Onchocerciasis Control Programme in West Africa Programme de Luttv. contre l'Onchocercose en Afrique de l'Ouest. JOINT PROGRAIUME COMMITTEE, COMITE CONJOINT DU PROGRAMME Office of the Chairman JPC-CCP Bureau du Pr€sident I JOINT PROGRAMME COMMITTEE JPC9.4 L !a Ninth session ( ocP/BB. 1) Dakar- 29 November - 2 December 1988 0ctober t9B8 Provisional item 13 ONCHOCERCIASIS CONTROL PROGRAMME IN WEST AFRICA PLAN 0F ACTIoN AND BUDGET FoR lg8g I !- ; ONCHOCERCIASIS CONTROL PROGRAMME ocP/88.1 ]N WEST AFRICA TABLE OF CONTENTS Page 1. INTRODUCTION 3 L e 2. OVERVIEW OF THE PLAN OF ACTION.. 4 3. GENERAL CoNSTDERATToNS 0N THE pRopoSED BUDGET FoR lg8g 6 pstTuatEs BY PRoGRAMME AcTIVITY. t 4. 14 4.r. office of the Director. 14 4.2. Statutory meetings 77 4. g. Vector control t9 4.4. Epidemiological Evaluation 24 4 .5. Biostatistics and Information Systems 28 4.6. Socioeconomic Development 37 4.t . Onchocerciasis Chemotherapy Project. 33 4.8. Administrative and Support Services. 36 ANNEXES 1. AVERAGE COSTS USED FOR BUDGETARY CALCULATIONS 4o 2. COST OF PERSONNEL SERVICES 1981 TO 1989 4r 3. AERTAL oPERATToNS FRoM 1gB1 r0 lg8g 4z 4. QURIITTTY PURCHASED VERSUS COST OF LARVICIDES FROM 1981 TO 1989 4l 5. VEHICLES IN OPERATION FROM 1981 TO 1989 44 6. RATES oF ExcHANGE oF THE US DoLLAR 4s 7. CHART AER]AL OPERAT]ONS 46 8. vcu ENToMoLoGICAL EVALUATIoN NETIIoRK 1989 4t 9. PROPOSALS FOR RESEARCH AND SERVICE CoI\TTRACTS 1989 4g PRoposED 10. REVTSED VCU PLAN 0F OPERATTONS FoR lggg 57 11. SUMMARY CONSOLIDATING LARGE-SCALE IVERMECTIN TREATMENT ACT]VITIES 7987-7990 52 MAp TVERMECTIN 12. - TREATMENT - lg8g 55 NUMBER 13. AND PERCENTAGE OF OCP STAFF BY COUNTBY OF OR]GIN (1 JULY 19BB) 56 t ocP/88.L Page 2 LIST OF TABLES Page TABLE 1 BUDGET BY PROCRAMME ACTIVITIES ... 9 J J TABLE 2 BUDGET BY CATEGORY OF EXPENDITT]RE.. 10 TABLE 3 PROGRAMME BUDGET FOR 1989 - SIJI.IMARY BY ACTIVITY AND BY CATEGORY OP EXPENDITURE. 1L t TABLE 4 OFFICE OF THE DIRECTOR. 15 TABLE 5 OFFICE OF THE DIRECTOR - SUMMARY BY CATEGORY OF EXPENDITURE AND BY SECTION 16 TABLE 5 STATUTORY MEETINGS 18 TABLE 7 VECTOR CONTROL. 23 TABLE 8 EPIDEMIOLOGICAL EVALUATION 27 TABLE 9 BIOSTATISTICS AND INFORMATION SYSTEMS 30 TABLE 10 SOCIOECONOMIC DEVELOPMENT 32 TABLE 11 ONCHOCERCIASIS CHEMOTHERAPY PROJECT. 35 TABLE L2 ADMINISTRATION AND SUPPORT SERVICES 38 TABLE 13 ADMINISTRATION AND SUPPORT SERVICES - SI]MMARY BY CATEGORY OF EXPENDITURE AND BY SECTION 39 TABLE L4 PROPOSED IVERMECTIN BUDGET 1989 AND 1990 . 54 i t I ocPl88.1 Page 3 1. INIRODUCTION 1.1 The Plan of Operations for Phase III foresaw that by 1988 vector control would no longer be a constant conponent of OCP operations in all of the Original area and that a corresponding reduction of the entomological surveillance network would take place. However, due to the spread of resistance within the Original area in 1986/L987 and the incomplete control I of reinvasion, following the non- implementation of the planned attack operations in the Extension it was found necessary to continue larviciding during L986/L988 at a higher"r".", level than expected but with some reduction in the nileage of treated riveri, periods of larviciding and entomological surveillance. L-2. According to the Plan of Operations, the two Extension areas were expected to be in the attack phase (ful1 vector control) by 1988: larviciding commencing throughout the Southern Extension area as from 1985 and, beginning in L986/87, in the eastern third of the l,Iestern Extension area with conplEte coverage of the entire area by L988/89. As a result of the resistance to temephos, the decline ln value of the US dollar and increased cost of goods, services and salaries, a deray in the implementation of the planned operations rras unavoidable. Vector control activities in the Extenslon areas were thus confined in L986/87 to a Partial control of sources of reinvasion and, as approved by JpC, vrere expected to continue at that level in 1988. However, in 19gg it proved possible to expand larviciding to cover all of the Southern Extension and part of the northern zone of the Western Extension area, l-. 3. During 1988, epidemiological evaluation activities were carried out accordlng to plan with the addition of ivermectin field trials. 1.4. Other Programme activities such as support to socioeconomic studies and training have developed on the whole in conformity rrrlth the plan of Operations for the three years in question. 1.5. As a result of the intensive efforts made to deal with the spread of resistance, the Progranme has greatly enhanced its capability to rith lowered susceptibility to larvicides through the rotational use of the five"op. compounds now available to OCP. It has thus been possible to work out tactical treatment schedules for each river basin on a weekly basis throughout the year. It should be stressed, however, that tenephos has remained effective in rotation with other Iarvicides and is used routinely in extensive parts of the entire OCp area, including where resistance was previousry registered to the compound. Furthermore, the computerization of hydrological data and of loiistical support to larviciding operations has led to greatly improved cost-efficieicy of the vector control operations. 1.5. The conduct of ivermectin field trials and the analysis of the resulting data, which took uP an appreciable part of the Programme,s effort and t1me during the last two years, will help deterrnine the future role of this drug in onchocerciasis control. I.7. Final1y, special efforts have gone into tightening the management of operations with a view to obtaining maximum cost-effectiveness in the use of resources. The Director of the Programme, after reviewing the increasingly strained financial sltuation of oCP early in 1987, issued strict guidelines for the approval of expendltures, linking such approvals to operational prioritles and the urgency of implementation. Regular consultations between the Director and his staff were reinforced so as to ensure a continuous review of programme operations and take immediate corrective action in case of need, a process iacilitated by an improved budget monitoring system. ocP/88.r Page 4 2. OVERVIEI{ OF TIIB PIAN OF ACTION 2.L. on the side of vector control, 1989 will be characterized by an imPortant expansion of larviciding operations in the l{estern Extension area. This, together with the start in 1988 of full larviciding in the southern Extension area and in the north-vrestern part of Mali (originally Ielayed to l9g9/90), will alrow a the Programne to recuPerate two out of the three years formerly expected to be I lost due to the spread of resistance and other adverse developments encountered in 1985 and early 1987. 2.2. Vector control in the original oCP area will continue unchanged from a 1988 leaving out the northern third of the area where larviciding has, i.n effect, ceased since 1985. Preparations will be made for the withdrawal 6f aerial larviciding from the original area in 1990 with the exceprion of cerrain circumscribed foci which will require continued vector control beyond 1990. The entomological surveillance network will remain at its 19gg revel. 2.3. Vector control operations will continue to cover the whole of the Southern Extension area i.n 1989 but with a great deal of emphasis on selectivity and seasonality in the application of larvi.id.s. In the western Extension area larviciding will be extended to the Gambia and Faleme river basins in senegal and to the Upper Niger basin in Upper Guinea which has been treated only seasonally since l-987- Here again, there will be room for operational flexibility aiming at the highest possible cost-efficiency. rt is also planned to treat pre-strned sources of reinvasion in sierra Leone during the April-Juiy period. The vector control infrastructure will be compreted in 1989 throughoui the western Extension area in time for larviciding to cover the totarity of th"t "r"" as from 1990. 2.4. In 1989, with five larvicides available to ocp and its ability use them ro according to rotational schedules, the Progranme should be capable of coping with any future instances of resistance. Trials of improved formulations and search for alternative compounds wilr, however, continue. 2.5. The efforts of the Epidemiological Evaluation Unit will, to a large extent, be directed to the organization, implementation and follow-up of laige- scale treatment with ivermectin. A great deal of the actual field work will be carried out by national teams in close collaboration with, and under supervision by, OCP staff. 2.6: The Programme staff concerned, together with national epidemiological evaluation teams, will continue the examination of strategically located indicator villages in connectlon with the planned cessation of larvfcidini within the originar ocP area. Also, efforts wirl go into rhe finalization of rt. epidemiological map of Llestern Extension area and the preparation of a sinilar nap of the Southern Extenslon area. 2.7. One of the principal activities of the unit of Biostatistics and Inforrnation System will be the continuing analysis of the results of ivernectin field studies whtch will be of crucial ilnportance to the determination of the use of the drug in conjunction with larviciding and of the balance betteen the two means of control in future oCP operations. The lntegrated operational rnodel is expected to be of particular importance in this connectlon. In addition, the unit will strengthen lts support to other operatlonal and administrative activities of the Programme. ocPl88 .1 Page 5 2.8. Support to soci.oeconomic development is now the responsibility of the Committee of Sponsoring Agencies (CSA). In this connection, there will continue to be collaboration in CSA-sponsored studies on settlement in onchocerciasis controlled zones, liaison between CSA and the Participating Countries, consideration of soci-oecononic factors in relation to OCP activities, e.g.