HEALTH ORGANIZATION

EAcil" ₃ G)

WORLD

HEALTH ORGANIZATION

ORGANISATION

MONDIALE

DE

LA

SANTE

ONCHOCERCIASIS CONTROL

PROGRAMME IN

WEST

AFRICA

PROGRAMME

DE

LUTTE

CONTRE L'ONCHOCERCOSE EN AFzuQUE

DE L'OUEST

AD HOC MEETING OF NATIONAL COORDINATORS AND E,NTOMOLOGISTS

(Guiriea Brssau and Senegal)

OCP, Ouagadougou, 7 -9

May

2001

OCP/EAC22.3C

3

I. INTRODUCTION

The ad hoc meeting between OCP on the one hand, and Guinea Bissau and Senegal

on

the

other, was held from 7 to

¹¹

May 2001 at the

headquarters

of the former in

Ouagadougou to ascertain

the

progress

of

onchocerciasis

control activities. The aim of the

meeting was

to

raise residual issues

in

order

to find

solutions that could enable the gains

of

onchocerciasis control

to

be maintained.

2. ^OPENING

The opening ceremony came

off

on 7

May

2000 at 15h 30, and was presided over

by Dr. L.

Yam6ogo

Chief VCU,

since

the Director of

OCP

was absent.

Present

at the

meeting

were

Dr.

Akpoboua,

Dr.

Soumbey and

Dr.

Siamevi,

with the national

Coordinators

of the two

countries mentioned above (Drs. Antonio Tamba Nahque and Lamine Diawara).

All

present recognised the irnportance

of this

meeting, especially at

this critical time of

the

end of the Programme. The various

speakers touched

on the particular

attention

that must

be accorded the various adjustments that needed to be discussed during the

rneeting.

The

two

national Coordinators

at the

meeting

were to give an

update

on the

epidemiological,

entomological

and administrative situations, as

well

^as the challenges to be taken up by the end

of

2002.

MAIN ISSUES TO BE DISCUSSED (Subjects of common interest and

specific problems)

3.I GUINEA BISSAU

3.1 ^.

I

Epidemiolo sical results.

The last

evaluations

in the

rnajor basins

(Rio

Gebu and

Rio

Corubal) date

back to

1997.

These evaluations had to do

with

¹¹ r,illagr:s on the

Rio

Geba, and 15 villages in that

of

the basin

of Rio Corubal.

The results of these evaluations indicated a prevalence on the

Rio

Geba, ranging

from 0.5ohrn

Tabassay

to l.lYo in

the

village of Meta Seidi.

On the

Rio

Corubal the prevalence

vary

between 0.9 and

I2.2%

in the 8 villages where positives were found.

Due

to the fact

that

no

treatment has been carried

out in this

basin since

this period, it

is necessary

to

conduct epidemiological evaluations

in

these

2

basins

by the

end

of OCP. In

this direction, 38 villages

will

be evaluated effective

May 2001.

The results

of

these evaluations

will

be interesting fi'om the scientific

viewpoint,

given that they

would

reflect the situation after 9 years

of

continuous

treatment. A

Letter

of

Agreement has been signed

in

this connection, and measures are being taken to facilitate the implernentation of this evaluation.

3.1,.2

lmplementation of

CDTI

Since the cessation of mass campaigns, no treatment

with

ivermectin has been carried

out in

Guinea-Bissa'r (except the

training of community

distributors), becruse

of

the social and

political

disturbances,

and also meningitis

and

cholera outbreaks. The

drsturbances

coincided with

the beginning

of CDTI

implementation in

May

¹⁹⁹⁷ ,

by

the training of nurses and technicians

of

health centres. The

training

took place

in

Gabu,

with

36 technicians and nurses from health centres

from

the

Gabu region and

8 fiom the

Bafata

region.

These health workers

that

were trained,

in

turn,

trained community distributors (CD) during the

same

period.

These

CDs carried out their

first treatment

in

¹⁰⁴

villages during the

practical

fieldwork of their training. We were not

able to undertake

any other activity

since then, neither retraining

nor ordering of ivermectin etc..

The actions

to be

undertaken

will

depend

on

the results

of

epidemiological evaluations

that will

take place

in

May/June

2001.

We

will

take advantage

of

the evaluations

in

the villages to train the CDs,

who will

continue

treatment.

Ivermectin needs

will

be covered

by OCP. CDTI will

be extended later

to villages which,

usually, were treated

by

mobile teams, and

may

also

be

extended

to

other villages.

Responses to

followins

issues

I How to arouse and sustain the interest of health personnel (especially at

the

district level) for the continuous management of onchocerciasis control

activities?

The appointment

of

the Gabu Regional

Directol

of Health as deputy Coordinator

will

help to

take into

accouut

oncho control activities in the 2

affected regions

(Gabu and Bafata).

These activities

will

be integrated into the minimum package of activities.

Concrete actions planned for ^ensuring the sustainability of distribution (incentives and ownership of CDTI by communities, incentives of community distributors,

etc..)

Strengthening

supervision of CDs at the begimring of activity implementation.

The rnhabitants, through the management comrnittees

u,iil

^as usual, give incentives for these

CDs.

^These CDs

will

be accorded special attention by doctors

for

their own health care, as

well

as that

of

their farnilies.

3.

Measures that are actually taken or envisaged for the integration

and

decentralisation and of CDTI activities, as well as epidemiological

and

entomological

surveillance.

Training of

technicians on evaluation techniques

(skin

snip, reading, census

etc...),

Special

training of a

physician/entomologist

to train

technicians

so as to meet country needs.

This entomologist has already been identified, and

will

undergo training at Odienne in August 2001.

4.

Preparedness of decentralised teams (training, availability,

incentives,

equipment). How to make means available to ^{these teams} for activity implementation?

Training

of

decentralised teams has already started. There is need to retrain them, since they have not undeftaken any activities since

1997.

Several staff members who had already undergone

training

have deserted, thus reducing the number

of

technicians on the

field.

Incentives

for

health personnel have been a problem due to the

difficult

economic situation

of

the country

(low

salaries,

difhcult working

conditions etc. ^. .).

It

has been planned

to

equip the health structures under the

National Health

Development

Plan.

This plan is yet to be

financed.

The re-launching

of

the Bamako

Initiative will

contribute to

)

fundrng

onchocerciasis

control in an

integrated

health

system

framework (the World Bank

is currently supporling this

initiative

to be put in place).

Regular data collection, proper

management

at operational, intermediate

^and

central

levels

for appropriate decision-making (capacity for

analysis/action).

There is need to train the staff of these various

levels.

Re-starting

CDTI

and epidemiological surveillance activities

will

facilitate the data management system.

Training/retraining of health workers, supervision/monitoring, actual consideration

of oncho

control activities in

plans of action.

Sarne as

for

item No. ⁵

7.

Sources/lnechanisms of

financing

Oncho

activities after

OCP

The Govemment of Guinea-Bissau, under the National Health Development Plan has already drawr-r up and

which

takes all health problerns

into

account.

8. Ivermectin

orders/supplies

(peripheral, regional

and

central

levels)

We are

waiting

for the re-stafl

of

activities ir-r 2001

in

order to plan the ordering

of

our tablet neecis fron-r

MDP for

treatment

in 2003.

OCP

will

continue

to

ensure drug

availability for this

year eud for 2002.

9

Current and potential partners that may support countries to continue rvith activities.

Apart from the

^State

^{and OCP,}

Guinea Bissau does

not have any other support. lt

^is

therefore necessary to look for other sources

of

funding, especially among NGOs.

3. 1 .

-l

^{Study of} the impact of ivermectin on transmission for 2001 and 2002

No such study has been

^conducted

in

Guinea-Bissau

since the training of

^national

Entomologists.

Proposals were made to OCP

for

the

first

study to be conducted

in

July

2001.

The Letter of Agreement is being reviewed for signature.

3.2 ^SENEGAL

3.2.1.

Epidemioloeical results

in

2000

These results were presented ^at the last JPC

in Yaounde.

The results of the epidemiological evaluations

of villages

on the Garnbia, Falerne and

tlie Koila

Kabe

in the 4

health

districts of

the onchocerciasis

zone of Senegal. On the whole, 20 villages were

evaluated,

with an

average prevalence rate

of

3.3o

, ^varying

^between

^{0.6 and} 8.3%.

Tn these

20 villages,

119 persons were four-r., to be infected

in

19 villages, out the 3595 persons

th-t

underwent skin

snip. This

means the parasrte reservoir is present and that efforts have to

be r;doubled. During discussions with CPET, the possibility of

envisaging

the elimination of

onchocerciasis

in

Senegal,

through

the ,ntensifying of current CDTI efforts was obvious.

5

6

For

2001, epidemiological evaluations

will

take place

in 31 villages, distributed

^{over the} various

basils.

The evaluations started since

i9 April2001

and

will

continue

until6

June 2001.

The

implementation

of

evaluation activities

is entirely

taken care

of by the

national team based at Tarnbacounda,

in

close collaboration

with

technicians

of

district teams (lab. Technicians

for

underlaking

skin

snip tests and reading snip results,

PHC

supervisor

for

census

activities).

The

district chief medicil officers participate with the other

members

of the evaluation team in

sensitisation activities

in the

villages, as

well

as

in

the

parallel

evaluation

of

the

quality of CDTI

implementation. These evaluation activities ^have become routine ones in the districts.

Marntaining a single evaluation team, based tn

Tambacounda

and working itr

close

collaboration with the district teams is the option

^chosen

as part of the

decentralisation

of

epi clenr olo gical survei llance.

The new magnifying ^glass given to the national teant was

requested

by the

national

Coorcllator,

since the one

in

use dates back to the beginning

of

activities

in

1987.

What remains to

be

done

is to train

doctors and supervisors

in

the area

of

epidemiological surveillance

of

onchocerciasis

with

regard

to decision-making. An

application

must be

made to OCP in this direction for financing, after discussions have already taken place

with

CPET.

3.2.2

Study of the impact

of

ivermectin ^oD transnrission

11 1999 and 2000, studies of the impact

of

ivermectin on transmission were carried out at the catchipg

poilt

of Mako,

in

collaboration

with

the molecular

biology

laboratory of OCP.

This

catching

point

proved

to

be less productive

in

the course

of

the

2

^years

of study.

We were not able to assemble the 8,000 blackflies required per

year.

These studies were, however, very

infonr-rative. In

fact,

we

realised the commitment

of

communities through the

village

captors, ^as

well

^as the support community leaders gave

them. In

addition, we were able to put

in

place, during the second year, a system

for

dispatching flies to

the

laboratory

by

the

EMS

^(express

mail

service), which gave us satisfactory services. This channel

will

henceforth be used

in

future.

3.2.3

Implementation

of CDTI

CDTI was

launched

in

June 1998

in

Kedougou

during a training

session

which

brought together trainers (Regional and

district Chief medical officers,

supervisors

of PHC),

as

well

^as

parlners (Prefect, sub-prefect, head

of rural

community, local

journalists). _This

workshop, which

was

financed

entirely by OCP, was

attended

by the CPET and a

consultant

of OCP. It

was appreciated by all the participants, and gave a clear vision

right

from the beginning

of

CDTI.

ResDonses

to

the

followins

^issues:

1

How

to arouse and sustain the

interest of health

personnel (especially

at district

tevel)

for

the

continuous

management of onchocerciasis

control activities?

To do this, we undertook several training/retrair-ring sessions, ^as

well

as workshops, which

l-relped to share

with

tlie various health workers ^a clear vision

of

oncho control.

The training sessions the personuel received were very rnotivating and helped them to focus on the programme.

Supervision

of

activities

by

level also contributed to strengthen their capacities, especially

of

health centre chief nurses, around whom the entire

CDTI

device is built.

The

participation of the

Coordinator

in

some coordination meetings

of the district

(which

bring

together, under

the direction of

the

Chief district

medical

officer, all chief of

health centre nurses) improved the output of the programme.

The

support

of the NGO

named

OPC to the Chief

nurses

contributed to

enhance their motivation

(fuel

for supervision, motorbike ride sometimes, treatment allowance per village etc..)

Concrete actions planned for ensuring the sustainability of distribution (incentives and

ovl'nership

of CDTI by communities, incentives for community distributors, etc...)

En suring permanent ^{avai I} abrlity o

f

ivermectin.

Training CDs by chief nurses.

Advocacy

with

community leaders (chairpersons

of

health committees,

village

chiefs

etc...)

to

solicit

support for the CDs.

Measures

actually taken or

envisaged

for

the

integration and decentralisation of CDTI activities,

as

well

as

epidemiological

and entomological

surveillance.

CDTI

management

tools are integrated into the information system for purposes of

management (national

MIS),

and

CDTI

data are taken

into

account during semester

rnonitoring

at the health post level.

training of teclurical tearns (laboratory technicians and PHC superi,isor)

in epidemiological surveillance;

participation of the latter

in

annual epidemiological evaluation activities;

Onchocerciasis

control

taken

into

account

in

a module being designed

by the

national Coordinator of surveillance (who is a former Coordinator delegate

of

Oncho);

Training of

doctors

is

scheduled

forby

the end

of

2001 on epidemiological surveillance

for decision-making.

Technical assistance is solicited from PET and seems to have been obtained.

Providing a budget line item under the Integrated Health Development Plan for

evaluation activities and an impact study

in

the 2001 and 2002 budget.

4.

Preparedness

of decentralised

teams

(training, availability, incentives, equipment).

How to put

means at the disposal of these teams

for activity implementation?

Under CDTI,

decentralised teams

totally integrated oncho control activities into

other activities

of

disease

control

and epidemiological

surveillance

Emphasis

is

^placed

on the

model

district

[eam,

on the

supervision

of CDs and on training/rutraining of chief

nurses,

given

the desertio,r

of

staff.

2

3

With respect to epidemiological

evaluations,

we opted for a single team based

at Tambacounda,

which

works

in

close collaboration

with

district teams during evaluations.

The

level of

equipment

of

the team is quite good presently (especially

Holth forceps).

The magnifuing glass,

which

is

wom

out, needs to be replaced.

A

request has been made

to

the CPET and we hope

it

would be procured under the PDIS budget,

if

need be.

Regular collection, proper

management

of data at operational intermediate

and

central

levels,

for appropriate

decision-making

(capacity for

analysis/action)

CDTI

data management has become part

of

the

routine.

Problems however crop up when

it

comes to village reporting, especially when the CD is illiterate.

The

management

of

evaluation data

is yet to be integrated. This will be

done

after

the

training of the 2

technicians

we

^have requested

PET to offer. The 2

technicians

might

come to Ouagadougou

with

forms at the end

of

the evaluation early June

2001.

From this tirne on, we

will

be

in

a position to easily manage by ourselves the various data

in

the data banks of OCP.

6.

Trainingiretraining of health workers, supervision/monitoring,

actual

consideration

of oncho activities

in

plans of action.

Trair-ring/retraining sessior-rs were conducted betu,een 1998 and

2000.

We are rather going to

put

emphasis

on the follow-up of training,

especially

in the

area

of CDTI. Training of CDs

is

ongoing in the districts with funding from PDIS

and

PLCME where the Oncho

programme is housed. We are

waiting

for training modules which are being finalised at OCP.

7.

Sources/mechanisms of

linancing for

oncho

activities after OCP

The State

of

Senegal and OPC (NGO)

The greater part of funding

will

come through annual Operational Plans (OP) under a general planning system

within

the

Ministry

of health.

8. Ivermectin supply/order

(central, regional,

peripheral

levels)

Senegal,

for

the past 4 years has been placing Ivermectin orders directly

with MDP.

We met

with

community tax issues (ECOWAS,

UEMOA),

which delayed the delivery

of

drugs at

all

levels.

It is

necessary

that the WHO

representation

in Dakar, which has

some

waiver privileges

get involved in the ordering of drugs.

9

Current and potential partners that could support countries to continue with activities.

We are currently being assisted by OCP and OPC in the implementation

of activities. In

the post-OCP period,

we

are

likely to still

enjoy the support

of this NGO (OPC).

The Oncho control activities

will, naturally

continue

to

get assistan;e

from PDIS,

under

the global financing of

the health sector.

5

4.

8

MEETING WITH THE ADMINISTRATION

A

meeting was organised between the administration and Coordinators

of

Guinea-Bissau and Senegal,

in

order to review the various existing problems and

find

solutions to them.

4.1 ^Guinea

^Bissau

The logistics

problems and those

relating to bank

accounts

were raised. With

regard to vehicles,

only

the Coordinator's is

in

good running state. Another vehicle could be repaired to make

it road-wor1hy.

There are, however,

2

vehicles

in

Gabu

that

are wrecked, and

which

need expert valuation so that a decision could be made on them.

The various bank accounts that existed and

which

were provisioned,

prior to

the outbreak

of

conflicts, r-nust be reviewed

for

a decisron to be made on them.

4.2

^Senegal

Logistics-related problems were raised, and

it

was agreed once again

to

assign

two

vehicles to the national teanr.

The

monthly

administrative liaison needs to be irnproved to ensure better output

The

establisliment

of the Letter of

Agreement

for administrative supporl

and supporl

for supelvi.ion

were also raised. Actions are undenvay between OCP and the National coordinatiorr.

5. CONCLUSIONS AND RECOMN{ENDATIONS

5.1 Guinea

Bissau

Restart

of

evaluation activities in Mav/June 2001

(NC, MOil)

Restart

of CDTI

activities

by

end of 2001 (NC,

MOH)

5.2

^Senegal

Continuation of current efforts (NC,

MOH)

Easing imporlation of ivermectin by WHO representation

Continued suppofi of PDIS to National Oncho control Programme under the Health Sector Global funding.

Training

of

doctors and supen,isors in 2001

in

epidemiological surveillance,

with

a vie'uv to rnaking decisions.

Continuatior-r of technical, matenal and financial assistance (OCP)