Sixteenth session of the Joint Action Forum - Abuja, Nigeria, 7-9 December 2010: final communiqué

aAFRTCAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) Sixteenth Session of the Joint Action Forum - Abuja, Nigeria, 7-9 December 2010 FrNAL COMMUNTqUÉ Agenda item 1: Opening of the Session 1. The Sixteenth Session of the Joint Action Forum (JAF) of the African Programme for Onchocerciasis Control (APOC) was hosted by the Government of the Federal Republic of Nigeria, from 7 - 9 December 2010 in Abuja, Nigeria. The meeting was attended by the Honourable Minister of Health Nigeria, the Minister of State for Health Nigeria, and General T.Y. Danjuma (retd), Grand Patron of MITOSATH and President of T.Y. Danjuma Foundation, Honourable Ministers and Deputy Ministers of Health, Permanent Secretaries and Directors of Public Health and Disease Control of L5 APOC and former OCP countries, 13 Representatives of the donor community, WHO (Geneva, WHO/AFRO), World Bank, UNICEF Nigeria, the African Development Bank (AfDB), the West African Health Organization (WAHO), Economic Community of Central African States (ECCAS), Economic Community of West African States (ECOWAS), Non-Governmental Development Organizations (NGDOs), the Mectizan Donation Programme, Merck & Co., lnc., Pfizer Pharmaceuticals, Research lnstitutions, Directors and Coordinators of National Onchocerciasis Control Programmes, Representatives of the Statutory Bodies of APOC, Representatives of the External Mid-Term Evaluation Team, Professor Adetokunbo Lucas and DHL. A complete list of participants is attached as Annex 1 2. JAF thanked the Government of the Federal Republic of Nigeria for the warm hospitality, and for hosting JAF L6. 3. ln his welcome speech, Professor C.O. Onyebuchi Chukwu, Honourable Minister of Health Nigeria acknowledged the historic significance of JAF L6, which comes at a point when APOC member countries have the possibility of eliminating infection and interrupting transmission of onchocerciasis. The meeting marks the 15th year of APOC's existence and is also being hosted in Nigeria for the first time. Professor Chukwu reiterated that the elimination of onchocerciasis and other Neglected Tropical Diseases (NTDs) will be a major contribution to poverty alleviation and the achievement of the Millennium Development Goals (MDGs). 4. MrAndre Mama Fouda, Ministerof Health Cameroon, and outgoingChairof JAF 15, represented by Mr Hayatou Alim, Secretary of State for Public Health, noted that onchocerciasis has been slowing the socioeconomic development of the African populations but there is now significant progress in the control of the disease. ln view of the new objectives of eliminating infection and interruption of transmission of onchocerciasis, approximately 10 additional years from 2015 and stronger engagement of African governments and the international community will be necessary. Mr Hayatou, also mentioned the need for continued harmonized and concerted cross border activities to achieve this objective. 5. Dr Uche Amazigo, Director APOC, thanked the President of the Federal Republic of Nigeria for generously hosting JAt 16. The meeting is particularly significant because of the recent External Mid- Term Evaluation of APOC, which addressed important issues of the future of APOC. Dr Amazigo emphasised that in order to achieve focal elimination of infection and interrupt transmission of River blindness, an additional USS 56 million would be required. She called for the increased commitment of national governments and donors, and that using the CDTI strategy and engaging and empowering communities to deliver ivermectin was estimated to save more than USS 10 million in 2009, when compared to the cost of other means of delivery. APOC has demonstrated to the global health Page I of 27 community the value and effectiveness of community-driven projects, especially in view of the growing interest in tackling NTDs. 6. Dr Suomi Sakai, UNICEF Country Representative Nigeria delivered a goodwill message which highlighted UNICEF continued commitment and support towards the control and elimination of onchocerciasis since 1991. UNICEF's interest in the onchocerciasis control programme is imperative considering that about 2% of an estimated 8 million people infected with the diseases in Nigeria are children between the ages of 5 and 15. 7. Dr Luis Gomes Sambo, Regional Director WHO/AFRO, noted in his statement that the 16th session of JAF was attended by some of the same donors who attended the first meeting in Washington DC, L5 years ago to initiate APOC - now hailed as one of the leading public health programmes in Africa. He highlighted the success of Equatorial Guinea, supported by APOC, in eliminating the blackfly vector of onchocerciasis from Bioko lsland. Finally, Dr Sambo congratulated Dr Uche Amazigo for the excellent performance of APOC under her pioneering leadership, noting that this would be her last JAF as Director of the programme, as she is retiring. 8. General T.Y. Danjuma, Grand Patron of MITOSATH and a prominent Nigerian entrepreneur described his personal experience with onchocerciasis, and because of his wish to see this disease eliminated, he generously offered to contribute to the APOC Trust Fund an amount of USS 1 million. General Danjuma, also requested the Government of the Federal Republic of Nigeria to consider contributing USS 10 million to the APOC Trust Fund towards closing of the gap of USS 66 million. 9. His Excellencythe Presidentof the FederalRepublic, DrGoodluck EbeleJonathan in his address, read by the Honourable Minister of Health welcomed all participants to Nigeria. ln recognition of the socioeconomic consequences of Onchocerciasis and other NTDs, the President reiterated the government's commitment to their control. Being aware that elimination of river blindness is a real possibility and determined that this debilitating disease should never again affect the African people, His Excellency expressed concern that APOC was due to wind-up by 2OL5, and thus stated that his government was willing to support APOC past this period. The Honourable Minister promised to bring to the attention of the President the request of General Danjuma for the Federal Government to support the APOC Trust Fund. JAF 16 was officially declared open. Agenda item 2: Election of Officers 10. The JAF elected the Government of the Federal Republic of Nigeria, in the person of Professor C.O. Onyebuchi Chukwu, Honourable Minister of Health, as Chair of JAF 16, and Kuwait as Vice Chair, in the person of Dr Abdul-Redha Bahman, Advisor, Kuwait Fund for the Arabic Economic Developrnent. Agenda item 3: Adoption of Agenda 11. The provisional agenda was adopted without any amendments Agenda item 4: Reflections of the Committee of Sponsoring Agencies (CSA) L2. Dr Chris Mwikisa, Chair CSA, highlighted CSA's support to APOC Management in putting together a set of detailed Terms of Reference and contracting an independent evaluation team to carry out the external mid-term evaluation of APOC requested by JAF 15. The objective of treating 90 million people by 20L5 and a vision of Africa without onchocerciasis are achievable given the sustained support and commitment of all partners. CSA thanked APOC Management for the excellent work they continue to perform. Page 2 of 27 i Agenda item 5: WHO Progress Report 13' The World Bank as fiscal agent thanked Dr Uche Amazigo personally for her contribution to the control of onchocerciasis in Africa which will go down as a historic landmark. Dr Amazigo has been at the helm of this programme which is not only for Africans by Africans, but also one of the most successful public- private partnerships within the health sector. 14. The WHO Progress Report (2009-2010) highlighted APOC's key activities during the reporting year, including the successful introduction of CDl in the curricula of 34 faculties of medicine, schools of nursing and health sciences in 20 African countries. Furthermore, in 2010 ApOC appointed a Gender Specialist in order to promote gender mainstreaming throughout the APOC programme. ln a special report, the Management showed how the policy decisions of JAF led to operational research (multi- country studies) and subsequently directed implementation strategies, resulting in the huge positive impact of APOC. As requested by JAF, an update on the implementation of JAF 15's decisions was presented and distributed to participants. L5' Following the presentation, there was discussion on the challenges facing the goal of treating 90 million people by 2015 and how to optimise motivation of CDDs, With regards to motivation it was pointed out that a multi-country study on incentives had been conducted and published by ApOC. lt was also noted that large populations remained untreated especially in post conflict countries, however, the appointment of Technical Advisers to these countries and renewed commitment of governments would aid in the attainment of the 90 million treatment figure by 2015. 16. JAF decided that analysis and plan on how to reach the remaining untreated population of 20 million by country, be presented to JAF 17. Agenda item 6: Country Reports L7 statements were given to the JAF by Honourable Ministers of Health of ApOC and ex-OCp countries. JAF thanked the ministers for their statements and endorsed the issue of sourcing new ways of funding for NTD control. Given a shift in donor funding from single disease to integrated health programmes, countries should increase efforts to integrate onchocerciasis with other NTDS while safeguarding the progress and achievements of onchocerciasis control programmes. 18' lt was noted that 30 countries have developed 4-5 year strategic plans for NTD control, and that WHO/AFRO and APOC have produced guidelines and are providing continued support for the production of such plans. 19' The treatment coverage presentation showed that 133,000 thousand communities in 15 countries distributed ivermectin in 2009, reaching a total population of 68.4 million, thus achieving geographic and therapeutic coverages of gL.4% and 73.Lo respectively. 20. The financial contribution of both governments and the NGDOs towards core CDTI activities and for equipment, logistic and salaries was presented. ln 2009, Governments disbursed a totat of USS 2,253,974 towards core CDTI activities and USS 7,724,3O8 towards equipment, logistic and salaries. The NGDOs released USS 700,250 for core CDTI activities and USS 688,973 went towards salaries. Page 3 of 27 Agenda item 7: Report of the Technical Consultative Committee (TCC) 21. Professor Mamoun Homeida, Chair TCC, presented the reports of the last two TCC meetings which were held in March and September 20L0. TCC had spent a considerable amount of time discussing the feasibility of elimination of infection and interruption of transmission of onchocerciasis, developing guidelines on criteria for elimination and reviewing the results of epidemiological evaluations. The committee also reviewed analyses of REMO data to assist in the delineation of transmission zones. The Chair of TCC informed JAF that APOC had recruited a gender specialist to reinforce gender rnainstreaming throughout the APOC Programme and that CDTI data was now being analysed and presented disaggregated by gender. Agenda item 8: Sub-regional Ministerial Meeting on Cross-Border Collaboration: Special Report from Chad 22. Following a recommendation of the first cross-border meeting for countries of Central Africa, held in Douala in October 2009, a second meeting was held in Ndjamena, Chad in April 2010. The Regional Director of WHO-AFRO, Dr Luis Gomes Sambo who was represented at the meeting, observed that onchocerciasis and other neglected tropical diseases knew no borders; so attention must be paid to cross border activities for control. To be efficient these strategies should not only be directed on onchocerciasis and NTDs but should equally integrate the efforts to control other diseases such as HIV/AIDS, meningitis, and notably, eradication of polio. After examining technical reports the Ministers rnade a number of statements including recommendations that countries should specify NTDs including onchocerciasis in their State budgets and to identify transmission zones for onchocerciasis. APOC was requested to provide technical and financial support for the finalisation of integrated mapping of priority NTDs and elaboration of strategic plans. Agenda item 9: Status of Onchocerciasis Control in Former OCP Countries 23. Dr Traore Mamadou Omar, National Onchocerciasis Coordinator (NOCP) Mali, provided an update on the status of onchocerciasis control in Former OCP countries which highlighted that in 2005-9 the threshold of 85% therapeutic and LO0% geographic coverage has been reached in all countries, except thefourpost-conflictcountries. Resultofanentomological studyof t83,264blackfliesfrom41 sitesin 6 countries were satisfactory, except in 7 sites in countries receiving support from APOC to improve the epidemiological situation, where infectivity rate is higher than the threshold of 0.5 per thousand flies. Agenda item 10: Elimination of Onchocerciasis Transmission in Africa: Recent Evaluation Studies and Update on Disease Distribution Map 24. ln response to a decision of JAF 15 directing APOC to build on information on elimination and to give advice on when and where treatment can be stopped - Dr Hans Remme informed JAF 16 that a conceptual framework has been written and circulated, and national workshops have been held to discuss and inform the countries on this issue. The latest and final results of the epidemiological evaluation conducted in six countries to assess progress towards elimination of infection and interruption of transmission showed that, 16 of the 17 sites were making good progress towards elimination and 8 of them with zero infection levels may have reached focal elimination. 25. JAF congratulated the team on the encouraging final results, and endorsed the need for entomological data to be used to contribute to decisions on when to stop treatment. Page 4 of 27 26. Discussion point: Epidemiological evaluation is an essential procedure in determining progress toward elimination. However, the unwillingness of some communities to accept the skin snip test for diagnosis of infection remains a challenge. Non-invasive methods of detection of infection, such as the Diethylcarbamazine (DEC) patch, need to be urgently made available for future evaluation and surveillance work. The legal agreement between WHO and the manufacturer of the non-invasive DEC patch has not yet been completed. Decision; JAF urged WHO to continue their efforts to conclude the legal agreement with the DEC patch manufacturer and encouraged countries to review related dossiers that WHO will provide to them in a timely manner. This is a prerequisite for the release of the DEC patch by WHO once the legal agreement with the manufacturer is concluded. 27. Discussion point: ln an elimination scenario there may be a need to treat with ivermectin in hypo- endemic areas, and the issue of possible SAEs in such areas co-endemic for loiasis was discussed. Decision: Treatment may be necessary in some areas of hypo-endemic onchocerciasis to interrupt transmission, however in areas with hypo-endemic onchocerciasis and greater than 40% prevalence of loiasis, treatment with ivermectin is not justifiable in view of the high risk of Severe Adverse Events (SAEs) in these areas. Further research is needed using other tools to eliminate onchocerciasis in these areas. 28. Discussion point: lt was noted that in an area with over 20 years of treatment positive cases are still found. This could be due to non-compliance to ivermectin treatment or other reason, i.e. human migration from other areas. ln summary, 17 sites had been surveyed in the last two years in 5 countries including Vina valley, Cameroon, which is regarded as having the highest prevalence of onchocerciasis in the world. Decision: Before changing the strategy to achieve elimination in such areas, JAF decided that APOC should undertake research to determine the reason for the occurrence of these positive cases. Entomological surveys should be undertaken as quickly as possible to determine the next steps. 29. Discussion point: The issue of transmission zones, which cross international boundaries, for example between DRC and Uganda, illustrated the need for cross-border collaboration. Decision; JAF requested countries to ensure that treatment should cover the entire transmission zones in such areas and this would require strengthened cross border collaboration, 30. Discussion point: ln light of the frequent low treatment coverage in projects in some post conflict countries, it was noted that there might be a need for alternative approaches, especially to accelerate progress towards elimination. Decision: JAF endorsed further research by APOC in post conflict countries as a means of identifying other approaches to increase treatment coverage. Agenda item 11: Co-implementation 31. The results of co-implementation in 2009 presented to JAF, showed that a total of 98.6 million treatments had been given for nine health interventions including delivery of ivermectin. Details of the proportions of female CDDs delivering these interventions were shown to demonstrate how the gender balance of male to female CDDs varied by country and disease. 32. WHO/AFRO thanked APOC Management and Dr Amazigo personally for her close collaboration with WHO/AFRO on co-implementation of NTDs using the CDI strategy. This new spirit of collaboration is fundamental in helping reduce the burden of NTDs in the African population. Presentation by the Department for lnternational Development (DflD) 33. ln 2008, DflD made a commitment to support co-implementation. Noting that the economic downturn has made decision-making more challenging, DflD had doubled its support to onchocerciasis control to Page 5 of 27 f1 million annually and fortunately the development aid funds from UK had been 'ring-fenced'. However, Mr John Gibb emphasised the need to demonstrate results of co-implementation in order to maintain and increase support. This would require strong communication messages although NTDs are still getting more recognition. Health system strengthening is also receiving a larger proportion of the health budget. Also, there is still a need to maintain funding to develop new drugs, diagnostics and for operational research. 34. Following discussion on the need for good communication to maintain funding, JAF decided that APOC's communications strategy should be strengthened. Agenda item 12: Capacity Building of Countries 35. Among other key capacity building activities, results from APOC fragile states for the period of 1996 - 2009 showed that there were 40 CDI projects operating in 7 fragile states where 25+ million persons had been treated in 2009 with a geographic coverage of 9lo/o. A total of more than 157,000 Ministry of Health staff and CDDs had been trained by APOC. Country level training had covered the CDI strategy, HSAM, mapping, financial management, data management, reporting, Geographical lnformation System (GlS), epidemiology and entomology. Agenda item 13: Report of the External Mid-Term Evaluation of APOC, 20LO 36. Following a decision of JAF 15 an evaluation of the APOC programme took place between July and September 2010. The Objectives were to evaluate: establishment of country led CDTI systems, strengthening of health systems, co-implementation, and the shift from control to elimination, The team was requested to give a fonarard looking vision in their report. The methodology, conclusions and recommendations have been published in a report provided to all participants of JAF 16, concluded that APOC is an evidence-based Programme and nan outstanding privote-public portnership for diseose control, remains one of the teoding heolth intervention success stories in Africa". The key conclusions and recommendations are related to APOC's contribution towards strengthening of health systems and co-implementation; the Programme's capacity to facilitate guidance to countries for elimination; progress made with transition to country ownership and transforming APOC's governance arrangement including its secretariat now and beyond 2015. 37 . JAF endorsed the external evaluation report and approved its recommendations subject to the comments outlined under the 'Outcomes of the Closed Door session agenda item.' 38, Donors noted with satisfaction that the report addressed issues of sustainability, and cautioned partners on the potential burden of the shift from control to elimination and the need for flexibility in managing future challenges. 3g. Discussion point: The conclusions of the report of the external evaluation describe a number of recommendations for the future of APOC. The cost and prioritisation of each of these recommendations will need to be estimated in order to aid decision-making especially in view of the potential burden of shifting from control to elimination. Decision: JAF requested APOC to work closely with its statutory bodies (CSA and TCC) to make a proposal based on estimated cost and priority of each of the different recommendations to be presented to JAF 77 in 20LL. 40. WHO/NTD noted that the sustained implementation of yearly community-wide distribution of ivermectin by APOC had managed to interrupt transmission of onchocerciasis in selected areas' lt is the biggest reward for a well-run programme that has managed to sustain effectively its activities over the last 15 years. APOC was encouraged to closely link its efforts with WHO to scale up comrnunity based Page 6 of 27 chemotherapy for NTDs. WHO/NTD concurred with the technical analysis made by the APOC mid-term evaluation in 2010 on the need to focus on consolidating the present achievements in onchocerciasis control and not to "become the lead institution to manage multiple diseases." Lastly, reference was made to the remarks of the Regional Director of WHO/AFRO to ensure a one WHO approach in leading our effort to intensify the struggle at the global, regional and national level against NTDs in Africa Agenda itern 14: Outcome of Closed Sessions 41. Separate closed sessions of African Health Ministers, Donors and NGDOs were held to review the Report of the External Mid-Term Evaluation of APOC. JAF accepted the report and endorsed its recommendations subject to the following: 42. Discussion point: Recommendatlon on Contribution of APOC towards System Strengthening and Co- lmplementation (page 41, para 114 - 116): Undeftake comprehensive reseorch to explore the dynomics of existing CDls including incentive and sustainability option so it may be better stondardized ond replicoted for Communiÿ Health System strengthening in countries to support co-implementotion, Decision: Accepted with guidance provided to APOC to: o Prepare a document on guidelines for health systems strengthening with the guidance of the Regional Director of WHO/AFRO. Special arrangements should be made for a discussion of this report at the Regional Committee meeting of WHO/AFRO in 2011 (Minlsters of Health). o lntegrate CDTI with other community driven programmes such as cost free delivery of ITNS and vitamin A, where such programmes exist in APOC supported countries. The creation of parallel programmes was strongly discouraged (NGDO Group). o Consider this recommendation within the framework of WHO/AFRO's NTD plan (NGDO Group). 43, Discussion polnt: Recommendation on APOC Activities and Capacity to Facilitate Guidance to Countries for Elimination (page 42, para. tl9 - 1,24lz APOC should continue the mopping of the stote of each tronsmission zone. This will allow the progromme and partners to be precise on when and where to stop ivermectin distribution. Decision: Accepted with the following observations: o Surveillance and cross-border activities should be strengthened in the African region (Ministerc of Health) o APOC should continue the mapping of transmission zones. APOC was requested to address the issue of whether and how to treat hypo-endemic areas; the report should be shared with JAF17 (NGDO Group) o Elimination should be targeted to projects showing long duration of ivermectin treatment with high coverage, however there is need for flexibility in order to respond to different epidemiological situations for APOC (NGDO Group) o APOC should develop a clear comprehensive communication strategy for countries that are targeting elimination (NGDO Group) o The request to hire additional Entomologists was endorsed; however, priority should be given to devolving activities to the countries. (NGDO Group) o APOC partners are committed to attaining the goal of elimination; this would provide good advocacy for partners and encourage collaboration between APOC and WHO/AFRO. (NGDO Group) o The Executing Agency should advise on legal and programmatic implications of the new memorandum of understanding that would possibly need to be developed and signed between countries and funding partners. (NGDO Group). PageT of 27 44. Discussion point: Recommendation on progress made with transition to Countries lpage 44, para. 129 - 132): There is need for a consultont to be recruited to do o proper interventions analysis ond costing scenorios organization of services ond in view of the acceleration towards elimination. Decision: Adopted with request to APOC to: (i) consider this recommendation within the framework of WHO/AFRO's NTD plan (NGDO Group); (ii) engage in debates on NTD control activities (NGDO Group). 45. Discussion point: Recommendation on Transforming APOC Governance Arrangement lncluding APOC Secretariat: now and beyond 2015 (page 45, para 135 - 136): The governing body of APOC should consider engoging the expertise of a consultant (or health systems monagement consulting firm) with experience in orgonizotional restructuring to study and make recommendotions for tronsforming APOC's governance. Decision: Adopted with acknowledgment that this recommendation focuses on the post 2015 scenario and the suggestion from JAF 15 discussions that there is a need for a 'Think-tank' or other advisory mechanism for onchocerciasis control. APOC in some form should post-2015 continue to operate as a centre of excellence for CDTI, Lastly, it was concluded that APOC has much to offer in terms of tools and lessons learnt from its experience in implementation of CDTI (Donors). The need for a robust APOC communication strategy was reiterated (NGDO Group). 45. Following the statement, all groups reaffirmed their commitment to onchocerciasis control and its elimination where feasible; and the Ministers of Health thanked donors and appealed to them for flexible donations for co-implementation of activities beyond 2015. Lastly, an overarching observation was the need to harmonise recommendations in the executive summary with those found in the main part of the report. Agenda item 15: Health !mpact Assessment of APOC Operations 47. The presentation highlighted the impact of APOC on prevalence of onchocerciasis infection and related disease, taking account of mass treatment provided since the start of APOC up until 2009. ln this period the prevalence of itch declined from !4.3% to 2.7Yo, the prevalence of low vision from 1.0% to O.7o/o and the prevalence of blindness from 0.4% lo 0.2%.The burden of disease decline from about 2000 to 643 DALYs/100,000 people. With an estimated APOC population of a 100 million people in 2010 the absolute number of people with low vision and blindness is estimated al 2.8o/o, 0.7 million and 0.2 million respectively. This corresponds to a disease burden of 0.7 million DALYS. 48. APOC Management noted that the capacity building workshop on ONCHOSIM was very helpful and that similar meetings will be held annually, Agenda item 16: Current Research within APOC and TDR Collaboration 49. Dr Annette Kuesel from TDR informed JAF of the progress in (1) development and testing of CDI -based strategies in urban, nomadic and pastoral communities, and in rural communities to strengthen Primary Health Care, 12) research for markers of O. volvulus response to ivermectin, (3) development of moxidectin and ( ) research to discover new molecules that could be evaluated for their potential to improve onchocerciasis control. The unblinded results of the Phase 2 moxidectin study suggest that moxidectin is not a single dose macrofilaricide but extends the period during which no microfilaria are detectable in the skin and reduces skin microfilaria levels at 12 and 18 months post treatment relative to ivermectin. There is no safety concern with Moxidectin in Phase 2. The data will be further analysed for the implications for further development. The Phase 3 study is now ongoing in Liberia, DRC and Ghana; as per the agreed upon strategy, the community trials should start in 20tL or 2012 and be completed by 2015 or 2016. They will provide the data required to assess whether moxidectin is safe Page 8 of 27 for onchocerciasis control programme use and has an effect on parasite transmission sufficiently superior to that of ivermectin to warrant consideration for control programme use. Agenda item 17: Report of the NGDO Coordination Group for Onchocerciasis Control 50. Members of the NGDO Group supported 84 million treatments in the Americas, Africa and Yemen and contributed USS 7.7 million to country programmes and projects in 2009, The Group's report focused on the achievements and challenges faced by the Group during the reporting year, including lack of NGDO support in some projects in Angola, DRC and Uganda. The Group renewed its commitment towards onchocerciasis control and elimination activities in view of the new trends towards NTD control. Additional funding from the APOC Trust Fund would be needed to address new challenges. 51. JAF received with thanks the report and encouraged the Group to seek other funding opportunities independent of the APOC Trust Fund. Given that funding is now focused more on NTDs, there are significant benefits to making broader coalitions. Agenda item 18: Ouagadougou Multi-Disease Surveillance Centre (MDSC) 52. Professor Evariste Mutabaruka, Director MDSC provided results of entomological surveillance conducted by the centre in 2009. Current research projects include (i) trans-border fly movement between Benin and Nigeria; (ii) feasibility of elimination on onchocerciasis and; (iii) modelling of onchocerciasis using G|S-remote sensing. The centre continues to expand its training programme, and had provided entomology training to APOC countries in 2010. 53. Discussion point: Between 2009 - 10 the APOC Trust Fund has disbursed close to US 51 million to MDSC for personnel costs and utility expense, specifically towards onchocericiasis activities. The centre currently faces an immediate financial crisis with no funds for staff salaries for the onchocerciasis surveillance unit as of January 2011. Decision: JAF recognised the vital role of MDSC especially in relation to the shift from control to elimination of onchocerciasis, and expressed serious concern about the funding and staffing of the centre. (i)JAF requested that MDSC prepare a budget and a business plan for 20LL exploring alternative funding sources and should submit it to CSA; (ii) JAF also requested APOC to prepare an estimate expenditure on onchocerciasis surveillance to be reviewed by CSA (iii) JAF requested that CSA propose rapidly a solution to ensure sustainability of surveillance activities on onchocerciasis, and take the necessary actions on its behalf and report back to JAF L7; (iv)JAF encouraged MDSC to position itself as a leading institution on disease surveillance activities in Africa and to expand its support to other NTD surveillance within the continent. Agenda items L9-2L: Programme Management and Finance 54. Discussion poînt: The audit report, additionalfunding of the Plan of Action and Budget (PAB) and the plan of action and budget for 2072-2013, (for the amount of USS 36,108,000) and the current state of the APOC Trust Fund were presented to JAt. Decision: JAF approved : (i) the additional funding for Phase ll and Phasing out period, Plan of Action and Budget 2Ol2 - 2015 for an amount of USS 49,5 million (ii)the Plan of Action and Budget 2072-2073for an amount of USS 35,108,600. Page 9 of 27 Agenda item 22: Financing of APOC 55' The World Bank as fiscal agent presented a balanced budget for APOC activities up to 2015. This budget did not include cost relating to the recommendations endorsed in Agenda item 14. Agenda item 23: Donor Pledges 55' The international donor community and the NGDO Group reaffirmed their commitment to onchocerciasis control in Africa, and pledged more than USS 30 millions to support member states through APOC over the next biennium. Other Pledges 57. The Grand Patron of MITOSATH, General T,Y. Danjuma pledged an amount of USS 1 million to the ApOC Trust Fund. The Kitasato lnstitute also pledged USS 60,000 for bicycles and mobiles phones to Community-Directed Distributors (CDDs) of lvermectin working in areas with Severe Adverse Events (SAEs). OTHER BUSINESS: o Onchocerciasis Control-from Abuja and back: onchocerciasis control through changing health scenarios 58. Professor David Molyneux former Chair of the OCP Expert Advisory Committee (EAC) and also former Director of the Centre for Neglected Tropical Diseases Liverpool School of Tropical Medicine, described the history of the development of onchocerciasis control from aerial larviciding up to the present progress of treatment using ivermectin alone. He emphasised the fact that NTDs account for a similar burden of disease to malaria and TB and cause more death than maternal mortality in Africa. Professor Molyneux, noted that there are many issues associated with elimination of onchocerciasis that need to be examined with care, for example, certification of elimination. He further advised that a flexible approach to elimination would be required and suggested the need for a "think tank" to assist the changing environment and mindset towards interventions against Preventive Chemotherapy (Pfi) diseases. o A eulogy for Dr René Le Berre 59. A minute of silence was held in memory of Dr René Le Berre, a Scientist from the French lnstitute for Research in Development (lRD) and first Director of Vector Control Unit of OCP. He undertook and encouraged capacity building of Africans before joining WHO in Geneva, where he remained committed to onchocerciasis activities until his retirement. Dr Le Berre is remembered for his pioneering ideas which led to the creation of OCP, a Programme that would for the very first time adopt a regional approach to diseases control in the African continent. . Statement from Dr Uche Amazigo, Director APOC 60, ln her retirement speech from her current position as Director APOC, Dr Amazigo expressed gratitude to Dr Margaret Chan, WHO Director General, Dr Sambo, Regional Director WHO/AFRO for their guidance and support. She also thanked the governments, donors, CSA, WHO /Legal, NGDOs, TCC, NOTFs and researchers from Africa, Europe and North America and her colleagues and staff at both WHO Geneva, WHO/AFRO and APOC in Ouagadougou, for their unparalleled commitment to the programme. Dr Amazigo thanked the Governments of Nigeria and Burkina Faso and gave her personal thanks to the President of Burkina Faso for the warm hospitality extended to APOC and OCP. She also thanked her family for their love and support. Page t0 of 27 {61, JAF acknowledged the tremendous impact that Dr Amazigo had personally made toward the control of onchocerciasis in Africa. Citations were read from partners in appreciation. . Special tribute to champions of onchocerciasis control 62. JAF acknowledged the dedicated contributions to APOC and onchocerciasis control made over many years by Dr T. llunga, former Manager of Health Division, AfDB; Professor D. Molyneux, former Director of the Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine and Dr M. Ntep, National Onchocerciasis Coordinator, Cameroon. o Presentation of gifts to JAF heads of delegations by the Government of the Federal Republic of Nigeria 63. The JAF delegations were presented with gifts by the Government of Nigeria. Agenda item 24: Date and Place of the Seventeenth Session 64, At the kind invitation of Kuwait, the lTthsession of JAF will be held in Kuwait. Dates will be communicated to JAF members in the coming months. 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