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[email protected] ANtlEx o-1
ONCHOCERCIASIS CONTROL
IN THE
VOLTA RTVER BASIN AREA
RePort prepared for the Governnents of Dahomey, Ghana, Ivory Coast, Mali, Niger, Togo and UPPer Volta
TO TTIE AT.INEX O.I: TERMS OF REFERENCE OF THE PREPARATORY ASSISTAI'ICE MTSSION AI'ID UPPER VOLTA GOTIERNMENTS OF DAHOMEY, GHANA, MRY COAST, MALI , NIGER, TOGO
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Geneva I973 t
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United Nations Development programme a Food and Agriculture Organization of the Unlted Nations fnternational Bank for Reconstruction and Development World Health Organization 1-
TERiIS OF REFERET.ICE OF 1TIE PREPARATORY ASSTSTAI'ICE MISSION TO THE COVERNMENTS OF VOLTA DAIIOMEY, GHANA, I.RY CIOAST, MAL[, NIGER, TO@ Ar'ID UPPER a INREI,ATIoNTooNcHocERcIAsIscoNTRoLINT1IEvoLTARIVERBASIN
CONlENTS
Paragraph
I. TTfIRODUEIION A. Basis for the Mission I
B. Epideniological background . . 7
T2 II. O&IECTTVE
L4 III. ORCAT.IIZATIONAL STRUCII'RE .
IV. WORI( PT.AT,I FOR TTTE MISSION t5 A. Phases . .
16 B. Activities . . 8.1 Collection of data L7
8.2 Analysis of data 27
B.3 Establistrment of work plan for the control of onchocerciasis in the recomended zone . . 3I C. Milestones (events) 46
D. Work procedures of the Mission . . 47
E. Manpower requlrements 51
F. Supplies and equipment . 52
G. Miscellaneous 55
v. BUDGET OF THE MISSTON 56
t -2-
I. INTRODUCTION
A. Basis for the Mission I 1. In July 1968, WHO, jointly with the United States Agency for International Development (US-AID) and the "Organisation de Coop6ration et de Coordination pour la Lutte contre les Grandes End6mies" (OCCGE), convened a technical neeting to obtain advice fron the most promi- nent experts in the field of onchocerciasis as to the technicat feasibility of onchocerciasi.s control with available nethods as well as guidance concerning requirenents to be net in any large-scale control project.
2. In their reportrl ah" experts stated that onchocerciasis control is at present technically feasible, as has been denonstrated in some geographically well-defined foci, and that its chances of producing successful, durable effects, are greatest if it is carried out in sufficien- tly large ecological zones which obviate the need for continuous protection against re-invasion of flies from untreated areas. Large-scale campaigns are also cheaper to operate.
3. When considering the possibility of launching a large-scale onchocerci.asis control programae, the meeting reconrmended that, at the present time, Africa receive priority and that first atten- tion be given to an area related to the Volta River Basin including adjoining parts of seven countries - Dahomey, Ghana, Ivory Coast, Mali, Niger, Togo, and Upper Volta. This area, as delineated on the accompanying Eap, was recomnended because onchocercal disease is not only highly prevalent but also severe with particularly high rates of blindness; successful opera- tions are under way; an appreciable a.oount of data both technical and economi.c is already available; and the governments as well as the people are anxious to co-operate i.n a control act ion.
4. In 1969 and 1970 letters emanating from the highest authorities in several countries have been addressed to international and bilateral assistance organizations likely to interest themselves in the project, among others to UNDP, WHO, FAO, IBRD, FED and US-AID. Such re- quests for assistance were received fron the President of the "Conseil de lrfitente" on be- half of the Member countries - Dahomey, lvory Coast, Niger, ?ogo, Upper Volta - as well as from the Presidents of the Republic of Ivory Coast, Mali, Niger, Togo and Upper Volta, and from the Minister for Foreig-n Affairs of Dahomey. Ghana has also indicated its interest in principle, to WHO in discussions that took place with authorities in the country.
5. The seven Governments concerned having declared their interest in participating in the recortrmended regional onchocerciasis control project in the Volta River basin, UNDP agreed to give consideration to a proposal Eade by t{HO to provide assistance, in a first stage, for a Preparatory Assistance Mission which would have as broad objectives: (i) to cotlect and assess all available epideniological, entomological and other data required for the pre- paration of a regional onchocerciasis ca.Epaign; (ii) to draw up a feasible plan of work to undertake the control of onchocerciasis in the area, taking into account the econonic develop- ment of reclained areas; (iii) to work out the costs involved and identify and analyse the possible financial resources available; and (iv) to assist the Governnents in preparing such requests for assistance to I,JNDP and other sources cf assistance as are required for the im- plementation phases of the project on the basis of the plan of work drawn up by the Mission.
6. UNDP then invited WHO to prepare draft terns of reference for the proposed mission. a These were eranined in detail and completed at an inter-agency consultation which UNDP and WHO jointly organized in Geneva on 6 and 7 July 1970 at the suggestion of IBRD and with the participation of representatives fron the Conseil de lrEntente, Ghana, OCCGE, FAO, FED, IBRD, UNDP, US-AID and WtlO. The resulting terns of reference for the UNDP Preparatory Assistance Mission to the Governments of Dahoney, Ghana, Ivory Coast, Mali, Niger, Togo and Upper Volta are defined in the present document. ' roirr. us-AlD/occGE/vHo Technical Meeting on the Feasiblllty of Onchocerciasis Control, I\rnis, 1-8 July 1968, RePort, unpublished docr-ment wHo/otcHo/es. zs -3-
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\ TI :l \ ir e!:caE o -c c I c l'- o-c I 2 o I $ a -c e c C a a- 0I o t I t 1- al e. I I I s (s. (\. s0 -4- B. Epideniological background 7. In West Africa, onchocerciasis, or river blindness, a disease resulting from infection with the filarial worm Onchocerca volvulus, is found in association with principal the river t systens with foci of partlcularly high endenicity in the Sudan savanna. Light infections produce few s5rnptoms, but heavy and repeated infection may cause severe manifestations and blindness. In villages subject to hyper-endenic onchocerciasis, blindness rates of over 10 per cent., often representing 3O per cent. or nore of the working population, are not uncoEmon. While the disease is not fatal, its over-all effect on the communities can be disastrous, and is the main reason for the continued depopulation of the river valleys. 8. The only vector of hunan onchocerciasis in West Africa is Simulium daronosr.m. The larvae and pupae of S. damrosum, Iike those of all other species of blackfly, are attached to supports of various kinds and hence can develop only in water flowing at a certain speed and bringing them food, oxygen, etc. These relatively rigid conditions of life for S. damnosun are re- flected in a fairly strict localization of the breeding sites. These ecological conditions hence allow accurate location of the larval resting places, which constitutes a favourable factor for the developaent of a larviclding campaign. 9. One basic peculiarity should be borne in mind with regard to the bio-ecology of the vector female; the dispersal of fenale blackfly, more particularly of the species we are concerned with here, is considerable and may attain, if ecological conditions permit, several dozen kilornetres. It is thus obvious that, from the point of view of a campaign for the con- trol of this insect, such a leve1 of dispersion activity largely nullifies the advantage ob- tained from the relatively strlct localization of the breeding places. I't therefore con- stitutes the nain obstacle to control ca.mpaigns, since it necessitates the creation of a wide belt of insecticide protection to shield the zone under treatment from reinfestation by females from breeding places outside the zone. IO. Apart fron its effects on the health of populations (mainly the savanna populattons), this disease can have a c.rucial inpact on the economies of the countries of West Africa. The savanna populations are, under normal conditions, in a state of precarious equilibrir.rn and the adults experience considerable difficulty in providing for the needs of the rest of the population (children and old people). When, in addition, a substanttal proportion of the adult population is suffering fron economi.c or even total blindness, the disequilibrium is further accentuated and the population concerned moves away from the water-courses where transmission is Eost intense and, often, where the best land is located, settling.at the outer limit of the area. 11. To conclude, it is at present fair to state that in Africa little can be achieved to- wards the further developnent of the savanna territories (fron 80 to l2o north in West Africa) if account is not taken of this endemic disease; in the worst affected zones human population wiLl refuse to come - or return - and settle near water-courses if transmission is not reduced. I T. OBJECTIVE L2. The objective of this document is to present the tentrs of reference for the Preparatory Assistance Mission to Dahomey, Ghana, Ivory Coast, Mali, Niger, Togo, and Upper Volta, here- after referred to as "PAG Mission" or "Missi.on". This nission will be organized and financed under Preparatory Assistance to Governments (PAG) arrangements of UNDP. 13. Thus the present objective supports the over-all objective which is the control of onchocerciasis in the recommended project zone. The time sequence of the objectives is shown in Figure 1. -5- FIGURE I. TIME SEQUE{CE OF OBJECTMS OF IIIE ONCHOCERCTASTS CONTROL PROJECT IN THE VOLTA RTVER BASTN llork plan for achieving Terms of reference Control of control of onchocerciasis onchocerciasis for PreparatorY and deterEination of Assistance Mission in reco@tended econonic develoPEent zoner to GovernBents activities Initial Intervening ultimate obiective sub-object ive sub-objectives (over-al1 obiective) * Wrth concurrent or subsequent development of reclaimed areas identified as Dost promising for economic development. I I I. ORGA}.IIZATIONAL STRUCfl,RE 14. Ttre organizational structure of the Mission is su@arized in FiSrre 2. FIGURE 2. ORGAI'IIZATIONAL STRUCTURE OF THE MISSION I,.lNDP tfHo FAO Headquarters Headquarters Headquarters 2 ?t -' --' Other sources of asslstance WHO Regional Office for Africa T,INDP wHO Chief Resident Representatives PAG Missionl Representatives sources Other wHo FAO of assistance staff staff support staff support 'I Chief of Mlssion has lines of comunication with requesting governnents and inter- governnental bodies. 6- IV. WORK PTAN FOR TTIE MISSTON A. Phases 15. T'lre phases are described in Table 1. TABLE I. PHASES Time Title [.ocation (nonths ) I Preparatory activlties 7 t{Ho-HQAFRO 2 Collection of data 7 Mission base & 3 Analysis of data and preparation countries of requests 3 included 4 Establishnent of plan for control of onchocerciasis ln the recomnended 2 lYHo-HQ project zone B. Activities 16. The lndividual activities are listed in Table 2. The activities are plotted in a net- work as shown in Figure 3. Since nost of the activities are self-explanatory, only the three activities "collection of data", "analysis of data", and "establishnent of a work plan for control of onchocerci.asis" need clarification. B.1 Collection of data L7. The data to be collected from each of the sev6n countrles of the reconmended proJect zone include: I8. Epideniological and entoEological data Such data will be broken down bY: (1) - areas known to be free of onchocerciasis; (2) onchocercal areas under treatnent; (3) onchocercal areas surveyed for the following: (a) prevalence (endenlcity) level and severi.ty of dlsease; (b) Eapping of vector breeding sites Ln the different seasons; (c) adult vector density (duration of surveys, description of catching nethods, findings, in particular seasonal variations) ; (d) disease trangnission (deteroination of transEission level in "indlcator" areas ); 7- o rO loro |o |o rO o Oal(O$roto(o(oF'O o,t trF' 'l,)rodoodottt d FI a fr. r/) P |oro |o r..) 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(l N C{ g) tt 19, Chemotherapy data Such data will include results of trlals. 20 Vector control data Results of canpaigns using conventlonal methods and aerial application of insectlcides t wllt be indicated. Special attention will be given to current trials and new techniques. 2L. Health hazards data Potential hazards to health arising specifically as a consequence of onchocerciasis con- trol (e.g. water-related diseases) will be defined. 22. Agricultural data Potentialities for agricultural and animal production in areas to be reclaimed will be identified, and projects which are being or could be inplemented in coniunction with the onchocerciasis control campaign indicated. Identification will be made of a number.of areas in which agriculturat development would have the greatest chance of taking place. 23. Geographical data AII relevant existing information on soil, clinate, hydrology, vegetatlon, topography, roads, airports, etc. will be gathered, and aeri.al photographs and naps inventoried. 24. Demographic and sociolocical data The dynanics of populations will be investigated on the basis of available studies and knowledge. 25. EriellnlhqC[h inEregqCglttle The availability of existing health services, technical facilities, organizations and institutes directly or indirectly concerned with onchocerciasis will be ascertained. 26. Exlsting internationally supported schenes These will include projects and programmes operating or planned in the project zone especially in regard to staff and facilities that could be made available to the project. 8.2 fuialysis of data 27. Tte Mission will: 28. - determine the status of each focal area with regard to available epidemiological, entomological and therapeutic base-line data, and/or state of progress so far achieved in control operations. Sun up information on map of project zone; 29 - evaluate control efforts regarding results: (a) comparison of conventional ground applicatlon with aerial larviciding as to efficacy; u (b) comparison of costs of different types of control; (c) control problems: technical know-how; lack of epideniological or entomological data; administrative linitations; logistical probleos; lack of funds and delays in financing, etc. -10- 30. - ensure feedback of infornation as gathered and locally appraised to WHO Reglonal Office and WHO Headquarters, together with processing lnstructlons. B.3 Establishment of work plan for the control of onchocerciasis in the reconmended zone 31. The work plan will include chapters dealing with the following subjects: 32. Objectives of the project to control onchocerciasi.s , Ttris should include irapact indicators (quantified objectives, e.g. decrease in incidence of disease during a fixed period of tine). 33. Organizational structure Responsibilities and lines of comr.urication to ensure proper efficient operation of the project will be defined. If necessary, new organlzational arrangements should be sought for new needs. 34. Inter-country co-operation Recognizing the need for inter-country co-operation at all technicaL and adninistrative levels during all phases of the project, the Mission shall indicate the ways and neans by which this may be achieved. 35. Phases In planning this long-term project, it may be advisable to consider various phases. The activities of the first phase will have to be spelt out in great detail, while the activities of the subsequent phases can only be determined after the evaluation of Phase 1. 36 Determinat ion of control activities and the ir tininc For Phase I the individual activities have to be deternined and the tine needed to execute theE estlDated. Tttis includes: (l) Where needed, completion of epideniological, entonological, and other baseline data prior to initiation of control progr,me. (2) Training of personnel in two related centres, one for English-speaking participants (in Ghana), and another for French-speaklng participants (in Upper Volta or Ivory Coast). Apart from theoretical and field tralnlng offered at both centres to professional, technical and laboratory staff, other forms of training should be provided in aII dis- ciplines as required, e.E. fellowships for acadenic training with extensive follow-up fiefd training in onchocerciasis control in West Africa, training at selected centres or in field studies for high-leve1 professionals. (3) Support to operational research to raise the efficiency of control methods. Anongst other points, consideration witl be given to the following inter-related problems: - Testing of various insecticides, especially of bio-degradable compounds; Improving and standardlzing the techniques for aerial napptng of breeding sites; Improving and standardizing the techniques for aerial application of larvicides; a - Assessing the effects of control at different seasons; - Studies of the vectorts survival during the dry season; - Chenotherapeutic trials. -11 - (4) Dellmttation of operational sectors and'definition of activities and methods to be used (i) in Phase 1; (ii) projection for subsequent phases, including naintenance phase when internatlonal support will cease. (5) Definition of assessment methods, with or without chenotherapy: (a) fitonological nethods: I - Effects of insecticides on larval population; - Eventual variations in the susceptibility of larval populations to insecticides in the course of control operations; - Follow-up of reduction of larval population density; study of residual populations; study of reinfestation; - Assessment of level of residual transnission. (b) Clinical and epideniological nethods: - Reduction in the prevalence of disease (qualitative skin biopsies); - Reduction ln the intensity of infection in the individual (quantitative skin biopsies); - Reduction of ocular lesions (in prevalence and in severity). (c) Efficiency. (d) Econonic consequences. (6) Advice on the future of the Onchocerciasis Advisory Team (AFRO-O131) financed under INDP/TA in relation to the onchocerciasis control project in the Volta River basin, with special attention to its research and training cor0ponents. 37. Determination of economic development activities Deternination of activities required to develop production In areas freed of onchocerciasis includes (see Figure 1): (1) ldentification of areas which owing to their econonic potential and location in relation to centres of population density could be developed; <2) Drafting of prelininary terms of reference for pre-investnent studies which should be undertaken, taking into account the needs for: (a) An appraisal of natural resources (soils, clinate, water resources) of the areas and their suitability for various types of developnent; (b) An exaoination of the neasures required to realize th,e potential of these areas, including, illustratively, supplemental investnents for infrastructure, irrigation and flood control, land clearing, credit and extension, etc., that could result in naxinizing the benefits obtained in relation to the costs. (c) An assessnent of existing land rights and sociological factors bearing on the possibilities and rapidity of realizing the econonic potential of these areas; (d) A consideration of the nost effective and econonic neans of settling people in these areas, including the nature and extent of assistance that should be pro- vided by the governments concerned to facilitate settlement; L2- (e) An assessment of the market for the production that could be developed in these areas. 38. The Mission will proceed with the foregoing, utilizing work that has already been done, with a view to discussing with the governments concerned the advisability of submitting to IJNDP the necessary requests for financing of such pre-investnent studies even before the pAG Misslon has conpleted the assignment. t 39r Graphical presentation and maps For better connunication amongst the project participants, graphical presentation (Gantt Chart ana/or network) and standard maps are reconmended. 40. MiLestones MainLy for project budget purposes and for reasons of project nonitorinf valuation, milestones (events) may be listed with the earliest finish and latest finish. 41. Milestone indicators Mainly for nonitoring/evaluation purposes, milestone indicators which relate to the outputs to be reached at significant nilestones should be planned. 42. Determination of national and international resources (manpower, supplies and equip- nent, conputer tine) for Phase 1. 43. Tentative determination of the national and international resources for the subsequent phases. 44. Presentation of pro.iect budget information for Phase 1 Various forms of presentation nay be necessary in accordance with the purpos€r €.g. raising fturds, monitoring and evaluation. This should include indication of how the seven countries participate in the project costs. 45. Tentative pro.iect budget covering all phases of the recommended project C. Milestones (events) 46. The events are listed in Table 3. D Work procedures of the Mission 47. [t is recommended that the Mission establishes its base at Ouagadougou. The Mission will naintain close contact with the respective offices of the Resldent Representatives of I'}IDP. 48. The governments and agencies concerned will facilitate the work of the Mission by granting the approprlate authorizations and facilities requested by the Mission to perftrrm the tasks assigned to it under the present terms of reference. In particular, the Mission shall be provided with all relevant infornation and be able to nake any contact it considers necessary in order to obtain authoritatlve information and a opinions. It shall have complete freedon of movement within each country, and fron one country to another country included in the recomended zone to observe conditions and perform sinple field investigations as night be needed. -13- 49. Ttre Mission is authorized to arrange for jolnt consultations that will be required fron tlne to tine wlth technical ofllcers fron two or Dore countries. ltre respective goverments and organizatlons w111 authorize the attendance at these consultations of those deslgnated by the Mission at the place deterolned by the itlsslon. a SO. Ttre Chiel of Misslon shall subnlt briel technlcal progress reports on a quarterly basis Executing Agency and INDP in accordance with the reporting provlsions of UNDP (Speclal I to the Fund). Experts and consultants assigned to the Mission by other agencies nay subnit technical reports to their respective headquarters and are also required to provide the Chief of lllission with information on progress in their respective sectors to pernit an over-all report to be establ ished. Agencies and organizations involved in the project will exchange such technical reports as may emanate from their consultants. TABLE 3. MTLESTONES (EVE{TS) No. of Description of event Finish event (3) (1) <2) I Start -7 2 Availability of staff and supplies and equipnent explored -5 3 Chief of Mission selected -1 4 Mission neets o 5 Mission discussions/Urieting completed o.5 6 Initial visits to governments made r.5 7 Data collected (Upper Volta) 3 I Data collected (Ghana) 4.5 9 Data collected (Ivory Coast) 5 10 Data collected (Mali) 5.5 1t Data collected (Niger) 6 L2 Data collected (Togo) 6.5 l3 Data collected (Dahomey) 7 ? 14 Analysis of data made and government requests prepared 10 15 Work plan for control of onchocerciasis established and studies conpleted for L2 determination of economic developnent -14- E. Manpower requirements The 51. nanpower requirenents are shown in Table 4. a TABLE 4. MANPOWER REQUIREIT{E\rTS Date of Starting activity TotaI joining Mission FoIlowing Title activities no. of ( r) Project (6) months Code Description Month (7) (2) (3) month no. (s) (4) E(perts Chief of Mission G Clearance -1 May H-S 13 ( Epidemio logi. s t/2U r ic of visits Health Administrator) to Governments fitomologist I Briefing o June J-S t2 Economist I Brieflng o J-S L2 Consu I tants Project planning expert I Briefing o KtRrS 7 Statistician T Briefing o K,R 5 Human geographer I Briefing o K,L,R 6 Socio-e thnologi st I Briefing o tt K,L,R 6 General agricultural T Briefing o Part of 3 economist K'R Costing expert T Briefing o Part of 3 K,Rrs Consulting firm (sub- I Briefing o tl To be contracted by FAO) determined 67 Secretarial assistance Secretary G Clearance -t May 14. 5 of visits to Governments Locally recruited staff Drivers (4) J Initial visits o.5 June 38 to Governments Auxiliary staff (2) J o.5 tt 19 I 71. 5 15- F. Suppties and equ ipment 52. The supplles and equipnent needed for the ilission are shown in Table s.l a TABLE 5. SUPPLIES AI.ID EQUIPiT|EX{T t Date of arrival Description Amount (us E; Project month Month/year (1) (2) (3) (4) Vehic les 3 x 4O4 Peugeot estate cars (air condrtioned)* I 700 o June I x Landrover* 3 500 I 5 .luty/August I x bicycle 50 o June Other equipment Maps (coloured soil maps, etc. ) r 500 o Office supplies 500 o 3 x dictaphones 150 o tt 4 x sets of camping equipment I 400 o I x typewriter 100 o I x calculating machine loo o I x reproducing machine 500 TotaI 16 500 t Including one set of spare tyres. l ? t 'Consideration may be given to the possibility of undertaking aerial reconnaissance, for which no provislon has been included 16- 53. Office accomnodation and laboratory facilities will be made available under special arrangements with the host country. t 54. If needed, the facilities and services of the coEputer located in WHO headquarters will be placed at the disposal of the Mission. t G. Miscellaneous 55. The various miscellaneous costs which must be anticipated as a charge to the Missionrs budget are shown in Table 6 below. TABLE 6. MISCELLANEOUS Descript ion Anount (US $) (1) <2' I Incidental local operating expenses, 2 600 including cables, postage, etc. 2 Operating and maintenance costs of 6 000 vehicles 3 Inter-country technical consultations, including international travel, per diem, 8 900 etc. Total t7 500 A i -L7- Y. BUMET OF THE MTSSION 56. The budget of the Mission is as follows: tr { Total no. Total t of estiEated nan-nonths cost us$ Personnel (as per Table 4) Experts and Consultants 67 156 400 Consulting firm 30 000 Secretary, drivers and other auxiliary staff 7r.5 15 600 Supplies and equipnent (as per Tabte 5) 16 500 Miscellaneous (as per Table 6) t7 500 TotaI 236 000 i I