National Onchocerciasis Committee: final report of the thirteenth meeting, Ouagadougou, 6-9 June 1989

NATIONAL ONCHOCERCIASIS COMMITTEES Thirteenth meeting Ouagadoqgou, !:9 t!4e 1p!! FINAL REPORT CONTENTS A. OPENING OF THE MEETING B. ELECTION OF OFFICERS C. ADOPTION OF THE AGENDA PROGRESS REPORT OF THE PROGRA},IME DEVOLUTION SOCIOECONOMIC DEVELOPMENT OF THE ONCHOCERCIASIS-PROTECTED ZONES OTHER MATTERS DATE AND Plj,CE OF FOURTEENTH MEETING ADOPTION OF THE REPORT CLOSURE OF THE MEETING ANNEX 1: LIST OF PARTICIPANTS ANNEX 2: STATEMENT ON DEVOLUTION BY THE REGIONAL OFFICE OF I.IHO FOR AFRICA. ONCHOCERCIASIS CONTROL PROGRAMME IN WEST AFRICA PROGRA.I,IME DE LUTTE CONTRE L'ONCHOCERCOSE EN AFRIQUE DE L'OUEST Noc/13 Page L2 13 13 T4 t7 2 2 2 3 3 7 D E F G H I J l2 ( N0c/13 Page 2 A. OPENING OF THE MEETING 1. The thirteenth meeting of the National Onchocerciasis CommitEees (NOC) was held in the headquarters of the Onchocerciasis Control Programme (OCP) in Ouagadougou from 6-9 June 1989. The meeting was opened by the Programme Director who extended a warm welcome to participants, especially to those who were aEtending for the first time. 2. The Programme Director recalled that during the twelfth meeting of the National Onchocerciasis Committees (Conakry, 1988), Ministers of Participating Countries decided that they would not participate in the 1989 meeting, but would allow the technicians of their minisEries to address the practical i-ssues scheduled for discussion. It was therefore hoped that the parEicipants would take fuIl advantage of this opportunity to freely express their views and to seek clarification on points of particular concern to them. 3. The composition of the delegations (1 representative from Ehe Ministry of Rural Development, 1 from the Ministry of Planning and 1 from the Ministry of Health) was a reflection of Ehe Prograrnme's and of the Donors' views that the developmenE of onchocerciasis-controlled land, for food production, was a high priority. Now that a large part of the original Programme area was available for development it was very important that the appropriate natlonal authorities give serious attenEion to the formulation and implementation of their development plans The Committee of Sponsoring Agencies (CSA) would always be ready to assisE Governments in this respect, but it had to be remembered thaE development was a national respons ibility. 4. It was recalled that during the sixth session of the Joint Programme Committee(Geneva, 1985) it was decided that CSA would be responsible for conducting regional development studles. These had commenced some time ago and the first one, known as the "Hunting Survey", had aready been completed. A second populaEion, reseEtlement study, was now in progress. B. ELECTION OF OFFICERS 5. As the neeting was addressing two important subjects, separate officer{ were elected for the Devolution Bureau and for the Socioeconomic Development Burdau. For the DevoluEion Bureau, Dr A. Tiemtor6 (Burkina Faso) was elected Chairman, and, Dr B. Be1la (C6te d'Ivoire), Vice-President. For the Socioeconomic Development Bureau, Mr K6dagni S6d6gnan (Togo) was elected Chairman and Mr Abdou Hima (Niger) Vice - Chairman. C. ADOPTION OF THE AGENDA 6. The following agenda was adopted: (i) Progress report of the Programme (1i) Devolutlon Progress Report of Burkina Faso - Study of the draft Plan of Devolution of Niger - Prellminary study of the draft PIan for Devolucion of Mali - Guidelines for the draft Plans for Devolution of the oEher countries in ) NOC/13 Page 3 the initial OCP area (Benin, C6ce d'Ivoire, Ghana, Togo) Collaboration of the western and southern extension countries in ivermecti-n distribution (iii) Socioeconomic development of the onchocerclasis-protecced zones - Introduction - Work in groups - Presentation of reports by delegatlons - Discussion (iv) Other matters (v) Date and place of fourEeenth meetlng (vi) Adoption of report (vii) Closure of the meeting. D. PROGRESS REPORT OF THE PROGRA},IME 7. The Programme Director reiEerated that Ehe Programme was progressing according to plan towards its final objective, which was to control onchocerciasis as a disease, buE noE to eradicate it. In this respect, the greater part of the original Programme area (affecting 7 participatlng countries) was under effective control with the Programme's objecEive having been achieved. Control operations had also been extended to the l.Iest and to the South-east. 8. Accordingly, both Ehe Prograrnme and some of the Particlpating CounErles were now ready for devolution. A plan for Burklna Faso had already been prepared and adopted by the JPC. Similar plans were being formulated for Niger and eastern MaIi. In 1990, it would be appropriate for Benln, Togo, C6te d'Ivoire and Ghana to complete their respective devoluEion plans. As lras the case with Burkina Faso, representatives of the tlorld Bank and of the Programme would visit the oEher countries to collaboraEe in the forrnulation of their plans. 9. Control activities were now being conducted over the whole of the Programme area chrough combined larviciding and ivermectln distribution. In the extensi-on areas, where larviciding operations has commenced only recently, lvermectin distrtbution will be an additional tool for onchocerciasis control. 10. Finally, the Programme Director underlined the importance of rigid budget conErols Eo maintain maximum cost-effectiveness in all activlEles, whether they were conducted by the Programme or by the Participating Countries. E. DEVOLUTION 11. Dr M. Tour6, Director of Programme Management, and representatlve of the Director of the Regional Office of LrHO for Africa presented a statement on devolution, which is presented in Annex 2. Progress report of Burkina Fas o 12. The reporE presented by Burkina Faso reviewed the schedule of actlvities NOc/13 Page 4 undertaken by the Department of Epidemiological Surveillance and Vaccination within the framework of devolution, si-nce the 9th sessi-on of the JPC (Dakar, 1988). 13. One hundred and ninety-five health workers, people employed in Ehe field(doctors and especially nurses of different categories), had been trained in Ehe meEhodology of surveillance and of the treatment of onchocerciasis with ivermectin. The tasks allocated to such trained personnel essentially consisted of: i) tracing the last remaining cases of onchocerciasis and treating them, and, ii) monitoring and keeping a close watch on all possibilities for recrudescence of the disease. These same health workers had also been Erained in the methodology of surveillance and of the control of trypanosomiasis, for which disease there was fear of recrudescence. One third of the OCP area in Burkina Faso was already covered by these trainin€: activities. 14. On the subject of training, the Programme Director recalled that: i) preference had to be given to training in African institutions, for reasons of efficacity and cost, and to curtail the drain of people who had been trained, ii) the Programme was exploring the possibilicies of reinforcing at least one Francophone and one Anglophone institute for training epidemiologists from OCP countries. 15. It was reportsed that cerEain Ghanaian villagers feared to return to zones liberated from onchocerciasis. However, experience in Burkina Faso had shown that this problem did not exist in that country, in view of: i) the scarcity of fertile land, and, ii) the severity of recent droughts. Nevertheless, it was strongly recommended to proceed with sErict sensitization of villagers with regard to the return of blackflies which, in any case, would not be infected. 16 Burkina Faso had not experienced any great difficulties in its ivermecEin treatment campaign at Pendi6. However, special attention had to be given to the treatmenE of other ailments in order co faciliEate the acceptability of ivermectin. 17. The strengthening of health structures was of paramount importance in the opinion of the participants. In chis regard Ehe Programme Director advised the participants that it would be wise to be moderate in their requests for assistance in the reinforcement of their national health structures. It was advisable that only a few other diseases be associated with onchocerciasis, if financing for projects was Eo be easily secured. 18. The search was continuing for macrofilaricides which were effecEive against O.volwulus . 19. The supply of ivermecEln to the Participating Countries was aE present father complicated in that Merck had decided that: i) OCP would only receive ivermectin destined for use in the OCP area, by OCP staff or under OCP supervision, and, ii) any organization could receive ivermecEin direcE from Merck provided that the application passed through the Minlstry of Health of the country concerned. 20 The meeting recommended Ehat for the eleven Participating Countries, OCP continues to be the sole lnstltution responsible for the ordering and for the delivery of ivermectin. Noc/13 Page 5 Study of the draft Plan of Devolution of Niger 21. The draft plan of devoluEion of Nlger, not havlng received clearance from the Niger authorities, was presented ln only broad terms. 22. This plan placed emphasis on the extension of the surveillance prograrnrne to the Regions of Kolo, Tillaberi and Gaya, ln addition to those of Say and T6ra in which onchocerciasis had been entirely controlled. 23. The plan took account of: i) the total interruptlon of transmisslon in Niger, and, il) the intention of applying the standard OCP methodologies for surveillance and for the treatment of onchocerciasis with ivermectin. 24. The Programme Di-rector announced Ehat representatives of the Programme and of che World Bank would soon visit Niger to assist in the finalization of che p1an. He insisted on Ehe necessity to have this task accomplished before the end of July 1989 so that the plan would be available for the Donors' ltleeting later in Ehe year. Preliminary studv of the draft Plan of Devolution of Mali 25. The draft devolution plan concerns that part of the original Programme area located in Mali, i.e. the Regions of Slkasso, S6gou, Koulikoro and Mopti. 26. In addition to onchocerciasis, the proJect would also be concerned wlth trypanosomiasis, malaria, schistosomiasis and dracunculosis. 27. Surveillance of onchocerciasis control had been placed under the responsibility of the Department of Public Health, Divlsion of Epidemiology and Preventive Medicine. 28. Activities would be principally oriented to the "cercle" level and directed tolrards the detection and treatment of onchocerciasis, and to the surveillance of onchocerciasis in order to rapidly detect any instances of recrudescence of Ehe disease. A11 Lhese activities would be preceded by the tralning of health workers in the sEandard OCP methodologies for disease surveillance and treatment. 29. The draft plan will be finalized with Ehe arrival in Bamako of che consultacive mission of the Programme and of the World Bank. Guidelines for the draft Plans for Devolution of the other countrles in the initial OCP area (Benin, C6te d'Ivoire, Ghana and Togo ) 30. Each in turn, Benin, C6te d'Ivoire and Ghanar gav€ assurances that since the 9th session of the JPC certain necessary actions had been taken, mainly: - the creation of devolution committees, - the making of inventories of health infrastructures, - the mobilization of personnel. 31. AII the countries were now awaiting the visits of representatives of the Programme and of the World Bank for the elaboratlon of their devolutlon plans, which will be submitEed ro the JpC in 1990. NOC/13 Page 6 Collaboration of the western and southern extension countries in ivermectin distr ibution 32. The Programme Director introduced this topic explaining that in the Western and Southern Extensions, ivermectin was considered as a second means of onchocerciasis control. He requested all the countries concerned to present Eheir views on the quality of the collaboration existing between the Programme and their countries in the distribution of ivermectin. 33. Countries of the Western ExEension (MaIi, Guinea, Guinea-Bissau, Senega)- and Sierra Leone) and of the Southern Extension (Ghana, Benin and Togo) commented on their ivermectin mass treaEment campaigns. Details were given of the numbers of persons treated, of side-reactions recorded and of the quantities of ivermectin distributed. 34. A11 the countri-es noted wiEh satisfaccion, the excellent collaboration which had exisEed between the Programme and the National Teams during the course of the treatment campaigns. 35. The effective participation of administrative authorities and of village organizations during the course of the campaigns was underlined. 36. Some particular problems experienced in some of the counEries were explained: in Togo the quality of Ehe circulation of information between the Programme and the National Coordinator needed Eo be improved, in Sierra Leone i) some non-goverrulental organizations had obtained supplies of ivermectin without the knowledge of the National Coordinator, ii) it was considered desirable to extend lvermectln distributlon to the south, to the Bo Region, - in Benin there needed to be a quicker notification of the results of ivermectin campaigns to the National Onchocerciasis Committee, To all these questions, satisfactory replies were provided and proposals given to improve the quality of collaboraEion between Ehe Programme and the National Teams 37. tlith regard to the financing of the devolution plans of the Participating CounEries, the Programme Director announced i) that finance would be provided on a bilateral basls between Ehe countrles and the donors, in accordance wich the proper administratlve arrangements existtng in each country. Requests should be submitted by the Governments Uo the represenEatlves of donor agencies in tsheir own counEries. ii) In reply, delegates recommended that the Programme Director sensitize Ehe CSA to ensure chat the necessary support was provided for the lmplementation of national devolutlon plans. 38. On the subJect of Eralning, the meeting called for uhe creation of an insEitute of tropical epidernlology ln Africa and expressed Ehe wish that Ehe Eraining of high-level epidemlologlsts in troplcal diseases be rapidly underEaken. It also recommended that the future utilizatlon of such staff ln the field be considered when selectlng candldates for tralning. NOC/13 Page 7 39. The meeting recommended that OCP assists the Participatlng Countries in their efforts Eo obtain the technical equipment required for dlagnosls and surveillance, and in the training and re-orientaEion of support staff. 40. Finally, the meeting expressed the wlsh that devolution plans take into consideraEion, and are integrated into the three-phased health development scenario F. SOCIOECONOMIC DEVELOPMENT OF ONCHOCERCIASIS-PROTECTED ZONES 4L. In his opening remarks the Prograrnme Director explained that the meeting had been split into two separate sections, concerned wlth devolutlon and wiuh socioeconomic development, purely for admlnlstratlve convenlence. In reality, the two subJects were so closely reldted and lnterlocked Ehat lt was lmpossible to address one in lsolation from the other. He stressed that the soclal side of socioeconomic developmenE was, in facE, human health. 42. The Programme Director went on to remind particlpants that before onchocerciasis sufferers actually became blind they were clinically and socially debilitated. They could not work productlvely, they could not adequately feed themselves and their families, and, because their lmrnune response was reduced, they were particularly susceptible to be a host of other diseases. It also had Eo be remembered that although onchocerciasis was not regarded as a killing disease, lt could reduce life expectancy by up to 15 years. 43. A11 these different facEors determined the gravity of community infection and Ehus the viabilicy or otherwise of village life. Development should therefore not only be oriented towards those onchocerciasis-controlled lands to which people could now safely return, but, equally t.o those areas where onchocerciasis-affected communiEies had lingered on in the face of declining levels of health and socioeconomic wellbeing. It should therefore be amply clear to all participants that health improvement and economic development had to proceed hand in hand, and, that the Programme provided unique opportunities to facilitaEe this. PresenEation of reporEs by delegates 44. The Chief of che Socioeconomic Development UniE OCP, explained that rhe objective of considering this item was to bring partlcipants up-to-date on the activities implemented or prograruned in the onchocerciasis zones of the ParticipatingCountries, following the recommendaEions of the "HunEing" Report (HTS/O & E) . 45. Participants were referred to the three sub-iEems under iEem 6 of the agenda in respect Eo their presentations concerning the developments in their onchocerciasis-controlled zones. 46. Delegates were requesEed to first address themselves to the recommendatlons contained in the "Hunting" Report (HTS/O & E). These referred to developmentproposals and to National Development Studies in the Oncho-protected Zones (NOZDS). Based on the commenEs of the JPC and of the CSA, reports of the delegates should underline the difficulties encountered with regard to implementation, donor support and the Presenc sicuation, and, those envisaged wlth regard to proposals and Ehe subsequent steps. 47. The second item to be addressed was the listing of new acEivities under implementation or being programmed. Each of these should be locallzed geographically N0c/11 Page B with indications concerning their importance and the sources of financing. 48. The last item to be addressed lras concerned with activities, projects for essential development and questions of immediate or future importance of interest to a rational utilization of the natural resources made available by the control of onchocerciasis. Their priority in respect to national development programmes should be indicated. I I I49. This last item, and che difficulties encountered in carrying out the su!,gested proposals, was discussed during the presentation of country reports in plenary session. Benin 50. In Benin the "Hunting" Report had been Ehe subject of a national discussion and had involved participanEs from all deparEments concerned. This discussion resulted in a national consensus on projects for Ehe construction of feeder roads and of cereal storage facilities in villages. 51. In a follow-up phase the projects of road construction have been extended Eo other provinces than Borgu; Ehe requirements are now esEimated to be in the order of 320 km instead of ttre l2Okrn as indicaced in the "Hunting" Report. 52. A component concerning the maintenance of feeder roads has been added Eo the projects. A description of the projects was under elaboration and a requesE was being prepared for a feasibility study. 53. Several new activities, or projects under preparation, were developing in che oncho-zones of Benin. Without going into details, these activities were: pilot projects for developmenE, projects for developing or enhancing the sEructure of development organizaEions and projects concerning the protection of the enviponmenE Burkina Faso 54. After a review of the development strategy in the oncho-controlled zonep delegate of Burkina Faso underlined the importance of the Nouhao valley in wfr proposed development concerned agriculture and livestock. I , the ich the 55. The preliminary studies (hydrogeology and pedology) have been completed and a masEer plan has been considered at a national seminar before being submitEed to the Italian Government which has expressed inEerest in financing the project. 55. Other projects, like "Bagr6 Sud" instituted Eo receive the population displaced frorn Ehe Grand Bagr6, the village land management programme and the project concerning the control of soil erosion, were of importance in implementating development programmes in the oncho-controlled zones. C6te d'Ivoire 57 . As regards C6te d'Ivoire the developmenE proposals in the "Hunting" ReporE conformed with Ehe national development programme "North East". The continuation of this programme was of particular interest insofar as ic would help to recEify the imbalance between this region and other parts of the country. Noc/13 Page 9 58. The second phase of the programme almed at an lmprovement of llvlng condltlons and the development of rural populatlons by attempting to create a sultable enviroruuent through: 1) the sale and storage of food-stuffs, (yams in particular), and 2) the opening-up of the region to allow for the "exportation" of food-stuffs. The financing of the progranme was being negotiated. 59. New projects, such as the settlement of young people at Serebou and rural developmenE at Katiola/Dabala, were belng lmplernented ln uhls reglon. Ghana. 60. The "Hunting" study had been conducted with the collaboration of the Ghanaian authorities. The proposals of the "Huntlng" Report Eherefore agreed with the Ghanaian national development plan and were accepEable to the Ghanaian Government. The zone identified by uhe "Hunting" survey for socloeconomic developmenE concerned the valleys of Ehe rivers Sissili and Kulpawn in northern Ghana. The development projecEs proposed concerned mechanized rain-fed rice, food crop production and livestock production. 61. Constraints to development in the Sissili/Kulpawn zone included lack of access, shortage of water resources (a dry season of 7 months), flooding in the wet season,shortage of health and educational infrasEructures and inadequate facilities for credit and marketing. 62. In an endeavour to overcome Ehese constrainEs, iE was proposed to insEall several new structures and services, in particular: construction of roads and two brldges (over Ehe rivers Sisslli and Kulpawn), installation of 56 bore-holes equipped wiEh manual pumps, creation of 6 health posEs to deal with other diseases, the formation of service complexes, especially for the rice-growing areas. 63. 0ther development projects were being elaborated in collaboratlon with UNDP and FAO and directed to crop production, livesEock and the role of \.Iomen in the development process. 64. With regard to financing, negotiations were in progress with the Italian Governmenc for the funding of the rain-fed rice project. Some of the OCP donors qlere also examining the proposals for other projects. Guinea 65. The "Hunting" Report has satisfactorily identified the serious economic problems facing Guinea. The Government had established a programme for econonic development in the oncho-controlled zones, and this was part of the programrne dealing with the adjustment of structures. 66. A number of studies corresponding to the naEural regions of the country were becoming available in the context of the public investment programne. 61. The priority of activicies was strongly linked wich the problems posed by the opening-up of the plains (road building), waEer supplies and education of the rural populations. N0c/13 Page 10 Guinea- Bissau 68. For the delegation of Guinea-Bissau, the "Hunting" Report was a fair reflection of the situation in the oncho-infected zone, where trade and prices had been liberalized resulting in a stimulation of private initiative. 69. The developmenE prograrnme in the oncho-infected zones was an integral part of the country's overall development efforts. The invesEmenEs in these ,o.r." *fr. directed to agriculture (integrated development, popularization of cultures buch as rice growing, waEer supplies and livestock). 70. The major difficulties were connected with the lack of resources (financial and human), the concentracion of senior staff in the capital and the lack of various infrastructures . Mali 7L. The national development study as well as Ehe development projects in the oncho-conErolled zones, were incegral parts of the National Development Plan. A request for funds for aerial photographs had been submitted Eo the World Bank in the context of NOZDS. 72. llcproposedl poject b constnrct 5]1trn dfeederroadjs interd€d bopen rp the Upper Bani-Niger zone (Cercles of Bougouni, Yanfolila and Kolondi6ba) with a view to the developmenE of Ehe Sikasso region in terms of ensuring self-sufficiency, food safety, mobilization of rural savings and the control of the effects of drought and desertification. 73. Mali considered the follow-up and the coordination of the different activiEies as an essential aspecE of the implementation of projects and had asked for institucional support to its Ministry of Planning. I d.6nors74. Similarly, Mali requesEed the governing bodies of OCP to arrrange that finance proJects and develolment studies in the oncho Zor€so Niger 75. The delegation of Niger considered that the recommendaEions of the "HunEing" Report which resulted from the analysis of che "Development project of oncho-controlled zones" failed to give proper importance Eo the overall socioeconomic development strategy of the country. 76 An integrated developmenE approach, as foreseen in project designed to develop the onchocerciasis-controlled zones and as formulated by Niger, was Ehe most approprlate one for the problems which were prevalent in these zones, which were rich ln natural resources. Senegal 77. The shortcomings of the "HunEing" Report were pointed ouE by the delegacion of Senegal, in particular with regard to the omission of reference 1) to che Pocential for mlning, tourism, and hydro-electiciEy in Ehe oncho-cransmission zones, as well as 2) to Ehe activities of development projecEs such as "PRDI" and "SAED", and, 3) the exclusion of the onchocerciasis zone in the Department of Velingara. NOc/13 Page 1 1 78. The studies foreseen by the "Hunting" Report had already been lnitiated either through the development structures or as a result of previous studies. 79. New activities were under development in such fields as regional health development, water supply, mining, road building, livestock and telecommunications 80. Issues of particular importance for Ehe Senegalese delegation included che control of migration and environmental protectlon. Sierra Leone 81. Sierra Leone agreed with prciposals contalned ln the "Hunt.ing" Report as far as Ehe north of the country was concerned, but, stressed tshat development had co be considered for a much larger part of the country. 82. Plans for specific projecEs had not yeE been formulated. However, certain suggesEions could be put forward which were in accordance with the primary development objectives of the Government (overall improvement of Ehe national economy, self-sufficiency in food commoditles, and, grass-roots participation in development) . 83. Several constraints to development could be identified, such as: the human factor: greater participation at the loca1 level was necessary in the planning and i.upleoentation phases of develolmeart, inadequate means of communication and of transport, inappropriate agriculcural techniques, insufficiant healEh and educational lnfrastructures, the low price of rice (the staple food commodity), shorEages of fertilizers, pesticides and spare parEs for agricultural equipment and machines. 84. that made It was concluded that special atEention had to be given to all these faccors and there would have to be maximal community particlpation if progress was to be in the formulation and implementation of slgnificant development plans. Togo 85. The zone identified for study and development in Togo constituted a national priority. It had been decided to implement the project ln an integrated manner. 86. Draft Terms of Reference had been prepared taking into consideration the intervention philosophy, familiarity wiEh the populaEions concerned and the overall approach Eo development activities. The project had also been given priority in negociations with donors. 87. t^Ihile negotiations with the World Bank and UNPD were underway, the Government was planning to initiate the most pressing components of the project by extension of activities already underway in the neighbourlng M6 plaln. Discuss ion 88. The country reports presented co the meeting had identlfied a number of issues, NOC/13 Page 12 as followss 1. financing:, 2. control of nr-igrationt 1. lack of roads, {. erwirormental protection, 5. problems of conmercialisation and stora6e as well as questions of regional interest. 89. As regards difficulties in financing all delegates underlined the advisory role which CSA should play in undertaking development in the zones where onchocerciasis was controlled or being controlled. This should materialLze in the strategy designed to seek financing by developing projects, with various components, of inEeresE to bilateral and multilateral donors. NGOs should also be approached. 90. The delegates recommended that CSA members should participate in future NOC meetings. 91. For the problem of migration, the delegates felt that a better understanding of the phenomenon itself and its causes would be a prerequisite for finding its solution. It was recommended that detailed investigations should be undertaken in this connection. 92. In resp ect to infrastrucEures , the delegates unanimously recognized that all ch oncho-zones suffered from a high degree of isolation, which should be overcome by activities that fitted in with the integrated development programmes. This would take inEo consideration all aspects of development. Consequently, the delegaEes recommended that all parties involved in the OCP, support the Participating Countries in obtaining the financing of such projects. 93. Concerning environmental protection as part of development in oncho-conErolled zones, ic was agreed that this issue should be an essential part of all strategies It was recommended that this be generally accepted and that it be drawn to the attention of donors. G. OTHER MATTERS Future meetings 94. The meeting wished it to be recorded that members of the CSA were cordially invited to attend all future meetings of Ehe National Onchocerciasis Commitlees. I 95. It was also recommended that during Ehe last day of the next meeting of technical participants, l.liniscers should attend a plenary session to review and endorse the meeting report to facilitate its presentaEion to Ehe next session of the JPC. Submission of the Report 96. Ir was agreed thar che [ogolese RetrublLc wou"ld present the Report of the thirteenth meeting of the Natlonal Onchocerciasls CommiEtees, to the tenth session of the JPC (The Hague, December 1989). H. DATE AND PIACE OF FOURTEENTH I,IEETING 97. IE was decided that the fourteenth meeting of the National Onchocerciasis CommiEEees would be held frorn Tuesday 29 l.lay Eo Thursday 31 May 1990, at Ehe headquarters of Onchocerciasis Control Programme, Ouagadougou. NOc/13 Page 13 I. ADOPTION OF THE REPORT 98. The report was unanimously adopued with a number of amendments proposed by the delegates. J. CLOSURE OF THE MEETING 99 . During the closure of the meeting in the afternoon of 9 June, delegates warmly expressed their gratitude to the Government of Burkina Faso and the Onchocerclasis Control Programme. NOC/ I 3 page 14 ANNEK I LISTE DES PARTICIPA}ITS LIST OF PARTICIPANTS BENIN M. Candide Hounkanrin, Secr6E,aire adminisEratif du CNLO, IlirllsEare de 1a Sant6publique, Cotonou M. Edouard Bankole, Responsable de la lib-er-ees de l-Oncho, Chef de Divislon la stat.ist.ique, Cot,onou Ce1lule charg6e du D6veloppemenE des zonesdu D6veloppetrenE rural, MinistEre du plan et de M'D'- Barth6l6ny otohoun, Conseiller cechnlque au MinistEre du D-eveloppetrenE rural eEde l-Actiou coop6rative, Cotonou BURKINA FASO Dr Ambroise Ti-emt016, coordotrnat.eur naEiouar oncho, MinistEre de la saot6 et deI-Aacion soolale, Ouagadougou Mme Lougu6 Maria, Plaaificatrice r6gionale, Directi-on de la planifioatioo duD6veloppenent, MlnisrEre du plan et de la Cooop6ratiotr, Ouagad ougou M. cora I'tathlas Batab6, l'linistdre de r-Agrloulture et de 1-Elevage, COTE D-IVOIBE 0uag4dougou Dr Bouffard Bella, Direoteur des Relacioos r6gionales eE iut.ernati-onales, llinistEre de la Sant6 publique et de Ia PopulaEion, Abidjau l'1. Bertln Gbayero, Sous-Di-recteur de la Plaaif icatioa agricole, IlinisEEre deI'Industrle et du Plau, Abidjan M. Kouakou ErtresE, Sous-Directeur des Produits agricoles, MlnistEre de 1-Agrioulture, Abldjan GHANA Dr Joe A. Adanafio, Deputy Dlrector of ttedloal Services, Mlaistry of Health, Acora t{r Fred Buatsi., Executlve Dlrector, Nati-onal Ouchooerclasls SeoreEariat, Mialstry of Fiuance aud Eoononlc P1annlng, Acora Mr Stanley Y. Anane, Reglonal Director of Agriculture, Mlnistry of AgriculEure, Tamale GUINEE Dr Yaya Kass6, Chef du ProjeE Ondro, M.iaistEre de la Saat6 M. Siaffa Beavogui, Chef seot,lon Organlsnes sp6cialls-es, MinlstEre du Plaa et de Ia Coop6ratlon int eruationale ltue Alssatou Cossa, Dlvislon des An6nagernents hydroagricoles, MlnlstEre de I -Ag rl oul t,u re NOC/ I3 Page 15 GUINEE BISSATI Dr Ant.onio Tamba Nhaque, Directeur r6gional de la Saut6 de Gabu et CoordonDateur national Oacho, MlaistEre de la Sant6, Gabu-Blssau l'1. Aqulno Antonio Duarte, l,llnlstdre du Plan, Bi.ssau Dr Carlos A. Fiuza, Respousable du Servloe d'Elevage daas la r6glon de Bafata, l"llniscEre du D-eveloppement rural et de 1'AgrlculEure, Blssau MALI Dr Isaka Niamb6l-e, CoordinaEeur nat,lonal 0uaho, Dlvlslon de l-Epld6mlologle et, de la Pr6vent,1on, Mlnist.Ere de Ia Sant6, Bamako M. Aliou Coullbaly, Ing6oteur du G6nie rural, Dlrectlon nat,looale de Ia Planiflcatlon/DAT, MlnistEre du Plan, Bamako M. Malamine Sanogo, Ing6nieur Agronoue, Dlreotion nat.lonale de 1-Agrloulture, I'linlstEre de 1-Agriculture, Bamako NIGER Dr Baraze Assane, Directeur-adjoint., Dlreot,ion de l-HyglEne et, de Ia l'l6dealue mobile (DHMI'{), Responsable de Ia Divislon statlsElque, Vaocluatlon et Laboratolre, MlnlstEre de la Saur6 publique et des Affalres soolales, Nlamey 11. Abdou HJ-ma, Secr6taire g6n6ral adjoint, Pr6feoture de Tlllaberl, Ilinlstere du Plan eE de la PlaniflcaE.ion r-egionale, Nlamey Adamou Abdoulng6nieur des Eaux et Fordts, Dlreoteur adjolat de I-Envlronnement, n, Niamey SENEGAL Dr Abou Beckr Gaye, Dlrecteur Servloe natlonal des Grandes End6mtes, MlnletBre de la Saac-e publique, Dakar M. Alassane Niane, Adjoint, au Dlreot.eur des Affalres soj-entiflques ec teohnJ.ques, MlnistEre du Plan eE de Ia Coop6ratlon, Dakar M. llamadou DlaLlo, Coaselller t,echnlque, MlalstEre du D6veloppeEent, rural, Dakar SIERBA IJONE Dr Abdul R. l.Iurie, Coordlnat,or Oncho Progranme, Minlstry of Health Govr. HosplEal, Magburaka Mr Beroard M. N-Javombo, Pri.nclpal Planaing Offloer, Ministry of Natlonal Developnent and Econouic Planning, Freetolrn Mr Junlsa A. Kawa, Senior Agrlcultural Offlcer, Mlnlstry of Agrlculture, NaturalResources & Forestry, KeDema, EasEera provlnce NOC/ i3 Page 16 TOGO Dr Tchasseu Karsa, Direcceur de publique, des Affalres sociales la Division de 1-Epid6miologie, IlinlscEre de Ia Sanr6 eE de la Condicion f6minine, Lom6 M. 56d6gnan K6dagnl, Plao, Lom6 Chef de Ia Division de Planif icatioa agrlcole, I'linistEre du M. Kodjo Agbegninou, Ing6nieur d-Agriculture, Directloo 96n6rale rural, MlnlstEre du D6veloppemeot rural, Lom6 du D6veloppement ous/AFRo Dr Madj-ou Tour6, Di-rect.eur BrazzavLLLe de la Gestion du Programme, Bureau r6gloaal AFRO, Onohocerotagls Coatrol Progranme Dr Ebrahin M. Samba, Programme Director, Ouagadougou Dr K.B.L. Akpoboua, Vector Coutrol Unit., Bouake Dr 0. Ba, Epidemlological Evaluation Uait, qq4gadougou Dr D.A.T. Ba1dry, Chlef OCP Liaisoa, Geneva Dr D.A. Carvalho, CoordiaaEor, Direot.or-s Offlce, Ouagadougou Dr O. W. Christensea, CousulEant, Geaeva Dr G. De Sole, chief, Epldemiological Evaluatloa unit, ouagadougou M. c. Pharaud, chlef, AdmlnlsEraElon and Management., ouagadougou Dr D. Quillevere, Chief, Veotor Control UDlt, Ouagadougou Dr J-H.F. Remrne, Chief, BlosEat,istics and Inforuatique systems Uait, Ouagadougou Dr A. Seketeli, VeoEor Control UnlE, Bauako M. E.J. Senghor, Iuformat.ion Officer, Ouagadougou M. D.G. Zerbo, Veotor Cont.rol Unlt, Ouagadougou l'1. J.B. Zongo, Chief , Socio eoonomic Developuent. Unit., Ouagadougou N0c/13 Page 1 7 llqHEr 2 DECI-ARATION ON DEVOLUTION AT THE THIRTEENTH MEETING OF THE NATIONAL ONCHOCERCIASIS COMMITTEES(by the World Health Organization Regional Offlce for Afrlca) 1. The 35th session of the Regional Committee for Africa (September 1985) adopted a framework to accelerate health development ln the Region, called "three-phase health development scenario". This concerns the strengthening of the three levels of the national health systems through: - operational support at the peripheral or distrlct level; - technical supporE at the intermediate or provinciaL/teglonal 1evel; - strategic support at the central/natlonal level. 2. For Ehe past five years, acEiviEies have been carried out throughout the countries in the Region to iniEiate and develop the district approach to health development. The evaluation made during the 38th session of the Regional Committee (September 1988) showed that 54t of the health districts (as agalnst 20t in L987) had become operational. 3. Devolution, as conceived now, is a dynamlc and responslble participation of nationals in onchocerciasis conErol so as Eo achieve trdo objectlves progressively (i) to detect any recrudescence of onchocerciasis and treat those affected with ivermectin; (ii) to distribute ivermectin on a large scale. It is therefore a matter of mainEaining the results of OCP in terms of public health and economic development. Devolution is therefore a continuaEion of the control on another scale. In clear terms, this means cleaning up the pockets of resistance after Ehe great war has come to an end. 4. To this end, Ehe health development scenario offers an operatlonal framework to the devolution activities. Devolution will have to be conceived and lmplemented within the framework of Primary Health Care as advocated by the scenario. There is Eherefore no need to develop new strategies, but rather the implemenEation of those already defined should be strengthened and accelerated. Concrete actlvities at the districc level are proposed for onchocerclasls control ln the framework of che communiEy structures: family, village, district. 5. The Regional Office will carry out its responsibilities fully. It has established new structures to meet better the needs of the countrles, particularly in the organization of Ehe acceleraEed implementation of PHC at the three levels of the national health system. Thus: 5.1. The WHO Representatives and the country teams will monitor devolution activiEies in the countries. 5.2. The decision Eaken in March 1985 by the Regional DirecEor, in agreement with the Director-General and in consultaEion with the OCP Director, Eo base the Subregional Office in Bamako, in the hearE of the Programme and near the OCP headquarEers, was motivated, among other things, by the NOC/13 Page 1B prospects of monitoring of OCP activities, notably devolution. The intercountry health developmenc team, the subregion's spearhead, comprises personnel corresponding to the Eechnical elements of devolution, particularly an epidemiologist for the epidemiological surveillance and ivermectin distribution aspect. It will Eherefore henceforth be greatly involved in the supporc for and montoring of devolution activities. It will report to subregional meetings and to the Regional Director on the collaboration with OCP. Thus, as OCP fades away, Subregion I will evolve. Buc it would not be wise to dismantle Ehe Ouagadougou structures, even if the conventional OCP donors decided to stop contributing. In the long run and even beyond the year 2000, the collaboration between Ouagadougou and Subregion I which covers all che OCP countries will remain active. 6. Onchocerciasis, as a public health problem and obstacle to economic development, arises at the district level. The repercussions are felt at the intermediate and central level. The remarkable resulEs obEained by OCP have led to the liberation of the formerly-abandoned fertile zones which are nold being used for farming. The socioeconomic development of these "new" lands is the responsibility of the countries, from the viewpoinE of self-determination and self-responsibility; the socioeconomic activities should Eherefore be underEaken country by country and OCP should make a devolution to the countries whose consciousness has to be raised, even in the search for necessary funds for the development of the protected zones because this goes beyond health, OCP and even WHO; it is therefore not in the interest of OCP to maintain this aspect in its programme. 7. In conclusion, it will mainly be a matter of operational support at the district leve1, technical support at the intermediate level and straEegic support at the central level. These activities are carried out by the countries with thie support of the teams of the country and subregional offices and of the Regional Office as the need may be.