JPC21.3-eng.pdf - WHO | World Health Organization

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Onchocerciasis Control Programme in West Africa (OCP)Programme de lutte contre l'onchocercose en Afrique de l'Ouest

JOINT PROGRAMME COMMITTEE JPC - CCP COU T CONJOINT DU PROGRAMMEOffice of the Chairman Bureau du President

JOI NT PROGRAMME COMMITTEETwenty-first sessionYaound6. 14 - 15 December 2000

Provisional aqenda item 6

JPC21.3ORIGINAL: ENGLISHJuly 2000

EXPERT ADVISORY COMMITTEE

Report of the Twenty-first SessionOuagadougou, 5-9 June 2000

Executive summary and recommendations... ..................... -5

A. Opening of the session ........... gB. Adoption of the agenda...... ....................... g

C. Follow-up to the recommendations of the twentieth session of the Expert Advisory Committee..... 8D. Matters arising from the twentieth session of the Joint Programme Committee ..............9E. Review of the report of the twenty-first session of the Ecological Group........ .. ........... l0F. Country visit by EAC member............ ...........t.....:.....:............ ............ ....... I IG. Review of scientific, operational and technical issues relating to the implementation of the EAC

(1997) recommendations ......l2H. Application of the EAC19 conceptual framework for integration, transfer and country preparedness

including review of the conclusions of the National Coordinators' meeting(31 May - 2 June 2000)........ ................... 19

I. Priority actions to be taken during the last 2 ll2 yars of OCP operations to consolidate theachievements of the Programme and allow for maintaining them after 2002 ................21

J. Repor$ on progress of APOC including recommendations regarding operational research ofrelevance to both OCP and APOC............The programme for elimination of lymphatic filariasis in Africa: CSA Issue Paper................Progress in establishing the AFRO sub-regional centre for support to national multidiseasesurveillance and control systemsOther matters......Date and venue of the twenty-second session of EACAdoption of the draft reportClosure of the session

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CONTENTS

Report of the twenty-first session of the Ecological Group......... .

List of EAC2l recommendations...Recommendations of the lr4arch 2000 OCP Operational Researchand Strategy Meeting.National capability to maintain OCP achievements

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Annex IAnnex 2Annex 3

Annex 4

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I,IS-I'()IT I) . iIICIPAN'I'SE,A(l Mcmbcrs

Prof-essor Adenike AbioseConsultant Oplithalmologist, Sightcare International, P.O. Box 10392, Kaduna, NigeriaTel: 234-62-239373 I 238684 - Fax: 234-62-238973 - E-mail: abiose@infb web.abs.net

Prof-essor S. Ofosu-AmaahDirector, School of Public Health, University of Ghana, P.0. Box 13, Legon-Accra, Ghana

Tel: (233) 21 500388, (233)224 316413 - Fax: (233)21500388 - E-mail: [email protected]

Professor Roger K. PrichardInstitute of Parasitology, MacGill University, Mac Donald Camfus, 2l I I I Lakeshore Road,

Ste Anne-de-Bellevue, Quebec, Canada H9X 3V9,Tel: (514) 398 1729 - Fax: (514) 398 7857 - E-mail: [email protected]

Professor Detlef R. ProzeskyFaculty of Medicine, University of Pretoria, P.O. Box 667 , Pretoria 000 I , South AfricaTel. 2l-12-354 Il47 - Fax: ++ 27-12-354 1758 - E-mail uD.ac.7a

Professor Vincent H. Resh, Department of Environmental Science, Policy and Management,University of Californi a, 20 | Wellman Hall, Berkeley, California 9 47 20, US ATel. (510) 642-3327 - Fax (510) 642-7428 - E-mail: [email protected]

Docteur Mamadou Soungalo Traor6Commission europdenne auprds de la Direction XII E-4, Rue de la Loi, 200, 8-1049, Bruxelles-Wetstraat 200, BelgiqueTel: (+32-2)296.16.65 - Fax: 32 2296.62.52. E-mail: [email protected]

Dr Yoichi YamagataInstitute for International Cooperation (IFIC), Japan International Cooperation Agency (JICA),l0-5 Honmuracho, Ichigaya, Shinjuku, Tokyo, 162-8433, Japan

Tel. +81-3-3269-3851 - Fax: +81-3-3269-6992 - E-mail: [email protected]

Mrs Fatu YumkellaThe Programme for International Training in Health (INTRAH), P.O. Box 44958, Nairobi,Kenya, Tel:254-2- 21182011- Fax: 254-2226 824. E.mail: f),[email protected]

Dr Lindiri'e Elizabeth MakubaloDirector. Health Systems Research, Research Coordination and Epidemiology, Department ofIlealth, Private Bag X828, Pretoria 0001. South Africa.'fet: (012) 312-071415 - Fax: (012) 323-5003. E-mail: makubl'ZDltltrsa2.pri'r,.gor'.za

Dr Bernard Philippon, Directeur de Recherche. Institut de Recherche pour le Ddveloppement(lRD), Charge de Mission Sante. Departenrent Societes & Sante.213 Ruc La F-ayette,750l0 Paris

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ccdex 10. Tel.33l 4803 7109 - Fax: 3il 1803 71i06. E-nrai I:rrhilirrrrr l,rr'naris.ircl.tl'

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Dr r\trclre Yebakitr.;r. Directcur'. ('crttrc de r.cmoustification, ('onser, gencral, tl.l,. (r79,

97200 Fort-de-France, Martinique I'el. (Bur) : 05 96 60 37 21 - [rax (Bur) : 05 96 ]O 26 46E-mail : r,ebakima(li)wanadoo.fi' / r qbakinra c97).tr

National Coordinators

Dr B. Kargbo, National Oncho Coordinator, Makeni, Sierra Leone

Dr N.K. Diallo, Coordonnateur national du Programme de lutte contre l'onchocercose, B.P. 237,Kankan, Guinee -Tel: (224)710278

Dr A. Pana, Coordonnateur national du Prografirme de lutte contre I'onchocercose, Directeurr6gional de la Sant6, B.P. 487, Kara, TogoT6l: (228) 60 00 47 -Fax (228) 60 11 l0 - E-mail: [email protected]

Mddecin commandant L. Diawara, Coordonnateur national du Progriunme de lutte contrel'onchocercose, Service des Grandes End6mies, Vc Ministdre de la Sant6, B.P. 5899, Dakar,S6n6gal, T6l.: (221) 824 3533 - Fax: (221) 824 3532

Dr Souleymane Sanou, Coordonnateur du Programme national de D6volution, 03 BP 7009,Ouagadougou 03, Burkina Faso, T6l. (226) 30 87 90 - Fax: (226) 33 49 38

TJNDP

Mme Traor6 Alima D6borah, Assistante de Programme LCS/SS, UNDP Burkina Faso

WHO-OCP

Dr Boakye A. Boatin, Director, Onchocerciasis Control Programme, Ouagadougou

Dr H. Agoua, Vector Control Unit, Onchocerciasis Control Programme, Kara

Mr A. Ak6, vector control unit, onchocerciasis control Programme, odienn6

Dr L.K.B. Akpoboua, Vector Control Unit, Onchocerciasis Control Programme, Ouagadougou

Dr U. Amazigo, African Programme for onchocerciasis control, ouagadougou

Miss Angela Baffoe, Onchocerciasis Control Programme, Ouagadougou

Dr Y. Bissan, Vector Control Unit, Onchocerciasis Control Programme, Odienne

Dr O.W. Christensen, Consultant. Onchocerciasis Control Programme. Geneva

Prof. M. Kabore, Translator, Onchocerciasis Control Programme. Ouagadougou

N4r V. Kere, Vector Control Unit. Onchocerciasis Control Progranrme, Ouagadougou

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Dr.l. t-azdins. \,lanagcr. N4aclollI I)ro.1cct, Onchoccrciasis Contr.oI i'rogt'atnnie. (icttcva

Mr J.P. Thirion, Adrnir.ristration & Irinance Officer (AI'O) Onchocerciasis Control Programmc.

Ouagadougou

Mr S. N'Gadjaga, Biostatistics and Information System Unit, Ouagadougou

Dr Iv{. Noma. Aliican Progratnme for Onchocerciasis Control. Ouagadougou

Mr M. Sarr, Vector Control Unit, Onchocerciasis Control Programme. Odienne

Dr K.E.M. Siam6vi, Planning, Evaluation and Transfer Unit, Onchocerciasis Control

Programme, Ouagadougou

Dr A. Soumbey, Chief, Biostatistics and Information System Unit, Ouagadougou

Dr L. To6, Vector Control Unit, Onchocerciasis Control Programme, Ouagadougou

Dr L. Yam6ogo, Chief Vector Control Unit, Onchocerciasis Control Prograrnme, Ouagadougou

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EXECUTI\ I] SUMMARY AND TT,,COI\{MENDA.IIONS

The twenty-first session of the OCP Expert Advisory Committee (EAC) was held at theOCP Headquarters in Ouagadougou from 5 to 9 June 2000 with Professor AdenikeAbiose in the Chair.

In opening the session, Prof. Abiose regretted that Drs. Frank Walsh and Marcel Tannerwere no longer able to attend EAC sessions. She congratulated Drs. Boakye A. Boatin onhis appointment as Director of OCP and Laurent Yameogo on his appointment as Chiefof the Vector Control Unit. Prof. Abiose welcomed two new Members of EAC, Drs.Bernard Philippon and Andre Yebakima. She then drew the attention of the Committeeto the recent accidental death of Dr Kweku Sampson who had for many years served theCommittee as interpreter. The committee observed a miniite of silence in his memory.

Dr Boatin asked the Committee for guidance in respect to future control strategies in thespecial interyention areas; on the development of a field-applicable macrofilaricide; andon the sustainability of Community-directed Treatment with Ivermectin (CDTI)progftunmes. He also asked for advice regarding the new GEF-supported project designedto "conserye biodiversity and manage ecosystems' in the oncho-freed zones; and on theplanned AFRO Multidisease Surveillance and Contol MDSC) Centre.

'The Programme Director then summarised the Programme's follow-up to therecommendations made at the 1999 session, which had practically all been implemented.

Prof. Abiose reported on her attendance at the December 1999 session of the JointProgramme Committee where she had highlighted the good progress of the Programme;the satisfactory geographical coverage of CDTI activities although the coverage has notreached 100%; and the question of potential residual foci. She informed EAC about thediscussions in The Hague on the Lymphatic Filariasis Elimination Programme and itslinks with OCP and APOC as well as on the creation of the AFRO MDSC Centre.

Hydrobiolosy

The Ecological Group recommended that the 1999 monitoring stations and the samplingfrequency be maintained through 2000 and called for publications of the work ofhydrobiologists in the OCP countries which should be emphasised at the December 2000session of the Joint Progralnme Committee. A project funded by the Global EnvironmentFund to conserve bio-diversity and enhance management of ecosystems in the oncho-freed zones was under preparation and EAC requested the Committee of SponsoringAgencies to give it full support.

Dr Yoichi Yamagata had spent the period 22 - 28 May 2000 in Ghana to look into thereasons why certain river basins in Ghana showed higher prevalence rates than expected.He inforrned the Committee about his findings and recommendations.

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EAC Member's visit to the Proeramme area

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h IIAC Membcrs wclt: infbnned that the entomologrca[ situation througltout the Programme

remained satisfactory. IJowever, certain river basins needed special attention and for some

of them it would be necessary to continue control (ivermectin treatment and ground

larviciding) after the end of OCP operations. A detailed review was prepared during the

session, shorving the planned activities until 2002 and those to be continued beyond that

year by the national authorities (see section I. under "National oncho control activitiesbeyond 2000, including vector control"). The procedures for entomological detection ofrecrudescence of infection in flies were now well established and carried out by national

entomologists.

Planning, evaluation and transfer

The activities centred during the period under review on support to, and consolidation ofthe residual activities already transferred to countries, including strengthened

collaboration in the field of ivermectin distribution, epidemiological/ophthalmologicalevaluations and the transfer of skills in data processing and analysis. With a fewexceptions the evaluations carried out during the year showed satisfactory results. Anextemal evaluation of the CDTI process conducted in four OCP countries concluded that

on the whole CDTI was weli in place. Sets of criteria for cessation of larviciding and ofivermectin treatrnent were brought to the attention of EAC Members. The DEC patch test

was being tested under field conditions with a view to standardisation. Work had started

to update the ONCHOSIM model to include the data produced by new tools and newfunctions describing the transmission of microfilariae.

Macrofil

A full description of the activities of Macrofil was provided to the Committee whichrecommended that the project give priority to further studies on moxidectin and on

resistance to ivermectin including the development of tools for detecting such resistance.

EAC appreciated the important contribution of the Onchocerciasis Chemotherapy

Research Centre (OCRC) to the search for micro/macrofilariae and expressed the wishthat this Centre would continue its contribution after the end of OCP.

Aoolication of the for intesration and transfer

'fhe Committee was informed about the recommendations made by the recent meeting

of the National Onchocerciasis Coordinators concerning diagnostic tools; data

management; budgeting for post-OCP residual activities; criteria for cessation ofivermectin distribution; motivation of Community Drug Distributors (CDDs); and

monitoring/supervision of CDTI programmes. EAC Members were also acquainted withthe findings of a stud1, on CDD motivation carried out in tluee OCP countries.

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Prioritt,action for the reniaininq 2 7z ycars of the life ol'OCl'}

This subject was dealt with by working groups making recommendations under tlrreeheadings: " National oncho control activities beyond 2002, including ttectorcontrol","National capability to maintain OCP achievemenls" and"C)ontribulion of theAFRO Sub-regional Centre to maintaining OCP achievements".

Progress of APOC

The Comrnittee was informed about the activities of APOC iu support of CDTIprograrnmes and about the various monitoring and evaluation exercises undertaken by theProgramme.

OCP-APOC and the Lymphatic Filariasis Elimination (LFE) Proeramme

EAC Members, after a review of the many issues involved in establishing collaborationbetween OCP-APOC and LFE, agreed to a recommendation that this collaboration goesahead with the understanding that efforts be made to find answers to the questions putforward.

Other matters

It was recommended that a post-OCP evaluation be undertaken, about two to three yearsafter the cessation of OCP operations.

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,,\. 0I,ENIN .; OI' 't I{E SI'SSION

1. 'fhe twenty-lirst session 01 the Expert Advisory Committee, held at the OCP

Headquarters in Ouagadougou, was opened by Professor Adenike Abiose, Chair of the

Committee, who congratulated Dr Boakye A. Boatin on his recent appointment as Director ofOCP and Dr Laurent Yameogo on his appointment as Chief of the Vector Control Unit. She

welcomed the new Members of the Committee, Drs Bernard Philippon and Andre Yebakima.

She regretted that Dr Marcel Tanner had resigned his membership of EAC as a heavy workload

at liis home station, particularly pressing during the time of the sessions of the Committee,

prevented him from attending EAC sessions. Also, and regrettably, Dr Frank Walsh was no

Ionger able to attend sessions of the Committee as he had joined a project in which his

responsibilities did not allow him to come to Ouagadougou during its June sessions.

2. The Chair then drew the attention of the Committee to the recent accidental death ofKweku Sampson, who had for many years serued EAC and other OCP meetings in Ouagadougou

as interpreter. The participants in the EAC session observed a minute of silence in memory ofDr Kweku Sampson.

3. The Programme Director, in welcoming participants to Ouagadougou, expressed hisgratitude to the Expert Advisory Committee for its ever ready preparedness to provide OCP wittlsound scientific and technical advice. The present final stage in the life of the Programme was

particularly critical as OCP was faced with new challenges while continuing to deal with the

challenges of the past.

4. Dr Boatin asked the Committee specifically for guidance as regards future controlstrategies in the specific intervention areas until, and beyond, cessation of OCP operations; the

development of a cost-effective, field-applicable macrofilaricide; and how best to ensure

sustainability in the Community-directed Treatnent with Ivermectin (CDTI) grven that the initialenthusiasm of communities and the community-directed distributors (CDDs) was likely to wane

with time. He also requested the Committee to give its advice on the project proposed by the

Ecological Group to "conserve bio-diversity and manage ecosystems in the oncho-freed zones"

under preparation for funding by the Global Environment Facility (GEF).

5. The Progamme Director also solicited the views and recommendation of EAC on the

planned AFRO Multi-disease Surveillance and Control (MDSC) Support Centre. Finally, given

the late hour of the Programme, he was of the opinion that care should be taken not to open up

too liberally for new areas for operational research.

B. ADOPTION OF THE AGENDA

6. The provisional agenda, as reflected in the list of contents of the present report, was

adopted.

C FOI-LOW-UP TO THE RECOMMENDATTONS OF THE TWENTIETHSESSION OF THE EXPERT ADVISORY COMMITTEE

I. [)r lJoatin summarised the fbllorv-up and implementation of thc tnost importantEAC20 recomntendations as fbllor.r's:

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- l- oktgrc'al Groult. thc st..ly on re-colonisation p, eutial after ccssatiou ol-lan,iciding hadbcen completed; ecological data st:t. as other OCP data, were being included in a CD-ROM;and cross-border environmental problerns caused by socio-economic development in oncho-lieed zones was being dealt witli.

- Ivermectin distribution; twice-yearly treatment had not been instituted in Kulpawn and Mole;the stability of Mectizan packs, once the sealed bottle had been opened, had now beendetermined as four months.

- OCP staff accompanied pilots on their spraying rounds

- Planning, evaluation ond transfer.' National Onchocerciasis Coordinators were increasinglybecoming involved in what would become post-OCP.acti-vities; however, the duration of post-OCP ivermectin treatment was as yet unknown; and training of nationals in ground larvicidingwas proceeding according to plan.

- Macrofil: work on moxidectin was given priority attention and a group of scientists wasdealing with the detection of potential lowered susceptibility to ivermectin.

- ONCHOSIM: The school of Public Health of Ghana had expressed interest in receiving acountry-adapted version of the ONCHOSIM model.

-Training: the OCP epidemiological surveillance training module was made available to AFROfor incorporating it into the AFRO Integrated Disease Surveillance module.

- IEC: a workshop attended by Coordinators, IEC specialists from Ministries of Health andcommunication experts from Helen Keller International had been held in Ouagadougou; andwork had been initiated on the preparation of onchocerciasis messages in the "Facts for Life"format.

- Transfer: the stability of ivermectin tablets, once the sealed bottle had been opened, had nowbeen determined as four months.

MATTERS ARISING FROM THE T\ITENTIETH SESSION OF THE JOINTPROGRAMME COMMITTEE

8. The Chair raised the following points in her report to JPC20 on the EAC20 proceedings

- OCP was proceeding satisfactorily towards reaching a minimum level of infection by 2002and was intensifying support to countries to maintain its achievements;

- Progress had been rnade in establishing the AFRO MDSC Centre;

- There had been satisfactory geographical coverage of CDTI although the coverage has notreached 100%;

- 'l'he question of potential residual foci:- The progress of Macrofil.

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9. l)r, l' ,\t'riosc rclcrrcd to th, t)CP-r\l)Ot'.lornt Sessi, rr that consrdcrcd thc pt, 'rbilitl o1'()('['and APOC acting as cnl.rv points for thc Lyrnphatic Filariasis (l-F) I:lirnination l)rogrammc ancl

requested the Committee of Sponsoring Agencies (CSA) to prepare an issuc paper lbr the I)ccernbcr

2000 session of tlie .loint Session. LF mapping should proceed forthwith.

10. JPC further considered such issues as the integration of oncho data into national health

information systems and called for the AFRO MDSC Centre to become a centre of excellence, science-

based, and developed with a strong involvement of OCP countries.

1 l. She finally informed the Committee that a potential shortfall in the financing of OCP up to the

end of its operations had been closed by an extra contribution of US$ 5 million by The Netherlands.

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12. In addition to its activities in support of OCP operations, the Administrative and Finance Unitcontinued to render services to APOC in the fields of personnel, hnance, transport and supplies.

13. The general reduction in the OCP fleet of vehicles continued throughout the period under

revlew

14. The OCP radio network covering all capitals of the Participating Countries had been completedwhile purchase of capital equipment was gradually decreasing.

' 15. The OCP staffcomplement had been maintained at282, of whom 94 were on WHO/OCP status,

with the remainder working under Special Services Agreement. 259 national staff employed in theirown countries and paid by their governments, with some benefits also accruing from the Programme,were under OCP technical and administrative supervision.

16. Training of staff with a view to preparing them for post-OCP employment continued in such

fields as office management, informatics, vehicle mechanics, finance and laboratory work. The Unitalso organised information sessions for the staffwith a view to preparing them for their departure fromOCP wllen the Programme came to an end.

E. REVIEW OF THE REPORT OF THE TWENTY-FIRST SESSION OF THEECOLOGICAL GROUP

11. In presenting the report of tlie twenty-first session of the Ecological Group, its Chairman

Professor Vincent Resh expressed his satisfaction that the recommendations of the previous session o1

the Group had been implemented by the Programme or were still under consideration.

18. Satistaction rvas also expressed on the entomological results as welI as u'ith the progress made

regarcling the opcrational use of llucillus thuringiensi.s H-14 at discharge rates exceeding l5 ntr/sec.

rvliich wor,rld add to the eftlcacy of the rotational strategy and could be ol'irnportance fbr post-OCI'}

nuisancc control.

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19. Or"r the sidc of aquatic e ,rvironmeutal rnonitoring. rt \vas repoflcd that the ri.rrnber of lish sltcciesseemed to be incrcasing, possibly as a result of later years favourable liydrological conditions. T'hcGroup recontmenclcdthat the 1999 monitoring stations and the sampling frequency for invertebratesand fish be maintained during 2000. It also recommendedthatcommendation of hydrobiologists havingworked for more than ten years with OCP be brought to the attention of JPC in December 2000 to makeparticipants aware of the existence of national competence in this field. It was furthermore proposedthat a brochure on the protection of the aquatic environment be prepared, that video coverage ofmonitoring techniques be undertaken and that a scientific synopsis be published in a widely distributedscientific journal.

20. The Ecological Group was pleased with the progress in ecological monitoring in relation tosocio-economic development in oncho-freed zones. A workshop was held during the session of theGroup regarding a proposal for a project to "conserve bio-diversity and manage ecosystems" relatingalso to the need to maintain the hydrobiological expertise established by OCP after the end of theProgramme. The project would seek funds from the Global Environment Facility (GEF).

21. Concern was expressed that the training of younger hydrobiologists was essential if nationalprogress was to be successful. This consideration was crucial to the success of all OCP activities to betransferred to national teams.

EAC comments and recommendationi

22. It was recommended that techniques be developed to make community involvement moreeffective and clarifications were sought about how the results of the GEF project would be evaluated;it was suggested that nuisance control of blackflies and its potential effect on bio-diversity beconsidered by the prqect.

23. The Committee recommended that the Committee of Sponsoring Agencies (CSA) stronglyendorse "The West African Freshwater Bio-diversity Conservation and Ecosystem Management"project under consideration by the GEF and the World Bank.

F. COUNTRY VISIT BY EAC MEMBER

24. Dr Yoichi Yamagata reported on his visit to Ghana during the period 22 - 28 May 2000 withthe specific objective of looking into the situation in the basins of Lower Black Volta, Mole andKulpawn rivers which had been showing higher prevalence rates than expected. During this missionhe was accompanied by Dr Kofi Ahmed, Director of Onchocerciasis Control, Ministry of Health inGhana. Visits were paid to health offices at different levels and interviews were conducted in villagecommunities and with community distributors. Briefing and debriefing sessions were held in theMinistry of Health.

25. The following observations and recommendations were made

- CDTI: there was generally a high therapeutic coverage (around 75%). cases of unsatisfactorygeographical coverage were the result of non-availability of ivermectin. No CDTI was carried out inUpper West Region (covering Kulpawn rii'er basin) in 1999. while the other trvo regions, the BrongAhafb and the Northern Regions, made only one distribution in the same year. Community registershad been formatted for one distribution per year.

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- ()grttrttutiilt'pct'L'al)ttort ttf onchoL(')'L'iLt.\i.\ Lut(l tvartttcc'liz tl,.cho \\ras l)erccived by corl-Illlullit\'

distributors as blackf-lies. not as the disease. r.vhilc the comrnunities apprectated tlie immediatc

benelrcial effects of iverrnectin (killing of Iice, bedbugs e1c); "unpleasant side-effects" were accepted

as an expression of the effectiveness of the drug.

26. Recommendations:

improvement of the drug delivery systenl and reinfbrcement between state and regional

levels to ensure effectiveness of CDTI

(re)training of community distributors, sub-district and district health workers

revision of register columns in case'of biannual tfeatment

districts to estimate community consumption of ivermectin based on previous records

analysis of CDTI with a view to its extension to other health activities e.g. vitamin Adistribution

description of breeding sitqs to be kansferred to the national entomologists for planning ofground larviciding.

G REVIEW OF SCIENTIFIC, OPERATIONAL AI\D TECHNICAL ISSUES RELATINGTO THE TMPLEMENTATION OF THE EAC (1997) RECOMMENDATIONS

27. The overall entomological and epidemiological situation throughout the Programme area

remained satisfactory.

VECTOR CONTROLProgramme report

28. The Committee was informed that the entomological situation had remained satisfactory in

1999 with very low transmission of human onchocerciasis (O. volvulus)by the savannah species of S.

damnosum (out of 107 catching points regularly visited, only two had an annual transmission potential'above 100, i.e. Asubende in Ghana and Titira in Togo). These good results were recorded in spite ofa globally more abundant rainfall than in 1998, so that in some areas, some tributaries which habitually

no longer flowed started flowing again, thus leading to an extension of the larviciding coverage to these

watercourses. which caused a slight overrun (0.60%) of the guaranteed flight hours.

29. To cope witlr the situation, the Unit intensified the prospections as well as ground larviciding

i1 support of aerial larviciding while implementing a strategy of prospection/treatment by helicopter

in the specihc intervention areas. At the same time, an intensification of the susceptibility tests made

it possible to better adjust the use o[the different lan,icides for more effective control, especially in

Guinea where the populations of S. damnosum.r.s encountered during the low rvater period proved to

be inrnrune to higher concentrations of ternephos.

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30. Al..o to be Itoted is thc conl,r'uration of the efficacl,t -l'eknar (about l0 Kn-r tr, cllbctive carryat l4l mr/s) and the noticeable improvement of the perfornrance of Vectobac l2 AS (with an effectivecarry of 21 to 27 Km at 169 mr/s), which allowed for a greater use of these products instead of lessselective larvicides (such as phoxim and pyraclofos).

31. Some special studies (breeding of blackflies from a single egg laying) are under way in thebasin of the Upper Niger and its tributaries in Guinea, as well as on other watercourses situated in there-invasion path in Guinea, Mali and C6te d'lvoire. The specimens will be used for an in-depth studyof the genetic variability of S. sirbanum species during the re-invasion period, thanks to thecytotaxinomic and molecular biology methods of identification.

32. The national entomologists trained by the Programme in 1998 were made operational in 1999.Entrusted to their care were the studies on the impact of ivermectin on transmission and the detection

of any possible recrudescence of transmission. These studies were for the most part jointly financedby the Participating countries and the Programme. In addition, in order to leave the countries with thebasic tools needed to ensure the maintenance of the achievements of onchocerciasis control, somemodules for the training of technicians and entomologists as well as some consolidated reports on thedifferent river basins treated by the Programme are being produced with the assistance of someconsultants. Some of these Consultants used to be OCP staffmembers.

33- A computer prograrnme which is being finalised will allow for the integrated management andanalysis of all the data collected by the Vector Contol Unit. The Nationals of the countries have beentrained to the use of the programme called "VCU Data Manager" and the data have already beentransferred to them.

PLAI\NING, EVALUATION AND TRANSFER

Programme report

34. The current and planned activities of the PET Unit were centred around support to, andconsolidation of, the residual activities already transferred to the national teams. This includedstrengthened collaboration with the OCP countries in the fields of ivermectin distribution and in-depthepidemiological and ophthalmological evaluations as well as transfer of skills in data processing andanalysis.

35. During the period under review, more than 20,200 villages were under ivermectin treatment inthe OCP area and 6.9 million persons were treated. All the countries had now adopted the Community-directed Treatment with Ivermectin (CDTI) method of distribution with a geographical coverage of 86%o

and a therapeutic coverage around 72o/o. Apafi from a few specific zones where treatment was givenevery six months, the treatment schedule of ivermectin was once yearly. Non-governmentalDevelopment Organizations QIIGDOs) continued to provide countries with technical, logistical andfinancial support.

36. Certain constraints in conducting CDTI were, however, encountered. -fhey included inadequacyof financial and logistical resources impairing the supervision and monitoring of CDTI activities;delal'ed collection and fot'warding of activitt'reports by district staft: difficulties of some communitydrug distributors (CDDs) in carrying out their tasks; CDDs claiming remuneration; and the frequentmovenlent of health staff at the peripheral level which require the training of new staff.

Il,('ll II',rrc I -1

l7 l:prde nrroloIi al sr.rr.r,crllancc/evaluati, ,l \\'1s coutplctcd lirtpr.l ,l\ 1()99 to N4a1 2000 i, 2lOvillagcs rn basins mainly in Burkina lraso. Niger and Cote-d'lvoire as ucll as in tlte E,xtension Areas

of thc Programme in Benin, Ghana, Guinea, Mali, Senegal and 1-ogo. .l'he

overall results werc

satisfactory. In the Dienkoa basin in Burkina Faso, under combined larviciding and ivermectintreatment during the past ten years, the prevalence had decreased considerably reaching 0.0 to 2.8

percent. Higher prevalence rates were, however, observed in Benin [(the Zou river basin (17.8%)]; inGhana [(the Sene area (18%) and the Tanfi basin (45.7%)]; in Guinea [the Mafou basin (27 .2o/o) and

Kaba area (19.3%)); and in Mali [(the Dlani tributary to Niger (29.5%)).

3 8. After eleven years of exclusive ivermectin treatment in the savannah fbci of the Gambia basin

in Senegal the results were excellent with the highest prevalence reaching 4.6Yo at Oussounkala.

39. The results of extemal evaluation of CDTI were presentedto the Comrnittee by the Coordinator

of Togo, Dr Assimawe Pana. The evaluation was carried out in Burkina Faso, Cdte- d'lvoire, Senegal

and Togo by consultants from Benin and Ghana with the participation of the Coordinators of Togo and

Cdte-d'Ivoire.

40. In the 74 villages visited in the four countries, the coverage rate ranged between 50Yo arrd

95.6yo, the lowest rate was found in C6te-d'Ivoire. The average proportion of the people covered bythe treatment was 75.2% in Burkina Faso,660/o in C6te-d'Ivoire,77Yo in Senegal and8l.4Yo in Togo.

41. tn66Yo of the villages the CDDs were selected by the communities and in29Yo by the health

staff.

42. The following constraints were noted: lack of re-training of CDDs; lack of logistic means forfollow-up by the nurses; break in ivermectin stock; lack of motivation; delay in reporting; and a low

" level of community participation.

43. It was concluded that, overall, CDTI was well in place in the four countries although in C6te-

d'Ivoire the treatment was more in line with the community-based approach.

44. Ophthalmoloeical evaluation rvas conducted in seven villages in Burkina Faso and three villages

in C6te-d'Ivoire within the Original Programme Area. Preliminary findings showed absence of ocular

microfilariae and of lesions in most of the villages but new ocular lesions were observed among adults

in Mouvielo village in the Bougouriba basin, (Burkina Faso).

45. A set for cessation called for a thorough analysis of the entomo-

epidemiological data; ATP at zero during the last tluee to four years; and the prevalence of infectionapproaching zero without incidence during the most recent two epidemiological evaluations. There

should be also detailed epidemiological mapping in the neighbouring villages of the basin to assess the

level of infection.

46. Once these conditions had been met, larviciding could cease. However, the national authorities

r.vould need to continue broad ecological, entomological and epidemiological studies during the

tbllo,,ving two vears to ensure that the situation remained satisfactory. Should such studies indicate

r.ursatisfactorl' epidemiological situations. large-scale. community-drivetr N4ectizan treatment would

nced to be reinstated by the countr)'.

.IPC] I 3

l)asc I 5

1l . 'l'cntalivc .;rrteria to rLlldc thc cess .l,ion ol ivemrectin treatr cnt had also been der, Ioped as

lb[[ows: regressive prevalcnce trends and prevalences belou, 5%o at lbur epidemiological evaluations,at an interval of 3 to 5 years, with zero incidence at the latest evaluation; infectivity rate in batches ofblackfly heads equal to or below 0.5 infectious females per 1000 females captured; 100% of targetvillages covered at each treatment; therapeutic coverage in each eligible village at least 65%o at eachtreatment; and at leastl2 years combined larviciding ivermectin treatment or not less than l5 years ofexclusive ivermectin treatment.

48. The DEC patch test rvas being apptied together with skin snips during evaluations. TheIaboratory procedure for tlie preparation of the test material was transferred to all OCP countriesexcept Guinea Bissau and Sierra Leone where training in the use of the DEC patch test would take place

once the security situation so permitted.

49. In areas in Burkina Faso with no transmission and relapse in transmission and in forest zonesin C6te-d'Ivoire a rapid test for the detection of IeG4 antibodies to Onchocerca volvulus had beencarried out with promising results.

50. Epidemioloeical modelling.'. two new integrated epidemiological and entomological data bankshad been developed and were used as tools for consultation and analysis for OCP decision-making andfor facilitating the continuation of the transfer of data to the countries.

51. ReSearch aiming at improving the ONCHOSIM model had started by a statistician from theUniversity of Rotterdam recruited to re.examine the predictions in the light of the results obtained byusing the new tools for diagnosis in the field and by incorporating the new functions describing thetransmission of the microfilariae.

" 52. While waiting for these results, the predictions made for two villages of the basins of Niandianand Milo where the results of the prevalences based on the use of the diagnostic test made considerablymore sensitive by application of PCR, demonstrated that the model remained reliable.

53. The Programme awarded 28 fellowships for traininq essentially in epidemiology and publichealth with 30% of the candidates being women. District medical officers and nurses/technicians inCDTI areas were trained to conduct "on-the-job" training of community distributors. More than 18 000CDDs had been retrained.

54. OCP data dating from the inception of the Programme had been transferred to the countries withthe exception of Sierra Leone and Guinea Bissau. Selected clerks in a number of countries had beentrained in data entry, and first exchanges with the Programme of such data and their preliminaryanalysis were underway. Second data entry, updating of the central data bank and analysis anddissemination of final results were undertaken at Programme headquarters.

Discussions and recommendations

55. Members of the Cor-nmittee stressed the importance of considering simultaneously bothentomological and epidemiological, as well as socio-demographic, criteria in decision-makingregarding cessation of lan'iciding, taking also into account the local historl' of the disease and itscontro [.

.t I,('l i 3

I'lrgc I (,

56. liAC rac'ontntattdad rrrat CDTI cvalLtattons lrc.rn'tcd out in nrorc OC'[).,runtrics; that it-ttcgratton

be strengthened at the district level;that continuecl training of CDDs bc strcngthcned, and tl-rat local

partners. r-rotabl1, NCDOs. bc mobilised

57 . The Con-rmittee noted, with satisfaction, the most recent development in the field of integrated

analysis of OCP data and the updating of ONCHOSIM and recomnrcnded that theProgralnlne continue

its work on epidemiological modelling, making it easicr to use by the nationals and this in the

frame,uvork of the transfcr and decision-making after closure of OCP.

58. It was pointed out that ground larviciding did not attain as high a coverage as aerial treatment.

This would need to be taken into consideration whenever countries were advised to continue ground

Iarviciding after cessation of OCP operations. Furthermore, in such cases the capacity to assess the

ecological impact would be lacking in many situations. Thert couldalso be a problem of insufficientmanpower, resources and logistics.

59. As to the ground treatment of the Niger river in Mali, the Committee recommended that this

be divided into two operations, one dealing with the main river itself, the other controlling the

tributaries.

60. In response to a question, the Committee was informed that the decision regarding cessation oflarviciding in Guinea, foreseen for 2001, could be reconsidered after entomo-epidemiologicalevaluation with the possibility of extending treatment through 2002 (see table on page23).

61. [n Sierra Leone it had been hoped to commence CDTI operations during the current year and

district health staff had been trained as trainers of peripheral health staff and CDDs in March. This

,. training started in the South and part of the East of the country whilst conditions in the North excluded'

treatment. Much of the population to be covered were resettlers. It might be necessary to reinforceCDTI by direct involvement of health centre staff.

62. As to the treatment of displaced persons, the Programme Director suggested that advantage

should be taken of the experience in for instance Southern Sudan where APOC-supported CDTIprogrammes operated in spite of a war situation. He further suggested that under such conditions a

second treatment during the year would allow to treat defaulters at the first treatment round.

63. Concerning the criteria for inclusion of communities in CDTI prograrnmes, it was explained that

originally villages with a Community microfilarial Load (CMFL) of l0 mf/s or more in areas withlarviciding or those with CMFL of 5 and above in areas without larviciding, were included in the

treatment by mobile teams. With the introduction of the CDTI mode of distribution, the area covered

had greatly increased due to the use of the incorrect administrative strata to include villages to be

treated, and health centre supervision was in some cases being overstretched.

64 In respect to geographical coverage it was pointed out that hamlets lar from the villages to rvhich

thcy rvere attached'rvere sometimes unknou,n to the health centre staff or cvett "igtlored" by the CDDs

because of tlie distance to be covered to reach the hamlets.

(r-5 [t rvas suggested that caution be exercised in increasiug ir errrectirt tre-atment to threc times a

1'car considering thc pote ntial risk of invoking resistancc to thc drug.

.rP(-21 3

l'rtqc l7

66. As a mt rrls to securc sustainabil, r,of intcrYerttrorl progra, ,nres. the Ctlmnrittee raL /mntanda(l

that costing of interverltion could be conducted alongside projections of sustainability and

recrudescence. Several scenarios could be presented to show differential cost inputs including forinstance health carelservice costs that would be required in the short and long term in the event ofrecrudescence and cessation of intervention activities i.e. the cost of supplementary interventionsagainst health care costs in the absence ofoncho interventions.

MACROFIL

Programme reportClinical studies

67. Currently the Onchocerciasis Chemotherapy Researcfu Centre (OCRC) conducted, or plannedto conduct, clinical studies dealing with the macrofilaricidal potential of ivermectin combined withlevamisole, albendazole, and doxycyclin as well as the evaluation of non-response of onchocerca-infected individuals to ivermectin.

68. Other studies, including patients from high onchocerciasis prevalence regions, concemed thehuman pharmacokinetic (PK), safety and efficacy of albendazole + ivermectin combinations forlymphatic filariasis controVelimination. Based on the experience of the PK ivermectin + albendazolestudy, additional studies examining th6 PK profile of albendazole + DEC and additional evaluation ofthe safety'hnd efficacy of albendazole + ivermectin against lymphatic filariasis were to be initiatedduring 2000 with expected results in 2001.

69. An investigation was underway in a cohort of individuals from the Asubende and Bui area inGhana who after multiple cycles of ivermectin treatrnent continued to harbour high numbers of

' microfilariae in their skin, to determine if this was due to the presence of ivermectin resistant parasitesor to other factors. The study to be carried out at OCRC, in collaboration with the Ghana NoguchiMemorial Institute and the Ghana Division of Onchocerciasis Control, would evaluate the generalhealth of the individuals concerned; the individual PK; ivermectin efficacy against micro- and macro-filariae; and determine the parasite phenotype through observation of larval maturation in blackfliesunder ivermectin pressure.

Pre-clinical and research activities

70. It had been decided with TDR to promote moxidectin within the drug development portfoliofor evaluation in patients. The compound had shown efficacy in sterilisation or death of female worns,its elimination half life was longer and the volume of distribution was greater than ivermectinsuggesting the possibility of less frequent treatment or greater effectiveness; and it could be a

replacement compound in case of ivermectin resistance.

71. Informal discussions had taken place with the commercial owner of the product in order toinitiate formal negotiations aiming at clinical development of the compound for human use.

72. Animal studies had revealed that tetrac-vcline targeted the ll/olbachia endobacteria of filariaeresulting in a macrofilaricidal effect. This effect had been demonstrated in bovine infections withOnchocerca ochengi after long-term treatment. A human study ri,ould be conducted at OCRC incollaboration r,r,ith tlie Bernhard-Nocht-lnstitute of Tropical Medicine in Germany to evaluate the

.lP('l I II)rrr,e I S

potcnttitI o1'contbrr,rng Mectizan uitlr rlcox.-r,clrne in rcsl-lcct to sal'er_ and nracl()- itnd tntcro-l,.aricidale[1icac1,.

Ilcscarch leads

13. 'fhe need to implement inyilro "whole parasite" screening methods had been recognised withan adult worm assay and an O. licnalis, volvulu.s microfilaricidal assay or an in vitro T. colubrifurmisassay to be undertaken. These assays would be of relevance not only for "connecting" the in vitromolecular target screens that might become available, but with the whole animal screens. The more

complex screens (cattle, dogs) had been downscaled due to financial constraints.

"New molecular targets for filariasis" initiative

74. Research on the AA tRNA transferase and tubulin as a potential target for drug discovery was

being supported with the objective to identifu filarial-specific inhibitors. Successful crystallisation ofthe AA tRNA enzyme/inhibitor and expression of O. volvulzrs tubulin had been achieved. In addition,research on the genetic information from filarial parasites was being utilised to define additional new

drug discovery targets.

Detection of ivermectin resistance

75. Changes in the dynein of amphids, changes in the level of P-glycoprotein (transporter of drugs

across biological borders) and molecular changes in the ivermectin receptor had been identified as

resistance mechanisms. One team was addressing the field situation in order to identiff resistance whileanother team was concemed with the development of a tool for detection of ivermectin resistance based

on genetic information.

The DEC patch test

76. Contact had been made with a commercial firm vvith expertise in transdermal delivery systems

lf collaboration was agreed upon, the cost of the standardised test would amount to US$ 0.10.

EAC comments and recommendations:

77. Tlre Committee recommended that Macrofil give priority to the development of moxidectin.

78. EAC endorsed the studies on the use of antibiotics as macrofilaricides carried out in humanpatients at the OCRC facility in collaboration with the Benrhard Nocht Institute.

79. The Committee having considered a letter from Professor Trees of the Liverpool School ofPublic Health to the TDR Drug Discovery Research (DDR) programme regarding the development ofa macrofilaricide, expressed its agreement with the latter's response (see also section M. Other

matters).

80. A request rvas made for ONCHOSIM to update the rnodel on field application of a

niacrofrlaricide developed some )/ears ago. The Cornmittee agreed that arry update should await the

identitication o{- thc specifics ol a macrofi laricide.

ft

JPC2I .3I)agc l9

t3l. [:r\C notcd. with apprecration. thc critical rolc plalcd br OCI{C in conductinscluucal studies

firr OCP antcl t'ac'ontntcnded that cffirrts be made to continuc support to this facilitl, bcyond thetcrnrinatiorr of O(-P.

82. The Cor-r-rmittee also recontmended that the current study on the detection of resistance toivermectin and the development of tools for diagnosis and monitoring of such resistance, be placed

high on the priority list.

83. EAC fully endorsed the need for the development of a standard DEC patch test which could be

used to monitor recrudescence in areas cleared of onchocerciasis.

84. In view of the considerable essential work to be accomplished by Macrofil before OCP cameto an end, the Commitlee recommended that Macrofil not be subjected to cuts in the budget, additionalto those made recently, and, if possible, have its budget restored to its previous level.

H. APPLICATION OF THE EAC19 CONCEPTUAL FRAMEWORK FORINTEGRATION, TRANSFER AND COTINTRY PREPAREDNESS INCLUDINGRE,VIEW OF THE CONCLUSIONS OF THE NATIONAL COORDINATORS'MEETING (31 MAY - 2 JUNE 2000)

85. The fust part of this asenda item was introduced by Dr Nouhou Diallo, National OnchocerciasisCoordinator for Guinea, who presented the list of recommendations arrived at during the Meeting ofCoordinators held during the week immediately preceding the current session of EAC.

86. In all, eight recommendations had been made dealing with diagnostic tools; data management;the need for countries to budget for post-OCP residual activities; criteria for cessation of ivermectindistribution; motivation of CDDs; and monitoring/supervision of CDTI programmes.

87. The National Coordinators attending the EAC session outlined briefly their respective positionswithin their national health administrations and their involvement in, and responsibilities for, otherhealth prograrnmes than onchocerciasis control. Practically all of them held senior positions within theirnational health structure and were actively contributing to the implementation of a variety of controlprogrammes while assuming the role of advisors on onchocerciasis control within their respectiveMinistries.

EAC comments and recommendations

88. As to the recornmendation concerning "strategies and means of motivation" it was suggestedthat motivation and supervision of CDDs should come from the communities themselves, possiblyassisted by other levels whenever material incentives rvere provided to community distributors. In thepoorest communities unable to provide nraterial incentives. moral support could be the only, butimportant. means of n"rotivation.

89 fo a question concerning the extent to which National Coordinators would be able to assumetheir responsibility for the implementation of the recommendations, the Committee was reassured thatNational Coordinators in their capacitl'as menrbers of the central health administrations had sufficientinfluenc" to hclp inrplenrenting the rc'conrnrendations.

JPC2I.3Page 20

90. In connection w'ith the move torvards integration i1 uas suggestcd that the appointutent o1'

Coordinators tended to irnply verticality. At tl-re same time, it rvas stressed that some health activitieshad to be vertical tionr the begiming both to demonstrate early success and to satisfy donor preferences.

91. As regard a recormendation that Participating Countries should earmark resources in their ownbudgets for residual onchocerciasis control activities, it was explained that in spite of the currentdifficult economic situation in many countries there was a move towards self-sufficiency and that thismove was particularly important at the district level. This should be seen as an important factor inachieving sustainability. This issue was not particular to onchocerciasis control but applied to numerousother externally assisted health prograrnmes.

92. The second part of the asenda item was introduced by Professor Detlef Prozesky who presenteda motivation study of community distributors carried out in December 1999 in Ghana, C6te-d'Ivoireand Benin by a team consisting of three researchers including himself. The team used the Handy modelthat depicts motivation as a situation-specific decision to expend "E" (energy, effort and enthusiasm)to meet a person's specific needs.

93. The report prepared by the Ghanaian researcher was copied to participants in the session whileProf. Prozesky presented his findings from Benin regarding the village level distibutors. He reportedthat the level of motivation varied considerably, as did the factors that affected it in each case. Thenumber of distributors that showed a low level of motivation was worrisome. Distributors needed theesteem of the villagers and the health workers; self esteem; a possible career; and money for theirfamilies.

94. The factors wtuch influenced the level ofmotivation varied from case to case. Distributors wereprompted to spend more "E" by factors like a desire to serve, and to be of use to one's community asthe most important factor. However, the "E" that distributors were prepared to spend was limited byobstacles like a large and dispersed village.

95. Other findings were that most distributors also did other voluntary work and that CDTI was alow priority for most of them; that the normal way of distribution was house-to-house (which takes alot of time); and that their training was often inadequate.

96. Prof. Prozesky suggested that similar research be carried out in each of the OCP countries; thatthe findings be used as a basis for wide consultations in each country with people inside and outsidethe Programme, leading up to a plan; that the plan be implemented on a limited scale, and that its resultsbe evaluated before wider application.


97. EAC Members and other participants expressed their satisfaction with the findings of the studywhich had gone a long way in identifying the various factors at play in securing or losing motivation.

98. EAC took note of Dr Uche Amazigo's remark that the APOC guidelines had omitted to stresstlie needs of CDTI rvorkers to be fulfilled in order to lay the ground for sustained motivation. Also,communities should be informed in advance about the constraints inherent in the implementation ofthe CD-l'l proccss.

.IPC2I J

l'age 2l

99 -['o cxpand thc .itudy aud prourote motir.,tion, she lurthersuggcstrJ to involve groups rvith ,ieldexperience in advocacl': they should Iink up rvith the Coordinators.

100. 'fhe recognition by the community of the distributors could play an important role in sustainingmotivation. It had aiso been observed that CDDs were keen on having continued contact with theirsupervising healtl'r centre staff.

101. Due regard rvould have to be paid to the job-expectations of both the distributors and the healthcentre staff and care should be taken to ensure that they be given a reasonable workload. Another factorin loss of motivation could be the lack of feed-back from the centre.

102. It was suggested that contact be made with field workers in other health prograrnmes relyingon motivation e.g. trypanosomiasis control, to draw on their experience.

103. Strategies for sustainable CDTI should emanate from the community level

104. The questions of why CDDs also dealing with other prograrrmes and those involved only inivermectin distribution performed equally well and why there did not seem to be any dif,flerence in themotivation between community-appointed and health staff-appointed distributors needed furtherstudies.

105. Other issues for an expanded study would be to examine the reasons why CDDs loose theirmotivation and how to translate the recommendations of the current study into practice.

106. On the operational side, it was advised against organising distribution on a house-to-house basis

and rather organise central distribution to save time for the CDDs but the decision should lay with the

" community.

107. A suggestion was made to invite local politicians to support and promote CDTI programmes

PRIORITY ACTIONS TO BE TAKEN DURING THE LAST 2 II2 YEARS OF OCPOPERATIONS TO CONSOLIDATE TTIE ACHIEVEMENTS OF THE PROGRAMMEAND ALLOW FOR MAINTAINING THEM AFTER 2OO2

.108. This agenda itern was considered in three working groups for presentation and comments inPlenary.

"National oncho control activities beyond 2002, including vector control"

109. The major conclusions of the working group are reproduced in the follorving two tables (pages

23 and 24).For sorne river basins (Oueme-Zou- Okpara, tributaries of the Oti, Bou, Middle course ofthe Niger, Mafou, Tinkisso and possibly Niandan -Kouya. Bale), the projected date for the cessation

of larviciding is at the end of 2002. However. this does not mean that by this date the Programme willhave obtained fully satisfactory results allorving for a riskless cessation of vector control operationsaccording to the established criteria. Such cessation rvould be by default because of the planned endof the Prograrnme rather than by choice. l'his is in spite of the tact that larviciding shor-rld continue inthese basins for a period to be detennined bv the ONCHOSIM predictions based on the currentlyongoing entomo-epidemiological studies.

I

.ilrc2l iI'.ruc l-l

110 It rvas rccontntendcd ,'rzrt cln thcsc basrns, suci, cssation Llc c()utllensirte .' l()r b1 thc instil-uticln

o1'ground larviciding. Ilorvever, cven lhough this is technicaill and tinanctalll' lbasiblc, such

treatments could not, in all events, be anything more than stopgap l-llcasurcs u,hich at best, wouldprovide partial and fleeting protection to the sole communities nearest to the treatment sites.

1 I I . Most of the strategic scenarios emphasise the need to continue such treatments at least in the

dry season of 2003. This is in order to complete the effect of the last 1,ear of the Programme's

larviciding operations which by so doing will neutralise the peak of the transmission cycle at the lowwater level of 200212003. Furthermore, the finalisation of such ground Iarviciding and its extensiort

to virtually all of the large basins raises a number of questions : its objectives (control of the disease,

protection against blackfly nuisance, neutralisation of the sources of re-invasion), the selection of the

sites to be treated, the choice of the periods of treatment, their duration throughout the year and the

conditions for their seasonal or definitive cessation (criteria fqr making such decisions), the conditions

and methods of entomological surveillance and monitoring, its feasibility in logistical and economic

terms (required budget, cost/effectiveness ratio). These questions should be reviewed as soon as

possible by a group of OCP technicians, national specialists and external experts.


ll2. During the discussion in Plenary on this report the following issues were brought up

a) ground tarviciding in the five basins in question beyond 2002 would be instituted in lieu ofaerial larviciding, fully realising that ground larviciding would not be at the same efficiency level as

aerial larviciding;

b) for answers to questions relating to operational issues regarding ground larviciding', (monitoring of ecological impact and vector control effectiveness, when to discontinue, evaluation etc.),

it was recommended that task forces be set up with a view to make recommendations to national

authorities;

c) as to the funding of post-OCP activities, negotiations with donors would be undertaken

whenever required;

d) the Committee was reassrued that feasibility studies for post-OCP ground larviciding were

well in hand.

JPC21.3Page23

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"National capability to maintain OCP achievcments"

The lbllowing summarises the report of the working group

113. It was determined that the national teams' goal were a) to prevent recrudescence and b) tomaintain a decrease in the level of onchocerciasis.

114. The following would be the major tasks: epidemiological surveillance; entomologicalsurveillance; ground larviciding; CDTI; and IEC. To accomplish these tasks, national teams needed totake into account human resource training; supervision; procurement of resources, management; andcoordination, including the integration of onchocerciasis surveillance and control into the healthservices.

115. The transfer would require budgetary support from countries afld long-term donors. In addition,transfer activities needed to address the following specific issues a) acquisition of equipment for skinsnip; b) standardisation of the DEC patch method in commercial form; c) undertaking research andpolicy development to empower communities to address the issue of motivation; d) experimenting withthe model of an experienced ssmmrrnibr distributor and coordinating the work of other CDDs in a localnetwork; e) meeting the IEC needs for sustaining the CDTI process.

116. Special consideration should be given to Sierra Leone and Guinea Bissau, including mass andpassive distribution of ivermectin and possible transfer to APOC after 2002.

Detailed analysis and recommendations are provided in Annex 4.


ll7. During the presentation in Plenary a number of suggestions were made:

a) there was a need to undertake research at the level of integration and the process ofmotivation to promote consciousness;

b) when modiffing software, users' agreements should be obtained in order to avoid confusion;

c) on the issue of standardisation of the DEC patch test, the Committee was informed that thiswas being tackled by the Programme;

d) support was sought from the Programme to strengthen university training inepidemiology through the use of OCP data;

e) post-OCP ophthalmological evaluation would only be carried out in case of recrudescence;

f) denominators for the calculation of CDTI coverage rates should be based on reliable CDDcensus,

g) irt recrudescence foci, concentric villages rvould be evaluated to determine the extent ofCDTI control:

JPC21 3

Page 26

1 18. [:A(] Mcmbcrs rcaliscd that OCP rvould not attaln its oblectivc in ccrtain nver bastr.rs w'hcre

prevalencc ol sonre importancc wcluld remain rvhen aerial larviciding came to an end in 2002 andwhere national post-OCI) ground larviciding was recommended. The Comnrittee recomntended thalspecial attention be given to this issue.

"Contribution of the AFRO Sub-regional Centre to maintaining OCP achievements"

'fhe report of the working group is summarised below

1 19. Background to the Multi-disease Surveillance and Control Centre (MDSC): the Centre was tobe based on the premise, among others, that it should maintain OCP achievements.

120. Functions which countries will perform after OCP operations ceose:CDTI, epidemiologicalsurveillance/evaluation, entomological surveillance and data rnanageftrent.

l2l. Main activities of the Centre: pending further consultations between OCP, the countries andAPOC, and AFRO the following are recommended:

a) training in the followine fields: laboratory techniques; epidemiological techniques @ECpatch test, skin snip); data management; use should be made of sub-regional capabilities andworkshops bringing interested parties together;

b) collection of information on the various aspects of onchocerciasis control including theassembly of an institutional memory of the Programme and its results, in the form of "textbooks" onthe various subjects;

c) information and communication networks: establishment of a network among OCPcountries, APOC and epidemiological block countries in the sub-region; links with the OCPInformation Documentation centre; and the close links forged among countries by the Programmeshould be maintained and fi.rrther developed. Upgrading could be achieved by using radio, e-mail,internet/web-site and fax.

d) development of decision-making tools, database and the modelling of diseases, theirepidemiology and control on the lines of ONCHOSIM (being rehned by adding additional parametersfor decision-making)

e) strengthenins of laboratory functions:training in laboratory techniques of critical impoftance;

f) cross-nationai activity: development of analytical capacity to examine onchocerciasisprobletns in the sub-region and sharing analytical results among the countries,

g) operational research: to include investigation into ivcrmectin resistance and its means ofdetectrtln:

h ) brokeraqe betrveen institutes/countries to cnhance ctt I laborat iorr :

r) l'he \\'est..\tiican [rrcsllrrlrtc! []ro-divcrsit] [)rtlcct shoulcl t,c anotltcr cross-natronalpro.lCe t,rl tllr' . etltrr'

JPC2I .3

Page 27

l) lurthcr recourtnendations: pliasing ol'thc der,elopnrent of thc Ccntre; revierv of t|ectxrposition and size of the staff in relation to the functions of the Centre to ensure its effectiveexecution; and that AFRO support countries in advocacy and resource mobilisatiol.

lrAC comnrents and recommendations

122. The importance of the Centre expanding its activities beyond onchocerciasis surveillance andcontrol was stressed as was the commitment of the countries involved to contribute to the budget ofthe Centre as well as making available qualified staff, possibly on a rotational basis with nationalMDSC centres.

123. The importance of a phased approach was underlined, suggesting the beginning being limitedto only one or two diseases in addition to onchocerciasis, gradually increasing the number of diseasesto be included.

124. Another suggestion was to imitate the new TDR approach in which the first phase developedfunctional areas such as epidemiological surveillance and social science leading to expertise in theseareas which in phase two were then applied to specific disease areas.

125. There would be a need for developing criteria for the selection of the diseases included in theprogralnme of the Cente in close collaboration with AFRO. The Programme Director informed theCommittee in this connection that a draft plan for the Centre is in preparation by AFRO which wouldthen be sent to experts for comments. AFRO would appoint the Centre staffon its regular budget andsolicit extra-budgetary funds for the operations of the Cente.

126. The importance of including arnong the staffexpertise in social science and human behaviourwas stressed. Also, it was recommended to expand the capacity of the DNA laboratory to increase itsmolecular tools.

127. The Committee recommended that the relationship of the AFRO MDSC Centre withthe OCRC in Ghana be examined for future collaboration.

128 EAC funher recommended that the West African Freshwater Bio-diversity Project be linkedwith the MDSC Centre

REPORTS ON PROGRESS OF APOC INCLUDING RECOMMENDATIONSREGARDING OPERATIONAL RESEARCH OF RELEVANCE TO BOTH OCP ANDAPOC

129. 'l'he status of REMO in APOC countries, and refinement exercise undertaken in areas of co-cndemicity ol onchocerciasis and loasis following reports on cases of severe adverse experiences(SEAs)and llve deaths in Cameroon were discussed. The presentation also highlighted steps taken bythe partners oIAPOC and the Management to address community concems regarding SIlAs. Guidelineslor Ittattasclncnt of cases have since been developed for use in affected countries.

li0. Irlfirrlllalitlrl uas provided on trcatntent figures. achievcurents in training of hcalth pcrsonlel anci('l)l)s rttld titc pctfbrntancc o1'l() (XX) conrnrunitics ur l99t) I'hc \trL.ngths and rvcakncsscs olCDl'lpr()lce t: ttie tlltlletl i,) ttttlcpe ndent nr()r.utor,rtt: tcAnts. l\sLlc\ ol'g1111.,r'p to AIr()(1. rrcrc :11r,et.i qrtI

J

JPC21.3Page 28

EAC. Further. the rcsults and lcssons leernrcd lronr con.rnrunrtr scll-monitorinq. a nc\\'acti\ity launchedin Malarvi and Uganda in 1999, were discussed.

131. Responding to repofts from national field teams and a request from OCP, thcTDR'fask Forceon Filariasis had begun with the revision of the Pictorial Fon... for use by non-literate as well as literateivermectin distributors. The Committee u'as informed that the revised Pictorial Fomr and the Guidelinesfor health workers training of CDDs on the use of the Forms rvould be pre-tested in two OCP and theeAPOC countries before the end of the year. Furthermore. the findings of a multi-country study onsustainability of CDTI and the recommendation for control programmes to initiate stakeholders'meetings were explained.

EAC comments and recommendations

132. As to the Pictorial Form, it was recommended that they be sciutinised by the communities tofind out how best to "reach" them, before finalisation.

133. In respect to inadequate supervision from the central level, it was suggested that lower levelsand the communities themselves "take over" supervision of specific prograrnmes.

134. Although not supported by scientific dat4 there was stong evidence that the direct involvementof women in CDTI activities would enhance the performance in many projects.

K. THE PROGRAMME FOR ELIMINATION OF LYMPIIATIC HLARIASIS IN AFRICA:CSA ISSUE PAPER

135. The Programme Director informed the Committee about the background for launching theLymphatic Filariasis Elimination (LFE) prograrnme and the progress made so far in implementing theprogralnme. He referred to the Joint OCP-APOC Session in December 1999 which requested theCommittee of Sponsoring Agencies to prepare an issue paper for the December 2000 session.

136. In respect to the possibility of OCP and APOC collaborating with the LFE Programme, DrBoatin enumerated the various difflerences between onchocerciasis control and LF elimination, notablythe life span of the three Prograrnmes (OCP ending in2002, APOC in2007 and LFE in 2020); OCPand APOC control in hyper-mesoendemic zones while LFE includes also hypo-endemic areas; LFEtreatment in urban areas; and the dosage of albendazole fixed at one tablet, while oncho control tookinto account the height of the people.

137 . He raised the question if in OCP. and soon APOC areas, rvhere ivermectin had been dispensedfor several vears. a considerable impact on LFE had not alreadv been made. In any case, anycollaboratiou between OCP and LFII rvould need to be inrplementcd in a rnanner u'hich rvould notprejudice the achievements of OCP. Irurthermore. the need to generate additional evidence of thesuperiority of ivermectin + albendazole versus ivemtectin alone was noted.

138. Additional issues were brought up during the discussion on this agenda item. It ri'as pointed outthat LFtl ainted at 100% coverage r.vhile CD'l-l rarelr exceeded 70%: thcre rvas contraindication on LFtreatnrent in Lott-lort areas which rnight result in learing bchrnd lirci o[-re-invasion into treated arcas;also. the cxclusittn o1-trcatnrent ol'prcunirn[ \\,()nr(]n ctluld ,-'ntllrnltcr the tilrqet covcr.iqe ol'the LIrl;.I r ou,ran.tr.t.tc

JPC21.3[)agc 2c)

139. ll'it u'ere proven that ivcrnrcctin trcatmcnt of ccrtain indivrduals inttctcd riith fu.ra-lr.ra couldbe nrortal, the Committee recontntended that political and health authorities in countries whereonchocerciasis and Loa-loa co-exist be informed about this risk.

140. It was pointed out that a study was required to determine whether yearly treatment wouldprogressively decrease the microfilaraemia and lead to elimination, and that the residual microfilariaeafter treatment did not represent microfilariae or adult worms that were tolerant to the drugs.

l4l. Ivermectin and albendazole had been separately registered by the national regulatory authoritiesand the combination did therefore not require registration. However, in order to ensure the safety of thecombined treatment, national LF Coordinators had been advised to organise strict surveillance duringthe treatment of the first 2000 persons.

142. The Committee was aware that the LFE Programme had already started operations, essentiallymapping of co-endemic areas, in some countries and that the programme was undertaken under WHOauspices. It was therefore agreed that the Committee would support the collaboration between OCP andLFE with the understanding that answers be sought to the many questions raised above.

L. PROGRESS IN ESTABLISIIING THE AFRO SUB-REGIONAL CENTRE, FORSUPPORT TO NATIONAL MT'LTIDISEASE SURVEILLANCE AND CONTROLSYSTEMS

M.

This issue has been dealt with in section I. above (paragraphs 1 19 to 128)

OTITT',R MATTERS

143. Article in Lancet (vol. 355 pages 1663 - 1664) "Programmatic Goals and Approaches toOnchocerciasis" by F. Richards, D. Hopkins and E. Cuppi EAC states that the concerns andrecommendations raised in the article are based on assumptions and do not appropriately reflect thefuture fate of the African areas under onchocerciasis control prograrnmes. A resolution to respond tothis article was approved.

144. Requests from Prof. S. Trees and Dr Renz to reconsider the TDR decision to stop funding theO- ochengi centre in Cameroon: EAC decided a) to firlly endorse the statement of Dr R. Ridley to prof.Trees regarding this decision; b) to acknowledge the observation regarding the tetracycline effects onmacrofilaria and recommends that the observation should be further evaluated in human clinicalstudies. EAC states that the evaluation of the scientific proposal conceming Macrofil was a functionof DDR Steering Committee and that there was no reason to question or interfere with decisions of thiscommittee.

145. Tlre Committee recommended that an evaluation be carried out, about three years after cessationof OCP operations, to assess the extent to which the achievements of the Programme had beenmaintained. The modalities of this evaluation would have to be worked out at a later date.

N. DATE AND VENUE OF THE TWENTY-SECOND SESSION OF EAC

146. 'fhe Committee decided to meet in its trventy-second session in Ouagadougou on 4 to 8 June200 I

JPC21,3

Pagc 30

O. r\I)OI'TION OF ]'I{E DITAF'I' ITEPOII'I

l4l . A dralt of the repoft was approved by the Committee with the understanding that modificationsagreed upon during its consideration would be incorporated.

P. CLOSURE OF THE SESSION

148. After statements of the Chair and the Director of the Programme, Prof. Abiose declared thesession closed.

1-ABLE OIT CONTEN'|S

SUMMARY OF RECOMMENDATIONS

A. INTRODUCTION...

ADOPTION OF THE AGENDA

FOLLOW UP OF RECOMMENDATIONS OF THE 2OTH SESSION OF THEECOLOGICAL GROUP ............ ..................:.....-.............

VECTOR CONTROL UMT ACTTVITIES IN 1999 .....

AQUANC ENVIRONMENTAL MONITORING ACTIVITIES .

ECOLOGICAL MONITORING AS PART OF THE SOCIO-ECONOMICDEVELOPMENT OF ONCHO-FREED ZONES

woRK pRocRAMME FOR 2000/2001 ..........

ARRANGEMENTS FORTTIE NEXT MEETING

I. READING AND APPROVAL OF REPORT

CLOSURE OF THE SESSION

Appendix I : List of participants...............

Appendix 2: List of documents ..............

Appendix 3: Work Programme for 2000

Appendix 4: Bamako list ...........

JPC21.3I'}age 3l

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32

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JPC21.3

I'}age 32

i\rtnex I

1. Land-use changes monitoring, which might involve remote sensing application should beincorporated into environmental monitoring studies in Oncho-freed zones (Para l3).

Handling of excess programme insectides

2. OCP should approach appropriate agencies for them to handle excess insecticides at the end ofthe Programme (Para 38).

3+. Commendations should be awarded to hydrobiologists who have been involved in OCPactivities for more than 10 years (Para 57).

4+ Prepare a popular illustrated booklet of about 25-30 pages which witl highlight OCPenvironmental activities (Para 57).

5* Prepare a synopsis of scientific results from monitoring activities as a special issue of ascientific journal (para 57).

Aquatic monitorine

6. Monitoring activities during 2000-2001 should be on the same watercourses and at thesame frequency as in 1999 (Para 58).

7. Organise a one rveek workshop to review and calibrate fish data collected by the nationalhydrobiological teams (Para 58).

AS of

8. A strong synergy between bio-diversity conservation and ecosystem management studies inoncho-freed zones and existing development activities should be established (Para 6l).

* Recommendations also made during 20'h session

SUi\{MARY OF RECOMMENDATIONS

The summary of recommendations made by the Ecological Group is presented belorv:

Monitoring of Land-use chanqes as part of environmental studies in Oncho-freed zones

Recording and valorisation of achievements during the fifth financial phase

JPC2I.3Page 33

Anncx 1

A. I N'TITOD UCTION

l. The twenty-first session of the Ecological Group was held in Bamako, Mali, from 23'd to the 26,r,February, 2000, under the Chairmanship of Professor V.H. Resh, Chair of the Ecological Group.Present at the meeting were the Director of the Onchocerciasis Control Programme, Dr. Boakye A.Boatin, all members of the Ecological Group, a Representative of the Committee of SponsoringAgencies (Mr M. Sonou from FAO, Accra) and a World Bank consultant on Onchocerciasis, Dr S.Leloup (see annex I for list of participants and 2 for list of documents).

Opening session

2. The opening ceremony was presided over by the Representative of World Health Organization(WHO) in Mali, Mad'm H6ldne Mambu-ma Disu. The Chairman welcomed all participants to themeeting and gave the floor to the Programme Director. He alsorvelcomed all present to the 2lo sessionof the Ecological Group indicating that he was looking forward to seeing the whole Ecological Groupat work for the frst time, having previously only read and heard of their work. The Director recountedsome of the major achievements of the Programme, its collaborators and supporters, including theEcological Group.

3- Achievements listed included the liberation of about 25 million hectares of fertile valleys,preservation of the environmen! and the human resource development associated. As the programmeis to come to an enci soon, the Director expressed OCP's concem over especially, how excessinsecticides would be handled and how all the liberated lands could be used with biological diversity,and other natural resource conservation and management in mind. He ended by extending theProgramme's invitation to all for initidtives to address the various concerns and wishea participantssuccessful delitrerations. -

4- The acting Chief of the Vector Control Unit (VCU) of the Programme, Dr. L. yam6ogo, in ashort address welcomed participants and indicated that the VCU always took lessons while observingand discussing environmental issues with the Ecological Group and associated experts. He assured theEcological Group of the importance VCU always attaches to their recommendations and the efforts theymake to implement them. Dr. Yamdogo ended by extending the sincere appreciation of VCU to all forcoming again to assist the Programme.

5. The WHO Representative in Mali, Madam Hdldne Mambu-ma Disu speaking in the nameofthe African Regional Director of WHO, thanked the Authorities of Mali, for the support they give toWHO activities. She indicated that WHO in Mali, was pleased to host the Ecologi"ui Group meetings.She then recounted the significance of aspects of the success of the Oncho Control programme andcraved the indulgence of direct beneficiary countries to maintain the gains of the progiamme withspecial reference to judicious use of nafural resources in oncho-freed areas. Finally, she declared themeeting opened with a wish for fruitful deliberations.

6. Before continuing with the agenda of the meeting, Prof. V. H. Resh also welcomed participantsand thanked all present, especially the WHO Representative in Mali, her collaborators, members of theEcological Group, invited experts, and the Hydrobiologists for their continued support to theProgramme. As the previous speakers, Prof. Resh indicated the concerns of the Ecologicai Group overenvirorunental management in Oncho-freed areas. I{orvever, the Group was hopeful that the workshopto take place dtlr,rrg the meeting will eveliruallv contribute some auswers to the concerrls.

JPC2I.3Page 34

Annex 1

Joint Llvdrobiolo loeical Group meetinq

7. This session was mainly devoted to a workshop on a project proposal for bio-diversity studiesin the Oncho-freed zones. Nevertheless, a sum-up of the results of invertebrates and fish monitoringwas made by the hydrobiologists (see section E) and the meeting received and discussed brief technicalpresentations by two members of the Ecological Group and two invited experts.

a) Views on the bio-moniioring and ecologicol consequences of the insecticide treatmentin the Programme.

8. Dr B. Statzner, Research Director, CNRS France, a Hydrobiologist who was involved in theinsecticides screening activities of the OCP, but had been away from the Programme area for severalyears, reviewed some of the current approaches in relation toearliertonsiderations, predictions andconcerns, including those related to the prospect of rotating two larvicides during 1978.

9. For current considerations, Dr Statzner highlighted the issue of Surber sampling without dueregard to surface area available for sampling and river discharge. He regretted that it had still not beenpossible to interpret drift data to reflect densities and diversity of benthic fauna because that was theoriginal intention for the drift sampling. However, he was pleased that apprehensions of the early daysover rotating two insecticides had been overcome and seven insecticides were being rotated with noundue impact on entomofauna.

b) Bio-diversity measurements in relation to reptiles and amphibians.

10. Professor R. Drewes is Curator and chair of Departnent of herpetology, California Academyof Science. His presentation was aimed at widening the scope of bio-indicators to be considered in themonitoring component of the project to be related to bio-diversity conservation in Oncho-freed zones.He drew attention to several issues to be considered in bio-monitoring of aquatic environment and theirriparian zones, and based on several of them presented amphibians as excellen! "multi-environment"and early waming indicators in aquatic ecosystems.

I 1. Finally, he reminded participants of the opportunity West African post-graduates will get tostudy systematists of amphibians, if the organisms were included in the project, indicating thatamphibian systematists were a "dying species".

c) Methodologt of site description based on remote sensing using the cases of Leraba andPont de Po.

12. Prof. A. Reenberg a member of the Ecological Group, exemplified her presentation with aerialphotographs of the Leraba area at different scales. She demonstrated the potential utility of aerialphotography and remote sensing products in large scale habitat monitoring and thus land-use changes.The presentation was applicable to the current habitat quality assessment study undertaken by theHydrobiologists and also the future project under consideration.

13. In the discussion which followed, Prof. Reenberg indicated that interpretation of aerialphotographs by f-armers has been shorvn to be feasible. She emphasized that it would be very useful toinclLrde l-.trcl-use changes rnottitor,,rg in the project for Onc,,.r-tieed zones because tlicr.also indicated

JPC21.3I'agc 3,5

,,\nnex 1

horv much pressure was on the land. The Ecological Group summed up the discussion byrecommending that if appropriate. land - use changes monitoring which might include some of theapproaches mentioned by Prof. Reenberg should be included in the project for the Oncho-freed zones.

d) The economical importance of the principal recommendations of the Ecological Group

14. As an up-date to the status of the assessment, Prof. Colman member of the Ecological Group,indicated that some progress had been made, but the job was not concluded. First, decisions had beenmade about the size of marketable fish catch throughout the sub-region impacted by the Progamme, butfurther consideration needed to be given to the time profile of beneficial impacts. Also some fish pricesfor Mali since 1974 had been obtained but more was needed from the other countries. prof. Colmanindicated that he intended also to consider larvicide cost arising from the decision to reduceenvironmental damaging effect which would otherwise have Impped. The discussions which followedwere mainly suggestions of new parameters for Prof. Colman to consider and their justification.

e) Workshop on project proposal for bio-diversity studies in oncho-freed zones.

15. Prof. Resh opened the workshop with reference to concerns of the Programme overenvironmental issues within aquatic ecosystems in Oncho-freed zones. He indicated that one of theinitiatives by the Programme had yielded a preliminary project proposal, which was the subject of theworkshop. He then introduced Dr. Susanne Leloup, a consultant to the World Bank who was at themeeting to coordinate the workshop. Dr Leloup introduced a preliminary proposal document with thetitle: "West African Freshwater Bio-diversity Conservation and Ecosystem Management project."

16- Copies of the proposal document were distibuted to participants as Dr Leloup explained partsof the document and some characteristics the World Bank would expect the project to have in theprocess of finalising the proposal. For example:

That the project would be expected to aim at preventing the loss of bio-diversity mainlythrough the action of local communities.

ii) The project would be expected to function to compliment existing or ongoing efforts atrural development through bio-diversity conservation or management.

iii) That it was imperative to communicate project concept and intended sites to countryfocal points GEF for discussion and support.

Various issues raised by Dr Leloup in her presentation were discussed and the followingdecisions made :

a. Burkina Faso, COte d'Ivoire and Ghana would be country participants of the project. Guinea wouldbe considered a potential partner, pending outcome of project finalisation workshop.

b. The target areas shall be watershed areas involving OCP monitoring sites where human populationpressure is experienced due to settlement or settlement activities.

I'he project rvill emphasise threats to bio-diversity ri,hich are controllable by communityparticipatory rnanaSLnrent practiccs.

i)

C

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r\nnex 1

d. "Environmental Itrpact Assessment" as is usually understood, shall not be an issue of the projectwith respect to developmental activities in target areas.

e. 'fhe project, as an activity, shall identify locations within target areas which should berecommended for protection for wider bio-diversity conservation interests.

f. There should be a partnership between the GEF project and the development projects on thewatershed areas.

g. Hydrobiologists of project countries shall be requested to provide some site characteristicinformation for proposal finalisation prior to the follow-up workshop.

h. The life time of project shall be "short"; that is up to threayears. -

A project finalisation workshop would be held in Ouagadougou in June 2000.

17. In view of discussions held and agreements presented, a call was made for suggested activitiesof the project. A long list of subjects was submitted (Annex 4). This was preliminarily organised by agroup of participants as part of the Workshop. Finalisation of the activity was left as part of thepreparatory activities for the follow-up workshop.

l8 The Chairman ended the workshop by thanking participants for their contributions.

ADOPTION OF THE AGEIYDA

The agenda as presented in the table of contents was proposed and adopted by participants

FOLLOW T]P OF RECOMMENDATIONS OF TIIE 2OTH SESSION OF THE

20. Almost all recommendations made by the Ecological Group during its 20h session wereimplemented. However with regard to activities of valorisation the Group gave precision/ clarification(see chapter E)

D. VECTOR CONTROL TTNIT ACTIVITIES IN 1999

General overview of VCU activities

2l . The acting Chief VCU reported that activities of the Unit during 1999 were accompanied bythree Major facts as follows :

A new aerial operations contract which needed only five helicopters instead of nine used in1998. Thus the reduction of guaranteed flight hours from 4770 to 3002.

b. Reduction in research activities

19

B.

C.

a.

C I)artii., r'eorientation oIaquatic inonitorinq activities

l.

JPC2I.3I'}age 37.,\nncx I

In spite of the above alterations. vector control activitics continued with the same intensityputting emphasis on the use of the biological insecticide B.t Il-14 as a replacement for phoxim forexample. Intensive prospection and captures were conducted in specific interventions areas (troublespots), and larviciding was also intensified wherever necessary, with the pilots being accompanied bytechnicians from the Programme.

22. Results obtained were good. For example, out of 107 points of capture regularly visited only8 had annual transmission potential (ATP) higher than 100 infective larvae of Onchocercavolvuluslman/year.

23. Then considering transmission of human onchocerciasis by the savanna species of Simuliumdamnosum, only three catching points have an ATP higher than 100. These were Fifa on the Tinkissoin Guinea" Asubende on the Pru in Ghana and Titira on the Keran in Togo. For these locations, actionsare being taken to improve the situation.

24. Finally, the unit stressed on the transfer of certain entomological activities to national teams.Thus, national entomologists fiained earlier by the Programme led the following activities during 1999.

D Studies for early detection of recrudescence.ii) Impact of ivermectine on transmission.iii) Simulium.nuisancecontrolactivities.iu) Inventory of local repellents and testing of the most common and widespread ones.

25. This fust step benefited from the financial involvement of some participating countries.

Generally speaking, activities of VCU during the year centered on resolving problems at troublespot areas as well as country preparedness for conducting post.OCP entomological activities. In thewhole located area, precautions taken with use of larvicides included rotation of the gperationalinsecticides and adherence to cautions sounded by the Ecological Group on the use of permethrin andCarbosulfan. Criteria for choice of larvicides to be used were:

i)iDiii)i,o)

Susceptibility of the Simulium damnosum larvae to the larvicideToxicity on non-target aquatic fauna.Discharge of the riverCost / effectiveness ratio for the use of the larvicide.

Utilisation of larvicides in the East Zone

26. In relation to entomological results and discharges recorded in the eastem zone, there was totalsuspension of aerial larviciding for three weeks during the year 1999. These were the 14, l5 and 16'hweeks (i.e. 05 to 25 April). There was also minimum treatment during the l2'h and l3'h weeks (i.e.March 22"d ro April 4'r'). Maximum treatment was effected in week 39 (i.e. 27'h September to 3'dOctober).

27. The Oti was experimentally treated during Januarv and February of 1999 with a cycle oftemephos, four cycles of pyraclofos and one cvcle of 8.1. FI-14. Thc Daka river was also experimentallytreatuJ fiom *'eek 34 to 39 r,r'i.ir 5 cycles of pvraclofbs.urd a cyclc of permcthrir, with the objective of

JPCZI.3Page 38

r\nnex I

protecting the river Pru. However, no impact of the treatments were observed on the Pru. Furtherprospection pointed to the source of the problem on the Pru and the necessary steps are being taken.

28. In addition to carrying out larviciding in rotation adhering to the cautions of the EcologicalGroup regarding the use etafinprox, pyraclofos/permethrin and carbosulfan. Careful entomologicalevaluations carried out revealed that out of 5l vector catching points in the zone, two had an ATPhigher than 100. These were Asubende on the Pru in Ghana and Titira on the Keran in Togo. Actionsare in progress to correct the situation.

Utilisation of larvicides in the Western Zone

29. In the Western Zone, eleven rivers, in three countries were heated with larvicides during 1999.The river cotuses treated added up to 6,673 Km and thus eligible to ldrviciding. The longest circuit oftreatrnent occurred during the 5ft week, with 4,330 Km of river distance heated and the shortest circuitof 5 l0 km occurred during the 48ft week of the year. Aerial larviciding was suspended during weeks14, 15 and 52.

30. Precautions taken included the none-use of pyraclofos on the mean Niger river due to resistancedetected during 1998 and 1999. Also, six cycles of perrrethrin were effected on the Niger. The otherlarvicides were rotated with standard precautions including, not more than four consecutive cycles oforganophosphates. In C6te d'Ivoire, only the Sassandra river was treated and this was without the useof Abate due to known resistance.

In Guine4 Carbosulfan was not used on the Sankarani, Milo and Niandan as instructed by theEcological Group. Furthermore, resistance was detected to various larvicides in parts of the country,as follows: Resistance to temephos on the Sankarani the Niandan and the Upper Niger (river basins).Resistance to pyraclofos was detected on the Tinkisso and resistance to phoxim on the Kaba. Takingall the above into account the larvicides were used successfully in rotation.

Entomo lo g i cal research and I arvicide formulations

31. The current research activities are aimed at refining tools and methodologies which would beeasily used in maintaining the achievements of the Programme. Activities included improvement ofoperational performance of insecticide formulations and the use of available molecular biologytechniques in the study of populations of vectors and parasites to enhance analysis of entomological andepidemiologicaI data.

32. For the improvement of cosVeffectiveness of insecticidal formulations, attention was centeredon evaluation of effectiveness and follow-up of stability of the two formulations of Bacillusthuringiensls-H-14 (8.t. H-14) used by the Programme. These are Vectobac 12 AS and Teknar HP-D.The rational behind the investigation on B.t. H-14 is that it is the only biological insecticide amongseven used by OCP, thus the most environmentally friendly to use by national teams for nuisancecontrol of Simulium after OCP.

33. During 199711998 the operational performance of B T. Yl-14 formulations were evaluated atconcentrations of 0.54 Lln'3ls(75Yo of operational concentration) at discharges of l5 m3/s to 108 m3/s.Witlr ref'erertcc to cl^cctive range,-l-eknar Ht' D recorded a longer efl",.tive range (la km) conrpared

JPC2I.3Page 39

,\rtnex 1

to Vectobac 12 AS (6km). In collaboration with Abott Company river trials were conducted in Octoberand Novetnber I 999 at relatively high discharges levels( 141 m3/s for Teknar HP-D and 169 to 402 m3/stbr Vectobac l2 AS). The results obtained indicated an effective range of 2l to27 km for Vectobac l2AS at a discharge rate of 169 m3/s.

34. This was an improvement in the performance of Vectobac l2 AS although the results wererecorded under atmospheric disturbances (including strong rain 12 hours after treatment and increasein water level on the day of control of treatment effectiveness). With Teknar HP-D, observations madein the earlier studies were confirmed. At a discharge of 14l m3/s the effective carry was 30 km witha detachment of 97 .9 o/o of the larvae.

3 5. Investigations to assess the effect of temperature on the stability of Vectobac I 2 AS have beeninitiated. In that connection, three experimental samples in bapels specially equipped with recordingthermometers received in September 1998 are being studied. The results will help Abbott to a betterunderstanding of the role of temperature in the degradation process of Vectobac l2AS in fieldconditions.

Susceptibility of .Sinzlizm daznoszrz s.l. larvae to oreanophosohorus larvicides

36. Vector control activities dwing 1999 was characterised by the intensification of susceptibilitytests of larvae to insecticides. Results of tests conducted mainly during low-water period in the Easternzone indicated good sensitivity of larvae to organophosphate larvicides. In the Western zone, resultsalso obtained during tow-water period, showed intermediate sensitivity of most Simultum larvalpopulations to temephos and pyraclofos and some stong resistance to temephos at certain localities.This observation seems to be athibutable to seasonal altemation of relative abundance of savannaspecies of Simuliun (predominance of ,S. damnosum s.s. during drop in river level period and S.sirbanum during rising in river level period). However, susceptibility of larvae to phoxim has been goodat all locations visited.

Discussions and conclusions

37 - The Ecological Group congratulated the VCU for the excellent presentation and for the goodresults obtained in relation to control of the vector while limiting the use of least selective larvicides.The Group also indicated its satisfaction for progress made towards the operational use of B.t. H-I4 atdischarge rates higher than 15 m3is ; that situation has influenced the rotational strategy of thelarvicides and has opened a better prospect for nuisance control by larviciding in the post-OCp area.

38' As regard the issue raised by the Programme Director conceming stocks of larvicides that couldremain at the end of the Programme, while VCU is taking care to have virtually no residual stock, it wasalso suggested that OCP contacts appropriate agencies that have experience in the management of suchsituations.

IPCZI.'3Page 40

Annex I

E. AQUATICENVIRONMENTALMONITORINGACTIVITIES

Introduction

39. As general introduction to presentations from the monitoring teams, the Aquatic monitoringCoordinator of the Programme indicated that all recommendations of the Ecological Group related toHydrobiologists for 1999 were carried out. These included (i) the involvement of national personnelto undertake invertebrate monitoring in COte d'Ivoire; (ii) organization of a four week data handlingworkshop for Hydrobiologists in August 1999; (iii) the provision of computers to each monitoring team

to enhance their analysis of data and iv) support to a Hydrobiologist of COte d'Ivoire to participate ina " Fish bio-diversity conservation and wise use" meeting in Ghana, using fish monitoring data as basis

of his presentation. The coordinator also stated that reports of monitoring received indicated thatmonitoring in all countries had been accomplished properly. -

National teams from C6te d'Ivoire, Ghana and Guinea together with an OCP team monitoredthe state of re-colonisation of invertebrate fauna in the rivers where OCP larviciding has been stoppedas well as the state of fish an invertebrate fauna in relation to curent larviciding during 1999. The teams

also monitored habitat states of their stations However, the Programme still awaits publication articlesfrom Hydrobiologists based on their monitoring data which could be summarised as follows :

Fish Monitorine

40- Fish teams in all countries monitored the four parameters below of fish communities andpopulations at their stations in relation to OCP larviciding.

DiDiii)iv)

Continuous occrurence of fish species per sampling station,Catch Per Unit Efforts (CPIJE) of fishing trend,Species richness of catch,Coefficient of Condition of principal species per sampling station.

a. Cdte d'lvoire

41. Three rivers were monitored during1999. These were the Ldraba at Pont Frontidre, WhiteBandama at Niaka and Como6 at Gans6. Treatment of all the rivers stopped more than five years ago.

- Species occurrence: the number of fish species encountered at the stations were 34, 33

and 33 at Pont Frontidre, Niaka and Gans6 respectively. The species and numbers encountered per

station were similar to previous observations and no species was considered persistently absent.

- CPUE: for all stations, total CPUE during the year were comparable to records of recent

years. Thus a stable trend. However, catches at stations were dominated by particular species. At PontFrontidre on the L6raba and Gans6 on the Comoe, the catches were dominated by Alestes baremozewhile Brycinus nurse dominated catches at Niaka on the white Bandama.

- Species richness ofcatch : A general slight increasing trend in species richness has

been observed during the past three 1,ears considering observations of the last l0 years.

JPC2I.3Page 4 1

Anncx I

- Coetilcient of Condition :The average values of Condition o1'principal species at allstations rcmained comparable to previous records.

b. Ghanct

42. One river was monitored in Ghana during 1999. This was the Pru at Asubende. The river isstill under treatment.

- Species occurrence: Fifty one fish species were recorded in catches at the station during1999. All the species had been previously encountered and no species was peristently absent.

- CPUE: By both numbers and biomass, the CPUE at the station during 1999 wascomparable to the lowest recorded for the station which occurred in 1998, thus a general decreasingtrend seem to continue

- Species richness : the number of species encountered during the year was 5l whichwas comparable to the highest number of species encountered per year during the past l0 years.However considering observations of the past 5 years the results of the past two years representedslight increases.

- Coefficient of Condition : Average Condition values of all principal speciesremained comparable to previous records. Thus Condition of fishes remain stable.

c. Guinea

43. Three rivers were monitored for fish in Guinea during 1999. These were Sankarani atMandiana; Milo at Boussoul6 and Dion at Baranama. All three rivers are being treated.

Soecies occrurence: Species known for stations continue to occur in catches.

- CPUE: For all the stations, total CPUEs recorded increasing trends during the year as

observed during the last three years. Also, the level of catch in all rivers were highly comparable.

- Species richness: Generally an increased trend in species richness at all stations hasbeen recorded during the past three years apparently associated with the increased CPUE.

- Coefficient of Condition: The mean coefficient of condition of principal species at allstations remained stable as in previous years.

d. Conclusion

44. The following conclusions could be drawn from results from all stations

- Species richness an occurrence: Fish species known for individual stations continue tooccur in catches at various rates of occurrence. The number of species at all monitoring stations seemto be increasing, in most cases since 199411995. This situation is attributed to stable favourablehydrological conditions in recent years and improvement in species knowledge of teams.

JPCZI.3Page 12

r\nncx 1

- CPUE: No major changes in trend ol-catch per station. comparcd to recent years as laras total CPUEs are conccmed. That is:

increasing trend at most stations in Guinea

Stability at stations in C6te d'Ivoire

Decreasing trend at Asubende in Ghana.

Therefore no corrunon trend that could be attributed to larviciding effect. Catches in smaller

mesh nets are higher in most cases compared to CPUE of the big mesh nets.

- Coefficient of condition: No dete.ctable changain-thecondition of principal or most

species at stations and small intra annual fluctuations were attributable to seasonal variations.

Entomoloqical monitorinq

45. The emphasis of entomological monitoring during 1999 was on the study of re-

colonisation of water courses where larviciding has stopped. However, some monitoring of impact

of larviciding continued at treated stations.

Results of studies

Marahoud

46. River Maratrou6 has not been treated since June 1997. At the two stations monitored (i.e.

Entomokro and Danangoro) three groups of organisms have been recognised during the monitoring.The first group, consisting of 17 taxa at Danangoro and 19 taxa at Entomokro occured regularly inmonitoring samples.

The second goup consist of 7 taxa at Danangoro and 6 at Entomokro. Their presence in samples

are often characterised by long periods of absence. This group which includes Leptophlebiidae and

Tricorythidae at Danangoro and Ecnomidae at Entomokro are to be particularly followed during re-

colonisation studies.

The third group consist of taxa which have occurred very rarely at the two stations. They

include Gyrinidae, Oligoneuriidae and Neoperla sp. They are also to be followed closely inrecolonisation studies.

Nazinon, L,lraba, Comod and White-Bandama

47. At one station each on the rivers Nalnon, Leraba, Como6 and the White Bandama, studies were

conducted in 1999 for indications of re-colonization of invertebrate fauna.

- On the Nazinon, the occurrence of Philipotamidae, Pyralidae and to a lesser extentl',lcoperla were considered as indications of re-colonisation. However, a taxon, Oligoneuriidae,has still not [..,cen eucountered in samp,es since treatment was stoppcd.

.rPC2l.3Pagc -{3

,\rtncx I

- On the Conloc, taxa u'hose occurrence in samples indicated a nteasure of re-colonizatiop.durrng 1999, rvere Nertperla, Pyralidae. Gyrinidae and Caridina sp. However. Notonectidae, Sisyridaeand Hydrophilidae continue to be absent in spite of apparently favorable habitat quality.

- On the Leraba, a regular occurrence of Caridina sp. and Gyrinidae was considered afavorable indicator of recovery.

- On the White Bandama, re-occurren ce of Neoperla sp in samples during 1999 was theonly indicator of recovery.

48. Generally, the above observations indicated the re-occurrence of some taxa which had beenabsent in samples at entomological monitoring stations in Burkina Faso and Cdte d'Ivoire when therivers were being treated.

Red Volta at Nangodi

49. During 1999, Caridina and Tricorythidae, which had previously been among taxa encounteredat the Nangodi station continued to be absent as observed in 1998. However, samples from the stationwere appreciably high in densities and diversity.

Conclusion on re-colonisation study data

50. Indications of re-colonisation by taxa for example Neoperla sp an Caridina sp which had beenaffected during teatnent period of rivers were observed at majority of stations. Among taxa distinctlyabsent from samples is Oligoneuriidae. However, for a more comprehensive assessment of post -treatnent status of fauna in comparison to the sifuation during teatnent years, more post-treatment datais required.

Results of entomoloqical monitoring at treated stations

Ghana on the river Pru at Asubende and river Oti at Sabari

51. The Pru was heated with B.r. H-14, Phoxim, Pyraclofos and Permethrin during 1999. However,indices of drift and densities of organisms were stable compared to data of 1997 and I 998. The apparentlack of impact of treatment was attributed to the situation that sampling occurred during treatmentsuspension period. In spite of the stability of fauna Neoperla sp. and Oligoneuriidae were notencountered in samples.

Regular treatment of river Oti was stopped in 1992. Since then however, situations haveapparently necessitated occasional short cycles of experimental treatment. During 1999 densities ofinvertebrates obtained in Oti samples were low compared to data of 1998. And Oligoneuriidae whichhas been absent in samples since 1985 continued to be absent. The observation was attributed to thesituation that samples had been taken immediately after an experimental treatment of the river.

Guinea on river Milo at Boussould, lViandan et Sansambaya and Dion at Tiri

52. At Boussoule dcnsities of sanrples obtaineci rvere relativelv lorv. Assessrncnt ol relativeabutrdaucc of'tltree tarrnomic grollps in relatrrrr to treatnteut irrdicatecl that [:phentcroptera \\,,t.cobviousr v all'ected b1' larvicides.

JPC2I .3

I)age 44

z\nner I

- Data available lionr Sansambaya station since i 984 indicatb that densities of f'atura startcdto decline in 1998 and continued in 1999. Considering species richncss of samples,2l taxa rvere

rccorded in 1999 compared to 33 in pre-treatment years.

- Generally observations indicated that densities of total fauna at all the stations exceptBoussoule w'ere stable. Also non-target diptera were abundant in samples at all stations.

Sumntary conclusion on observalions at trealed stations

53. Densities of benthic fauna at treated stations were observed to be low but stable except at

Boussoule on the Milo, where density is decreasing due to water quality degradation. As regardstaxonomic groups Ephemeropterans continue to decrease due to their greater sensibility to larviciding.

54. As a result of the above it was considered that studies at treated stations should continue toconsolidate observations.

Discussion on Habitat Assessment Study

55. A description of status of various monitoring stations using the Habitat Assessment study formintroduced during the early part of 1999 was presented. Together with the results photographicdescription of some stations at different times of the year were also presented.

56. Various teams suggested amendments in the data recording sheets for the study. Discussionof the suggested amendments were summed up by the Chairman as follows :

Each site of invertebrate or fish monitoring shall be evaluated during each sampling eventduring the year 2000.

All odd-numbered figures (eg 15, 17 and 19) within "type of situation" score shall be

omitted.

Habitat parameter # 7 may best be obtained from a map or aerial photographs.

Habitat parameter # l0 (riparian vegetation zone) is in reflection of human influences at a

site. The vegetation zone width should be measured as true gallery forest, not as a sahilianvegetation (eg grasses).

The study was reconlmended to continue with the amendments in mind

Valorisation activities durine the frfth financial phase

57. Monitoring activities have been strengthened by the inclusion of habitat quality assessment

studies and on-going elforts to involve Hydrobiologists in activities related to the socio-economicdevelopment of oncho-fieed zones. However. the need to promote the monitoring activities was

reaftlrmed bv the I:cological Group. Therefbre

a

a

a

o

a

a

a

.IPC2I 3

Pase -15

.,\nrtex I

'l'he idea put tbrw'ard rn 1999 to commend hvdrobiologists rvho havc',vorkcd for more thanl0 years in thc Progranrme \\.as re-examined. The Ecological Group reconrmended that theissue be llnalised by the time of the JPC rneeting so tlrat participating countries would beinformed of the existence of their national competence in the area of environmentalmonitoring.

It was proposed that a brochure of between 25 and 30 pages depicting activities of OCp inrelation to protection of aquatic environment be prepared. The activities should include;monitoring, selection of insecticides; insecticiding strategies, etc. The illustrated brochureshould be in English and French and aimed at the general public. An estimate for thepreparation and printing was presented. The Ecological Group approved and supported theproposal.

It is considered that a scientific synopsis of results obtained by OCP be prepared andpublished in an international scientific review joumal (eg. Hydrobiologia). For this, it wasconsidered necessary to bring together about l5 experts who have been involved in OCpactivities. The Ecological Group proposed Dr. L. Yameogo as Chief editor of the synopsisassisted by Profs D. Calamari and C. L6v6que. An estimate of the work was considered andthe Ecological Group recommended that the Programme solicits resources from potentialdonors for the project.

ResPonse of the Ecolosical Group to recommendations of the Hl/drobioloeists

58. Work done by groups of Hydrobiologists taking into account the results of the monitoring in1999 led to the following recommendations:

' Monitoring stations for both Invertebrates and Fish during 1999 should be maintained for 2000.

' Frequency of sampling for both groups be kept at the 1999 levet.

' Re-colonisation studies be continued at stations indicated (Annex 3).

' Habitat quality Assessment should continue to be documented at all station on all samplingoccasions - with photographic documentation of state of habitats.

' video coverage of monitoring techniques be undertaken by ocp.

' A one week workshop to review and calibrate fish data collected by the national hydrobiologicalteams.

The table presented in Annex 3 show's the monitoring programme for the year 2000.

59. The Ecological Group appreciated and endorsed the recommendations made by theHydrobiologists, and recommended to the Programme to do what was in its power to bring them about.'fhe Chairman of the Group added that he will provide disposable calneras to the Ill,drobiologists forthel-u to takc photographs at sites and send exnosed trlrls to thc acluatic nronitr)rins Ceorclinatpr lordevcloprnclrt anrl priul.lng.

F-

.tPC21.3

Page -16

,,\rtrtcx I

ECOLOGICAL MONITORING AS PART OF THE SOCIO-ECONOMTCDEVELOI'MENT OF ONCHO-FREED ZONE,S.

The ecological Qlsup expressed satisfaction at the progress being made towards ecologicalmonitoring in relation to socio-economic development in Oncho-freed zones. This was with referenceto the outcome of the rvorkshop on a proposal for a project to conserve bio-diversity and manageecosytems in the Oncho-freed zones. The Group invited the Committee of Sponsoring Agencies tosupport and ensure the success of the project because it takes care of most of the Group's concernsexpressed during the 20'r' session. For example, w'ith reference to i) what becomes of theHydrobiologists after OCP and thus expertise produced by the Programme with patience anddifficulties; ii) Trans-border problems arising from and through socio-economic development of theOncho-freed zones.

60. The representative of the Agencies at the meeting, Mr M. Sonou indicated the following

i) In determining locations for the project, an idea of areas already identified by FAO and relatedagencies as areas for socio-economic development must be kept in mind.

ii) Monitoring of human impact on aquatic ecosystems should include land-based indicators inaddition to aquatic-based ones.

iii) Perhaps a checklist of measurable indicators in the total aquatic ecosystem should be developedduring the early part of the project.

61. Discussion by the Ecological Group of points made was summed up by the Chairman that : theGEF project shall initially emphasise aquatic environmental issues but remain responsive tocollaboration. However, for the project to be successful, concerns and involvement of localcommunities were paramount. Thus recommended strong synergy between the new project and existingdevelopmental ones in common areas.

G. WORK PROGRAMME FOR 2OOO I2OOI

62. Aquatic monitoring activities will continue on rivers and stations retained by the EcologicalGroup for 2000. In addition to the usual programme, work will include:

The preliminary evaluation of the impact of ivermectine on the aquatic environment in thePro-eramme area. Prof. Calamari rvill present a paper on the subject based on bibliographicsearch at the next Ecological Group meeting.

-fhe Programme is to make contact with external experts betbre June 2000, for their

participation in the dratiing of a popular publication with the collaboration of Programmestaff.

Irinalisation of the analysis o1'the economic importance of decisions of the EcologicalCiroup.

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Page -17

,\nncr I

l;inalisation atrcl subnrission of proposal 1br lunds to (ll:l: ((ilobat I..nvironnrcntal Facility)to support pro-icct on bio-diversity consen'ation and nranagcnrent in Oncho-fieed zones.

H. ARRANGEMENTS FOR THE NEXT N{EETING

63. The twentl'-sccond session of the Ecological Group is scheduled to be held in Cotonou,Republic of Benin in zone East, tentatively, on the 7'h and 8'h of March 2001 . The meeting would bepreceded by the joint Ecological Group - Hydrobiologists meeting on 6'r' March and the meeting ofHydrobiologists on the 4'h and 5'r' of March 2001. During the meeting, a field trip would be organisedto Okpara on the Ouemd river. The visit rvill provide an opportunity for members to appreciate I ) Theenvironmental conditions in an area where transmission of onchocerciasis is still high and 2) activitiesin progress to control the situation.

I. READING AND APPROVAL OF REPORT

64. The main points of the Ecological Group meeting as recorded during the meeting were presentedand approved after some corrections. The minutes of the meeting that will be written based on theapproved document will be submitted to the Chairperson of the Ecological Group for approval priorto its presention to the Expert Advisory Committee in June 2000.

J. CLOSURE, OF THE SESSION

65. The meeting was closed on26 February 2000. The Chairperson of the Ecological Group thankedhis colleagues and the personnel of the Programme for the quality of their contributions to thediscussions. He thanked invited experts for responding to their invitations and the scope added todiscussions. The Chair then, on behalf of the Programme, and his colleagues expressed his appreciationto the World Bank, its representative at the meeting, the GEF and all who had contributed to thedevelopment and activation of the workshop on bio-diversity conservation and management studies inOncho-freed zones. He praised the WHO personnel in Mali and the OCP for the material andorganisational support provided for the meeting. The Chairperson then expressed his and the Group'sgratitude to the Programme Director for his presence and his contribution to the meeting, and hopedthat the Director would like to be with the Ecological Group at work again. He went on to congratulate,through the Director, the OCP and the national teams for their sound contribution to the EcologicalGroup's meeting. He then declared the session closed rvith an invitation to his colleagues for the nextn.reeting in 2001.

JPC21.3

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Anncx I

APPENDIX I

LIST OF PARTICIPANTS

Members Ecological Group

Professor Davide Calamari, Environmental Research Group, Department of Structural andFunctional Biology, University of Insubria, Via J.H. Dunant 3, 2l 100 Varese VA, Italy,Tel: 00 39-0332-421546 - Fax: 00 39-0332-421554, E-Mail:[email protected]

Professor David Colman, School of Economic Studies, University of Manchester, ManchesterMl3 9PL, United Kindom, Fax: 0161 275 4929 - Tel. 0l6l 275 4804,E-mail : [email protected]

Dr Christian Lev0que, Programme Environnement, Centre national de la Recherche scientifique,Vie et Societ6s, I Place Aristide Briand, 92195 Meudon cedex, Tel. 0l 45 07 5045 -Fax 0l 45 07 5124 - E-mail: [email protected]

Professor Vincent H. Resh, Department of Environmental Science, Policy and Management,Entomology Program, University of Californiu}}l Wellman Hall, Berkeley, Califomia94720,USA, Tel. (5 l0) 642-3327 - Fax (510) 642-7428 - E-mail: [email protected]

Professor Anette Reenberg, Institute of Geography, University of Copenhagen, Oster Volgade 10,DK-1350 Copenhagen K, Denmark, Tel: +45 35 322562 - Fax: +45 35 322501E-mail : [email protected]

Associate Member

Dr Joost Brouwer, Project Development Support, Wetlands Intemational - Afric4 Europe, MiddleEast, Droevendaalsesteeg 3A, P.O. Box 7002,6700 CA Wageningen, The NetherlandsTel: +31 317 478875 Fax: +31 317 47 8885 - E-mail:[email protected]

Invited Experts

Dr Bemhard Statzner, CNRS, Ecologie des Eaux Douces et des Grands Fleuves, Universitd Lyonl, 69622 Villeurbanne Cedex, France - Fax: +33 472 43 1l 4l - Tel: +33 472 44 80 34E-mai I : statzner @bi omserv. univ-lyon. fr

Dr Robert Drewes. Department of Herpetology, California Academy of Sciences, Golden GatePark, San Francisco. CA94118, USA - Fax: 1-4157507346 - Tel: (415)750 7036-E-mail : [email protected]

Others particioants

Mr Molse Sonou, Senior Water development Officer, FAO Regional Ofllce for Africa,P.O. Box 1628. Accra. Ghana - Tel: 233 217010930 (Ext 3l l9)- Far: 233 217010943 or 668427E-rnai I : Moise. Sor-rou,@fao.org

rP('l I .3

l)age -19

Aurex-I

Dr Suzannc Leloup. Ecologist, World Bank 1818 H. Street. N.U/.. Washington D.C.20433.Tel.:202 458 4720 - Fax: 202 522 3157 - E-mail: [email protected]

OCP Secretariat

Dr B.A. Boatin, Programme Director, 0l B.P. 549. Ouagadougou 01, Burkina FasoE-mail: @ocp.oms.bf

Dr L. Yarneogo, VCU/OCP, 01 B.P. 549 Ouagadougou 01, Burkina FasoE-mail : [email protected]

Dr H. Agoua, VCU/OCP, B.P. 36 Kara, Togo

A. Ak6, VCU/OCP, B.P. 504 Odienn6, C6te d'lvoire

Dr Y. Bissan, VCU/OCP, B.P. 504 Odienn6, C6te d'lvoire

M. M. Sam, VCU/OCP, B.P. 504 Odienn6, COte d'Ivoire

M. J.M. Tapsoba, VCU/OCP,01 B.P. 549 Ouagadougou 01, Burkina Faso

M. L. Bakon6, VCU/OCP, 01 B.P. 549 Ouagadougou 01, Burkina Faso

Dr E. K. Abban, Council for Scientific and Industrial Research, Water Research Institute(CSIR/WRI), P.O. Box AH 38, Achimota GhanaFax: (233) 21777170 or (233)21761030,Te1:233 21775511 - E-mail: [email protected]

M. P.R. Bdlemgoabga, COIWO, 01 B.P. 549 Ouagadougou 01, Burkina Faso

.il,('l I lI)uqe 5()

,,\rtttc\ r

APPENDIX 2

LIST OF DOCUMENTS

OCP/VCU/HYBIO/2OOO.1 Surveillance of the aquatic environment in Guinea in relation to arit

blackfly larvicidesKel6tigui Nabe

OCP/VCUlHYBlOl2000.2 _ Fish monitoring in relation OCP-larviciding in Ghana 1999 annual reporAbban, E.K. & K. Kwarfo -Apegyah

OCP/VCU1HYBIO12000.3 _ Surveillance du milieu aquatique en Guinee ichtyofauneM.E. Diop

OCP/VCU 1HYBIO12000.4 = lE99 OCP invertebrate monitoring in Ghana reportJ. Samman (1999)

OCP/VCU/IIYBIO/2000.5 - Surnmary of the annual report of the OCP hydrobiological evaluation uni(1eee)

OCP/VCU/HYBIO/2000.6 _ Report annuel de la COte d'lvoire (Entomologie - 1999)

M. Bihoum, P. Ayekoue & N.C. Kouassi

OCP/VCU IHYBTOI2OOO.T Rapport annuel de Ia C6te d'lvoire - Ichtyofaune ( 1999)

N.C. Kouassi

APPENDIX 3

WORK PROGRAMME FOR 2OOO

COUNTRY/RIVER/SITE

PERIOD OF SAMPLING iFREQUENCY

INVERTEBRATE FISH

January to April, November

and DecemberJanuary to December

COTE D'IVOIRE

Marahou6/Danangoro

Marahou6/Entomokro

LdrabalPont Frontidre

Bandama/Niaka

Como6/Gans6

GHANA

Oti/Sabari

Pru/Asubende

Red VoltaAtangodi

BURKINA FASO

Nanzinon/Pont Po

GUINEE

Niandan/Sassambaya

Dion/Baranama

Dion/Ter6

Milo/Boussoule

Sankarani/Mandiana

Once a month (1 day)

Once a month (l day)

Jan., Feb., Nov. & Dec(recolonisation)

Jan., Feb. and Oct. to Dec.(recolonisation)

Sept. to Dec. (recolonisation)

Jan., Feb. , Nov. and Dec.


Aug. To Oct. (recolonisation)

July to Nov. (recolonisation)




Once every 2 months (2 nights)







NI]: '[he drifl sunrltla: ura :uken rtnl.t to follor,' tut<tnontic' r'ichne.s.' of rtvers'

JPC21.3Page 5 1

r\nnex 1

.IPC2I 3

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APPENDIX 4

BAMAKO-LIST

This docunient represents thc objectives, activities and indicators of success resulting from the Bamako-Workshop. Although the listings are not exhaustive, they can still be used as a reference for thedevelopment of the final "West African Freshwater Bio-diversity Conservation and EcosystemManagement Project proposal. The list of activities that were mentioned during the Workshop areregrouped under the bullet points of activities (here either rephrased or not, italics means rephrased oradded) that were mentioned in the approved concept brief of the project proposal (see section 8 and 10of the PDF Block A ). The numbers just refer to the order of listing during the Bamako Workshop andcould be ignored.

OBJECTIVES

The objective of the project would be to support conservation of the freshwater bio-diversity andecosystems (including riparian areas but focussing on freshwater life) in West Africa against adverseeffects of increased human activities in the river blindness controlled areas. The project would focuson threats that could be controlled by community-based sustainable natural resources management.Community empowerment, building on the hydrobiology data base of the OCP and linkaging withexisting relevant progralnmes would be the main strategies to achieve these objectives.

ACTIVITIES

o Development of guidelines on how concern for freshwater bio-diversity and ecosystemconserryation can be incorporated in community-participatory rural development, naturalresources management and/or if needed, bio-diversity conservation programmes.

25 Identify threatsl7 Inventory of use of ogrochemicals24 Deal with household wastes17 Inventory of existing regulation relating land use and compliance

and wood- Limit adverse effects of livestock (grazing, menure, trampling)- Lintit use offish poison18 Prontote integrated pest management (subject of discttssion)4(?) Identify beneficiaries/stokeholders13 Analyses of fishermen populution and activities, locol customs, regulations8 Pcrrlicipatory assessment of villagers uses and wishes relating riparian and waler resources,

put people and socio-cultural ospects and knowledge and traditional ot centre (unthropologiculapproach)

15 Organizing local contntunitiasi ('ollcc't (.socio)econonticdutul9 llclution tvilh urbc,n L'enlar.\ whcra rtrders ma)'L'ome front (economic tra.s)

) rt)5 l't'ot'rda ullcrttu/it'e.s/.roltrtiott.s (incl Inlagrutccl Pa.st .\.lurutgunanl)

A

I17

11

t6

Scn'rilize und e ducution oJ ktcal population relating riparian and aqualic resolrcesProntote knou,ledge o.f regulations en regulalion cnforcemenlFormatiort, Educalion and Communication, related lo oncho, land use, regulalionBuild on l3 for EPA

' Dissemination and integration of guidelines to conserve freshwater bio-diversity andecosystems in existing community-participatory rural development, natural resourcesmanagement and/or, if needed bio-diversit5r conserwation programs.

1l Use proiect results at notional (and international) level, incl. political and practicalguidelines20 Link with existing activities, programmes and projects.

' Targeting of freshwater bio-diversity and ecosystem conservation interventions to species,habitats or stretches of freshwater resources in the targetwafershed area which seem tobe under particular high pressure related to human activities.

o Supporting the nomination of species, habitats or stretches of freshwater resources whichwould be of interest to total protection in the target watershed area.23 (and C) Point out possible extensions to protected area system (all OCP countries)

B CAPACITY BT]ILDING

o Training of local professionals to investigate freshwater bio-diversity and ecosystems in thetarget areas, through standardised technical and community-participatory methodologies.

o Training of local professionals to monitor and evaluate the impact of human activities on thefresh water bio-diversity and ecosystems in the target areas based on standardised technical andcommunity-participatory methodo logies.

o Training of local professionals to integrate guidelines to conserve freshwater bio-diversity andecosystems in existing community-participatory bio-diversity conservation initiatives, naturalresources management and/or rural development programs.

22 Development of training programme to achieve objectives/achievements and target groups.

C MONITORING AI\ID EVALUATION

o Investigation of existing bio-diversity of the freshwater ecosystems in the target areas,through standardised technical and community-participatory methodologies.

o Investigation of the impact of human activities on the freshwater bio-diversity andecosystems in the target areas through, technical and community-participatory appraisals.

I Establish habitat assessment system which monitors effect on riparian zone (traditional,economic and environmental aspecls), using existing data,

2 and monitor fish and birds and aquatic invertebrates3 inventory and monitoring riparian zone including vegetation and landcover change (make useof West African graduate students.l0 Monitor hydrological situation in relation to land ttse.

7 Correlate/analyse various bio-diversity data sets

JPC2I.3Page 53

Annex I

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..\nncx I

. Identification of biological species or habitats of the fresh rvater resources and stretchesof frcshrvater resources in the target n'atershed area rvhich seem to be under particularhigh pressure related to human activities, through technical and community-participatory appraisals.

. Jdentrficotion of biological species, habitats or stretches of freshwater resources whichcottltl be nominated as of interest to total protection.and 23 lrienti.fy possible extensions to protected area system

D REGIONAL COORDINATION AND KNOWLEDGE MANAGEMENT

o Establishment of a regional initiative to conserve freshwater bio_-diversity and ecosystems inWest Africa based on implementation by rtational entitieS embedded in existing programmes.

o Support to a regional administrative coordination unit for this initiative. This unit could belinked to the West African Subcentre for Multi-Disease Surveillance and Control. This sub-centre must begin operating within the next two years to help ensure sustainability ofOCP/WHOs achievements throughout the West-African subregion. (The discussion whethersuch a coordination unit would have to be established and to which institute it should belinked would be part of the PDF A activities).

o Organisation of an West-African symposium on the issue to disseminate the lessons leamedfrom the progralnme in the Participating Countries toward other non-Participating Countries.

o Linkage with international bio{iversity databanks (e.g. Environmental Information Systems)to disseminate on a global level the acquired knowledge on freshwater bio-diversity in theregion.

1 1 link wtth other datasets/lcnowledge

INDICATORS OF SUCCESS

. The number of people and total area covered by the local communities directly involved inthe programme.

. The potential number of people and total area covered by the local communities reachablethrough the partner programmes

. The potential number of people and total area covered by the local communities reachable bysimilar prograrnmes in other watershed areas.

. The number and linkages established with existing programmes.

. TIre number of people that received training

. The number or total area of species, habitat or stretches of streams that were successfullysubjected to recovery or conservation intervention.

. The number or total area of species, habitat or stretches of streams that were nominated as ofinterest to totaI protection.

. l'he ability to link land use with freshwater habitat condition.

JPC21.3Page 55

NNNIJX 2

LIST OF EAC21 RECOMMENDATTONS

'lhe Contmittee recommended that:

Ecological Group

Tlie 1999 monitoring stations and the sampling frequency for invertebrates and fish bemaintained during 2000 (paragraph 19);

Cotnmendations of hydrobiologists having worked for more than ten years with OCP bebrought to the attention of JPC in December 2000 to make participants aware of theexistence of national competence in this field (paragraph l9);

A brochure on the protection of the aquatic environment be prepared; that video coverageof monitoring techniques be undertaken; and that a scientific synopsis be published in awidely distributed scientific journal (paragraph l9);

Techniques be developed to increase community involvement (paragraph22);

CSA strongly endorse "The West African Freshwater Bio-diversity Conservation andEco system Management" proj ect (paragraph 23 ) ;

2.

J

4

5

6.

Implementation of EAC recommendations

(see tables on pages 23 afi24)

Planning. evaluation and transfer

Extemal evaluation of CDTI be carried out in several countries (paragraph 56);

Integration be strengthened at the district level (paragraph 56);

Continued training of CDDs be strengthened (paragraph 56);

Local partners, notably NGDOs, be mobilized (paragraph 56);

OCP continue its work on epidemiological modelling to facilitate its use at the nationallevel (paragraph 57);

Costing of intervention programmes be undertaken alongside projections of sustainabilityand recrudescence (paragraph 66);

Macrofil

7

8

9

l0

ll

t2

l3- Macrofil give priority to the development of moxidectin (paragraphTT);

JPC21.3Pagc 56

Ar.rr.rcr '

t4 I:llorts be made to continue support to OCRC be1'ond the ternrination of OCI'}(paragraph8l) and that its relationship rvith the AFRO MDSC Ccntre bc examincd for futureco I laboration (paragraph 127 ).

l-s 'lhe current study on ivermectin resistance and developnrent of tools for detection ofresistance be afforded priority (paragraph 82)i

16 Macrofrl be not subjected to further budgetary cuts and even have its budget restored to itsprevious level (paragraph 84);

Conceptual framework for integration. transfer and country preparedness

t7 Motivation and supervision of CDDs should come" from the communities themselves(paragraph 88) and strategies for sustainable CDTI should emanate from the communitylevel (paragraph 103);

l8 Due regard be paid to job-expectations of CDDs and they be given a reasonable workload(paragraph 101);

Prioritv actions

t9 Task forces be set up to consider and recommend to national authorities how to deal witha series of issues connected with post-OCP ground larviciding (paragraph ll2b);

Special attention be given to the issue of OCP not reaching its objective in certain riverbasins by 2002 after which national post-OCP ground larviciding is recommended(paragraph 118);

2l The West African Freshwater Bio-diversity Project be linked with the AFRO MDSCCentre (paragraph I 28);

Proeress of APOC

22. The Pictorial Form be scrutinized by communities (paragraph 132);

Lvmphatic filariasis elimination and OCP

Political and health authorities be informed about the risk of ivermectin treatment in Loa-Ioa areas (paragraph 139);

Other matters

An evaluation of the extent to which the achievements of the Programme have beenmaintained be canied out some years after cessation of OCP operations (paragraph 145).

20

Z)

24

JPC21.3Page 57

:\NNEX 3

RECOMMENDATIONS OF THE OPERATIONAL RESEARCHAND STRATEGY MEETING (March 2000)

Timetable for stoppin e larvicidine

1. To continue larviciding and consider stopping it in the year 2001 if the results of additionalepidemiological evaluations and of environmental surveys in the basins of Mono - Sio and LakeVolta East (Togo, Ghana), Dienkoa (Burkina Faso), Sassandra (C6te d'lvoire), Sankarani - Dion- Kourai, Milo and Kolente - Kaba - Mongo (Guinea) are satisfactory. (OCp, NationalCoordination (NC).

2. To continue larviciding and consider stopping it in the year2002in the basins of Oueme,Zou, Okpara (Bdnin), tributaries of Oti (Togo; B6nin), LakeVolta West - pru (Ghana), Middle- Niger (Mali), Niandan - Komya - Bale, Upper-Niger - Mafou and Tinkisso (Guinea). (OCp,National Coordination ).

Specific action plans

3. To consider the possibility of the national teams continuing ground larviciding at least duringthe dry season of the year 2003, in the basins of the tributaries of the Oti (Togo, Benin), Lakevolta west - Pru (Ghana), High Niger - Mafou and rinkisso (Guinea). (ocp, NC).

4. To conduct, before the end of the year 2000, socio-demographic studies to help improve thegeographical coverage of the villages to be subjected to CDTI and to ensure a reinforcedmonitoring of CDTI in the basins of the tributaries of the Oti (Togo, Benin), Lake Volta West -Pru (Ghana), High Niger Mafou and Tinkisso (Guinea) (OCp, NC).

Stoppine of ivermectin distribution

5. To conduct an analysis of the CDTI situation in each country on the basis of basin, districtand village, taking into consideration the longitudinal entomo-epidemiological data, thetherapeutic and geographical coverage rates in order to propose a timetable with appropriateguidelines for stopping CDTI after the year 2002. (NC, OCp).

6- To review in each country the list of villages to be effectively subjected to CDTI with theoperational level taking into consideration precise criteria of village eligibility for CDTI. QrlC,ocP).

7. To develop the capacities of the national teams to design operational research projects.(ocP, NC).

Effective inteqration of Oncho activities into the national health slrstems

8. To accelerate the review and production of OCP training modules and make them availablein the Participating countries at the central and peripheral levels. (ocp, NC).

JPC21 3Page 58

Atltcx -l

9. 'l-o strengthen the skills of health agerlts and drstributors in order to improve the monitoring.supervisir-rn and collection of data in the context of CDTI integration. (NC)

10. 'fo simplify the tools for the collection and analysis of epidemiological data in order toaccelerate effective decentralisation and integration at the central and peripheral levels in theParticipating Countries. (OCP, NC).

Final OCP disengagement

11. To sensitise, as early as the year 2000, the Participating Countries on the final disengagementof OCP in the year 2002. (OCP, NC).

L2. To establish, as early as the year 2001, in collaboration with AFRO and HQ, a committeeto design a scenario for the final disengagement of OCP (OCP Management).

.rPC21 .3

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.\,'r"N[:X.l

NT\TIONAL CAPACITY TO ]VIAINTAIN OCP ACHIEVEMENTS

1. What do the team have to achieve ?

Prevent recrudescenceMaintain/decrease the level of disease in the country

2. What are the tasks that h4ve to be undertaken bv the s in the countries?

Epidem iological survei llanceEntomological surveillanceGround larvicidingCDTMIEC

This involves the following task

finding and training/ retraining human resourcessupervisionProcuring resources (financial, equipment, transport, supplies, facilities)ManagemenUcoordination, including :

' Data management and> integration of onchocerciasis into the health service

3. Where are we now and where do we want to be ?

NOTE : In the discussions below the issue of the transfer of financial responsibility foronchocerciasis control activities to the State appears regularly. This implies laying new financialburdens on a body which in all countries is having problems meeting existing commitments.Therefore:- Target all relevant levels and regions of the State service for funding and resources, not just

the central one.- Limit requests to the minimum needed for eflicient functioning ("essential to have", not "nice

to have");- Start negotiating with the State immediately, with firm and motivated budget proposals.- Suggest a serious search for a long-term Donor to help - preferably linking the request to an

existing Agreement;- Decide whether it will be wiser for a particular country to ask for all at once, or to use a

phased/incremental approach (cuhnination in the State taking full responsibility by 2003),- Make the request in the context of activities which are integrated into a wider multi-disease

programme.

.rPC2l.3I)age (r0

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3.1 Epidcmiologicalsurveillance

Whcre lve are now : deficiencies/problems Where rve rvant to be : recommendations

The "snip" method : some decentralised teamslack the equipment they need

NOTs to work out minimum requirements(sharing where they can); negotiate with theState to supply at least part of the need

The "DEC patch" method : some are

decentralised surveillance teams are not yettrained in its use

NOTs to do the trainingOCP to refine existing training manuals ifnecessary (also for the "snip" method)

The "DEC patch" method : exactly when itwill be used is not yet clear ; development ofa standardised commercial form is stillunderway

OCP to continue testing, to establish exactcircumstances of future use; to draw up astandardised prof,rle for it; to overseecomplete development of to a commercialpatch

OCP still performs quality control ofsurveillance in some countries

OCP to work with NOTs to establish criteriafor quality control; to train them to carry it out

OCP still supplies resources for essentialsactivities in many countries :

- The "snip" and "DEC patch" methodsthe materials required

- For field trips: vehicles, petrol, perdiem allowances

- Cost of training

NOTs to draw up an itemised budget for theiryearly needs; to &aw suggested budgets for2001,2002,2003 (with an increasing statecomponent); to negotiate an agreement withthe State to implement it

Entering field data, data analysis, use offindings for decision making : level ofcompetence of NOTs varies

OCP to finalise simplified analysis software;to establish ownership of it, and useragreements; to produce clear guidelines forNOTs on decision making; to train two ormore NOT members per country up todecision making level; to encourage and assistnational/regional Public Health schools toprovide the same training with the same

software

The accuracy of CDTM coverage rates isproblematic, since CDs themselves establishthe denominator

OCP to initiate research into the scope of thisproblem, leading to methods of verification

JPC2I .3Page 6lAnncx 4

3.2 E,ntomologicalsurveillance

Where we are norv: deficiencies/problems Where rve want to be: recommendations

It is not clear whether there is a complete fullytrained entomological team available in eachcountry (national entomologist, surveillancetechnicians, village capturers).

NOTs to compile a list of the teams theyneed ; to train them fullyOCP to refine existing training manuals ifnecessary.

It is not clear whether the teams have all theequipment they need for their work (e.g. forthe field dissections).

NOTs to work out minimum requirements; tonegotiate rvith the State to supply at least partof the need.-

The financing of surveillance activities is atpresent shared between OCP and the State inall the countries:

- Field dissection and mass capture: thematerials required,

- For field trips: vehicles, petrol, perdiem allowance, wages of capfurers,

- Cost of training,- Cost of transporting flies to the

regional DNA laboratory.

NOTs to draw up an itemised budget for theiryearly needs; to draw suggested budgets for2001,2002,2003 (with an increasing Statecomponent); to negotiate an agreement withthe State to implement it.

It is not clear who is performing the qualitycontrol of the surveillance.

OCP to work NOTs to establish criteria forquality control; to train them to carry it out.

Entering field data, data analysis, use offindings for decision making: largely done byOCP,level of competence ofNOTs low/non-existent.

OCP to finalise simplified analysis software;to produce clear guidelines for NOTs on allsteps, from data entry to decision making; totrain two or more NOT members per countryup to decision making level; to persuadenational and regional Schools of PublicHealth to provide the same training with thesame software.

In some cases the countries to not get the datafrom the DNA laboratory, which is needed tocalculate'adjusted ATPs'.

DNA laboratory to start returning the findingsto the countries in all cases; OCP to train theNOTs how to calculate and use adjustedATPs.

a

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3.3 ()r'oundlarviciding

The ability to analyse entomological and

hydrological data, to make decisions aboutlarviciding, is not yet fully developed in the

case oIsonre NOTs.

OCP to produce clear guidelines for NOTs onall steps, from data collection to decisionmaking; to train two or more NOT membersper country up to decision making level; NOTto develop capacity to evaluate thehydrological situation in relation tolarviciding: to persuade national and regionalSchools of Pr"rblic Health to provide thc same

trai,ring.

Where we are norv: deficiencics/problems Where we rvant to be: recommcndations

The situation regarding ground larvicidingafter 2002 is under debate.

OCP to nrake firm, specific decisions aboutthe future as soon as possible: where tocontinue larviciding, for what purpose(nuisance control or transmission control) forhow long.

The training of the teams in each country has

been undertaken by OCP until now.NOTs to draw up a list of the teams theyneed; to identify trainers of such teamsOCP to refine existing training manuals ifnecessary, and to ensure that trainers are

trained to the required level of competence.

OCP has to date supplied all the equipmentthe teams need.

NOTs to work out minimum requirements; tonegotiate with the State to supply at least partof the need.

OCP has ordered the insecticide needed; it isnot clear whether OCP will leave sufficientstocks for after 2002, or whether the countrieswill have to order afresh.

OCP and NOTs to work out in detail howsuch ordering should be done in each country;to start doing such ordering before 2003.

The financing of ground larviciding is atpresent shared between OCP and the State inall the countries:

- For field work: vehicles, petrol, perdiem allowances, wages of labourers,

- Cost of training,- Cost of insecticide.

NOTs to draw up an itemised budget for theiryearly needs;'to draw suggested budgets for2001,2002,2003 (with an increasing Statecomponent); to negotiate an agreement withthe State to implement it.

Although standards have been established,OCP still perfbrms the quality control of thelarviciding in many cases.

OCP to work with NOTs to transfer qualitycontrol in all cases; to train them to carry itout.

I

I

3.4 Community Directed Treatment rvith Mectizan@

In some areas illiterate CDs will have to beused.

JPC2I.3I'}agc 63

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OCP to complete development and testing oftraining and reporting materials for suchu'orkers. as soon as possible

a

I

Where lve are now: deficiencies/problems Where rve want to be: recommendations

The subject of motivation of the CDs andhealth centre nurses is causing concern; thisissue has not been receiving specific attentionwithin countries.

OCPA.JOTs to perform research on motivationand its sustainability within countries.NOTs to arrange a national debate around theresearch findings (involving all levels includingnurses and CDs, members of other prograrnmes,and people with proven field experience ofsuccessful community participation).This debatechould-produce a sustainable,integrated, community empowering plan toaddress the issue of motivation, and shouldaddress the issues of recompense, transport,definition of roles and responsibilities,communication/feedback, the workload inlarge/dispersed villages.OCPNOTs to implement the plan in selectedareas, monitor its effect closely, adjust itaccordingly.OCP should liase closely with APOC; the twoprograrnmes must share their experiences; toinform NOTs of promising/successfu Iinitiatives.

NOTs lack experience of successfulcommunity involvement, which may hinder

CDTM successfulltheir to

NOTs to locate people in countries who havepractical expertise in the field of communityinvolvement, to advise them on CDTM.

In some countries the number of villages perhealth centre is too large for the nurses tocope with training and supervision (especiallyonce larger associated hamlets start havingtheir own CDs).

OPC and NOTs to select areas to where acategory of more experienced CDs is used totrain and coordinate the work of others in alocal network.NOTs to draw up a full plan for thisexperiment; OCP to fund it in full.

There is a lack of clarity regarding the rolesand responsibilities of each category ofstaff/stakeholder in the CDTM process.

OCP,AIOTs to draw up a short guide for useby all levels in the CDTM programme.

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JPC2I.3Page 64

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Soure areas repon problems withovcrconrplicated reporting requirenrents OCP (with NOTs) to take steps to simplify the

reporting requirements.

,

Transport for nurses is being provided by the

State but is in most cases inadequate for the

needs of the CDTM prograrnme.

NOTs to draw up an itemised budget for theiryearly needs; to negotiate an agreement withthe State to implement it.

There is considerable instability of staff at

district and health centre level; it is unlikelythat this can be changed.

OCP (with NOTs) to rvork out strategy forrapid orientation of new staff at these levels,so that the programme is not intemrpted.

OCP and the State at present share the cost oftraining for CDTM at different levels.

NOTs to drarv up an itemised budget for theiryearly needs; to draw suggested budgets for2001,2002,2003 (with an increasing Statecomponent); to negotiate an agreement withthe State to implement it.

Supervision checklists at district and healthcentre levels either don't contain CDTM ordon't exist/are not written down in some

countries; the same is true of "minimumpackages".

OCPA{OTs to arrange a high level meeting atnational level, involving senior MOH staffand the heads of similar programmes, todiscuss how this issue can be resolved.Content and style of supervision should be onthe agenda.

Written documents should be produced forthese two levels, which are routinely used bythe officials concerned (i.e. regional anddistrict level supervisors).

Although the countries have taken over theordering and distribution of Mectizan@ moreor less successfully, there are still regularreports of stock running out.

OCP and NOTs to develop a specific plan foryearly review of Mectizan@ supply, whichwill uncover bottlenecks so that these can be

dealt with; to implement and refine this planin the remaining two years.

ln some countries there are problems indistribution of Mectizan@ from national torcgional pharnracies.

NOTs to investigate and rectify

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3.5. IEC

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where we are now: deficiencies/problems Where we want to be: recommendations

National IEC teams often lack specifictraining in IEC.

OCP and Stare to identify suitablepostgraduate courses ; OCPA{OTs tonegotiate WHO and other bursaries for them

A < National guide for onchocerciasis relatedIEC )) is currently being prepared; one it hasbeen prepared it has to be put into action.

NOTs to work with national IEC teams todraw up a specific plan to operationalise the< Guide > fully by 2002; this plan shouldcover all lerrels; to €nsure that this guideaddresses not only technical issues, but alsothe matter of being responsive to changingcircumstances and needs.

Illiterate distributors lack materials whichthey can understand and use.

OPC and NOTs to make sure that the< Guide > and plans address this issue, andaccelerate the completion of the work.

CDs report that they lack the information theyneed to deal with community requests.

NOTs to ensure that the CD taining is donesystematically, using the manual developedby OCP.

There are misconceptions about the diseaseespecially at community level (e.g. also aboutthe community's role in cDTM).

OCP and NOTs to ensure that the planidentifies these and addresses them

Funding will be needed for thisoperationalisation ; NGDOs can't be reliedupon for ever

OCP, NOTs, NGDOs and the IEC coordinatorto draw up an itemised budget for their yearlyneeds ; to draw suggested budgets for 2001,2002,2003 (clearly denoting who will beresponsible for what) ; to negotiate anagreement with the State and the NGDOs toimplement it.

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3.6 Gcneral

sntioendrecombt tonwwe AreWheefic bro lems.ncies/d le polvr neweWhere

OCPiEAC to review the "conceptual

framework" (perhaps with NOTs)' using the

actions that EAC recommends in this

document as a guideline'

The "conceptual frame of reference for

transfer" is too general now, and does nottothi Sal stage,tailde neededtheevidpro

2002wardstogressproudgelNO'fSs who feel that their national policres

do not do justice to oncho, are encouraged to

initiate steps to rectify the problem'

National policies exist, or are being

elaborated, but we need to be sure that they

uJeq.,ut"ty reflect the needs of oncho control

(inciuding the recommendations in this

document).

OCP to alrange a high level meeting of all

stakeholders as soon as the situation is judged

sufficiently stable, to plan in detail for the

remaining Years.

ffrit pf"ritt ould address all the issues raised

in the section above, and should not shy away

from unorthodox and radical approaches' o'B'l

- Mass and Passive distribution of

r Mectizan@,- Transferring the country to APOC after

2002,- Larviciding after2002

The situation in Sierra Leone regarding all

main progralnme activities has been set back

and confused, due to the civil war'

OCP to iurange a similar high level meetingISsituationtheonso asASstakeholdersallof

thefordetailln,lanto pstable,sufficientlvalladdressshouldISThears planvremalilng

above.sectionsthesed nralISthe SUES

The situation in Guinea-Bissau regarding all

main prograrnme activities has been set back

and confused, due to the civil war'

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Documents

JPC21.3-eng.pdf - WHO | World Health Organization