AND ENTOMOLOGISTS NATIONAL MEETING

# EAC-rt J6t

WORLD HEALTH

ORGANIZATION ORGANISATION

MONDIALE

DE

LA

SANTE

ONCHOCERCIASIS CONTROL

PROGRAMME IN

WEST

AFzuCA

PROGRAMME

DE

LUTTE

CONTRE L'ONCHOCERCOSE EN AFzuQUE DE L'OUEST

AD HOC MEETING OF NATIONAL COORDINATORS AND ENTOMOLOGISTS

(Bertur, Burliina Fuso, Glttutu, Niger, Togo) OCP, Ouagadougou, 12

-

^{14 March 2001}

OCP/EAC22.3A

rl..

1

1. INTRODUCTION

A

meeting

of

National Coordinators and Entomologists

of

Participatirlg Countries (Benin,

Btrrkina Faso,

Ghana,

Niger and Togo) rvas held from 12 to 14 March 2001, at the

OCp lieadcluarters

in

Ouagadougou. Several OCP

staff

as rvell as the Programme Director also attended this meeting (cf.

List

of participants. ir-r Annex).

This

OCP-initiated meeting served as a consultative framework

prior

to preparing the zones meeting

for

in-depth and specific discussions,

in

concert

with

the various OCP Programme chiefs

of

Units.

2. OBJECTIVES OF MEETING

Review ltroblenrs thal nti_chl

cotlltrontisc

the achier,enterits o1'O('lr.

Rcvieu

(take stock) the level of transl'er ol-Onclro control l'estduili activrties

lor

eaclr country.

Evzrlttatc nectls

in

this dircction

to

cnable cach

of

the meurbcr counlrics adclress the post-OCP situation rvithor.rt much di ffi cu ltrz.

3. OPENING

OF

MEETING

The Progranlme Director in his

speech

recalled the

expectations

of the

Programme tttanagemeut

lrom

the meeting, namely: a concrete and detailed report

on

col-l1mon actior-rs

by

the various countries for a giverr river basin, as u,ell as actions carried out on intemal or specific basins.

The said report musl also contain a rvell-spelt out schedule of plar-rned action per country for 2001.

Tlre

\/CLI

chre1, on his paft, underscored the ovcrlaF'r

oi'al1

coordinatron activities

for

more lralpitble atrd cffectrve outcor-ne.

Hc

recallcd

thal

thc-

report rvrll

also

bc

presented

to the

EAC mecting to be held fi-onr 4 to 8 .lune 2001.

4. DELIBERA'I'IONS

After

the welconte address and the introduction of the ob.;ectives of the meeting, the Chief

of

PET gave the floor to participants to elect an

office

for the meeting. Members were as follows:

Chairperson:

Dr.

Sanou Souleymane, National Coordinator of Burkina Faso Rapporteur

I:

Dr. Dossa

Coffi

Sylvain, National Entomologist

of

Benin.

Raltporteur

II:

Dr.

Diallo

Salamatou, National Coordiuator of Niger.

Participants were to acldress the follou,ing subjects

A)

Problems and actions to be condlrcted in the zones that are conllrron to the countries.

The basir-rs in question are as

follows:

Oti-Pendjari.

Mo

(epidemiological _situation

of

Moala

in

Ghana), Sota

Alibori

and Tapoa in

Niger

^(cf. Table

A)

B) Countrv

specific

issues:

Togo (Oti and tributaries), Benin (r)ueme

and Okpara), Ghana ( (ulpawr.r Mole,

Bui

and Pru), Burkina Faso (Dienkoa and Bougouriba)

-

^(cf.

Table ^B.1.

C)

Actrvrties transfered to Participatrng countries (conceptual framework)

2

The summary of

discussions

on the

analysis

of the health situation in the context of

onchocerciasis and prospects,

per

country,

in the

common and specif,rc basins,

in relation to

the implementation

of the framework for

transferring onchocerciasis

control activities is

presented.

Details per country/basin are found in Tables

A

and B that are appended to this report.

I. ACTIONS TO BE CARRIED OUT

ON

RIVER BASINS COMMON TO THE RESPECTIVE COUNTRIES

I.1

The

Nieer

and its tributaries

This

basin

is

common

to Burkina

Faso, Benin and

Niger. Larviciding

dates back

to

more than

7 years. Impact

analysis that was conducted

both in Benin

and

in Niger

^gave satisfactory

results.

However given the

possibility of

the reestablishment

of

new unknown villages

up

along these water courses, especially where they cross the

W

Park,

with

the

blackfly

densities

still

high

in the Benin

area,

it was

planned

to

ascertain

an effective

treatment

with ivermectin.

Currently

ivermectin

treatment

is given on

a twice/year basis

in

the

eligible

villages

on

the

Benin side. A

demographic and entomological prospecting

in

the

Niger

area

of

the

W

^Park

is

also called

for. A survey of early detection of

recrudescence

could be

undertaken

on the Diamangou by

the Entomologist of Niger.

I.2

Oti-Pendiari and

tributarict

This

basin

is

made

up of

tributaries

of

the

Mo, the

Koumoungou, the

main Oti River

or

Pendjari, the Keran and the Kara and runs through Benin, Burkina Faso, Ghana and

Togo.

Prevalence

of

infection varies between 9 and ^620/o, due to the

following

reasons:

geographical inaccessibility,

poor management of ivermectin treatment

in

some villages, lukewarm attitude of health workers,

lack of interest

of

local and health authorities in some countries.

To ensure that prevalence rates come down, the

following

actions

will

be carried out during the entomolo gicallepidemiological year 200 I :

Collaborative monitoring between OCP and national coordinations

in

areas where there are bottlenecks to ivermectin distribution.

Enhancing

Community Directed

Treatment

with Ivermectin (CDTI)

capacity through complete prospecting of

ill

villages under ivermectin treatment.

Putting in place a material incentive strategy for health workers and distributors.

Engaging supervisors at the prefecture and departmental levels to ^ensure

^strict

monitoring of ivermectin distribution.

Organising exchange workshops

for officers of the

national coordination, the national administration, health workers and the general public.

J

II. ACTIONS TO

^BE

TAKEN

ON

SPECIFIC BASINS

2.i

Oueme-Okpara Basin in Benin

This

basin has been under

larviciding

since

1988. CDTI

was generally introduced

in

1997,

but

epidemiological and entomological results

of

most

of

the points that have been monitored thus

far are

still

unsatisfactory. This situation is caused by the reinvasion of water courses

by flies

from Nigeria.

For this

reason,

the

meeting requests

that

OCP and

APOC put in

place

a framework for

exchange among OCP,

the Benin

national coordination, and

the

national coordination

offices of

Ogun and Oyo states of

Nigeria.

The coordination of Benin was requested to:

draw up a

complete

list of eligible villages

and those

currently

under ivermectin treatment;

undertake enhanced monitoring and check on frequency of treatment;

ensure re-training of health workers and distributors;

monitor population migration in the villages under treatment;

ensure that the entomologists uses the tools designed

by

OCP (to

utilise

the control data) for the continuation of actions that may be conducted in Benin.

2.2

Haho-Sio basin in Togo

Vector control

combined

with

large scale

distribution of ivermectin

gave epidemiological and entomological results

with

a downward

trend.

The meeting recommends the continuation

of

the actions on course, ^as

well

as a survey of the distribution of ivermectin at the eligible points.

2.3.

The Pru.

Kulpawn-Mole

and

Bui

basins in Ghana

The control means employed on the basins of the Pru,

Kulpawn-Mole

and the

Bui

have been

larvicides only or combined with the

widespread

distribution of ivermectin. The results of

epidemiological evaluations carried out

in

2000 show an obvious downward trend, but not

without epidemiological indices. The

persistence

of infection,

despite

the

use

of the

above mentioned means,

calls for more vigilance on

the

part of

the national coordination

of

Ghana,

to whom

the

following

recommendations were made:

Involve all

the social strata, administrative and health outfits

in

the control

effort,

during a workshop, where the lead

control

actions

on

the basins concerned

will

be discussed and selected

in

^a participatory manner;

cany out a survey on population migration, especially on the Pru

taking into

account,

in

a comprehensive manner, the population around the Pru,

while giving

special attention to migrants;

camy out ground treatment in the ^areas that are inaccessible to aircraft;

Step up IEC in the villages that are monitored;

Improve the efficiency of ivermectin distribution

in

all villages;

Discuss,

in

^a participatory manner, the fomr

of

incentives to be given to distributors and healtli workers;

I

4

2.4

Dienkoa and Bougouriba

@

After larviciding

activities ceased, a residual focus

of infection

was observed

in

1992, but a combination

of

ground treatment and enhanced ivermectin distribution was able to

control the infection. The

area

is currently without

transmission

and the end of

treatment is scheduled for 2001.

With

regard to Bougouriba, the results are less impressive, especially

in

the districts

of

Dano, Diebougou, Batie and

Gaoua. Actions

are on-going

(for

a

of

discussions among leaders

of the National

Coordinators,

population

and health authorities)

for

enhanced ivermectin distribution and the intensification of IEC.

It

was agreed that the background

to

ivermectin

distribution

be

given in all

the basins to

highlight

the lapses so as to correct them as early as possible.

IIr. ACTIVITIES TRANSFERRED TO OCP MEMBER COUNTRIES (CONCEPTUAL FRAMEWORTO

After reviewing other

subjects, participants

brought the latter under 3

chapters, namely incentives

for

health workers and community distributors,

the

integration and decentralisation

of

residual activities

of

onchocerciasis control and sources

of

funding and partnership

of

participating countries.

With

respect

to

incentives, several actions were noted that could encourage and sustain the interest

of

health

workers in

managing

control activities on a

continuous

basis.

These include

training/re-training of ^health

personnel,

regular supervision, in-kind or financial

incentives,

information

feed back, periodic reviews,

which would bring all

stakeholders together, and

finally

decentralisation of activities.

In Niger, for

instance, health workers

of

Health Centres (CSD _are given

fuel

and per diem from

HKI

funding for supervision of IEC activities in the

villages.

Community Health Workers and

Village

Brigadiers, on the other hand, are given soap and salt as incentives.

In

Burkina Faso and Benin, there are no incentive packages as such, but negotiations on the

form of incentives are

underway

with the community or

management committees

of

training centres.

In

Togo, incentives

to

distributors and health workers (supervision

of CDTI)

are based on cost recovery.

With

respect to the integration

of

activities,

it

is worth noting that

in

all the countries, oncho

control

activities are included

in policy

documents, and onchocerciasis

is

part

of priority

diseases, except in Niger where the disease has become less

of

a

priority.

In ^Benin,

onchocerciasis

control activities are integrated at three levels

(national, intermediate and

peripheral).

For this reason, those

in

charge

of controlling

the disease take part

in

training, and supervision of health workers, and in epidemiological surveys.

In Togo,

integration

is

effective

at

the regional,

district

and peripheral levels,

for

control activities are integrated into the minimum package of activities of health services. Control activities are included

in

the

plan of

action

of

dispensaries,

districts

and regions, and are financed

on

cost recovery funds (e.g. incentives for community distributors, supervision by the CDTI nurse).

a

t 5

In

some countries such ^as Togo,

Benin

and

Burkina

Faso, onchocerciasis control activities are integrated

into

other diseases, namely, Trypanosomiasis, guinea wom1, lymphatic

filariasis

and

schistosomiasis. On the other hand, in

some

other

countries,

like in the

case

of Niger,

this integration is nominal, since each programme has its own Coordinator and is run separately.

In all the

countries, decentralisation

of activities is effective at the district level,

where action plans are drawn up, except in Niger, for the same reason mentioned above.

In the case

of

Togo,

CDTI

activities are entirely decentralised,

with

the exception

of

epidemiological surveillance

activities which

are

only partially

decentralised (the

regional team, for

^instance,

is ^yet to be

autonomous,

since it does not

have evaluation equipment).

a

The creation of

databases

and training of regional teams on the use of

the

"EPICROSS" software ^are planned for 2001.

Entomological activities are being decentralised

to

the regional level,

but

there are

still

no tools for dissecting blackflies.

The situation

in

Benin

is similar to

that

of Togo.

The problems encountered are at the

district level.

Onchocerciasis

control activities

are

not

carried

out on

a

timely basis.

This

is

due

to

the fact that the senior medical

officers

are

in

charge

of

other health progralnmes.

In Niger,

workshops

were

organised

to

sensitise

staff at the district level

^to

incorporate oncho activities

in

their plans

of action. As

a matter

of

fact, this

activity

is yet to be carried out

in

all the

districts.

Some

training

activities were undertaken:

training of district

teams

on

epidemiological surveillance;

CSI officers on

oncho diagnostics;

CHW on

oncho

IEC; village

brigadiers

on

^ground

larviciding;

village

fly

catchers

on blackfly

catching techniques, and teachers

of

educational

units

on oncho IEC in order to sensitise pupils/students in the ^area.

In Burkina

Faso, the situation is similar to those

of

Togo and

Benin. Difficulties

are

in

the area

ofdata

collection (lack ofnecessary tools, no data collection).

With

respect

to funding

sources,

all the

countries have allocations

by their

States, except

Niger

In Burkina

Faso, onchocerciasis

control activities are

supported

by a World Bank

loan

(Nutrition

Health Development Proj ect)

(WHO/AFRO/HKI).

In

Togo, Sight Savers Intemational

(SS!

supports

IEC activities. A

search for other donors (Organisation pour la Pr6vention de la Cecit6

-

OPC, Christoffel

Blinden Mission - CBM)

are on- going.

In

Benin, oncho control activities are

in

the

main

financed

from

the national

budget.

The Benin Coordination is cunently

in

search

of

other

donors.

Contacts have been made

with

OPC ^and SSI.

ln

Niger, WHO/AFRO and

HKI

are involved in IEC activities

Reflectir-rg on these subjects made

for

an evaluation

of the level of

implementation

of

the conceptual framework

of

oncho control residual activities

in

the

country.

Thus, generally,

it

could be said that several activities found

in this

document have already been taken

into

account

by

the various

countries.

There

is still a lot to be

done, however,

to

ensure

that all the activities

are actually financed by the countries.

RECOMMENDATIONS

The

analysis

of the

results

of

onchocerciasis

control in the

basins

of the

Oueme-Okpara indicates an unsatisfactory epidemiological situation

in

the villages bordering Nigeria, where oncho control is supported by APOC.

Consequently,

the

meeting recommends

that APOC

and

OCP

promote

a framework for

sharing ideas between the

two

countries (OCP/APOC, NC)

RECOMMENDATION

2

After

2002, the essential residual activities

to

be conducted

in

some States

will

consist

of

entomological surveillance and

vector control by

^ground

larviciding. To this

end,

the

meeting recommends

the

creation

of a medical

entomologist

position at the West Africa

Multi-disease Surveillance Centre, who could coordinate residual entomological activities to be undertaken by the countries after OCP ceases its operations.

RECOMMENDATION

3

At

the end

of

the Programme

in

2002, the oncho situation

will still

not be completely under

control in all

the basins, where there are

still

unresolved issues.

Given

that ground treatment and

CDTI might

be the only available "arms"

in

the various countries, the meeting recommends that the outcome

of feasibility

studies

on

ground _treatment be made available as

quickly

as possible, and that

if

need be, training and re-training of health workers

within

the national coordination outfits be

pursued; and that donors be solicited for the provision of

necessary insecticides

for

ground treatment

in

eligible basins (OCP; Countries).

RECOMMENDATION

4

In

order to optimise the results

of

control activities on both sides

or

along the common

river

basins, the meeting recommends the harmonisation

of CDTI

activities

by

the National Coordination on both sides and along river basins common to the countries (NC)

RECOMMENDATION

1

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Annex

1:

LIST OF PARTICIPANTS

Benin

Dr

Julius E. Gaba, National Oncho Coordinator

Dr

S. Dossa, National Entomologist

Burkina

Faso

Dr

Souleyane Sanou, National Oncho Coordinator

Dr

M6t6 Bonkoungou, National Entomologist

Ghana

Dr Kofi

Ahmed, Director Oncho Control

Niger

Dr

Salamatou

Diallo,

National Oncho Coordinator

Mr.

Lamine Seni, National Entomologist

OCP

Dr

Boakye

A.

Boatin, Director OCP

Dr L.

Yam6ogo,

CVCU

Dr

E. Soumbey

Alley,

CPET a.i.

Dr K.L.B.

Akpoboua,

ATO Dr K.

Siam6vi, PET

? )