II II JOINT ACTION FORUM Offrce of the Chairman African Programme for Onchocerciasis Control (APOC) Programme africain de lutte contre I'onchocercose JAF-FAC FORUM D'ACTION COMMUNE Bureau du Président JAFl0.10 ORIGINAL : ENGLISH October 2004 JOINT ACTION FORUM Tenth session Kinshasa DRC). 7-9 December 2004 Item l7 of the Provisional Aeenda TERMS OF REFERENCE FOR THE EXTERNAL EVALUATION of the African Programme for Onchocerciasis Control (APOC) for the period 2001-2004 t JAFI0.10 Page I 1. Introduction and Background (i) The primary purpose of the African Programme for Onchocerciasis Control (APOC) is to establish sustainable, community-directed ivermectin (Mectizan) delivery approaches covering approximately 90 million people in l9 countriesr which fall outside the scope of the earlier Onchocerciasis Control Programme (OCP) in rü/est Africa. These systems are being established to become sustainable'by 2OlO.It is estimated that a minimum of 30 million people living within the APOC countries are currently heavily infected with onchocerciasis. (ii) The formal objectives of APOC approved by the Joint Action Forum in 2001 in Washington reads as follows: "To establish, within a period of 12 to 15 years, effective and self-sustainable, community-directed ivermectin treatment throughout the endemic areas within the geographic scope of the Programme, and, if possible, in selected and isolated foci to eradicate the vector by using environmentally safe methods. Tlte attainment of tltis objective l's expected to contribute towards the elimination of onchocerciasis as a disease of public health and socio-economic importance througltout Africa and so contribute to improving the welfare of its people. It is worth stressing that the duration of APOC operations is limited in time and that the Participating Countries will assume, lvithout major external support and well beyond the end of APOC, Iïll responsibility for the continuation of community- directed treatment with ivermectin, set in course by the Programme." (iii) The principal tool for controlling and eventually eliminating onchocerciasis as a public- health problem is Mectizan, which is being given free-of-charge by the producer, Merck & Co., Inc., for "as long as needed." One dose of this drug given annually reduces the load of microscopic, larval worms in the human body by up to 95oÂ, without serious side effects. It thereby relieves intense itching and prevents occurrence of blindness. It is estimated that at least one billion free Mectizan tablets will be distributed over the life of APOC, having a value exceeding one billion US dollars. (iv) The total cost of APOC over the 15-year period is estimated to be US$135 million, to be contributed by the donor community and an additional of 25%o of this amount are bome by the Non-Governmental Development Organization §GDO) Coalition and the African countries.The average cost per person treated per annum after establishment of sustainable community-directed treatment with ivermectin (CDTI) ts approximately Angola, Burundi, Cameroon, Central African Republic, Chad, Democratic Republic of the Congo, Republic of Congo, Equatorial Guinea, Ethiopia, Gabon, Kenya, Liberia, Malawi, Mozambique, Nigeria, Rwanda, Sudan, Tanzania, Uganda Sustainability has been defined by an APOC special task force tn 2004 as follows: "CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high heatment coverage, integrated into available health care services, with strong community ownership, using resources mobilized by the community and the government." JAr'10.10 Page 2 US$0.25. APOC will protect the donor community's substantial investment of US$600 million in OCP. OCP has succeeded over the past 25 years in virtually eliminating onchocerciasis from a ten-country subregion in West Africa. By controlling onchocerciasis in Nigeria, APOC will protect the entire eastern flank of the OCP subregion from re-invasion by infective blackflies, which could otherwise re-establish the disease in the OCP countries. Twenty donors and all 19 African countries signed a multilateral agreement, bringing the program legally into force as of April 1996. Twenty donors have committed US$65 million in financing the Phase II (2002-2007) and the Phasing-Out Period (2007-2010) program, and ll7 projects in 16 countries had been approved for financing by the end of 2004 to alleviate suffering and prevent blindness among a total population of nearly 50 million people per annum. 2. 0biectives of the Review The objectives ofthe external review are: (i) To assess progress towards meeting the Program's objectives, including an evaluation of operations, and to make appropriate recommendations on the Program's strategies in order to fulfill its objectives by the year 2010. (ii) To make recornmendations on how best to sustain CDTI post-2O10 in order to eliminate onchocerciasis as a public-health problem throughout the APOC countries. (iiù To review the program's progress in light of the impact data. 3. Terms of Reference 3.1. Programlmplementation (i) To review and evaluate the performance of the Program to date, with particular emphasis on the Community-directed Treatment (ComDT) strategy and the effect on coverage and sustainability. (ii) To review treatment and evaluate also the performance and impact of focal vector elimination projects. (iii) To make recommendations on actions to be taken in areas where peripheral health systems are weak or non-existent. (iv) To examine the strategic prospects for achieving the Program's objectives by the year 2010. (") To assess the adequacy of monitoring procedures and to suggest improvements, which might be made. (vi) To assess the adequacy of the impact assessment of APOC operations and make recommendations for future impact evaluations. (vii) To evaluate operational research and application of its findings 3.2 3.3 3.4. 3.5. JAFl0.10 Page 3 (viii) To assess the role of the Program in conflict/post-conflict oncho-endemic areas and among displaced-person populatious. Coverage and Sustainability of the Program (i) To review treatment coverage achieved by the Program since its inception, as well as methods to expand coverage further. (ii) To review progress made towards enhancing the long-term sustainability of ComDT including the role of partnerships and community involvement and make suggestions for improvement. Integration of ComDT into the Health Systems (i) To evaluate progress towards integrating ComDT into existing health systems in the Participating Countries and, within this context, the utilization of the ComDT system for the integrated delivery ofother health interventions. (ii) To examine APOC's contribution to health-systems development in Participating Countries, particularly the achievements of the Program in local capacity building. (iii) To review the impact of the Program on the quality of local health services, including Primary Health Care, especially in the poorest communities. Financial integration of APOC (i) To assess APOC financial management systems and propose ways to progressively integrate them into national health accounts and general national public fi nancial management systems. (ii) To review present APOC financing systems and propose alternative ways of financing APOC under programmatic and general budget support, i.e. SWAP and PRSC respectively. (iii) Carry out a program expenditure tracking survey in a proper sample of APOC projects. (iv) To provide a preliminary assessment of the participating governments' willingness to continue hnancially supporting APOC program operations after 2010 and to propose steps which could facilitate the program integration. Program Management (i) To assess the adequacy and effectiveness of management and staffing at the Program Office in Ouagadougou and the role of the Technical Consultative Committee (TCC) and the Committee of Sponsoring Agencies (CSA) in light of consolidating and ensuring sustainability of Program operations. JAF10.10 Page 4 (ii) To examine the financial management and controls of APOC vis-à-vis projects rn the field. (iiD To review program management at the different levels of the national health systems and make recommendations for better integration and effectiveness. 3.6. Partnership (i) To assess the technical, financial, and operational contributions ofthe partners at the country level, namely the Ministries of Health, APOC, NGDOs and other partners. (ii) To assess the scope of the partnership and how it works at the country level. 3,7. OrganizationalAspects (i) The evaluation rvill be organized by the Committee of Sponsonng Agencies (csA). (ii) The evaluation will be carried out by independent experts. The CSA, with input from the donors and the NGDOs, will finalize the composition of the Evaluation team, insuring that the required expertise is represented, and arrange for secretarial support. (iiD The evaluation shall take place during 200412005. APOC staff will provide information to the Evaluation Team, and the Mectizan Donation Program (MDP), the NGDO Group, and members of the Technical Consultative Committee may be invited to act as resource persons where required. (iv) Evaluations of the roles of the various partners, 9.g. NGDOs, Participating Governments, and local communities will be grouped together and separated from the evaluations of APOC pgl se in the body of the report. (v) Field visits to the APOC area will be arranged as required. (vi) The evaluation report will be considered in final draft form by the CSA and presented to the December 2005 session of the JAF for adoption. 3.8. Skills Requirement The six members of the Evaluation Team would have the following skills: Epidemiologist, Social Scientist, Entomologist, Economist, Public Health Specialist, and an expert with experience in Administration and Finance.
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