Chairman CCP

(1)

Onchocerciasis

Control Programme in

West

Africa

^(OCP) Programme de

lutte contre

I'onchocercose en

Afrique

de I'Ouest

JOINT PROGRAMME COMMITTEE

JPC - CCP

COMITE CONJOINT DU PROGRAMME Office of the

Chairman

^Bureaudu Pr6srdent

JOINT PROGRAMME COMMITTEE Twenty-second session

Washington D.C., 10 - I

I

December 2001

Provisional aeenda item

l6

JPC22.t0

ORIGINAL : ENGLISH

EXTERNAL INDEPBNDENT EVALUATION

TERMS OF REFERENCE

(2)

I

a

ONCHOCERCIASIS CONTROL PROGRAMME IN WEST AFRICA EXTE RNA L I ND

E

PEND ENT E

VA

LUATIO IV

TERMS OF REFERENCE

OBJECTIVES OF THE ONCHOCERCIASIS CONTROL PROGRAMME (ocP)

OCP started operations

in

1974

with

the dual objective of:

Eliminating

Onchocerciasis as a problem

of public health importance x,ithin

the Programme area and as an impediment to socio-economic development, and

Ensuring that the Participating Countries

will

^be

in

a position

to

maintain the achievements

of

OCP.

The

two

objectives have been largely met as the OCP Programme

is

coming to a conclusion at the end

of2002.

The achievements

of

OCP

by

2002 can be summarized as

follows:

40

million

people protected from onchocerciasis;

more than

13

million

children

born

since OCP operations started

will

have been spared the

risk of

onchocercal blindness, and 25

million

hectares

of fertile

land have been freed

for

food production, sufficient to feed 17

million

people.

The

Riverblindness disease has been

eliminated and

there

is practically no

transmission

of

the

infection within the OCP countries even after stopping vector control for almost a

decade.

Furthermore, no instances of recrudescence of transmission have occurred in the original Programme area.

Furthermore, OCP has

supported

Participating Countries in

strengthening

their capability

to undertake post-OCP residual activities,

i.c.

effective detection and control of recrudescence. This has

included the

establishment

of a regional

multidisease-surveillance

centre in

Ouagadougou

by WHO/AI'RO.

However,

in four

"Special Intervention Zones," localized control

will

need

to

continue beyond the closure

of

OCP,

mostly by

exclusive treatment

with

ivermectin through national teams.

In

one or

two

special intervention zones, aerial

larviciding

operations

might

need to be continued

for

another

five

years to reduce the transmission

to

such a degree that the national authorities involved

will

be equipped to

fully

take over post-OCP surveillance.

(3)

2

a

OBJECTIVES

OF

THE EXTERNAL EVALUATION

a To review the achievements of OCP in view of its stated objectives;

To review the indirect impact in Participating

Countries (q.g., establishing

a

cadre

of

OCP-

trained staff of

entomologists, epidemiologists,

etc.;

strengthening

of

management capacity,

introduction of altemative delivery mechanisms such as community-directed

treatment

(coMDr).

To review the implication

of

closing OCP, !.9. the preparedness

of

the Participating Countries to effectively carry out detection and control of onchocerciasis recrudescence;

To review the

residual

control activities at the

closure

of the

Programme,

particularly

their institutional, financial, and operational implications, and

a To formulate conclusions recommendations of the evaluation

ORGANIZATIONAL

ASPECTS

The evaluation

will

be organized by the Committee

of

Sponsoring Agencies (CSA).

The evaluation

will

be carried out

by

a team

of

independent experts. The CSA

will

establish the membership of the Evaluation Team.

The evaluation

will

take place during the first

half

of 2002. OCP staff

will

provide information to the Evaluation Team and Members

of

the Expert

Advisory

Team (EAC) may be invited to act as

resource persons whenever required.

Also, the

Evaluation Team

may

attend the

EAC ad

hoc session in March and its regular session

in

September 2002.

Field visits to OCP countries

will

be arranged, as required.

The report

of

the Evaluation Team

will

be considered

in

its final draft form by CSA at its session during the

first half of

July 2002 and considered

by

the Donors at a

Donors'

Conference

in

late September/early

October before

presentation

to the

December

2002

session

of ^the

^Joint

Programme Committee.

**rF a

a

a a

o

a

(4)

3

ANNEX HISTORY

The Onchocerciasis Control Programme

in

West

Africa

(OCP) commenced field operations

in

1974,

originally

confined

to

Benin,

Burkina

Faso, Ghana, and C6te

d'Ivoire, Mali, Niger

and Togo. The area under control was extended as

from

1986 to the southern parts

of

Ghana, Togo and Benin, and

the

western

part of Mali while

parts

or

the

whole of

Guinea, Guinea Bissau, Senegal and Sierra Leone were brought

into

the Programme. The

total

OCP area was thus increased

to

1 235 000 km2

with

a population of 30

million

and 50 000 km of river under control.

At the

start

of

Programme operations

up to

60-70o/o

of riverine

communities

in

the most severely affected savanna areas

with

a high intensity

of

onchocercal transmission would harbor the parasite.

Up to l)oh of

the people might be

blind

as a result of the disease

with

20-30% suffering from severe

visual

handicap.

As

a result, many exposed populations sought

relief from

the

risk of

onchocercal infection

by

moving away from the

fertile

riverine zones

to

the less fertile, upland country resulting

in

serious socioeconomic problems.

The

objective

of

OCP was defined as eliminating

river

blindness

within

the Programme area as a

problem of public health importance and as an

obstacle

to

socioeconomic development. The

principal

means

of

reaching

this

objective,

which is

centered on the

blinding,

savanna

form of

the disease,

has been vector control combined since 1988 with ivermectin

treatment.

OCP

^has implemented a comprehensive training programme

with

a

view to

strengthening the capacity

of

the Participating _Countriesto detect and control recrudescence of onchocercal transmission.

The Programme has received technical and scientific, operational support from its Expert

Advisory

Committee

(EAC) which

has attached

to it the Ecological Group,

responsible

for studying

the ecological impact on the environment

of

the use

of

insecticides

in

the Programme.

Also,

OCP has, together

with TDR - ^{and later} the African

Programme

for

Onchocerciasis

Control (APOC)

-, established a project,

MACROFIL, originally

designed

to

deal

with work

the discovery and development of macrofilaricidal drugs.

The direction

and management

of

the Programme have been determined

by

consecutive Plans

of

Operations and a Long-Term Strategy approved

in

1986.

Apart from

the continued,

in-built

epidemiological and entomological evaluation

of

the impact

of vector control --

and more recently

ivermectin

treatment

--,

several external evaluation exercises

have been carried out, including the 1991 WHO

Independent Commission

on the

Long-Term Prospects

of

the Onchocerciasis

Control

Programme; the U.S.

AID

Impact Assessment

in

1985; an

External Review in ^1990; the

1994

Mid-Term

(Phase

IV)

Prospective Evaluation

by EAC;

an Extemal Evaluation

in1997,

and the 1997 Review of