tdli, Director of APOC, welcomed TCC Members, Dr Olikoye Ransome-Kuti and Dr Deborah McFarland, Members of the APOC mid-term External Evaluation Team, and other participants. He expressed his gratitude to Members of the Committee for their continued support to the Programme which now operated in 14 of the l9 APOC countries.(List of participants attached as Annex l). He referred briefly to the recent APOC Partners Meeting held in Ouagadougou in which five TCC Members had participated. In referring to a recommendation of TCC9, he was particularly pleased that the Nigeria NOTF had scrutinized all the submissions to APOC before submitting them to the Management. He wished the Committee 'bon courage' for its work during the coming week. 2. Item 1: Professor Mamoun Homeida, Chair of TCC. m operung the session, reiterated the impressron of the Prografirne Director that the APOC Partners Meeting had been successful in allowing for an exchange of experience among the various partners in APOC operations. He stressed the importance of ensuring a satisfactory rate of coverage in all CDTI projects supported by APOC and at the same time expressed his satisfaction that commitment to the Programme and its operations rvas being strengthened and that CDTI was now generally accepted as the mode of drug distribution and health care deliven, 3. Itent 2: the Provistonal Agenda, attached as Annex 2, lvas approved rvithout modifications (for items to be considered under 'Other rnatters' see paragraph I I below). 4. Item 3: Mr Bruce Benton, Chair of the Committee of Sponsoring Agencies(CSA), reported on tlre proceedings of CSA87 and CSA88. As to the issue of OCP and APOC as entn, points for operations of the Lvmphatic Filariasis Elimination (LFE) Programme he brought TCC up to date regarding the discussions that took place in the March and May sessions of CSA, the latter with participation of other partners in the LFE Programme (see under item 7 below for more details). 5. During the two CSA sessions, the Committee had considered the constraints of a number of NGDOs to expand their activities due to limited capacity and lack of financial resources. The issue would be taken up by CSA at its July 2000 session when a 'concept paper' would be considered by the Committee. 6. CSA approved at its March session the recommendations of TCCg with the exception of support to the Equatorial Guinea CDTI Project on the ground that it appeared that the project received funding from both the University of Barcelona and APOC. 7. As to the financial situation of APOC, Bruce Benton reported that follorving his rccent visit to Australia, the govemment of that country had joined the donor community at the level of US$ 250 000 a year and that the African Development Bank (ADB) would contribute US$ 2.7 million for Phase I in two installments in September 2000 and March 2001 upon signature of an Agreement in Abidjan on 7 Julv. UK had made a supplementary contnbution of US$ 500 000 and Canada had agreed. in principle, to contribute to Phase I as rvell as to Phase II. The actual levels of Canadian support could not be determtned until his visit to OtLawa early in July. Given these additional contributions and the economies madc bv the Programme, Phase I was now fully financed. JAF6.6 Page 2 8. Bruce Benton stressed the importance of the Extemal Evaluation since several key potential Donors would decide whether to support Phase [I of APOC based upon the conclusion of that Evaluation. He also emphasized that enlarging the scope of CDTI operations by f. ex. adding LFE control might strengthen the donor base for APOC since some Donors had expressed reservations concerning its single disease verticality. 9. Item 8: in respect to the follow-up of the recommendations of the ntnth session of TCC, the Prograrnme Director informed the Committee that practically all the TCC9 recommendations had been implemented. 10. Letters of Agreement had been signed for all projects with the exception of the Ogun State CDTI Project, pending the clarification of the status of the local NGDO, and the Ethiopian National Plan and CDTI Project which had been revised in consultation with the NOTF and were now being finalized. 1 I . Item I 3: the following issues were tabled under the agenda item 'Other matters ' , - Publication in the Lancet on APOC and OCP - Trvo additional CDTI Project Proposals for Nigeria (Akrvabon & Rrvers) - REMO in Mozambique: update - lssue relating to UNICEF support to onchocerciasis control in Liberia - Conrmunication by Professor A J Trees - Prevention of HIV infection of newborns - Organization of TCC sessions, including documentation B: REWEW, CONCLUSIONS AND RECOMMENDATIONS OF TCCIO B1: - REVIEW OF THB TECHNICAL AND FINANCIAL REPORTS OF THE FIRST, SECOND AND THIRD YEAR IMPLEMENTATION OF CDTI AND VECTOR ELIMINATION PROJECTS, AND RECOMMENDATIONS ON THE RELATED SECOND, THIRD AND FOURTH YEAR BUDGETS (item 10) Introduction: Summary budget of submitted proposals 12. The Cor-nmittee rvas informed by Mr Fortune Agboton. Chief of Administration and Finance (APOC) that at the current session TCC would review 41 projects. 13. The total budget of these proposals amounted to US$ 5 million 500 000 out of US$ 9 412 4rJ0 r.e. the funds rernaining after the commitments recoffImended by TCC9 Bla Progress reports and budget proposals recommended./br approval contingent on the submission to the APOC Management bv the NOTFs concerned of additional information and/or clarification as ond when required by TCC. Cameroqn technical and financial - 3'd bud TCC noted tliat the voluminous technical report showed duplication and contained much irrelevant infonnatron. The report did not mention the changes in the populatron following the ccllsus exercisc from which it would have been useful to have included preliminary figures. The Minlstry, of Healtli (MOH) needed to increase its support to the National Onchocerciasis Task riat 14. JAF6.6 Page 3 Force (NOTF) secretariat and the Committee urged the National Coordinator to pursue this with the Ministry. 15 The second year financial report and the budget were found to be unclear. Figures in the financial report submitted to the TCC were different from the figures provided by the APOC Management. There was no evidence of the size of the MOH's contribution. t6 The TCC was concerned about the lack of information on severe adverse reactions (SAR) in Loa lcta and onchocerciasis co-endemic areas. The Committee, however, noted the work done by the NOTF to initiate the refinement of REMO, and its distribution of guidelines for treatment in Loa loa areas. These activities were not reflected in the reports of projects operating in the af[ected areas. t7. Concern was also expressed that TCC had no information on the socio-cultural consequences ofthe severe adverse reactions although it appeared that some surveys had been conducted on this matter TCC requested tlrot NOTF and the NGDOs which had been involved in socio- cultural studies on SAR, Loa loo surveys and REA exercises forward copies of these studies to tlte APOC Management. The Committee recommended that a socio-cultural survey be performed, if tltis had not olready been done, so that appropriate IEC and public relations strategies could be developed 18. TCC recommended tltat the technical report be accepted ancl tltat all treatment.figures and annual treotment objectives be submitted with the annuul report. TCC .found the.financiol report unsatisfoctrtry and recommended tlrat it be rejected for re-submission with a table s lr owin g escpenditu res ag oin st fu nds receiv ed. 19. The 3'd year budget was accepted with the understanding that it be revised to not escceed the originol budgeted amount. Budget lines to be revisited were: trsining, partners nrcetings, training.for deoling witlt severe odverse effects (budget to be increased) and consultancy. Adamaoua Province (2"d vear technical and financial reports - 3'd year budeet) 20. The technical report showed progress in the development of CDTI u'ith extension into the Bunyo and Banhim health districts while a group of CDDs had been trained in the Tign6re health district. 362 cornrnunities were mobilised md 436 CDDs trained or retrained, but mostly onlv in census-taking techniques. CDTI was well integrated into most of the 362 mobilised communities, although no ivermectin had been distributed. The first round of ivermectin distribution was planned for July and August during the rainy season. Five motorbikes to be supplied by APOC had still not arrived. 21. The financial report was deficient and showed confusion about which period was reported. However, the imprest returns had been sent to APOC Managment. 22. The budget had increased to $10,000 above the pro.jected budget in the 5 year plan and some of thc arnounts were excessive. Tlre technical and.financial reports were recommended for approval under the.following conditions: Confirmation that ivermectin hod been tlistributed Therefore a further technical report should be submitted to APOC in September to conJirm thut at least 50% of treatment objectives have been met. The project should clari/-y wlry treatment was done in the rainy seoson ondwhy severql treotment rounds were necessary i/'CDTI was the ntode of distribution. (i) 2-1. (i, JAF6 6 Page 4 (iit) Full esiplanation to be given on what mone.y had been used, ond.from which yeor's budget.(ir) Budget dates to be lined up with the Letter of Agreement. 24. The 3'd year budget u)os recommended for opproval with reductions as follows: (, The budget should be reduced bv $20,000 to thot originally proposed in the 5 year plon. Reduction could be made on thefollowing budget lines: contribution to technical assistance, training (per diem of US $ 100 a da-y for plonning session ot distria level), running costs (6,000 for adverse reactions) and census-taking (CDDs should do the census). (i, North Province CDTI Project (2'd year technical report - 3"d vear budget) 25. TCC noted that this report was clearly written but raised the following issues (i) CDTI was reported to have been extendedto 70oA of communities but in reality only 40o/o of people treated in the reporting period were treated using the CDTI strategy; the remaining 60% by outreach. (ii) Wiilst geographical coverage was 90o%, overall therapeutic coverage rvas 60.907o: only one district, Touboro, (coverage 80%) exceeded the 657o minimum target. For areas urrder CDTI, population coverage averaged 48Yo only. TCC noted that the Annual Treatment Objective (ATO) was used to calculate the coverage instead of the total population. (iii) Some activities were pre-financed by GRBP due to late receipt of APOC funds. There was no indication of lvhich activities were pre-financed and whether APOC Management had approved the pre-financing. (iv) The actual period being reported rvas nou,Novernber 1999 to October 2000but activities rvere carried out from November 1999 to May 2000. (v) There was no evidence that the joint revierv reconrmended b1, TCC9 had been carried out Tlte pltased conversion Jrom outreach to CDTI wqs not evident snd tlre Committee recommended thut an independent review be carried out to assess tlte situation on the ground ond provide assistance to the project in this regard (Terms of Reference of the Reviety Mission attsched as Annat 3). 'I-CC wos concerned that theJinancial report indicates a transfer oJ.f unds at 500 CFA to tlte US dollar, o rate much lower than the bank rate- Clarification as to the exact estchange rote on eaclt transfer u,as required. This was applicable to most projects in Comeroon. TCC recommended the approval of the technical report but indicoted the need.for speeQv conversion .from outreach strategV to CDTI und the need to improve signijicantly on botlt populotion and geographical coverage A report should be submitted by the project to APOC Management at tlte end r{ October 2000. I.he Committee ulso recommended the acceptance of the financial report but noted that the report was conJusittg in that it included expenses .from Mo.1,98 to Februory 2000. TCCfurther recommended using the remoining l't year .futtds to corry out project uctivities. 26. 27. 28. 29. 30. 31 32. JJ. JAF6.6 Page 5 TCC noted that the budget had been weil presented and that efforts hod been made to uplain most of the items in the budget and recommended thqt it be approved. Certoin line items needed to be revised downwards, including personnel costs (tecltnical assistonce), severe adverse reactions, travel, communicotion, operating escpenses and central office costs. Littoral II Province CDTI Proiect (2"d vear technical report) The project activities during the current semester were marked by an unexplained "slow down" which TCC assumed was due to the concern about the cluster of Lcta /oa reactions in neighbouring Centre Province. 4166 treatments were reported so far among a total population of 87,185 but the period of this treatrnent was not specified. The ATOs for population and villages were not specified and this information was requested to appear in the next report. 510 CDDs had been trained in 440 villages with an acceptable ratio of l7l persons per CDD. No third year budget or financial report was available. The project, in its third year, was still operating on its first year budget which should be closed at the end of the current Letter of Agreement period in Septernber 2000. The year 2 budget approved bv TCC9 at US$ 75 245 rvould then cover the period October 2000 - September 2001 . TCC recommended the occeptance of the six month report with u request for an immediate clarijication on tlte stqtus of Loo loa in the srea (adverse reaction escperiences in earlier treatment rounds, preparotions in accordance with current TCC/fuIDP/I,IOH guidelines, ond REA activities). The Committee suggested tltat the independent review (see paragraph 26 above) include Littoral to ossist in determining any additional technical assistance that might be required b-y the portners, porticularly in regard to REA activities. Since no tlrird year budget vas presented, and the project had not .yet escpended its.lirst veor budget, TCC recommended that tltefirst year budget end September 2000 and the second yeor budget, alread-y approved, covers tlte period October 2000 - September 2001. Squth West I Province CDTI Proiect (2'd vear technical report - 3'd vear budset) 34. In rcvicu,ing the teclurical report TCC requested that (i) Information be provided on the activities performed. or to be implemented, in accordance with the recommendations of TCC9 on the strategy to be pursued in areas rvhere onchocerciasis and Loa loa are co-endemic. Information be made available on whether REA exercises are planned in all conrmunities before distribution. and whether levels of endemicity for Loa /oa infections have been evaluated. (iiD Census results and therapeutic coverage for years I and 2 be provided, and that more CDDs be trained to improve coverage. 35. TCC accepted the technical report and recommended thot the independent review assist in determining any additional technical assistance that might be required by the portners, particularl-y in regards to REA activities (see paragraph 26 abrtve), also to be undertoken in tltis area. The proposed budgetwos recommendedfor approval subject to the submission o.f'a.finoncial report to APOC Management. TCC further recommended thot ./unds be included .for perfttrming REA; the budget be increusedfor SAR; and the amounts.frrr technicol assistqnce at the provinciul level and troining be decreosed. 36. (ii) JAF6.6 Page 6 37. 38 Centre III CDTI Proiect (2"d vear technical renort and 3"d year budset) Tlre CDTI proposal was first approved for funding in September 1997. However, the date of launching the project was November 1998. The current Letter of Agreernent covered the period from December 1998 to November 2000. The project was supposed to operate in 9 districts during the first year. Five districts were covered while three were found to be non-endemic for onchocerciasis. The report did not provide the numberto be treated. Severe Loa loa related adverse effects occurred in one ofthe treated districts. The adverse effects (including fatalities) halted the project and treatment was eventually discontinued. 39. Few activities were carried out during the reported period. TCC noted that: (i) The endemicity figure did not match with other available infomration. (ir) There was no mention of how the severe side effects influenced the distribution (iiD No strategv rvas put forward to gain confidence of the people in the programme (iv) No tirne or action plan for ivermectin distributron was provided. 40. TCC recommended tlte rejection of tlre tecltnical report and requested that it be re-submitted to the APOC Management vith clariJicotion of the above issues. 41. Last year's budget \\/as approved to cover the period up to November 2000. Tlrerefore, tlre Committee recommended thqt the project re-submit tlte budget, based on the planned activities, to the APOC ManagemenL TCC noted thot the proposed budget was too ltigh and thot the budget linesJbr personnel,lrealth educotion, distribution costs and supervision should he reduced. Chqd Chad CDTI Proiect (2'd year technical report - 3'd year budset) 42. The technical report indicated that none of the comrnunities choose their CDDs or mode of distribution. This raised the question of whether CDTI was being implcmented in the country and suggested that the approach was more on the lines of Cor-nmunlty-based Ivennectin Treatment (CBIT) TCC noted that the technical report covered the period January 1999 - April 2000 whereas the financial report was from October 1999 - April2000. The teclrnical report was occeptedwith the condition tltat the NOTF ensures that activities ore geored to CDTI. The Jinancial report was ulso recommended .fbr opproval subject to the submission of a financial report to APOC manogement at tlte end of tlte project -year. TCC recontmendedthe approvol r{the 3'd yeor budget after o substqntial reduction in the antount .for personnel, and the reorrangement of the budget to tuke into account community ntobilisution and tlte need for IEC materials. The Committee olso recomntended that the omount.frtr technicul assistqnce not escceed tltat of'last .year. 43. 44. 45 ,17. 48. 46. JAF6.6 Page 7 Malswi Th},olo & Mwanza CDTI Proiect (3'd year technical report - 4t" year budget) TCC's comments on the reports were that: (i) The progress had been improving but at a slow pace and that the project should aim towards CDTI implementation in all communities by the end of the 4ft year. (ii) Integrationactivitiesneeded attention. (iii) There was a need for a major shift in responsibilities/contributions from APOCA{GDO to MOFUcommunity. (iv) Population figures should be broken down by communities to enable identification of areas with low coverage to initiate corrective measures. (v) A clear rvork plan was required. (vi) The budget proposal rqvealed dependency on APOC with minimal NGDO input. The committee recommended thut the technicol report be accepted and noted tltat the next technical report should include information on tlte extension oreos. TheJinancial report was olso recomntended.for approval with the balance of US$ 22,000 transferred to year 3. The ,l't' yeor budget wos recommendedfor approval when modiJied not to exceed the level of the year 3 budget by reducing thefollowing budget lines: personnel costs, copitol equipment (vehicle), training ond travel. Nigeria NOTF HO Support (2'd year technical report. 3'd year interim report - 4tr'year budget) The Comn,ittee commended tl-re NOTF for this report which clearly demonstrated the increased role of the headquarters and addressed all the issues raised with the partners. TCC noted with satisfaction that NOTF Hqs had reviewed project reports before their submission to APOC Management. The Committee also noted the following innovative ideas: Inter project linkages: use of staff on exemplan, prolects (e.g. Cross River State Coordinator) to train other State teams. (i,) Critrcal appraisal of projects: the NOTF Secretariat organised internal monitoring of CDTI projects that had completed their second year. (iri) The Sustarnable Management Training Centre (SMT), supportcd by the Carter Center and CDC. rvhich provides management training primarily designed for personnel ii'orking in onchocerciasis control but also in other PHC fields. TCC recognised its potential as a regional training centre and called for a sustained rvay of funding it to be explored. TCC also agreed to discuss the independent revieu, on thc SMT at the next meeting. (i) 49. 50. JAF6.6 Pagc ti (iv) The NOTF was encouraging the participation of local NGDOs in the CDTI process at project level. The Committee recommended tlte approvol of the technical andJinancial reports. The budgetwas olso recommendedfor approval after a substantial reduction so as not to exceedUS$l60,000plusavehicle Lineitemstobereviewedincludedpersonnelcosts,capital equipment, travel and other ocpenses. Bauchi State CDTI Proiect (1't vear technical report - 2"d vear budeet) 51. In reviewing the technical report, TCC noted the following (i) That the progress report covered only 3 months of the first year and that therefore few activities had been carried out and limited essentially to training, mobilization and advocacy which were still ongoing. (ii) Treatment followed the CBIT mode while preparations for CDTI were underway Training projections were promising for the introduction of CDTI. TCC accepted the report as on interim report and recommended tltat u.full report be submitted once tlre activities.for yeor one were completed. TCC noted that no financial report has been presented but attributed this to lack of project activity. The Comntittee recommended that the budget for -year 2 be accepted ofter appropriote adjustment bv APOC Manogementfollowing receipt oJ a tecltnical andfinonciol reprtrt lor year 1, togetlter witlt an anolysis of budget etcpenditure trends in activities carried out during tltut year. TCC also recommended that the budget lines.for training, travel and educstion und mobilizqtion be reduced P 1"t technical lnd All indrcators showcd that there had been a transfer to the CDTI strateg), in this project. TCC rroted. lrolever, that targets for training and treatment had not been specified. The Committee recontmended thut tlte tecltnicol and Jinancial reports be opproved. JJ. TCC also recomntended approval of the 2"d year budget with amendntents on budget lines suclt as capital equipment (10 additional motorcycles), consultonts, travel ond per diem and otlter expenses (community log boohs, community self monitoring and reviau meetings). Tlte budget should not escceed the total smount in tlte originol five year plan. Enusu/Anambra/Ebonyi State CDTI Proiect (biannual prosress renort - 3'd vear budeet) 56. TCC noted that the implementation of CDTI was satrsfactory in a great proportion of comrnunities. The Comrnittee requested clarification on the definition of "eligible population" as used in the report. Futurc therapeutic coverage should be calculated using the total population in the treated communities, and notthe total population of the State or the Local Govenrment Administration (LGA). T-ltc teclrnical and.fittoncial reports were recommended.fttr approval sub.iect to the submission ofsotisfuctnr-y snnuol reports to APOC Manogement. I'he budget wss olso recommended.fttr approval ofter reduction d'the budget lines .for teclrnical assistance, travel (maintenonce and fuel), und communicatiou (telephone). TCC requested.f urther in.fornmlion on the stqtus and use ol capitol equipment. 53, 52. 54. 57. 5& 60. 61. 59 66. JAF6.6 Page 9 FCT State CDTI Proiect (2'd year technical report - 3"d year budeet) The project was originally under CBIT including 420 communities. After conversion to CDTI, 513 communities were covered and the process of CDTI implementation was proceeding satisfactorily. However, only 361 out of the 513 communities were paying their CDDs in cash or in kind. The remaining communities should be encouraged to provide incentives. One of the weaknesses considered to be a threat to the project was identified at the LGA level and should be addressed to enhance CDTI activities. It was encouraging that MOH and NGDO staff participated in mobilisation and health education delivery. The technical reprtrt, although interim, was recommendedfor approval on condition that the complete yeor technicol and jinancial reports be submitted to APOC Monogement. The budget proposal for year 3 was reasonable and expenditure returns vere regularly submitted. The budget was therefore recommendedfor approval. Gombe State CDTI Proiect (1"t year technical report - 2"d year budset) Tlre Committee accepted tlre technical report with clarification rl' who had caruied out distribution in this area in 1991 ond how many CDDs hod been selected for the cunent projecL Tlt e b u dg et',v o s r ec o mmen ded fo r a pp r ov a I w itlt o u t mo diJicatio n. Imo/Abia States CDTI Project (2'd year. 6 month technical report - 3"d vear budset) This project used to have long delays in submiuing financial retums. Following the NOTF nreeting in April 2000, the delays were reduced to two months. TCC recommended tlte .financiol und tecltnical reports for acceptance. Tlte Committee ulso recommended tlte approval of the budget and requested tltat a work plan .for year 3 be proviclecl. It noted on access in tlte supplies, truvel and other expenses budget lines and recommended that Monagement omend as appropriate. Kaduna State CDTI Project (3'd year technical report - 4th year budeet) This was a good report providing all the required data. TCC noted increasing treatments and geographic expansion of the project. Coverage was excellent (82%), and training activities were exceeding objectives. Good progress had also been reported in compliance with CDTI indices. Cost per treatment ranged from US$ 0.07 -0.28. Expenditure retums were outstanding for a period of 2 rnonths. The balance of funds at the project account was not reported. The year 4 budget in the original five year proposal u,as US$ 51.383 whilc it amounted to US$ 5 1, 140 in the budget proposal. TCC recontmended the acceptance of tlte six monthly reportfor yeor 3, of the annual report .fot' .1,sqv 2 ond of the .financial report, subject to approval by APOC Management of the .financial reports und returns./br the.first, second and tltird .yeors. 62. 63. 64. 65. 67. 68. 69. 70. The Committee also approved the 4h year budget with adjustment to be vorked out by APOC Munogentent. 73. 74. 75. 7(t. JAF6.6 Pagc l0 7t TCC commended tlte project on the concise ond brief reports that could be used as models .for other projects. Kebbi State CDTI Proiect (l"t vear technical report - 2'd vear budset) 72 Good progress has been reported in training activities and in compliance with CDTI indices, but it was unclear why 'NA' was placed under determination of month of treatment by the conmunity (section 2,table II). The coverage during the previous years and the ATO were not clear; this infonnation was requested to appear in the next report. The financial report was not available and there were outstanding expenditure returns for a period of 4 months. The balance of funds at the project account in country was not reported. The year 2 budget in the original five year proposal was US$ 32,400 while the project submitted ayear 2 budget of US$ 34,695. TCC recommended the acceptance of the Kebbi State six month report./br Year I. Tlre Committee also recommended the approvol of the year 2 budget subject to opproval by APOC mqnagement of the financial reports ond returns .for tlte.first year. TCC requested Monagement to expedite provision of capitol equipment approved.fnr the project in Year 1. Kogi state CDTI Proiect (2"d vear technical report - 4th year summarv budget) 77 Infonnation was requested on how the "total population of treated communities" was defined and lrou,tlrerapeutic coverage could exceed 90o/o,taking into account that children less than 5 years of age and pregnant women represented more than 20%, of the total population. There was excellent performance rn training at all levels and training included the use of Management lnformation Systems (MIS). 78. The technical and.financial reporls were recommended for opprovul ruith clarification required on the issue raised sbove. 79, 7-he budget was accepted witltout modilication. TCC noted tltut a.full ycar's budget'tvos not used; the Letter of Agreement should be amended accnrdingly. Kano State CDTI Proiec 80. The coverage from the previous years and the ATO were not clear and this information should appear in the next report. The report rndicated that training goals were not met, but those goals \,vere not stated nor were new goals set for the corning year. An implementation plan was not included to justifi, the third year budget and should appear in futurc reports. Good progress has been reported in compliance with CDTI indices. 81. The financial report was not subrnitted. There were outstanding expenditure retums for a period of I month. The balance of funds in the project account in the countn, was not reported. Tlrc *,,sa1 3 budget in the orrginal five year proposal was US$ 52,726. The project had submitted to TCC ayear 3 budget of $63.495. The reasons for this increase were unclear. Travel costs made up over half of the budget. The Comrnittee requested Management to adjust the budget ruot to exceed the onginal Year 3 projection. 82. 83. 'I'CC recommended tlte acceptance of tlte six month report.for year 2. 86 88 84. 85. 87. 91. 92. JAF6.6 Page 1l Tlte Committee also recommended approval of the year 3 budget subject to approvol b.v APOC monogement of the financial reports and returns fnr the first and second yeors. The budget sltould not escceed the budget provided in the original live yeor proposol (adjustment to be provided bv APOC management). Kwara State CDTI Proiect (1"t vear technical gepoft - 2d yeat budeet) No implementation plan was provided to justi$ next year's budget and was requested for future reports. The coverage during the previous years and the ATO were not clear and should appear in the next report. Tlrere were certain inconsistencies in tables and text in the report (e.g. vlllage numbers). TCC noted that the project would expand to full geographic coverage next year. The report indicated that training goals were not met, however these goals were not stated, nor were new goals set for the coming year. Good progress had been reported in compliance with CDTI indices. No financial report had been subrnitted and there were outstanding expenditure returns for a period of 10 months. The balance of funds at the project account in the country was not reported. The 1,ear 2 budget in the original five year proposal was US$ 69,91 I while the 1,ear 2 budget proposal amounted to US$ 97,380 this increase being due to capital equipment costs related to a ne\.v car and 8 rnotorbikes. TCC requested Management to adjust the budget not to exceed the original year 2 projection. 'I'CC recommended tlte acceptance of tlre six montltly report. Failure to submit expenditure returns and.financial reports led TCC to recommend suspension rf any./urther transJbrs until the problem was solved to the satisfaction ol'the Monagement. Sub.iect to approval of the Jinoncial reports.fbr the first year b.v APOC Management, the Conrmittee recontnrcnded approval of the second year budget ( without capitol items) not to escceed the budget provided in tlte original live -veor proposal (adjustment to be made by APOC Management). Niger State CDTI Proiect (l"t year technical report - 2'd year budset) Nigcr State is srtuated in the belt of Nigeria neighbouring Benin, an OCP country. 13 out of 25 LGAs had been selected for CDTI treatment. Ivermectin treatment started on a lirnited scale in l99l with the assistance of UNICEF. The project had previousll, defined the endemic villages and was assisted by APOC Management and the WHO Countn, office in Nigeria to refine the REMO map of the State. The present report covered activities from January - April 2000. The Letter of Agreement applied to the period of January to December 2000 and the approved first ',,sa1budget amountedto US$ 200,240. The project was converting slowly from CBIT to CDTI. A pilot study was cstablished in 250 communities by UNICEF in 1997 but no details of this study was provided (communitv mobilization. selection of CDDs, performance of CDDs, support ofthe comrnunities to the CDDs. etc). During the period of the present report the project achieved rnobilizatron of the conmrunities and of key people in the State Ministry of Health. Training in the CDTI philosophy and its implernentation r,vas carried out in 5 LGAs and included health workcrs. teachers, women and dcvelopment offtcers. There was good State government conunitment to the project as shown by the contribution from the State Govemment of N 2.300,538 to CDTI activities. Treatment undcr CBIT included 88,500 people and under CDTI 9l 250. The conversion to CDTI was slow, cspccially sincc thc pilot project was ir-r-rplcmented in 1997. The pro.;oct was encouraged to 89. 90. 93 JAF6.6 Page 12 empower the comrnunity to select the CDDs and support them. The action plan should be clear in definrng areas to be covered and number of persons to be treated during the 2"d year. 94. The technical report was accepted with the above comments. 95. The 2"d year budget wos recommended for approval ofter reductions. The budget was e:ccessive. No justification wos provided for the purchase of a new velticle Travel should be reduced according to the cost of maintenance o/'non-APOC veh.icles, per diem and travel allowunces. Supportfor technical assistants should be revised. Osun State CDTI Proiect (2"d year technical report) 96. The progress report stated that the project planned to enroll 7 more LGAs in year 3. TCC requested clarification on whether they were CBIT LGAs and, if so, rnfonnation on when these LGAs would catch up in converting to CDTI. There was confusion in the numbers of LGAs enrolled in CDTI and clarification was required. The Committee was interested in being ir-rfonned why differences exist between the levels of contributions frorn one LGA to another. 97 The financial reporting period should be hannonised with the teclurical report. There was some confusion regarding the years of CDTI project implernentation and Management was urged to provide clarification. The enrollment of 7 new LGAs into CDTI resulted in the inclusion of additional capital equiprnent in the budget. Some budget lines such as travel. training, education and rnobilization should be revised. 98. The technical report tuos accepted as interim ond o complete report.for year 2 should be submitted to the Monagement. Thefinancial repnrt wss olso accepted in tlre interim until the whole year's escpenditure return ltad been submitted to APOC Management. 99 The budget wos recomntendedfor acceptance on condition that it be scaled dovttt on tlre qbove lines. Plateau/Nassarawa States CDTI Project (2'd year technical report - 3.d year budget) 100 TCC9 had approved the technical report although with reservation but had rejected the financial report and budget proposal. The resubmitted teclnical report was considerably irnproved emphasising more the problems and providing more realistic results in keeping rvith the results from the Independent Monitoring Group. 101 The financial report covered the complete year. The projecthad now sent the large backlog of imprest returns to APOC Management. The report stated that no money had been received from APOC rvhereas the letter addressed to APOC clearly mentioned amounts and dates when money n,as received. The competence of the financial management of this programrne still rernained in question. The rnonthly analysis of expenses had been completed but tt was not clear if this rvas based on funds actually received, recerpt on paper only, or based on funds received from GRBP. toz. The resubrnitted budget had taken into account comments made b1, TCC9. The total for the Natronal GRBP office remained ligh, 50% of the NGDO budget eamrarked for salaries. Capital equipment however included 2 vehicles to be purchased by GRBP. 7 nerv motorcycles for the LGAs was reasonable but 60 bicycles excessive. TCC was pleased to note that the LGAS rrcrc paving for CDD trairtiug It rvas clcar thatthe rejcction of thc rcports by TCC9 had given thc prolect time to sort out its problem and thc TCC rvas pleased to see somc definite improvements 103 JAF6.6 Page 13 104. APOC Manogement brougltt to the attention of the Committee a letter.from the Corter Center stating thot tlte project wos in need of funds to caruy out CDTI octivities and thst the project was not "covered under a letter of agreement". APOC Management was requested by TCC to respond pointing out the role of the Committee as on independent body whiclt reviews projects on their merits only. 105. The technical andfinanciol reports u'ere approved, in spite oJ'the continuing problems witlt the latter, as the project was now collaborating witlt APOC to solve these problem*s. 106. The budget was approved on condition that it be reduced to the level of the previous .year. APOC Management could look particularly ot capital equipment and personnel costs. Taraba State CDTI Proiect (3"d vear technical report - 4tr'year budget) to7 Taraba State is hyper endemic with blinding onchocerciasis. Treatment was started with Africare :-rl.1992 to 1996. Africare was then replaced by CBM and a local NGDO, MITOSATH. Tlre first Letter of Agreement covered in effect the period of November 1997 to October 1998. The second Letter of Agreement covered November 1998 to December 1999 and the third Letter the period January 2000 to December 2000. 108 Tlre current report related to the first 6 months of CDTI activity fronl October 1999 to March 2000. The financial report indicated that funds for year 3 were being used from the budget approved for year 2. 109. The project had progressively increased its coverage rate to reach the ultimate objective of 850,000 treatments. During the period under the current reporting satisfactory mobilisation and training r,vas achieved. No treatment had yet been given. Training centres were increased to bring them the closest to the communities. The support to CDDs by the conmunities was reported to be increasing. 110. The tecltnical report was accepted on un interim bssis. tIt The budget wos recommended for approval; it was reasonable apart .f rom the budget lines on capital equipment and travel. No justification .for o new vehicle was given and this item should be ercluded from the budget. Travel tpus too high and shou ld be reduced. 112. The report did not indicate if CDDs were being trained and did not include the number of people to be treated. No financial report was provided. I 13, Tlre technical report was accepted and TCC recommended that nrure emphosis should be placed on encouroging communities to support und increose the nuntber of CDDs. I 14. Tlte budget'tras recommendedfor approval not to escceed the level ci the original budget in the 5 year plan. Zamfara State CDTI Proiect (2"d year technical report - 3'd vear budset) The teclurical report was well written showing: (r) That conversion had taken place frorn CBIT to CDTI. Tlrat actrvitics werc ongoing in all lOti communitics of thc 5 mesocndemic LGAs and wero procecding satisfactorily I 15. (ii ) Yobe State CDTI Proiect (l't vear technical renort - 3"d year budget) JAF6.6 Page l4 I T6. I 17. (iii) Cornmendable involvement of State and local tiers of government. TCC recommended for approval the technical and.finoncial reports . Tlte budgetory request was ulso recommended for occeptance. Central African Repu blic CAR CDTI Proiect (2"d vear technical report - 3'd vear budset) 118 The fact that a third of the personnel had been recruited by the MOH was a positive aspect considering the situation in CAR. TCC noted that some of the CDDs were health workers and that few communities provided incentives to CDDs. 119 The majority of the staffwas based in Bossangoa but the decision had been made to move the core staffto Bangui. CBM had agreed to refurbish the building which would be provided by the MOH. 120. The technicol report wts occepted for approval as wos the Jinancial report subject to the submission ofa technical and a financial report to APOC Management st the end of the project yssv. 121 The budget vos recommended for opproval with reductions to be mode in o number of items, including administrstion (maintenance of office equipment), and the removal of maintenance of vehicles and motorbikes the cost of which was included in other budget lines providingfor qctivities relating to the use of vehicles. Tonzonia NOTF HO Support (3'd vear technical report - 4(r'year budset) 122. The HQ had been active in support of 4 CDTIs and one vector elimination project, especially in the fields of training. advocacy and ivermectin procurement, storage and distribution. The national offrce was becoming effective irr projects management and supervision. The report, horvever, did not provide data on ongoing activities in the country,, making it rmpossible to obtain an overview and observe trends. TCC urged that the HQ further strengthen support to projects and build on recent signs of government input e.g. promote annual line items for ivennectin procurement, training and supervision. 123 The financial report showed that activities had been funded by the approved 3'd year budget. There rvas also a need for reliable information to update financial statements. Management needed to detemrine balances from year to year and reconcile accounts. The budget was well presented but 60%, of the requested funds was earmarked for payrnent of the NGDO consultant u'hosc support was critical for the success of the projects as well as for support to HQ. I 24. TCC recommended scceptonce oJ'the 3'd year technicul report. Hou,ever, subsequent reports should provide dato on ivermectin distributiott snd otlter octivities./rom all projects in the country. I-he role o.f the l{HO oJfice in APOC activities should tlso be reported in greater detsil. The.financial report vos not accepted and the Committee recommended thot tlte .finoncial statements from the.first yeor be updated and reliable in.forntation provided. 'l-he tt' Year budget wus recomntended.for approvol but release o.f .funds wos sub.ject to the provisiott of a sotisfactor.y./inancial report to APOC Management. Continued support o.f the t25. JAF6.6 Pagc 15 NGDO consultant with APOC funds would be dependent on the provision of improved teclrnicsl and financial reports and his rapid training of the Deputy Coordinutor. Mahense CDTI Proiect (3"d year technical report - 4'r'year budget) 126. 179,502 treatments were reported with a 54'h coverage. The coverage from the previous years and the Annual Treatment Objective for year 4 were not clear and this information was requested to appear in the next report. Training goals were met, but the relationship between numbers of CDDs trained./retrained (405) did not relate to the total nurnber of CDDs (559). Good progress had been reported in compliance wrth CDTI indices. 127. The financial report was not available. There were outstanding expenditure retums for a period of 3 months. The balance of funds at the project account in the country was not reported. 128. The year 4 budget in the original five year proposal was US$ 28,972 while the budget proposal submitted to TCC amounted to US$ 28,341. An explanation of advocac)/ costs and operating expenses should be sought by Management before final approval. 129. Tlte TCC recommended the acceptance of the Moltenge Focus Project sLr. monthly report for )'eqr 3' 130. The Year 4 budget wqs recommended .for occeptance subject to approvol bv APOC Management of the.financial reports und returns .for the previous yesrs, and a review of certain line items in tlre proposed budget. Ruvuma CDTI Proiect (2"d vear technical report - 3"d !,ear budget) 131 . TCC noted that coverage was low but realised that treatment during the reported period was still ongoing. There r,vas little mention of government input. The Committee noted wrth interest that CDD mcentives were in the form of being excluded fron, doing community rvork .Ivermectin was rvell integrated into the national drug distribution system: horvever. the Medical Storcs (a partly,- for-profit agency) needed to agree with the MOH on its annual chargc. I3 2. The tecltnical and.financial report were accepted but TCC noted the oyer-reliqnce on APOC ./unds an issue whiclt needed to be addressed in.future. I 33. T'he budget was also recontmended for opprovoL Excesses were noted in sonte budget lines [operating expenses, training ond supplies (tlte computer to be made virus-.free and not reploced)J. Tukuyu Vector Elimination Proiect (2'd year technical report - 3'd year budset) 134. This project, located in an area with essentiallv onchocercal skin manifestations where ivermectirl treatment started in 1994, was based on a feasrbili6,studl,carried out ir-r 1995 since rvhen transmission had substantivelv reduced. Srmulrum dqmnosttm (Kiwira form) susceptibilrty to temephos, although within the acceptable range, tended to be closer to the lower limit. According to the currcnt plan, ground larviciding u'ould be carried out on a two week schedule, although the findings of an APOC consultant, who rvould visit the focus in July, miglrt call for weekly treatrnents. Additional treatment points were to bc established and larviciding would be implemented as plamred as from the third quarter of 2000, including vector control during thc dry season r,vhen thc larvicide rcquirements were less than during the rainy season. B. r susceptibilitl, tests wore planncd to be carricd out before the start of ground larviciding. 135. JAF6.6 Pagc 16 136. Onc problem for the project was the absence of a vector control expert in the Ministry of Health and./or in the NOTF. Also, there was a need to establish a closer interaction between this project and the Tukul,u CDTI project. 137. It was pointed out that once eradication of the vector had been achieved, ivermectin treatment would be confined to those already infected. 1s8. TCC recommended the approval of the technical report as interim pending the receipt by the Management of a complete report before releose of funds from tlte veor 2 budget. 139. T'he Comntittee also recommencled the approval of the budget ./br year 2 u:ith the understanding that it be reduced to tlte original five year plan. 140. The budget for the third year was also recommended for approval sub.iect to some scoling down by the Manogement in consultation with the NOTF. Tukuvu CDTI Proiect (1"t Year reoort - 2nd vear budset) l4l. The project agreement dated from December 2000 but the funds were received onll, in March and the bank account opened in May. In spite of the short period of financing the project had been very active: a new Coordinator was appointed, advocacy visits were made and a census had begun. It rvas planned that ivermectin would be available for dry season distribution. 142. Thc budget for year 2 showed an increase of almost US$ 10,000 on that origrnally proposed in tlie 5 year plan. US$ 9,000 were earmarked for radio broadcasts. Errors u,ere noted in calculations. I 43. T'CC approved the brieftechnical report and congratulated the project on its progress sofor. The Committee requested further technical and .financial reports after 6 montlrs to be submitted to Management. If they were satisfactor.y funds could be released .for 2"d .year operations. 1 44. The budget should be reduced bv APOC Mansgement to the level proposed in tlte 5 year plan porticularll,utith reductions in the nubilizstion and advocacy budget lines. Tanea CDTI Proiect (2"d year budset) 145. The budget was recommended for acceptance subject to modifications by APOC Management and the receipt of interim technical and .financial reports. TCC comments orl the budget were as.follows: (, There should be parity in per diem v'ithin the proiect.(iil T'raining and educatiott costs were too high.(iiil Overheads to the NGDO had been misculculated. Uganda Phase I CDTI Proiect (2'd year technical report - 3"d year budget) 146. TCC noted that the closure of the Cooperative Bank affected plamred activities rn Masindi and Kascse districts. Training objcctives were being met. The Committee also noted that the population coveragc in Hoirna district has been lorv as contpared to other districts. lnfomration \vas requlrcd as to rvhethcr this rvas due to population fatigue or inadequate supcrvision. TCC \\as ullprcssed rvrth thc high level of goverrutlcnt partrcrpation. JAF6.6 Page 17 147. The financial reporting had not been satisfactory to APOC Management despite all efforts made 148. Tlre technical reportwos acceptedfor approvaL There should, however, be no disbursement of .funds until satisfactory jinancial reports were submitted to Management. I 49. The 3'd year budget .wos recommended for approval subject to amendntents bringing it to a level not exceeding the totul omount contained in tlte original Jive year plan. TCC noted the excess on the budget lines for training, truvel and operoting ocpenses. Phase II CDTI Proiect (1"t year technical report - 3'd year budset) 150. The Committee had before it a technical report for year l, the financial report for year 2 and a budget request for year 3. The year 2 technical report was missing. 151. TCC recommended occeptance of the year I technical report but emphasised the need to address tlre decline in population coveroge rotes front 1998 to 1999 in oll districts but especially in the Bushenyi district which reported 48'% coverage onl-y. The Committee noted the strong community structures in Ugando but cautioned tltat the Engozi Society should not support CDDs tuithout proper understanding of community structures. I 52. The Committee requested submission of oJirst quarter report.for year 2 activities uthich wqs missing. I 53, TCC considered the 2"d year.financial report unsqtis/octory as it lacked .justification und wss not related to the approved budget. Tlte report wos not recommended.for approvaL I s4. Th e Committee recommended approval of the third year budget but tvith significant reductions especially under travel ond operational escpenses wltich appeored too high snd sltowed overlap, Releuse offundslyould hotyever be subject to submission r4l'a satisfqctory.financial report.for year 2. Itwara Vector Elimination Proiect (2'd vear technical report - revised budget) 155. The area had been under ivermectin treatment since 1990 and larviciding had been carried out between 1995 and 1997 with good results. The risk of reinvasion from neighbouring foci was mimmal. 45 000 people were at risk or infected but a dramatic fall in transmission had been observed. 156 Monitorrng through crab trapping at key check points at the main focus and in the Srisa sub-focus during March and April2000 showed absence of immature stages of S. neqvei while 0.97o of the crabs caught in the Aswa sub-focus were positive with immature stages. No adult vectors were caught. A four-weekly river treatment had been resumed in January 2000 in the two sub-foci. The S. neqvi vector was close to elimination but monitoring/evaluation would nced to continue. Also, extemal evaluation should be considered in the future to allow for independent assessrnent. 157. During 2000, four-weekly larviciding would become an eight-weekly treatment. TCC recontmended that the resubmitted 2"d yeor technical report ond the revised budget.for 2000 be approved rtith tlre provision thotfunds not he released beforc imprest qccount reports were received by the Monagement. I s8. JAF6.6 Page 18 Mpamba-Nkusi Feasibility Study (1" year technical report - 2'd year revised budget) 159. Of the two vectors. Simulium damnosum s.l.and S. neavei, only the latter bite man. 70 000 people in the area were at risk of infection. 160. The feasibility studies undertaken so far had demonstrated that ground larviciding was feasible and tl-rat vector elimination in the focus could probably be achieved. 161. During 2000 external expertise would be arranged to conclude finally whether or not vector eradication was obtainable while at the same time larviciding trials would be undertaken. 162. Tlre Committee recommended that the technical report be approved. 163, TCC also recommended the approval of the budget proposul v'ith the unclerstanding that the bolance oJ' the .funds already transferred would cover the proposed uctivities ond that Monagement receive the outstanding imprest accourlt reports. Liberia Lofa. Bong. Nimba & Montserrado CDTI Project (l'i year technical report - 2"d year 164 This project had started recently as APOC funds had only been recerved in March 2000 although sorne pre-financing by the NGDOs had permitted some start-up activities before March. 165 Only two districts had so far been rnobilised but77 cormnunitres has alreadv chosen CDDs who had been trained. Advocacl, was r,vell developed and radio and television had covered the project. It was evident that the year I budget was too lolv; almost half had been spent during the first two months. The budget proposal for l,ear 2 therefore showed a significant increase over the projected budget in the year 5 plan but was morc realistic in view of the proposed actrvities. 166. TCC accepted the report but requested that a.f urther technicql repnrt us well os a financial report be submitted to APOC Mqnagement oJier 6 montlts of activities and that if these were satisfactory, APOC could proceed witlt disbursement of the yssr 2 budget. 167. Tlre year 2 budget wss qpproved in principle bv the Committee altltough APOC nTonogement was requested to review tlte budget in more detsil and mqhe ninor udjustments- Equatorial Guineu Bioko Vector Elimination Proiect (2"d year technical report - 3'd year budset) 168. The area of the island of Bioko is 72x35 km2 with a mountain range in the South reaching 3 000 m and 40 small. fast flowing. seasonal rivers. Thc southem part of the rsland is accessible by boat onl1, 169. The population at risk was in thc orde r of 62 000 and mobrle ivcn.ncctrn distribution had been carricd out since 1990 with a reccrlt coverage of 29%, Thc feasrbility study had providcd hydrobiological- cnvironmontal and cntomologrcal baseline data as r,vell as infonnatiou on transmission and insecticrde susceptibilitv u,hich u,as satisfactory in rcspcct to tctncpltos. budeet) 170. t7t 172 I 73. 174. I)1h. t7s. I 76. JAF6.6 Page 19 Ground larviciding was feasible in the North while vector control in the southern mountaineous area could only be achieved by aerial larvrciding which in itself could pose a problem due to the dense vegetation. Large scale ground larviciding would start next year durrrg the dry season while a plan for aerial spraying would be developed and submitted to TCC.. If, eventually, helicopter spraying were to be undertaken, it would have to start while OCP was still in existence and could make the necessary arrangements with its current contractor. 7'he Committee recommended tltot the technical report be approved TCC further recommended the approval of the budget proposal but tronsfer of .funds would be conditioned bv the receipt of sotisfactor.y expenditure reports. Progress reports and budget proposals to be re-submitted to TCC Cameroon South west II Province CDTI Proiect (l"t year technical report - 2'd year budget) Tlrrs project planned to treat 316,443 persons in a hyper/meso-endemic area . The project rvas approved for funding by APOC in July 1999 though funds were onlv received by'the NOTF in February 2000 and in the SW II province in May 2000. This delay was due to the lack of a Coordinator for the project. Hettce, only limited activities were carried out. including micro- plamring at different health care levels and tramurg of heath care staff. No census rvas conducted and CDDs r'vere yet to be selected and trained. There was no mention of Loa /oa related side effects and no plan of action. The project was embarking on mass treatrnent with no previous history of ivennectin distribution and did not have a strategy to manage adverse reactions. TCC found the technical report to be inadquate and noted that funds were available for the prolect until April 2001. The Comtnittee also considered the budget to be excessive with littlejustification, and no action plan to enable it to be adequately revier,ved. TCC therefore recommended that a full activity technical report with a proper.financial report and o budget .for year 2 be submitted to TCCI2 (Morch 2001). B2: - REVIEW oF NBw NATIONAL PLANS AND CDTI PROJECTS (item I I) C0nrcrqqn CDTI Proiect for Haute Sanasa 177. Thc proposal rvas well written and provided the required information. Amrual Treatment Ob.Jectives should, however, be provided and all training should include recognition and ffIallagement of severe adverse reactions since the area is in a Loa loa endentic zone. I 78. 'Ilte Committee recommended the approval o.f the Huute Sanaga/Belaho project proposol with lhe etcpectation that the REMO refinement und REA escercise .for Comeroon would be completed prior to commencentent of the project. 7-he budget wqs reoso,toble, provided evidence ol sustainahilitv und showed commitment by oll partners- 'l'he hudget wos recommended.fttr upproval. I 79. JAF6.6 Page 20 180. CDTI Project Proposal for Western Province The proposal was well written and followed, for the most part, APOC guidelines. However, the following points were noted: (r) It was a CBIT project that was doing well and a conversion to CDTI should not warrant a delay of 16 months for preparations as suggested in the implementation schedule. Treatment should be continued even when preparations were underway. (ii) Increase of treatment coverage objectives frorn half a million to over one million in one ),ear seemed over-ambitious; treatment targets should increase gradually. Tlte proposal was occepted with rectification of these points. The budget was excessive. It should be retumed for reduction to a lllore reasonable level. Budget lines were over-estimated: (i) Capital equipment: one car should suffrce; motorcycle costs were over-estimated; laboratory equiprnent was not required for CDTI operations. (ii) Supervision/surveys was inflated and so was health education and training. (iii) Personnel costs were too high. For instance, the Project Manager could not dedicate 70% of his time to this project when he had also other projects to supervise. (ir) Operating expenses were also on the high side. The whole budgel needed considerable reduction and tlte Committee proposed tltat this sltould be done und u revised budget sltould be resubmitted to Managenrcnt. I 81, 182. I 83. Republic of Cctngo (Brazz,aville) National Plan 184. This plan had been near to completion in 1997 when civil war broke out and the onchocerciasis office was ransacked; all computers, furniture and archives were lost. The NOTF inBrazzavllle have reworked the National Plan although some details needed to be brouglrt up to date. 185. Thc Plan envisaged a CDTI operation to cover 4 sites at present, over half of them in the city of Brazzavllle Some extension of these areas may be needed after refinement of REMO. Areas of hypo-endemicity would be covered by clinic-based treatment to be rntroduced in 2004 when the CDTI prograrnme would be well developed. l8(t. The TCC opproved the National Plan, but recommended tlrat tlte REMO be refined not only as projected but that further refinement be done to validate oreas where the plans are based on other data (skin snip or leopard skin surve.ys). CDTI Proiect Proposal This CDTI prolect covcring a large area around Brazzavlllc. and thc rcgion Pool as well as two othor arcas covenng trtbutarres of Congo, Niari and Djoue rivers, \\,AS au cxtension of thc project bcgun in 1992 by the Rrvcr Blindness Foundation. This projcct u'as intcrrupted by the rvar and 187 JAF6.6 Page 2l no treatment had been made during three years. Organisation pour la Prevention de la Cecitd (OPC) planned to support the project for a 5 1,ear period. 188. The Committee recommended approval of the CDTI project under the.following conditions: (t) The REMO map needed further reJining to vulidate areas oJ'treatment. This was porticularly important in view of the presence of Loa lou in some sreas. I 89. (i, Proper plans should be made according to MEC/TCC guidelines in Loa loa areas(REA in each village, increased surveillance of odverse eJ.fects, trestment centres identiJied and equipped to handle severe CNS disturbances, etc). The budget wss opproved in principle. However, certain itetn^s were esccessive in number or cost [computers, camero, pltotocopier, per diem (porticularlyfor the city of Bra1xaville)J. TCC requested APOC Management to make adjustment to the budget as appropriate. 83: - UPDATE ON OPERATIONAL RESEARCH (item 12) 190. Dr Hans Remme, Manager of the TDR Task Force on Filariasis Intervention Research (FIR) provided an update of the ongoing and planned activities of the Task Force. Two multicountry studies had been carried out: (i) Implernentation and sustainability of CDTI (cornpleted): kel,baseline findings identified that there was poor communication and interaction between comr-nunit1, members and health lvorkers. An enhanced approach to CDTI was tested rvith as main enhancement local stakeholders meetings of community representatives and health workers. Treatment coverage was similar for enhanced and regular CDTI. The attitudc of health workers to CDTI irnproved over time with both approaches but most sigruficantly r.vith the enhanced approach. It was recommended that control programmes consider the use of local stakeholder meetings to encourage ownership of CDTI by the cormnunity and to improve iuvolvement of district health services. (ii) Studies on lvmphatic filariasis had also produced results of relevance to APOC. The effectiveness of community-directed treatment (achieving 77% - 88%o treatment coverage) was demonstrated compared to mass treatment b1,the regular health services (with only 44% - 47%o coverage). In this stud1,. fp11 was introduced to the comnrunities by the DHMT and the process was effectively managed by the regular healtl-r services. A rapid mapping method for lymphatic filariasis has been developed and plans for phased rnapping of lymphatic filariasis in Africa was being implemented by the Filariasis Elimination Unit of WHO with technical support of TDR. Country-wide mapping of the first 6 countries u,ould be con-rpleted by October 2000, and this should clarifi, the overlap bctween the distribution of lymphatic filariasis and onchocerciasis. TDR had recently undertaken a poll of research needs for lyrnphatic filariasis and onchocerciasis. A draft list of research needs was circulated among experts in research and control who scored thc importance of each item on the list. The top priority remained drug delivery strategies for high and sustained compliance. The workplan of the Task Force rr,as subsequently revised in accordance lvith the outcome of the review The revised rvorkplan and the specrfic issues for rvhich proposals were invited were presented to TCC TCC discussed the results of the rnulticountry studv on thc rmplcmcntatron and sustainability of CDTI and oxprcssed intercst in the concept of the local stakcholders ureeting and its potential l9l. JAF6.6 Pagc 22 192 193. 194. to enhance the sustarnability of CDTL The Cornmittee accepted the study recommendation that CDTI projects consider the use of such meetings to encourage community ownership and to improve involvement of district health services. TCC also agreed that the planned multicountry study on advocacy should focus on advocacy for sustained support for CDTI from the health and political system, including traditional healers, at the district and national level. The Committee expressed appreciation of tl-re collaboration with the TDR Task Force on Filariasis Intervention and looked forward to be kept informed of the outcomc of ongoing studies. TCC made the following recommendations related to operational research funded by APOC rvrthin the context of CDTI projects: (i) lmportant that NOTFs have the capacrty to plan and manage operational research (OR), and APOC intended to use some of its operational research funds to help strengthen this capacity. NOTFs wanting to take on project-specific, problem-solving and action- oriented OR on issues they consider a prioritl,, may request for APOC funding. A research protocol and proposed budget should be submitted to APOC Management for review and approval of funding. This type of OR should rvork towards strengthening project performance and evaluating reasons for poor to low treatment coverage or poor participation of communities. (ii) Bring on board new partners to APOC -funded projects who could provide expertise and other resources to NOTFs in conducting operational research. (iii) TCC to continue revierv of OR proposals that are not pro1ect-specific. in accordance rvith TCC guidelines. (rv) APOC/HQ to set aside funds within its general budget for OR proposals submitted b1, NOTFs in the context of OR mentioned under (i) above. OR proposals submitted to APOC Management should not exceed 6.000 per vear per issue. (v) TCC to develop a list of priority research to send to NOTFs for research proposals to be developed. B4: - ADDITIONAL SUBJECTS CONSIDERED BY TCC Item 4 Matters arising from the APOC Partners Meeting As pointed out by the Chair during the opening of the session, the APOC Partners Meeting had provided an opportunity for National Coordinators, NGDO representatives and other partners to exchange views and experience and seek solutions to problems. A high number of reconunendations l-rad been put forward and it was decrded that during the current session of TCC. Dr Amazigo together with Mr JeffWatson, who attended the Meeting. u,ould highlight the most solid and pertinent recommendations. The outcome of this activitv was discussed br,, 16e committee The Committee agreed on the following procedure for its review of the recommendations made by the Partner's Meeting: (i) Juh, MDP (Dr Meredith) to prepare a questionnaire based on all thc rccommendations m thc rcport. 19s. JAF6.6 Page 23 July: MDP office to forward questioruraire to all TCC Members and the Management of APOC for scoring. Analysis of questionnaire in MDP offrce(iiD (iv) 196 191 198. 199. Second week of August: report analysis sent to Ouagadougou for onward transmission to CSA and Members of the Mid-term Evaluation Team. Item 5: Update on the APOC External Mid-term Evaluation The Committee was informed of the arrangement made for field visits of Mernbers of the Evaluation Team to six (6) APOC-assisted projects in Cameroon, Uganda, Nrgeria, Tatzania, Equatorial Guinea and CAR. The Team would meet mid-September to agree on a first draft of its report which would then be submitted to CSA at its October session for comments and finalization before transmission to the participants in the Decernber 2000 JAF session. Item 6 Update on the Impact Assessment Studies Demographic, socioeconomic, dermatological, ophthalmological and entomological baseline data had been collected by four teams, each composed of four independent scientists, guided by two coordinators. Thirteen sites in 8 countries had been selected for examination. The data lvould be analyzed and established as the first data point in October nexl. The second round would take place in 2005 and a third was planned for 2010, three years after the end of APOC operations. It u,as suggested that CSA take up the matter of funding the third round ltem 7 The Elimination of Lymphatic Filariasis in Africa: role of APOC A series of issues were brought up during the consideration of this agenda item. including the extent to which the integration of Lymphatic Filariasis (LF) Elir.nination rvith OCP and APOC operations and within their structure was feasible; the costs of LFE as an independent operation versus its integration in/collaboration with onchocerciasis control in Africa, and the need to provide the participants in the Joint OCP-APOC session in December 2000 with the necessary rnfon-nation in advance of that session. In the meantime- work r.vas undenvay to prepare a first draft of the CSA issue paper requested by the Joint Session in December 1999. An outline would be presented to CSA at its July session and the final draft would be considered by the Conunittee at its October session before submission to participants in the December 2000 Joint OCP-APOC Session. Tlre Committee referred to the statement made in the report of TCC 9 (iterns 94 and 95) which noted the considerable complexities arising from coordinating onchocerciasis and Ly,rnphatic Filariasis Elimination (LFE) Programme in sub-Saharan Africa. TCC l0 again expressed concem with duplication of effort and of committees reviewing projects with sunilar activities in the same geographic areas, and recommended that technical and organizational aspects of the LFE Programme south of Sahara be integrated into the deliberations of an cxpanded TCC. and a rnodified APOC. TCC noted that a similar expansion had already been instituted b5,the Mectizan Donation Program to approve and coordinate ivermcctin and albendazole donations for African onchocercrasis and LF activities. The Conrrnittee felt that this recommendation should be comrnunicated to all interested parties concemed lvith the onchocerciasis and LF initiatives ur Africa. TCC requcsted that an approval of expanded TCC and APOC responsibilities be urgently considered bv CSA and JAF. A report on LF actrvities in Plateau/Nassarawa States was given b1, Dr Frank Richards. 200. (ii) JAF6.6 Pagc 24 Item 9 Report on the financial management of APOC-funded projects zot. Efforts had been made to reduce delays in the transfer of funds to the project imprest accounts, including the transfer already at the time of signature of Letters of Agreernent (LOA). At the same time projects were encouraged to comply with the clauses in the LOA requiring timely despatch of their monthly statements of imprest accounts and requesting replenishment as soon as 80% of the funds were spent. 202. At tlie recommendation of TCC9 a joint visit had been paid to Nigeria to examine the reasons for the long delays in the submission to APOC of the expenditure returns which entailed further delays in the replenishment of the imprest accounts. As a result of this visit the problems seem to have been solved with the support of the NOTF. 203. In Uganda and Tanzania where similar problems existed, APOC had co-funded an administrative assistant in each of the two WHO country offices whose role would be to assist the NOTFs and the project coordinators to solve administrative and financial problerns. Item 13: Other matters Publication in the Lancet on APOC and OCP 204. Frank Rrchards (principal author of an article entitled 'Programnatic goals and approaches to onchocerciasis" published in The Lancet, vol 355, May 13, 2000) explained to the Cornmittee the background and the field experience that had led to the publicatron. The article concluded that although the OCP vector control was close to reaching its oblective- the probabilitl, of recrudescence was high. and that twice-yearly ivermectm in APOC countries rvas called for if intermption of transmission was intended. The Conmittee felt that it would have been preferable. had the article been at least discussed in draft with the OCP and APOC Managements prior to publication. TCC rvas infonrred that EAC had considered the article and arranged for a response to be published. Tlre Connnittee recommended that careful examination continue to be madc of the considerable accumulation of data from both OCP and APOC countries to detennine the extent to u'hich ivermectin treatment would reduce transmission in additron to morbidity control. Two additional CDTI Proiect Proposals for Niqeria (Akwabon & Rivcrs) 207 The NOTF. following REMO refinernent, reported that the Akwabon and Rivers States were found to be meso/hyperendemic for onchocerciasis and had asked if tu,o new projects could be subn-ritted for APOC approval. 208. Initialll,, the Management was of the opinion that the two proposed projects might be included in ongoing CDTI projects ir-r neighbouring States. This, horvever- would entail future managernent problems e.g. differences in implementation years and the Management now proposed to accept the two new projects in spite of the previous agreelnent that no further project proposals from Nigeria would be entertained. 209. TCC agreed that the NOTF rnight request APOC support to the two projects in question REMO in Mozambique: update 2lo. An APOC suppofted REMO exercise two years ago in four provirrces bordering Malawi and Tanzania did not provide data convincing enough to dccide on whether or not onchocerciasrs rvas a public health problem in Mozan-rbique. 205 206 JAF6.6 Page 25 ztt. A subsequent country-wide REMO was funded by AIRCARE but did not produce data sufficiently reliable for conclusions regarding the endemicity of onchocerciasis. 212. Should local conditions allow for commencement of a new REMO exercise, APOC would contact the Ministry of Health bringing to its attention the previous atternpts at undertaking REMO exercises This would be followed by an advocacy visit in preparation for a new country- wide REMO to be undertaken by the Programme in collaboration with AIRCARE. 213. At the same time, AIRCARE would be invited to visit an ongoing REMO refinement exercise in other APOC country. It was pointed out that a high proportion of the population infected by the disease had spent several years in refugee camps and were now being resettled. Issue relatine to UNICEF support to onchocerciasis control in Liberia 214. The Government had intended to submit three CDTI and one HQs support proposal to APOC. However, UNICEF, Liberia had already planned to start ivermectin distribution on its own funds without wishing to enter into partnership with APOC. These funds had been provided by the US Fund for LJNICEF with the understanding that the UNICEF support would be provided within the APOC supported project. The funds had been earmarked for three years and an extension of the grant would depend on the results of an evaluation. 215. The Minister of Health at a recent meeting with a visiting APOC team expressed his intention to submit a project proposal to APOC in the near future and to take up the matter with UNICEF. 216. TCC recommended that efforts be made to improve the prospect of fliture collaboration with I.INICEF. Comrnunicatlady frcfessal 4-J- Ilqcs 217 Reference was made to the communication from Professor Trees on TDR's decision to stop funding the Onchocerca ochengi Centre in Cameroon. The Comn-rittee noted that the possible uracrofilaricidal efFect of tetracycline rvas already being investigated in ongoing studies in humans at the Onchocerciasis Chemotherapy Research Centre in Ghana and that results should bc available towards the end of 2001. The importance of having a field-applicable drug regimen was en-rphasized. 218. TCC endorsed the EAC view that the evaluation of scientific proposals concerning Macrofil was a ftinction of the TDR Drug Discovery Research Steering Committee and that there was no reason to interfere with the decisions of that Committee. Prevention of HIV infection of newborns 219 The Cornmittee was infonned by Professor Francois Taal, Director, Health and Family Department, Ministry of Health, Burkina Faso and Mr Hans Binsu,ager, Director, Rural Development Department- Africa Region, World Bank, about recent progress made in the prevention of HIV infection in newborns. The one-dose treatment of HIV infected women at the tirne of delivery with Nevirapir-re followed by the same single-dose treatment of the newborns had rcduced the risk of HIV transmission from mother to child by close to 50%o as shown in field studies in Uganda. Field application studies were underway in four urban and one rural area in Burkina Faso. HIV diagnostic tests which might eventualll, $e applied at the community level rvorc being developed. The cost was in the order of US$ 4 per dose of Nevrraprnc . 22O. During thc discussion scveral issues were brought up. It was suggcsted that the treatment be givcn to all pregnant women rvithout prior tcsting to avoid stignratization in tlrc comrnunity. JAF6.6 Page 26 However, this might only be feasible in communities wrth a high prevalence of HIV sera positivity. The feeding of the babies of HIV mothers was another problem as babies were traditionally breastfed in most African communities. This needed to be avoided where the mother was HIV infected. The presenters saw the CDTI mode of conununity involvement as a potential means of rapidly and effectively implementing this type of single-drug dose prevention of HIV transmission from mother to new-born child and they invited TCC Members to reflect on this possibilrty. Orqanization of TCC sessions. including documentation 221 A working group submiued a series of proposals which would be considered by the Committee atits ad y'ioc session in September 2000 (see paragraph 224 below). Additional proposals 222. During the consideration of agenda items specihc proposals were made some of which will be considered under the future debate on the organization of TCC sessions. 223. Other proposals were: all projects to show evidence of implementing the CDTI strategv in all communities bY the 4u')'ear; provision of well functioning capital equipment during the final vear; NOTF/HQ funding to continue as long as projects with different starting dates are in operation. prioritl'to protection of the borders of OCP de'r,elopment of systems to measure and monitor individual conununity coverage rather than aggregated data, 224. preparation of a progress report on REMO for a future TCC session. Item 14: Dates and places of TCCl1 (od hoc),TCCL? and TCC 13 sessions (i) The NGDO group was urged to meet back-to-back with TCC: (i,) od hoc session( TCCII) to rneet in Geneva. from Thursdav noon 14 to Frida), 15 Septernber. 2000; (iii) TCC 12 to meet from Monday 12 March to Friday 16 March 200l rvith CSA session one week later. last date of submission from the countries: 7 Januan' 2001; (iv) TCC I 3 to meet from 10 September to 14 September 200 I wrth CSA session during the week starting 24 September; last date of submission frorn the countries: 7 July. 2001 . Item l5: Closure Following statements by the Chair and the Programme Director, Professor Honreida (the Chair) dcclared the sessior-r closed. ))< I2. 3 4 JAF6.6 Page 27 ANNEX 1 LIST OF PARTICIPANTS TCC Members Professor (Mrs) Adenike Abiose, Medical Director, The National E1,e Center.P.M.B.2267, Kaduna, Nigeria, E-mail: abiose@infoweb.abs.net Professor Mamoun M.A. Homeida, Vice-Chancellor, University of Khartoum, P.O. Box 321, Khartoum, Sudan, Fax: (249) ll22 47 99;Tel: (249) ll22 47 62;E-naI.: amst33hotmail.com Dr Adrian Dennis Hopkins, Medical Consultant of CBM, C.R.H.P., B.P. 406, Kinshasa I, Democratic Republic of Congo, Tel & Fax (243) 88 03 940 - E-mail: Kincbm@maf.org Dr Frank O. fuchards Jr. Deputy Director, Global 2000 River Blindness Program The Carter Center, One Copenhill, Atlanta, Georgia 30307, Fax: (770) 488 4521:T61. (770) 488 4511, E- nail fxrl@cdc.gov Dr Basile Kollo, Directeur de la Sant6 Communautaire, Ministere de la Sante publique, Yaounde, Canreroun, Fax. (237) 22 44 19;Tel: (237) 23 33 84 ou (237) 23 93 50 Dr Stefanie Meredrth, Director, Mectizan Donation Program, 750, Commerce Drive Suit 400, Decatur, GA 30030, Atlanta, USA, Fax: I 404 371 ll38; Tel: | 404 371 1460; Email sr-neredit@taskforce. org DrBerthaMaegga> TukuyuResearchStation, NIMR-HQ, P.O. Box538, Tukuyu, Dar-es-Salaam, Tanzania, Fax: (255) 65 55 22 50;Tel: (255) 65 552250, E-mail: imatukul,u@maf.org Dr Miclrel Boussinesq, Centre Pasteur du Cameroun. B.P. l274,Yaotttde. Carneroun, Fax : (237) 23 35 84123 15 64. E-mail: Ll'srom$LQ@camnet.cm WHO/Geneva 9. Dr Hans Rernme, TDR/WHOGeneva, Tel 4122 791 3815. Fax. 4122 791 4854 10. Dr Ole Christensen, WHO/HQ/Geneva, Fax. 4122 791 4190 Tel 4122 791 3885 I L Ms Pamela Drameh, NGDO Coordinator, WHO/HQ/Geneva. Fax 41227914777;Tel:4122 7912642 WHO/AFRO 12. Dr J.B. Roungou, WHO/AFRO, clo OCP, Ouagadougou WHO/OCP 13. Dr Boakve A. Boatin, Director OCP/Ouagadougou, Burkina Faso 14 Dr L.K.B. Akpoboua, ATO, VCU/OCP/Ouagadougou, Burkina Faso 15. Dr E. Siamdvi, PET/OCP/Ouagadougou, Burkina Faso I (r Dr A Soumbe1,. C.PET a.i./OCP/Ouagadougou, Burkina Faso 5 6 7 8 JAF(r.6 Page 2tl 17. Dr Paul Richard Belemgoabga, COM/OCP, Ouagadougou, Burkina Faso WHO/APOC 18. Dr A. Seketeli, Director, APOC, APOC/Ouagadougou, Burkina Faso 19. Dr U. Arnazigo, CSD a.i., APOC/Ouagadougou, Burkina Faso 20. Dr M. Norna, CEV a.i., APOC/Ouagadougou, Burkina Faso 21. Ms Lydia Clemmons, COP, APoc/Ouagadougou 22. M. A.-F. Agboton, CAF/APOC, Ouagadougou, Burkina Faso Other Participants 23. Mr JeffWatson, CBM/Nigeria, 3A Gomwalk Close, Jos, Nigeria, Tel/Fax: (234) 73 456578,8- mail : j effrvatson@maf. org 24. Dr Olikoye Ransome-Kutr,Z}-AElsie Femi Pearce, Vrctoria Island, Lagos, Nigeria. Tel.234 470 I 544. E-mail: abfrco@infoweb.abs.net 25 . Dr Deborah A. McFarland, Rollins School of Public Health, I 5 I 8 Clifton Road, Atlanta, Georgia 30322, Tel: 404 727 7849 (office), Fax: 404 727 4590, E-r.nail: drncfarl@sph.emory.edu 12 J 4 5 6 7 8 JAF6.6 Page 29 ANNEX 2 AGENDA Opening Adoption of the Agenda Matters arising fiom the 87d', 88u' sessions of the CSA Matters arising from the APOC Partners' meeting Update on the APOC External Mid-Term Evaluation Update on the Impact assessment studies Update on the Elimination of Lymphatic Filariasis in Atiica: role of APOC Follow-up of the recommendations of the ninth session of the TCC: (i) Financial report of the Adamawa, Borno, Edo & Delta, Jigawa and Oyo states projects in Nigeria, financial report and Plan of action for year 2 tbr phase III and IV CDTI projects in Uganda; (ii) Follow-up of other matters Report on the financial management of APOC funded Projects Technical and tinancial review of the first, second and third year progress reports on the implementation of CDTI and Vector Elimination Projects: (a) Cameroon (7) Hqs Support, Adamaoua Province, Centre 3, Littoral Province, North Province, South West I and II Provinces CDTI Projects (b) Chad (1) (c) Liberia (1) lrta, Bong, Nimba and Montserrado counties l" year technical and financial reports (d) Malawi (l) (e) Nigeria (20) (HQs, Bauchi, Benue, Ekiti, Enugu,Anambra & Ebonyi, FCT, Gombe, Imo/Abia, Kaduna, Kebbi, Kogi, Kano, Kwara, Niger, Osun, Plateau/Nasarawa (resubmission), Taraba, Yobe, Zamfara States CDTI Projects) (f) Central Afiican Republic (1) (g) Tanzania (6) Hqs Support, Mahenge Focus CDTI, Ruvuma CDTI,Tukuyu fbcus Vector Elimination,Tukuyu CDTI, Tanga CDTI reports (i) Uganda (3) Phases 1 & 2 CDTI Projects and Vector Elimination in Itwara Focus and f'easibility Study in Mpamba-Nkusi fbcus) Consideration of the 2"o , 3'o and 4d' year budges of CDTI Projects in Cameroon, Chad, Central Afiican Republic, Liberia, Malawi, Nigeria, Tanzania and Uganda Review of new National Plans and Projects Proposals Update on Operational Research Other matters Date and place of the eleventh session of the TCC Conclusions and recommendations Closure of the session 9 10 l1 t2 13 t4 t5 t6 17 JAF6.6 Page 30 A ANNBX 3 GUIDELINES FOR TCC MISSION TO CAMBROON To assist in the application of MEC and TCC9 recommendations regarding the strategy to be used during Mectizan@ distribution in areas where loasis is probably endemic so that treatment activities can resume soon (the latter are defined using the maps provided by the Liverpool School of Tropical Medicine). To review progress on the collection of the fbllowing data by the NOTF, the NGDOs concerning: name and coordinates of the village, and localisation within the health map (health district, health area); the total population with the method used to evaluate it; the number of distributions perfbrmed in each community; where possible the therapeutic coverage reached at each distribution, and the method used to evaluate the latter; the level of endemicity fbr onchocerciasis in the village, the method used to assess it, and who made this evaluation. C. To check the preceding date in a number of communities by a mission in the tield D To assess how the health personnel in [-oa loa areas have been infbrmed and trained to ensure early identitrcation and proper management of severe adverse eft'ects, and to assure that APOC support is adequate to support that process. To determine if additional surveys should be carried out, so that a decision can be taken, using TCC9 recommendations on the strategy to be used fbr treatment and reaction surveillance/monitoring. To infbrm the NOTF and the NGDOs on the administrative procedures to be used for rapid release of funds from APOC fbr perfbrming the additional REA surveys. To evaluate whether some projects are in need of special technical and tinancial assistance for developing their activities. To study with the project leader why the change from CBIT to CDTI is so slow To develop a strategy to get CDTI in all areas before year 4. B a a a a a E F G H I
Всемирная организация здравоохранения (ВОЗ / WHO) · Technical Documents
Report of the tenth session of the Technical Consultative Committee (TCC): Ouagadougou, 26 to 30 June 2000
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