WHO/AFRO support to OCP devolution activities

Onchocerciasis Control Programme in West Africa Programme de Lutte contre I'Onchocercose en Afrique de I'Ouest JOINT PROGRAMME COMMITTEE Office of the Chairman JOINT PROGRAMME COMMITTEE Twelfth session Rivadh. l-4 December l99l COMITE CONJOINT DU PROGRAMME Bureau du Pr6sident JPCl2.7 ORIGINAL: ENGLISH JPC - CCP I 'l I i Et \ Provisional aeenda item l2 WHO/AFRO SUPPORT TO OCP DEVOLUTION ACTIVITIES Introduction l. During the eleventh session of the Joint Programme Committee (JPC) of the Onchocerciasis Control Programme (OCP), in Conakry, in December 1990, a programme of accelerating WHO/AFROI support to the efforts of the countries in implementing their OCP devolution activities was announced. One of the concrete actions that was taken soon after the JPCI I was the appointment of a consultant to coordinate the devolution activities in the countries. Prior to the devolution coordinator's assumption of his post a working group of eleven members, made up of AFRO and OCP staff, was convened inBrazzaville from 6 to 8 February l99l to operationalize the policy directives with respect to the WHO/AFRO support to OCP devolution activities. The working group recommended to the Regional Director the task of the devolution coordinator as well as the working relationship of the coordinator vis-a-vis the national authorities, the WHO Representatives, the OCP and the Regional Office. The task of the devolution coordinator is presented in the appendix. In addition, a standing committee of devolution task force consisting of representatives from WHO/AFRO, OCP and OCCGE2 was appointed. The task force held its first meeting in Ouagadougou in March 1991. The coordinator has been based in Ouagadougou, in the office of the WHO Representative, but working in close collaboration with expanded devolution unit of the OCP. The coordinator has been charged with the management support to national devolution activities. 2. A strong health infrastructure is indispensable for any successful disease prevention and control programme. Accordingly, a very high priority has been given to the strengthening of national health systems in collaborative activities with the countries. In spite of the severe economic crisis that has affected all countries, the health authorities in the Region at their annual meeting in 1985 took a courageous decision to adopt the three Phase Health Development Scenario. Within the framework of this scenario, operational support to the district, technical support from the intermediate and strategic support from the central levels are to be provided towards the support of district-based primary health care. All the countries have accepted this approach and the Regional Office has been collaborating through the support of the country teams, the intercountry teams based in the subregions as well as the Regional Office. Proeress made in suooort to orimarv health care (PHC) 3. So far a defined denominator for the health development programmes in all the countries of the Region has been determined. As a result of this exercise 1,800 districts with an estimated population of 219 million in the subregion have been identified. The next step was to embark on the organization of the various structures including committees within the community that are responsible for the planning implementation, monitoring and evaluation of activities. Up to 1989, 1 World Health Organization/Regional Office for Africa 2 Organization for Coordination and Cooperation in the Control of major Endemic Diseases tt a JPCt2.7 page 2 all the eleven countries in the OCP area had completed these two stages towards the development of primary health care. Obviously, each country has been developing its primary health care system at its own pace. The degree of integration of onchocerciasis control activities in the PHC in any country will depend on the level of operationality of the district PHC. 4. The level of operationality of the district health systems in the various countries has been determined using criteria that have been developed in collaboration with Member States of the African Region. These include: - implementation structures, - management cycle, - health infrastructure with referral system, - communityparticipation, - priority health activities based on low cost technologies, - availability of locally-managed funds. 5. A rapid assessment made at the end of 1990 in seven out of the eleven countries revealed that 799 districts out of a total of 1653 (48.4%) have established health committees, 975 (or 59%) districts are carrying out health activities at community level and 644 (or 39%) have locally- generated or self-managed funds. 6. Furthermore, a set of 27 community health indicators has been developed for the measurement of the impact of the health development programmes on health status, health care coverage and health-related social needs. This is the framework used in the collaboration with countries in their efforts to establish and strengthen viable district health systems for the support of disease prevention and control programmes including onchocerciasis. 7. The mechanisms for coordination of activities involving monitoring and evaluation between the country teams, the OCP teams and the various staff of the Regional Office were strengthened over the past year. There was a large volume of technical information gathered by the OCP teams which was made available to the WHO subregional team as the basis for the review and evaluation of national onchocerciasis control programmes. Some of the data was presented at the 40th Regional Committee meeting (RCM40) in September 1990 and it was discussed in detail. In particular, the application of some of the findings regarding the implementation of devolution plans were recommended to endemic countries in the OCP area. A resolution AFR/RC40/Rl0 was passed by the Regional Committee of AFRO in September 1990 on the control of onchocerciasis in the Region. The Regional Director's plan for taking the necessary action required to implement this resolution has been communicated to the Ministers of Health of each endemic country. 8. The OCP devolution coordinator during the year concentrated on the following activities in his consultations with the National Onchocerciasis Committees: I. Institutional framework l.l. Appointment of coordinator 1.2. Setting up of national teams 1.3. Situation of the NOC 2. Activities 2.1. Epidemiological evaluations 2.2. lv ermectin distribution 2.3. Training t I JPCt2.7 page 3 3. Resources made available 3.1. Personnel 3.2. Infrastructure 3.3. Logistics 4. Integration of activities of other major endemic diseases with onchocerciasis. 9. The close collaboration between the devolution coordinator based in Ouagadougou, Burkina Faso, and the national onchocerciasis control programmes on one hand and the OCP teams on the other has improved the coordination of support to ongoing programmes. During the country visits to Burkina Faso, Mali and Niger by the coordinator, it was possible to evaluate the respective devolution activities. 10. During the year under review, reports from the participating countries indicate that some progress has been made in the strengthening of the PHC system with respect to devolution in the respective countries. The areas of notable progress have been in: (l) training and retraining of national staff; (2) epidemiological evaluation and (3) community based ivermectin treatment. Reports at the May l99l National Onchocerciasis Committee (NOC) indicated that Burkina Faso, Cote d'Ivoire, Ghana, Mali and Niger have all made a significant start in these activities. I l. The progress in health eduction was also remarkable in the reports of the NOC. For example the existence of various community structures e.g. village development committees and the active role of these committees in information and education on ivermectin treatment campaigns in the original as well as the OCP extension areas was reported from the countries. The health education programme in Ghana for example has been focusing attention on training health personnel in effective communication skills in family planning, the expanded programme on immunization (EPI), diarrhoea, AIDS, onchocerciasis, yaws, leprosy and guinea-worm disease. An integrated approach has been adopted. Five countries, Guinea, Guinea-Bissau, Mali, Senegal and Sierra Leone have established community based ivermectin treatment programmes. 12. Apart from the formal training in epidemiological and entomological surveillance which the Regional Office has been undertaking over the past ten years, a new initiative in orientation for national onchocerciasis control staff in current field techniques has been developed over the past year. This short in-service training course is planned to take place in the Public Health Training Centre in Lome, Togo. Field staff from OCP and non-OCP countries are expected to take advantage of this new training opportunity. 13. Even when the current technical and management support of the OCP has been successfully taken over by the countries, there would still remain a need for some intercountry coordination of these activities. It has been envisaged that WHO/AFRO will take on this role. The mechanism of the Regional Office which has been instituted for this purpose involving the WHO country office and the subregional teams is expected to serve this purpose. The WHO Representative and his expanded country team assisted by the Regional office will be a ready source of support for such intercountry coordination. l JPCt2.7 page 4 ANNEX I99I WORK PROGRAMME OF THE DEVOLUTION COORDINATOR ADOPTED BY THE TASK FORCE Ouagadougou, 2l March l99l I. MANAGEMENT SUPPORT TO NATIONAL DEVOLUTTON TEAMS l.l. Obiectives - To strengthen the epidemiological surveillance and ivermectin treatment capability of the national teams in the endemic regions and districts. - To give management support to the national teams in the implementation of Devolution. - To strengthen the capability of the national teams to identify and solve operational problems. - To make the authorities and populations aware of post-OCP problems of onchocerciasis (consciousness- raising). 1.2. Activities to be carried out 1.2.1. Yisit by the coordinator to the seven Participating Countries in the initial Programme area (Benin, Burkina Faso, Cote d'Ivoire, Ghana, Mali, Niger and Togo) to: (a) contact the authorities; (b) raise the awareness of the authorities with a view to revitalizing the National Onchocerciasis Committees (NOCs) and, particularly, encouraging the setting up of a devolution unit in each country; (c) identify obstacles to the implementation of the Devolution plans at the central intermediate and peripheral levels; (d) identify the needs in the field of onchocerciasis control integrated into other diseases in the endemic areas, particularly in the districts, with a view to a real start of the activities in the plans; (e) assess the needs as regards the training of district health personnel in the field of prevention and control of communicable diseases, particularly onchocerciasis. 1.2.2. To prepare, with OCP and institutes in the subregion, modules for the training of the national teams, trainers, health educators, and district health personnel. I.2.3. In collaboration with these institutes and OCP, to identify the objectives and methodologies of the seminars and workshops for trainers, on the one hand, and district medical and paramedical personnel, on the other hand, in the fields of: - management - epidemiological surveillance of communicable diseases - ivermectin treatment - health education JPCt2.7 page 5 Annex 1.2.4. To prepare a detailed timetable for the seminars and workshops. 1.2.5. To set up a system for the regular follow-up of the trained workers in the field. 1.2.6. To participate in certain technical meetings of OCP and institutes in the subregion related to devolution. 1.2.7. To produce sufficient quantities of ad hoc training documents and tools. 1.2.8. To organize an intercountry training seminar for trainers. 1.2.9. To organize seven national seminars for the responsible officers in the endemic districts in the fields of: - management - epidemiological surveillance - ivermectin treatment 1.2.I0. To assist in the preparation and implementation of protocols for: (a) CSA surveys on the acceptability of and participation of the communities in devolution activities. (b) surveys on ivermectin treatment logistics. 1.2.1 l. To encourage the National Coordinators to prepare a timetable of national meetings likely to discuss devolution-related questions. 1.2.12. To encourage the countries to organize a national onchocerciasis day. II MOBILIZATION OF RESOURCES FOR THE FINANCING OF DEVOLUTION 2.1. Obiective To promote the mobilization of resources for the carrying out of devolution activities 2.2. Activities to be carried out. 2.2.1. To ask the national authorities to let the Coordinator and a delegate from the national Devolution Unit participate in national or regional meetings where questions concerning planning and financing of socioeconomic development plans will be discussed (meetings on five-year development plans, meetings of financial backers of development projects, NGO meetings, etc.). 2.2.2. To encourage the Participating Countries to integrate Oncho Devolution plans into socioeconomic development plans implemented in the endemic areas. 2.2.3. To review the different national devolution plans with a view to identifying realistic and feasible activities likely to be financed from national resources, the AFROPOC 1992-t993 budget for the Participating Countries or by donors. 2.2.4. To encourage, in each country, the holding of a consultative meeting bringing together Directors of Studies and Economic Planning of the Ministries of Economic Planning, Foreign Affairs, Agriculture, Rural Development and Public Health as well as the National Coordinator and the Devolution unit to take stock of the situation as regards the implementation of Devolution in the endemic areas. JPCt2.7 page 6 Annex 2.2.5. To prepare and make available to the National Coordinators a synoptic information sheet on the NGOs, the areas in which they operate, and the volume and field of their activities in the Participating Countries. III. WRITING OF PROGRESS REPORTS 3.1. Obiective To keep the Regional Office and OCP informed of progress made in the implementation of the national devolution plans. 3.2. Activities 3.2.1. To collect available data in each country. 3.2.2. To prepare a detailed half-yearly report on his activities and those carried out by the seven Participating Countries as part of devolution. 3.2.3. To prepare an annual report. JPCL2.7 page 7 Annex IV. TIMETABLE OF COORDINATOR'S ACTIVITIES - I99I a PREPARATION OF DOCTJMENIS 1.. Plan of action 2. Training prcgrammcs 3. Situational analysis protocol 4. Slmoptic shcct 5. Rcvicw of plans 6. Progrcss rcpors MEETINGS AND SEMINARS 1. Mccting of thc Task Forcc 2. Training scminar for traincrs 3. National scminars 4. Mccting of DSPs 5. National Oncho scminar 6. Statutory mcctings TRAVEL 1. Information visit to countrics in initial arca 2. Scminars for traincrs 3. National scminars 4. Onchoccrciasis day 5. Mccting of DSPs 6. Statutory mcctings ACTTVTIIES March April May Junc July Aug. Scpt. Oct. Nov, Dcc. NOC EAC JPC JPC DSP = Directoratc of Studics and Planning. JPCt2.7 page 8 Annex V. PROVISIONAL BUDGET V. I. COORDINATOR'S OFFICE Y. 2. TRAINING/SEMTNARS V. 3. SUPPORT TO NATIONAL TEAMS ra I i f ITEM QUANTITY UNIT COST TOTAL CFA COST US $ l $:250 Coordinator's salary Driver Purchase 4 WD vehicle Fuel and lubricant Travel of Coordinator (air) Coordinator's per diem Equipment, Coordinator's office Various supplies Sub-total I I I 20,000 km l0 trips 100 days Suff. quantity Suff. quantity 12,500,000 2,250,000 3,750,000 50 200,000 41,000 lump sum lump sum 12,500,000 2,250,000 3,750,000 1,000,000 2,000,000 4,100,000 500,000 500,000 26,600,000 50,000 9,000 15,000 4,000 8,000 16,400 2,000 2,000 106,400 Production of teaching materials Training of trainers - Travel - Per diem participants - Per diem Consultant (facilitator) - Logistics National seminars - Travel - Per diem - Consultants (facilitators) - residents - Consultants (facilitators) - non-residents - Logistics Subltotal : Suff. quantity 6 participants 7 x l0 days 2 x 15 days 20 x7 countries 20x7x7days lxTxTdays lxl0xTcount. lump sum 200,000 40,000 62,500 lump sum 15,000 22,500 37,500 62,500 lump sum 500,000 1,200,000 2,870,000 I,875,000 500,000 2,100,000 22,050,000 1,837,500 4,375,000 500,000 37,807,500 2,000 4,900 I 1,480 7,500 2,000 8,400 88,200 7,350 17,500 2,000 l5l,230 ONCHO day and meeting of DSPs' 7 pays 750,000 5,250,000 21,000 I Grand total rounded up to 278,630 US $ 280,000 us $ 'DSP = Directorate of Studies and Planning