JAF4.7-Eng.Pdf (6.762MB)
African Programme for Onchocerciasis Control (APOC) Programme Africain de lutte contre l'onchocercose
JOINT ACTION FORUM JAF.FAC FORUM D'ACTION COMMUNE Office of the Chairman Bureau du Pr6sident
JOINT ACTION FORUM JAF4.7 Fourth session ORIGINAL: ENGLISH Accra. 9-11 December 1998 September 1998
Provisional agenda item 9
,,-71 r\r- + q )
0 \
CONSIDERATION OF NATIONAL ONCHOCERCIASIS CONTROL PLANS AND PROJECTS PROPOSALS (CDTI, VECTOR ELIMINATION AND HEADQUATERS ST'PPORT) APPROVED BY THE CSA IN 1998
Projects submitted by the NOTFs of:
. DEMOCRATIC REPUBLIC OF CONGO - EQUATORIAL GUINEA - GABON - MALAWI . NIGERIA - SUDAN - TANzuNIA - UGANDA CONTENTS
1. INTRODUCTION 2
A. CDTI AND VECTOR ELIMINATION PROJECTS PROPOSALS 3
2 UGANDA ...... 3 2.1. General Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Uganda (seeFig. lbelow) ...... 3 2.2. Rukungiri,Nebbi,Arua,MbararaCDTlProject ...... 3 2.2.1. Backgroundinformation ...3 2.2.2. Budgetsummary ...4 2.2.3. TCC comments and suggestions . . . 5 2.2.4.ApprovaloftheproposalandratificationbyJAF ...... 6 2.3. Adjumani, Moyo, APAC, Gulu, Kibale CDTI Project . 6 2.3.1. Backgroundinformation ...6 2.3.2. Budgetsummary ...6 2.3.3. TCC comments and recommendations . . . 7 2.3.4. ApprovaloftheproposalandratificationbyJAF ...... 8
3 NIGERIA 8 3.1. General Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Nigeria (see Fig.8 below) 8 2.3. Enugu, Anambra and Ebony States CDTI Project 9 3.2.1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Enugu, Anambra and Ebony States (see fig.9 below) 9 3 .2.2. Background information 9 3.2.3. Budget summary 9 3.2.4. TCC comments and recommendations 10 3.2.5. Approval of the proposal and ratification by JAF 11 3.3. Kano State CDTI Project 11 3.3.1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Kano State (see Fig.ll below) 11 3.3.2. Background information 11 3.3.3. Summary budget 11 3.3.4. TCC comments and recommendations t2 3.3.5. Approval of the proposal and ratification by JAF t3 3.4. Imo and Abia State CDTI Project t3 3.4.1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Imo and Abia States (see Fig.13 below) 13 3.4.2. Background information 13 3.4.3. Summary budget t3 3.4.4. TCC comments and recommendations t4 3.4.5 . Approval of the proposal and ratification by JAF 15 3.5. Yobe State CDTI Project 15 3.5.1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Yobe State (see Fig.15 below) 15 3.5.2. Background information 15 3.5.3. Summary budget 15 3.5.4. TCC comments and recommendations t6 3.5.5. Approval of the proposal and ratification by JAF t7 (ii)
3.6 Zamfara State CDTI Project t7 3.6.1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Zamfara State (see Fig.17 below) T7 3.6.2 Background information t7 3.6.3. Summary budget T7 3.6.4. TCC comments and recommendations 18 3.6.5. Approval of the proposal and ratification by JAF t9 3.7 Edo and Delta States CDTI Project proposal t9 3.7 .1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Edo and Delta States (see Fig.19 below) t9 3.7.2. Background information T9 3.7.3. Summary budget t9 3.7.4. TCC comments and recommendations 20 3.7 .5. Approval of the proposal and ratification by JAF 2t 3.8 Oyo State CDTI Project proposal 2t 3.8.1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Oyo State (see Fig.21 below) 2L 3.8.2. Background information 2t 3.8.3. Summary budget 22 3.8.4. TCC comments and recommendations 22 3.8.5. Approval of the proposal and ratification by JAF 23 3.9 Jigawa State CDTI Project Proposal 23 3.9.I. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Jigawa State (see Fig.23 below) 23 3.9.2. Background information 23 3.9.3. Summary budget 24 3.9.4. TCC comments and recommendations 24 3.9.5. Approval of the proposal and ratification by JAF 25
4. EQUATORIAL GUINEA 25 4.1. General Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Equatorial Guinea (see Fig.25 below) 25 4.2. National Plan and Project Proposal 26 4.2.1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Bioko Island (see fig.26 below) 26 4.2.2. Background information 26 4.2.3. Summary budget 26 4.2.4. TCC comments and recommendations 27 4.2.5. Approval of the proposal and ratification by JAF 28 4.3. Bioko island Vector Elimination Project 28 4.3.1. Background information 28 4.3.2. TCC comments and recommendations 28 4.3.3. Approval of the proposal and ratification by JAF 28
5. DEMOCRATIC REPUBLTC OF CONGO (DRC) 29 5.1. General Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Democratic Republic of Congo (see Fig.28 below) 29 5.2. National Plan and Headquarters Support 29 5.2.1. Background information 29 5.2.2. Summary budget 29 (iiD
5.2.3. TCC comments and recommendations 30 5.2.4 Approval of the proposal and ratification by JAF 3t 5.3 Kasai CDTI Project Proposal 3I 5.3.1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Kasai (see Fig 30 below) 31 5.3.2. Background information 3t 5.3.3. Summary budget 32 5.3.4. TCC comments and recommendations 33 5.3.5. Approval of the proposal and ratification by JAF JJ
6 GABON 33 6.1. General Rapid Epidemiological Assessment (REA) of Onchocerciasis in Gabon (see Fig 32 below) JJ 6.2. National Plan and CDTI Project proposal 34 6.2.1. Background information 34 6.2.2. Summary budget 34 6.2.3. TCC comments and recommendations 35 6.2.4. Approval of the proposal and ratification by JAF 35
B REVIEW OF THE FIRST YEAR PROGRESS REPORTS OF ELEVEN (11) APPROVED PROJECTS AND IMPLEMENTATION PLAN FOR THEIR SECOND YEAR , , . . . 36
7 THYOLO AND MWANZA CDTI PROJECTS (MALAWI) 36 7 .1. Review of the first year progress report 36 7 .2. Review of the second year budget proposal 37 7.3. Approval of the first year progress report and the second year budget proposal 37
8 PHASE I (KISORO, KASESE, HOIMA, MASINDD CDTI PROJETCT (UGANDA) . 37 8.1. Review of the first year progress report 37 8.2. Review of the second year budget proposal 37 8.3. Approval of the first year progress report and the second year budget proposal 37
9, CROSS RIVER STATE CDTI PROJECT (NIGERIA) 37 9.1. Review of the first year progress report 37 9.2. Review of the second year budget proposal 38 9.3. Approval of the first year progress report and the second year budget proposal 38
10 KADUNA STATE CDTI PROJECT (NIGERIA) 38 10.1. Review of the first year progress report 38 I0.2. Review of the second year budget proposal 38 10.3. Approval ofthe first year progress report and the second year budget proposal 38
11 KOGI STATE CDTI PROJECT (NIGERIA) 39 11.1. Review of the first year progress report 39 llz. Review of the second year budget proposal 39 1 1.3. Approval of the first year progress report and the second year budget proposal 39
t2 TARABA STATE CDTI PROJECT (NIGERIA) 39 lL.L Review of the first year progress report 39 12.2. Review of the second year budget proposal 40 12.3. Approval of the first year progress report and the second year budget proposal 40 (iv) l3 NOTF/HEADQUARTERS SUPPORT PROJECT (NIGERIA) 40 13 . 1 . Review of the first year progress report 40 13.2. Review of the second year budget proposal of the NOTF/HQ 40 13.3. Approval ofthe first year progress report and the second year budget proposal 4t
t4 NOTF/HEADQUARTERS SUPPORT PROJECT (SUDAN) 4t 14.1. Review of the first year progress report 4I I4.2. Review of the second year budget proposal of the NOTF/HQ 4t I4.3. Approval ofthe first year progress report and the second year budget proposal 4l
15 NORTHERN SECTOR CDTI PROJECT (SUDAN) 4I 15. 1 . Review of the first year progress report 4t 15.2. Review of the second year budget proposal 4l 15.3. Approval ofthe first year progress report and the second year budget proposal 42
I6 NOTF/HEADQUARTERSSUPPORTPROJECT(TANZANTA) ... .. 42 16.1. Review of the first year progress report ...... 42 16.2. Review of the second year budget proposal of the NOTF/HQ . . 42 16.3. Approval of the first year progress report and the second year budget proposal . 42
t7 MAHENGE CDTI PROJECT PROPOSAL (TANZANIA) . . . . 42 17 .L Review of the first year progress report ...... 42 17 .2. Review of the second year budget proposal . . . . 42 17.3. Approval ofthe first year progress report and the second year budget proposal . 42
18. FINANCTAL MANAGEMENT OF THE ABOVE ELEVEN (11) PROJECTS . 43 JAF4,7 Page I
Table 1: SUMMARY OF APPROVED PROJECTS AS AT OCTOBER 1998
Date of Number to be treated Trust Fund US $ COUNTRY PROJECT Approval Year I Year 5 Approved Year I Malawi I Tyolo & Mwanza Dec-96 101 066 270 338 198 665 Uganda 2 Kisoro Kasese Hoima Masindi Dec-96 t39 473 153 210 163 555 3 Focal vect.eli. in Itwara focus Dec-96 28 186 4 Mpamba-Nkusi Focus Dec-96 t06 291 5 Kabale, Mbale & Busheny Sep-97 296 008 344 824 t54 6tt 6 Rukungiri, Nebbi, Arua, Mbarara Apr-98 371 188 433 217 151 833
7 fiusX$8::::::::::. :::i::iiiii:i:iii$65::,fi$:t: l:.:.:.:.:.,iii.65?.:17fi 5. i$diu iii:[-uroli:affiui:isului::Hiualei:it:::::::;: ljjjirrr:i::rirjjjjjjji: Nigeria 8 HQ Support proposal Apr-97 160 125 9 Kaduna CDTI project Apr-97 327 789 665 442 200 400 l0 Taraba CDTI project Apr-97 518 000 822 000 243 522 ll Cross River CDTI project Apr-97 300 000 654 870 226 736 12 Kogi State CDTI project Apr-97 406 890 1 081 590 161 243 13 Adamawa State CDTI project Sep-97 721 202 8tt 720 2r4 298 14 Bomo State CDTI project Sep-97 735 545 827 862 226 665 15 Federal Capital CDTI project Sep-97 201 562 280 704 213 603 16 Plateau State CDTI project Sep-97 679lLt 770 300 297 075 t'7 Osun State CDTI project Sep-97 226 160 623 326 292 741 18 Enugu, Anambra, & Ebony Apr-98 1 718 283 1 921 207 388 898 19 Kano, CDTI project Apr-98 230 000 400 000 174 612 20 Imo & Abia States CDTI project Apr-98 946 221 1 063 067 2s8 338 2t Yobe State CDTI Project Apr-98 I 89 000 315 000 160 545 22 Zamfara State CDTI project Apr-98 112 984 128 000 89 923
23 fiuf,+$8....ii.i.i ::::::t;:1:}4:::+?# 24 *u*l$,.,.,.,.,., ::::::;::liiiiilssii$f * 25 Augt98:r:!:,i:; :,!,!,:i.St::480 :::::::::tl:l::: :::::::::j::r:::::::: '',.,,,,: Sudan 26 HQ Support proposal Apr-97 157 815 27 Southem Sector Apr-97 406 890 316 845 28 Northern Sector Apr-97 I 00 000 540 000 262 657 Tanzania 29 HQ Support proposal Apr-97 150 187 30 Mahenge Focus Apr-97 267 004 295 873 t4t 492 3l Tukuyu focus vector elimination Sep-97 il3 366 32 Ruvuma CDTI project Apr-98 326934 373716 201 653 Cameroon 33 HQ Support proposal Sep-97 152 612 34 Meiganga, Banyo & Tignere Sep-97 92 s55 271 792 138 815 35 Nofih Province Districts Sep-97 t'72 000 172 000 219 360 36 South West Province Sep-97 305 000 408 379 238 167 5t Littoral II CDTI project Sep-97 139 081 334 330 105 410 38 Centre 3 CDTI project Sep-97 37 093 274 238 258129 CHAI) 39 CDTI Project Sep-97 7312'72 8892s0 492032 CAR 40 CDTI Project Sep-97 751920 1000000 177100 E.Guinea 41 CDTI Project Apr-98 33000 85000 72289 42 Bioko Island Vect.eliminat.project Apr-98 190474 D.R.Congo
Gabon TOTAL t4 024 298 22 451 018 8 926 10s JAF4.7 Page 2
Fis l: Proiects imolementation areas
"/ E- d
(:) Chad Sudu
s CAR Ethiopia s Equrloirsl Guitlts.
" CDTI projects = 36 Angola t) uQsupport=s -- Vector elimination = 4
1. INTRODUCTION
In 1996 arfi 1997, the Committee of Sponsoring Agencies (CSA) approved 29 Projects proposals recommended by the Technical Consultative Committee (TCC). These Projects proposals were ratified by the Joint Action Forum (JAF) at its second session in December 1996 (4 Projects) and third session in December 1997 (25 Projects).
For 1998, the CSA, on the behalf of the JAF, has approved 16 new Projects proposals recommended by the TCC at its various sessions.
Table 1 on the first page of the current document shows the total number of the Projects proposals (45) approved by the CSA as oftoday.
The 16 Projects proposals approved by the CSA in 1998 are herewith presented to the Joint Action Forum (JAF) for ratification.
Furthermore, after a technical and financial review of the first year progress report of eleven (11) APoc-funded Projects, the CSA upon recommendation of the TCC during its 5d' and 6d'sessions, has approved in April and October 1998, the second year funding of these Projects. This approval is also submitted herewith to the JAF for ratification. JAF4.7 Page 3
A. CDTI AND VECTOR ELIMINATION PROJECTS PROPOSALS
2. UGANDA
2.1. General Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Uganda (see Fig. I below)
Fig 2: UGANDA Rapirl Epidemiilogical Mapping of OnchocerciasF
Legend
i.3!r.n""., ^*, To r.nn. -noCl)T! t8)ffi r'nrt rr.t1.rrp1.amrnr U
Nodtrl. Prevaletrre ('2,) @ o0 g Ito9 o l0to 19 o 20to39 o 40 to 100
Ju- 0 2040
2.2. Rukungiri, Nebbi, Arua, Mbarara CDTI Project
2.2. 1. Background information
This phase III of APOC-supported Project in Uganda will be carried out in the districts of Rukungiri (assisted by Global2000 River Blindness Program), Mbarara (assisted by Christoffel Blinden Mission), Nebbi (Global 2000 River Blindness Program) and Arua (assisted by Christoffel Blinden Mission) (see doc. JAF4.4). It is a consolidation and reorientation of existing ivermectin distribution programmes in these districts that have been in operation since 1992 (Rukungiri and Nebbi districts) and1994 (MbararaandAruadistricts)andhaveenabledtreatment of 312,323 people in1997. Thetotal population in the Project area is close to 400,000. Fig. 3 and Fig. 4 indicate the detailed REMO results for the four districts concerned. JAF4.7 Page 4
Fig 3: Arua & Nebbi (Uganda) Rapid Epidemiological Mapping of OnchocerciasErZi
Legend Ira.i,. rn"r" Emptr rss DenDtre !r zu'es L_i&i To r€nnr - tro OT! l}ficDrr hk€h qirh p'p I l"*' o
Nodule Prevdcnc. (Yo) o0 o o I to9 o l0to19 o o 20to39 o 40 to 100
Jt- 0rc40
o
@ o
lz
Fig 4: Rukungiri & Mbarara Rapid Epidemiological Mapping of
Legend Ina.u.rn'r, ::':: EhPtY .re$ fubl*nn,,.,,,,nn.* To refitrc - no CDTI ( RIF!cDrr rikrrr * h u,o edn'trr Fxl L lLrr6
Nodule Prevrlence (Yo) o0 o lto9 o l0to19 o 20to39 o 40 to 100
0rc40Ju-
2.2.2. Budget summary
Table 2 below summarizes the five year budget as submitted by the NOTF/Uganda and Fig 5 shows the trend of the cost per person to be treated between 1998 and 2002. JAF4.7 Page 5
Table 2: Five year summary budget of Rukungiri. Nebbi. Arua. Mbarara CDTI Proiect as submitted by the NOTF (US $)
371,888 322,331 0.87 24t,880
383,416 260,487 0.68 184,140
395,302 219,222 0.55 t46,090
407, 556 t73,833 0.43 89 955
433,2t7 104,742 0.24 39,367
433,217 1,080, 615 2.49 701,432
Fig 5:Trend of cost per person to be treated L1998-2002)
1.00
0.90
0.80
0.70
0.60
0.50 f
0.40
0.30
0.20
0.10
0.00 1998 1999 2000 2001 2002
2.2.3. TCC comments and suggestions
TCC considered that this proposal as presented had the sufficient merit to be recommended to the CSA. TCC urged to review the budget inflated by duplication in all aspects of the same budget that has been presented for the second year funding in the proposal for phase I Projects in Hoima, Kasese, Kisoro, and Masindi districts, by the Secretariat. JAF4,7 Page 6
2.2.4. Annroval of the oronosal and ratification bv JAF
Based on the recommendation of TCC, the Management of APOC carefully revised and reduced by 37Vo the first year budget of US $ 241,880 submitted by the NOTF. The CSA therefore has approved the phase III CDTI Project for Uganda with the corresponding amended first year budget of 151,833 US $ which is herewith presented to JAF for ratification.
2.3. Adjumani, Moyo, APAC, Gulu, Kibale CDTI Project
2.3.1. Backsround information
This phase IV APOC Project proposal is a consolidation of on-going onchocerciasis control activities as well as the introduction of APOC strategy on Community directed treatment with ivermectin (CDTI) in five districts where mass treatment has been taking place since 1993 : Adjumani, Gulu, Apac and Moyo districts assisted by Global 2000 River blindness Program and Kibaale district assisted by Sight Savers International. In this Project proposal, mass treatment with ivermectin will be provided in622 communities per year, with 565,891 people to be treated in 1999, increasing to a total of 632,785 persons by the fifth year of APOC funding (see doc.JAF4.5) . Fig.6 shows the detailed REMO results for the five districts concerned.
Fig 6: Moyo-Apac-Gulu-Adj Rapid Epidemiological Mapping of
Nodule Prevalcnce (%o) o0 O I to9 O l0to l9 O 20to39 (D 40 to 100
Legend [^u*r.,,.u.
S" r"n"" u, -*. 'li r.frb. - no( I)1I ffi,'r,r r uurr .ur nun,rur,r f lr"'
0440
2.3.2. Budget summary
Table 3 below summarizes the five year budget as submitted by the NOTF/Uganda and Fig 7 indicates the trend of the cost per person to be treated from 1999 to 2003. JAF4.7 Page 7
Table 3 Five year summary budget of Moyo. Apac. Gulu. Adjumani and Kibaale CDTI project as presented by the NOTF (US $)
565, 891 198,425 0.35 33,527
581,781 189,793 0.33 32,439
s98 , 266 189, 604 0.32 38,126
615,262 153,604 0.25 32,390
632,785 130, 695 0.21 27,015
632,785 862, tzt 1.36 L63,497
Fig 7: Trend ofcost per person to be treated (1999-2003)
0.40
i TOTAL 0.35
0.30
0.2s APOC
o: 0.20
0.15
0.10
0.06 004 0.05 NGOOA MOH
0.00 1999 2000 2001 2002 2003
2.3.3. TCC comments and recommendations
The detailed comments and recommendations of the TCC on the above CDTI Project proposal are stated in section 4.4. of the document JAF4.5. In short, TCC considered that overall, this was a well-written, technically sound proposal and recommended it for funding by APOC Trust Fund. JAF4-7 Page 8
2.3.4. Approval of the proposal and ratification by JAF
Based on the recommendations of the TCC, the CSA has approved in October 1998:
(i) the phase MDTI Project proposal for Uganda covering the five districts of Moyo, Apac, Gulu, Adjumani and Kibaale.
(ii) the 1999 budget for the above proposal of US $ 33,527 to be paid from the APOC Trust Fund, with the understanding that APOC Management will review carefully this budget and communicate the amended amount to the NOTF of Uganda on the behalf of the CSA.
The above approval is herewith submitted to JAF for ratification.
3. NIGERIA
3.1. General Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Nigeria (see Fig.8 below)
Fig,.8: NIGERIA Rapid Epidemiologlcrl Mapping of Onchoccrclsstu 0une 1998)
Lsgend ! o"finit"Cotl."-
.tt: corr titelv {to rcnnc)
'ft CDTI wlikety (to rcfine) ffi Nonruoy"t litri No corl r------'lKM 0 100 200
Source: NOTF Nigeria, June 1 JAF4.7 Page 9
2.3. Enugu, Anambra and Ebony States CDTI Project
3.2.1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Enugu. Anambra and Ebony States (see fig.9 below)
Fig.9: Rapid
Reserve < _-- CrossRiv{y' Logond
Definilc CDTI arcas
CDTI likcly (b re{inc)
/4, cD'fl Inlikely (b refinc) ffi Nonevoy.r ri';it No corl
1, 2, 3: Urgent clarincaion KM data inconsistent with epi ento r-----l Source: NOTF Nigeria, June 0 2040
3.2.2. Background information
The three States comprising 51 Local Government Areas (LGAs) and 3335 communities have a total estimated population of 6,604,233. The Project seeks to establish CDTI in 3051 communities of the 43 meso or hyper endemic LGAs. The Project proposal is a reorientation of an existing programme, initiated in 1995 by Global 2000 River Blindness Program in jointpartnership with the Lions Clubs Foundation, which treated from 1995 to 1997 a cumulative total of 2,519,976 people. Fig.9 indicates the detailed REMO results for the States concerned.
3.2.3. Budget summary
Table 4 below summarizes the five year budget as submitted by the NOTF/Nigeria and Fig.10 shows the trend of the cost per person to be treated between 1998 and 2002. JAF4,7 Page l0
Table 4: Five year summary budget of Enugu. Anambra and Ebony States CDTI Project as submitted by the NOTF (US $)
1,718,283 1,706,000 0.99 1,280,000
r,766,910 960,000 0.54 685, 000
1,816,9r4 674,000 0.37 451,000
1,868,333 569, 000 0.30 384, 000
1,921,207 378 000 0.20 273,000
1,92L,207 4,287,000 2.23 3, 073, ooo
Fig.10: Trend of the cost per person to be treated from 1998 to 2002
1.20
o;gs 1.00
0.80 t^,:"'1x
H 0.60
0.40
0e5 MOH/NGrc 0.tS!
0.20 0.1.6,
0.00
1 998 19S9 2000 2001 2002
3.2.4 TCC comments and recommendations
TCC, after review, considered that this was a good proposal and recommended it for funding with the following amendments: (i) review REMO data as it indicates there may be a bigger population to treat; (ii) more effort to integrate into health system and avoid vertical programme with horizontal baseline, (iii) explain in detail the supply and storage of Mectizan; (iv) review the time line activities as they seem out of phase with seasonal activities; (v) reduce the cost of training materials, communications and other expenses. TCC's cornments and recommendations are described in detailed in section 4.2.1 of doc. JAF4.4. JAF4.7 Page 11
3.2.5. Approval of the proposal and ratification by JAF
Based on the recommendations of TCC, the Management of APOC cautiously revised the first year budget of US $ 1,280, 379 submitted by the NOTF. The CSA therefore has approved the Enugu, Anambra and Ebony CDTI Project with the corresponding amended first year budget of US $ 388,898, which is herewith presented to JAF for ratification.
3.3. Kano State CDTI Project
3.3.1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Kano State (see Fig.11 below)
Legend
o"finit" cott ! "r""t iii corr titetr tto rerne) // cottunlikely(to tl ffi No REMo vet
_t:. IJ 'i:ii.., No CDTI tl i
ir:
:cl tl a
3.3.2. Background information
The Project proposal covers 14 of the 44 LGAs of Kano State and will target for mass treatment, a total population of 400,000 people of which 225,000live in hyper endemic and 175,000 in meso endemic communities.
The proposed CDTI Project is a reorientation of an existing programme, assisted by Christoffel Blinden Mission, that has been in operation since 1996 and has treated so far a cumulative total of 108,857 persons. Fig.11 shows the detailed REMO results for Kano State.
3.3.3. Summary budget
Table 5 below summarizes the five year budget as submitted by the NOTF/Nigeria and Fig.l2 shows the trend of the cost per person to be treated between 1998 and2002. JAF4.7 Page 12
Table 5: Five year summary budget of Kano State CDTI project as presented by the NOTF (US $)
230 000 472,000 2.05 253 000
117,000 253 000 2.t6 76,000
325, 000 203, 000 0.62 53, 000
350, 000 226,000 0.65 39,000
400 000 20 1 000 0.50 32,000
400 , 000 1 , 355 , 000 3.39 453, 000
Fig.lZ: Trend of the cost per person to be treated from 1998 to 2002
2.50
Total
2.OO <\
o f 1.10 '1.00 AR}C o.62 ii lt:::,:Ut:.:,1:::::=,{ 0.50 ,:'1..,:r]E u.)) --.o. l6:i'd' o Il 0.00 '1998 1999 2000 2001 2002 3.3.4. TCC comments and recommendations TCC considered that this was a clear, well thought, well written proposal showing community involvement leading to transfer to CDTI. The detailed comments and recommendations of TCC are described in section 4.2.5 of doc.JAF4.5. In short, TCC recommended for approval, the Kano State Project proposal and pointed out that: (i) overall, the budget for the first year is high ; (ii) specific items need to be reviewed by the Management of APOC e.g. capital equipment, health education and mobilization. JAF4.7 Page 13 3.3.5. Approval of the proposal and ratification by JAF Based on TCC's comments and recommendations, the Management of APOC revised and reduced the first year budget of US $ 253, 000 submitted by the NOTF of Nigeria.The CSA therefore has approved the Kano State CDTI Project for Nigeria with the corresponding amended first year budget of US $ 174,612 which is herewith presented to JAF for ratification. 3.4. Imo and Abia State CDTI Project 3.4.1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Imo and Abia States (see Fig.13 below) Fig.13: IMO & ABIA STATES Rapid Epidemiological Mapping of Legend ! oefinite Cotl r.eu tft corr tit.ty 1to A CD'ttinlikety(to ffi roneuoy.r jrjil *o co'' 3.4.2. Background information The two states have a total of 44 LGAs and combined population of 5,529,112 people. 16 of 27 LGAs of Imo State and 8 of the 17 LGAs of Abia State are hyper and meso endemic for onchocerciasis. A community-based ivermectin distribution prograrnme has been in operation for the five past years in the two states. Ivermectin distribution is launched in 1993 as a partnership programme between the State Ministry of Health (SMOH), Global 2000 River Blindness Program and Lions Clubs Foundation (1995). From 1993 to 1997 , 12,954 community distributors were trained and they treated a cumulative total of 2,869,770 people. The proposed CDTI Project is an expansion and consolidation of the existing programme and will seek to establish CDTI in the two States known for their high community interest and involvement in self-developmentprojects. Fig.13 indicates the detailed REMO results for the States of IMO and Abia. JAF4.7 Page 14 3.4.3. Summarv budset Table 6 below summarizes the five year budget as submitted by the NOTF of Nigeria and Fig. 14 shows the trend of the cost per person to be treated from 1999 to 2003. Table 6: Five year summary budget of Imo and Abia States CDTI project as submitted bv rhe NOTF (US $) 946,22r 705 000 0.15 406, 000 967,212 469 000 0.48 288, 000 998, t63 423,000 0.42 243,000 1,030, t24 329,000 0.32 190, 000 r, 063,067 180, 000 0.17 108, 000 1,063,067 2, 106,000 1.98 1, 235, 000 Fig.14: Trend of the cost per person to be treated from 1999 to 2003 0.80 0.70 0.60 0.50 (r, 0.40 J AFOC 030 0.30 ii[StllNcoo: 0.10 0.00 1 999 2000 2001 2002 2003 3.4.4. TCC comments and recommendations TCC considered that the Proposed Project was building on a successful programme which had already trained high number of community based distributors, and was achieving high coverage at a JAF4.7 Page 15 cost of 0.19 US $ per person treated. The description of proposed activities, the integration to Primary Health Care (PHC) and the implementation process of the Project were clear and technically sound. Only the proposed budget, which starts high and remains fairly high at the end of the Project, is unacceptable and should be significantly reduced. Detailed comments and recommendations of TCC are described in section 4.2.4 of doc. JAF4.4 . 3.4.5. Approval of the proposal and ratification by JAF Taking into account the comments and recommendations of TCC, the Management of APOC revised and reduced the first year proposed budget from US $ 405,968 to 258,338 US $. The CSA therefore has approved the Imo and Abia State CDTI Project for Nigeria with the corresponding amended budget of US$ 258,338 which is herewith presented to JAF for ratification. 3.5. Yobe State CDTI Project 3.5.1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Yobe State (see Fig.15 below) Fig.15: YOBE STATE KM Legend Rapid Epidemiological Mapping of Onchocerciasis r---l 0 2040 ! o"finit.Con."* 1,2, 3: Urgent clarifiction iii CDTI liket, rror.tin.r data inconsistent with epi / )aa '//7 corr*ttx"ttlro .tji r:l:3. !) Nonruor"t .r;'l ffi ;1iil' No cou tl 3; !lt t) !: t: t !: 3. :a; t;. .r,c c l; t: It - .. :G:l: ..j I: r r. :r) !i' s 1i;:L1 l.l :::., ;,;'lfurl Nigeraa, 1998 lr) l; 3.5.2. Background information The Project proposal will cover 12 of the 17 LGAs of Yobe State with a target population of 315,000 persons. The proposal is a reorientation to CDTI and an expansion of an existing programme which is a partnership between the State Ministry of Health and Christoffel Blinden Mission (CBM). For the past two years, the programme has been operating in nine LGAs and treated 160,271people in 1997. Figurel5 shows the detailed REMO results for Yobe State. 3.5.3. Summary budget Table 7 below summarizes the five year budget as submitted by the NOTF/Nigeria and Fig.16 shows the trend of the cost per person to be treated between 1998 to 2002. JAF4.7 Page 16 Table 7: Five year summary budget of Yobe State CDTI project as presented by the NOTF rus $) 189, 000 449, 000 2.38 238, 000 225,000 238, 000 1.06 69, 000 274,000 190, 000 0.69 48, 000 288, 000 222,000 0.17 37, 000 315,000 190, 000 0.60 29, 000 315, 000 1, 289, 000 4.09 42L,000 Fis.16: Trend of the cost Derson to be treated from 1998 to 2002 2.5 2.38 Total 2 1.5 o o 1.29 l 1 0.77 0;69 0.5 APOC 0.5 0.31 ,CI.{3 0 1 998 1 999 2000 2001 2002 3.5.4. TCC comments and recommendations TCC considered that this was a well written proposal and noted with interest several innovative aspect mentioned herein and expressed regret that these ideas would not be subject to operational research. TCC found particularly attractive (i) the concept of Community distributors training community distributors ("each one teach one"), (ii) the devolution of monitoring to community level, tAF4.7 Page 17 including the use of older residents in semi supervisory capacity and community level problem solving, (iii) attention to special gender issues of strict islamic societies. TCC recommended the approval of the Yobe State Proposal with clarification from the NOTF on the budget related issues, epidemiology of onchocerciasis in the State, issues related to ivermectin distribution. Detailed comments and recommendations of the TCC are described in section 4.2.7 of doc. JAF 4.4. 3.5.5. Approval of the proposal and ratification by JAF With respect to the comments and recommendations of the TCC, the Management of APOC revised the budget submitted by the NOTF of Nigeria of US $ zsz, gso . The CSA therefore has approved the Project of Yobe State with the corresponding amended first year budget of US $ 160,545 which is herewith presented to JAF for ratification. 3.6. Zamfara State CDTI Project 3.6.1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Zamfara State (see Fig.17 below) Fig.17: Zamfara State KM Legend Rapid Epidemiological Mapping of I__-l 0 2040 I o"tinlt" Corl -co l!; corr utar tto 1, 2, 3: Urgent clarification data inconsistent with epi / ento 7f cotwtiuetylto ffi No nauo y"t iiiii No corl Source: NOTF Nageria, 3.6.2 Backsround information Zamfara State was created out of Sokoto State in 1996.It is made of 14 LGAs out of which 5 are meso endemic for onchocerciasis. The total population of the State is 2,169,915 people but only 128,000 are estimated at risk. Mass treatment started in 1996 through a partnership between the State Ministry of Health and Sight Savers lnternational (SSD. In 1996, 78,553 persons were treated and 84,180 in 1997. Figure 17 shows the detailed REMO results of the State concerned. 3.6.3. Summary budget Table 8 below summarizes the five year budget as submitted by the NOTF of Nigeria and Figure 18 shows the trend of the cost per person to be treated between 1998 and2002. TAF4.7 Page 18 Table 8: Five year summary budget of Zamfara State CDTI Project as presented by the NOTF (US $) 112,984 220,615 1.95 159 892 120, 000 119,027 0.99 56 855 125, 000 117,962 0.94 52 340 128, 000 91,414 0.7 t 25 455 128, 000 86,922 0.68 18, 150 128, 000 635,940 4.97 312,692 Fig.18: Trend of cost per person to be treated from 1998 to 2002 US$ 2.fi 2.00 ffi, 1.50 APOC o.ss 0.gi* '1.00 ,:0:?1 {r 5} 0,53 0.50 0.00 1998 '1999 2000 2001 2uo2 3.6.4. TCC comments and recommendations TCC, after review, considered that this was a good proposal and recommended it for approval with the following amendements (detailed corffnents and recommendations of TCC in section 2.4.8 of doc. JAF4.4) : (i) review of the timing of various activities, which do not follow in a logical order and do not follow normal seasonal activities, (ii) review of the number of personnel engaged in the Project, as the number is inappropriate for a community based Project of this size, (iii) the budget costs per person to be treated are high in comparison with the previous treatment cycles. The cost in the final year is above levels that indicate sustainability. JAF4.7 Page 19 3.6.5. Approval of the proposal and ratification by JAF Based on the comments and recommendations of the TCC, the Management of APOC revised the first year budget submitted by the NOTF of Nigeria of US $ tsl, 892. The CSA has therefore approved the CDTI Project proposal of Zqrnfara State with the corresponding amended first year budget of US $ 89,923 which is herewith presented to JAF for ratification. 3.7. Edo and Delta States CDTI Project proposal 3.7 .1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Edo and Delta States (see Fig.19 below) Legend an Delta Rapid Epidemiological Mapping of ! o.r.it. cotr *"u. !l: cort t*.tv tto 7f Cottrlikely {to ffi No nEuo y.t i:jii; No corr nug am e I 998 3.7.2. Backsround information The two States have a combined population of 4,700,000 people of which 1,134,777, dispersed in 21 LGAs meso and hyper endemic for Onchocerciasis, required treatment. The Project proposal is assisted by Global 2000 River Blindness Program and Lions Clubs Foundation which had experienced over the five past years a treatment round cost of 0.12 US $ per person treated. Fig.19 shows the detailed REMO results of the States of Edo and Delta. 3.7.3. Summarv budset Table 9 below summarizes the five year budget as submitted by the NOTF of Nigeria and Fig.20 shows the trend of the cost per person to be treated from 1998 to 2002. JAF4,7 Page 20 Table 9: Five year summary budget of Edo and Delta States CDTI project as presented by the NOTF (US $) 1,000,000 916, 000 0.92 589, 000 1,029, s00 36s, 000 0.35 251,000 1, 060, 900 326,000 0.31 207,000 l, 101,726 327,000 0.30 186, 000 l, 134,777 228,000 0.20 109, 000 L,134,777 2, 162, ooo t.9t l,342, ooo Fig.20: Trend of cost per person treated between 1998 and 2002 1.00 A0.e2 0.90 \ '*" 0.80 a\ 0.70 o.5$ 0.60 \ o 0.50 l 0.40 o,30 0.30 \ 0.24 !iUr*ii 0.20 ht# :MtlHINSnO 0.10 s.1l Uii, d.13 0.00 '1999 1 998 2000 2001 2002 3.7.4 TCC comments and recommendations TCC 's comments and recommendations are detailed in section 4 .3 .l . of doc. JAF4.5 . In short, TCC considered that, overall the Project should be funded but in a context which should take into account the stages of CDTI intervention and the efficacy which the systems had already achieved. The request to APOC involved a significant increase in treatment unit costs. It was important to evaluate how far the Project had moved towards sustainability and view the request in light of the TCC's desire JAF4.7 Page2l to see the Project reach sustainability with minimal additional (APOC and other) resources. TCC also considered that, towards the end of the Project an evaluation be attempted as to the impact the 10 year's treatment had had on onchocerciasis and its transmission. TCC instructed the Management of APOC to take into account the above recommendations in discussing the Project budget with the NOTF and the States authorities as the budget was not acceptable as presented. 3.7 .5. Approval of the proposal and ratification by JAF Based on the recommendations of the TCC, the CSA has approved in October 1998: (i) the CDTI Project proposal of Edo and Delta States; (ii) the first year budget for the above Proposal of US $ Sal, 313 to be paid from the APOC Trust Fund, with the understanding that the Management of APOC will review carefully this budget and communicate the amended amount to the NOTF of Nigeria on behalf of the CSA. The above approval is herewith submitted to JAF for ratification. 3.8. Oyo State CDTI Project proposal 3.8.1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Oyo State (see Fig.21 below) Fig.21 : Oyo State (Nigeria) Rapid Epidemiological Mapping of Legend ] u"fini,. Cott..^ lft cort tit.ty 1tor"nn"1 7/. CD'il nnlikely (to refine\ ffi No nur.lo y.t ' iii:r Nocorr "l 1, 2, 3: Urgent clariflcation needed data inconsistent with epi / ento info r----lKM Ed 0 2040 3.8.2. Background information The proposed Project area is located in Oyo State, in the South-Western part of Nigeria. The 25 LGAs of the State have a total estimated population of about 4,500,000 people. Ivermectin distribution assisted by UNICEF started in 3 LGAs in 1992 (10,749 persons treated) and expanded to 11 LGAs of the State by 1996 ( 143,941people treated). The Project proposal seeks to cover 1,124,554 people. Figure 21 shows the detailed REMO results of Oyo State. JAF4,7 Page 22 3.8.3. Summarv budset Table 10 below summarizes the five year budget as submitted by the NOTF of Nigeria and Fig 22 shows the trend of the cost per person to be treated from 1998 to 2002. Table 10 Five year summary budget of Oyo State CDTI project as presented by the NOTF ruS $) 474,480 441, t00 0.93 218, 000 880, 470 299,600 0.34 151,600 1,060,000 248, t00 0.23 99, 600 1,091, 800 206, 600 0.19 59, 600 t,124,554 180, 000 0. r6 34,400 L,124, 554 1, 375, goo 1.22 563,200 Fig. 22:Trend of cost per person to be treated from 1998 to 2002 1.00 o.e3 0.90 n rotnl 0.80 N o.70 \ 0.60 \ ffi +t 0.50 = '$q.*.=- 0.40 '=$,ffi 0_30 0.19 0.20 0.10 0.00 1 998 1 999 2000 2001 2002 3.8.4. TCC comments and recommendations TCC recommended the approval of this Project proposal under the following conditions: (i) the budget related issues are adequately addressed and the budget revised accordingly, (ii) clarification is obtained on the number of LGAs to be included and the population to be treated, (iii) in view of the importance of this focus on the border with Benin and of the historical focus of Loa-loa, the TCC JAF4.7 Page23 recommended that the NOTF seriously considers, in consultation with the Management of APOC and TDR, the possiblity of conducting relevant operational research there (see section 4.3.4 of doc. JAF4.5). 3.8.5. Approval of the proposal and ratification by JAF Based on the recommendations of the TCC, the CSA has approved in October 1998: (r) the CDTI Project proposal of Oyo State; (ii) the first year budget for the above Proposal of US $ ztt,600 to be paid from the APOC Trust Fund, with the understanding that the Management of APOC will review carefully this budget and communicate the amended amount to the NOTF of Nigeria on behalf of the CSA. The above approval is herewith submitted to JAF for ratification. 3.9. Jigawa State CDTI Project Proposal 3.9.1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Jigawa State (see Fig.23 below) Fig.23: Jigawa State Legend Mapping o"finit" Epidemiological of ] cotl -"^ KM a+. rro r---__l iailr CDTI likelv 20 40 ?/ cDrr$tikety (to ffi No nrr*ro y.t iiii: ro corr w t; 3. :rd c 3.9.2. Background information Jigawa State has a total of 27 LGAs out which 18 are endemic for onchocerciasis. However the Project Proposal will cover only 8 LGAs with a target population of 135,480 people dispersed in 10 hyper endemic and 22 meso endemic communities. The proposed project is a reorientation of an existing ivermectin distribution prograrnme (assisted by CBM) which has been operating since 1996 and treated 36,708 persons in 1996 and 37 ,820 in 1997 . Figure 23 shows the detailed REMO results of Jigawa State. JAF4.7 Page 24 3.9.3. Summary budget Table 11 summarizes the five year budget of Jigawa State CDTI Project as submitted by the NOTF of Nigeria and Fig. 24 shows the trend of the cost per person to be treated between 1999 and 2003. Table 11 Five year summary budget of Jigawa State CDTI project as presented by the NOTF (US $) 39,696 220,000 5.54 91,000 6s,484 113,000 t.73 25, 000 88, 618 108, 000 1.22 18,000 I 16, 960 109, 000 0.93 15, 000 135, 480 109, 000 0.80 12, 000 135,480 659, 000 4.86 161, 000 Fig. 24: Trend of cost per person to be treated from 1999 to 2003 6.00 A55a 1:: id .\llt" rorar l l 5.00 \rr -... 4.00 \ APOC M &13 25 o 3.00 f 2.O0 NGDO& MOH 1.00 0.00 1999 2000 2001 2002 2003 3.9.4 TCC comments and recommendations TCC recommended the approval for funding of the Jigawa State Project on the condition that the following issues are resolved to the satisfaction of the Management of APOC: JAF4.7 Page25 (D The NOTF should provide the Management of APOC with improved population data by LGA and community; (ii) The number of Community Directed Distributors (CDDs) that will be trained varies throughout the document. This issue must be resolved and the NOTF must provide APOC Management with a clear number of CDDs that will be trained and a justification supporting that need; (iii) An explanation of why in Year 1, there is a total 9-fold increase in funds (from US $ 26,200 to approximately US $ 200,000) provided to the Project but less than l0% increase in the number of people targeted for treatment. Detailed comments and recommendations of the TCC are described in section 4.3.2. of doc. JAF4.5. 3.9.5. Approval of the proposal and ratification by JAF Based on the recommendations of the TCC, the CSA has approved in October 1998: (i) the CDTI Project proposal of Jigawa State; (ii) the first year budget for the above Proposal of US $ 9O,SOO to be paid from the APOC Trust Fund, with the understanding that the Management of APOC will review carefully this budget and communicate the amended amount to the NOTF of Nigeria on behalf of the CSA. The above approval is herewith presented to JAF for ratification. 4. EQUATORIAL GI.IINEA 4.1, General Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Equatorial Guinea (see Fig.25 below) Cameroon % nodules o0 6 l-9 o 10-19 o 20-39 o 40-t00 KM o r---1 0 2040 JAF4.7 Page 26 4.2. National Plan and Project Proposal 4.2.1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Bioko Island (see fig.26 below) Fig.26 : Bioko island (Equatoria! Guinea) Legend Rapid epidemiological Mapping of Onchocerciasis I Detinite CDIT uer Rivieres - dlbFv*Hx O .00 to .00 O 1.00 to 9.00 o 10.00 to 19.00 O 20.00 to 39.00 O 40.00 to 100.00 KM I:------l 01020 4.2.2. Backsround information Equatorial Guinea consists of a mailand (Rio Muni) and two island (Bioko and Annobon). Out of the two Islands, only Bioko is endemic for onchocerciasis with a total population of 87 .706 (1994 census). The Proposed Project seeks to cover the four districts of Bioko Island with a target population of 85,000 persons. In the mainland, Rapid Epidemiological Mapping of Onchocerciasis (REMO) activities will help define the endemicity level and the strategy to be applied there. The proposed project is a reorientation to CDTI of an existing vertical programme operating since 1990 as a partnership between the Ministry of Health (MOH) and the University of Barcelona (Spain). During the past seven years, a cumulative total of 127 ,638 people were treated at a unit cost of 1.45 US $ per person treated. 4.2.3. Summary budget Table L2 below summarizes the five year budget as submitted by the NOTF of Equatorial Guinea and Figure 27 shows the trend of the cost per person treated from 1998 to 2002. TAF4,] Page27 Table 12 Five year summary budget of Equatorial Guinea CDTI project as presented b.v the NOTF ruS $) 33, 000 l13,708 3.45 68,246 85 000 43,725 0.51 14, 608 85, 000 33,479 0.39 LL,173 85, 000 25,753 0.30 9, 115 8s, 000 21,439 0.2s 6, 588 85, 000 238, 104 2.80 109,730 Fig.27: Trend of cost per person to be treated between 1998 and 2002 US$ 4.00 3.50 3.00 \i.,,, 2.50 \ Apoc \ \ 2.OO ^2.07 1.50 \ 1.00 *ooffiK \ 0.50 0.00 1998 1 999 2000 2001 2002 4.2.4. TCC comments and recommendations TCC's comments and recommendations are detailed in section 4. 1. 1 of doc.JAF4.4. In short TCC, after review, considered that both the National Plan and the CDTI Project proposal were well written and well documented. Detailed information on the Project as well as the proposed implementation outline of the Project are provided. However, some aspects of the proposed Project are of concern (i) fully integration of the Project in the PHC system will be possible only the last 2 years of the Project, in a context where only 158 of the 283 health centres existing in the island are fully functional; (iD APOC is being requested to support the salaries of Ministry of Health (MOH) personnel (including central level) whose specific contributions to the Project are not clearly described. This must be clarified and APOC support adjusted accordingly; (iii) the MOH should be encouraged to seek ways of minimizing Project dependance on external financial support, particularly with respect to salary support. Notwithstanding the above TCC recommended the approval of the National Plan and the funding of CDTI Project in the Island of Bioko. JAF4.7 Page 28 4.2.5. Approval of the proposal and ratification by JAF Based on the recommendations of the TCC, the Management of APOC carefully revised the first year budget submitted by the NOTF. The CSA therefore has approved the CDTI hoject of the Bioko Island with the corresponding amended first year budget of US $ 72,289 which is herewith presented to JAF for ratification. 4.3. Bioko island Vector Elimination Project 4.3.1. Background information The proposal is a culmination of over 10 years of preliminary studies to determine the feasibilty of elimination of Simulium from the Island of Bioko. The Project will be an adjunct to the above CDTI Project proposal which is a collaboration between the Ministry of Health, the Spanish Cooperation and APOC. The Vector Elimination Project intends to interrupt transmission permanently by eliminating the vector Simulium yahense "Bioko form". After vector elimination, ivermectin distribution will continue for at least 12 years until the parasite reservoir is also eliminated and entomological surveillance will be established to monitor flies return and onchocerciasis recrudescence. The vector elimination is planned to last three or four years with the first year for collection of baseline data and environmental impact assessment. 4.3.2. TCC comments and recommendations TCC's comments and recommendations are detailed in section 4.1.2. of doc.JAF4.4. In short, TCC considered that the proposal is well constructed, well planned and appropriate to eliminate the apparently unique form of S. yahense in Bioko. TCC therefore recommends support for year 1 of the Project after appropriate amendments of the budget. 4.3.3. Approval of the proposal and ratification by JAF Based on the recommendations of the TCC, the Management of APOC carefully revised the first year budget submitted by the NOTF, which was reduced from US$ 281,562 to US$ 190,474. CSA therefore has approved the Bioko Island vector elimination Project with the corresponding amended first year budget of US$ 190,474 which is herewith presented to JAF for ratification. JAF4.7 Page29 5. DEMOCRATIC REPUBLIC OF CONGO (DRC) 5.1. General Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Democratic Republic of Congo (see Fig.28 below) Fig 28: Democratic Republic of Congo Legend REMO in Ueles & Kasai Regions ftxi!(*i tit.t, cort,'.,. ,o ifit To conplcte, lik€ly tro CDTI ffi n-el,to ro ue aone il,lL national prruempty uea o"nr," con ffi "."nt $ Nocorr."". Nodules (%) 0 .00 to .00 1.00 to 9.00 o 10.00 to I 9.00 o 20.00 to 39.00 o 40.00 to 100.00 KM r----l 0 200 5.2. National Plan and Headquarters Support 5.2.1. Background information Democratic Republic of Congo (DRC) is administratively divided into 11 provinces with a total population of 48,660,000 people, out which 18,745,425 are at risk of Onchocerciasis. Completion of Rapid Epidemiological Mapping of Onchocerciasis (REMO) activities in successive phases will enable approximate estimation of the target population for mass treatment. In this regard, the National Onchocerciasis Task Force (NOTF), with respect to the size of the country (2,345,409 km2 ) and the nation-wide Public Health problem of the disease, has submitted a National Plan and a Headquarters Support Proposal. Approval of this proposal will strengthen the managerial capacity of the NOTF in preparation and implementation of CDTI projects. 5.2.2. Summary budget Table 13 below summarizes the five year budget as submitted by the NOTF of DRC and Fig 29 shows the trend of the contributions of the partners between 1999 and 2003. JAF4.7 Page 30 Table 13: Five year Summary Budget of ttre Democratic Republic of Congo HO Support proposal as submined by the NOTF (US $) 68. 18 147,744 100, 730 56.88 89,796 5 1 080 50.56 83 220 42,080 38.96 86, 180 JJ 580 36.48 85,189 31,080 52.54 492,128 258, 550 Fig.29 : Trends of partners'contribution to DRC HO Support 160 000 z++ 140 000 {z Total 1 20 000 \ '100 000 . - - -i a6 180i d0 000 l APOC 60 000 47 014 ff42080 40 000 MOH/NGDO 38 716 5+r r+o 20 000 0 1 999 2000 2001 2002 2003 5.2.3. TCC comments and recommendations The detailed corrunents and recommendations of the TCC on the above HQ support Proposal are stated in section 4.1.1 of the document JAF4.5. In short, TCC considered that the budget showed a clear trend of APOC contribution diminishing over the years. However, the overall budget remained quite high, especially with respect to the running costs. Likewise, the costs of technical assistance was JAF4.7 Page 3 1 high and capital costs even included items such as office furniture. Also, there was a multiplicity of closely-related administrative post requiring APOC funding, which role and contribution to the success of the project was unclear and poorly justified. In general, justification for this fairly high budget was rather weak. Notwithstanding the above comments, TCC recommended the approval of this otherwise well documented National Plan. The budget of the HQ Support Proposal, however, needed to be revised by APOC Management, especially with respect to personnel and capital costs. 5.2.4 Approval of the proposal and ratification by JAF Based on the recommendations of the TCC, the CSA has approved in October L998: (r) the HQ Support Proposal of Democratic Republic of Congo; (ii) the 1999 budget for the above proposal of 100,730 US $ to be paid from the APOC Trust Fund, with the understanding that APOC Management will review carefully this budget and communicate the amended amount to the NOTF of Democratic Republic of Congo on behalf of the CSA. This approval is herewith presented to JAF for ratification. 5.3. Kasai CDTI Project Proposal 5.3.1. Rapid Epidemiological Mapping of Onchocerciasis (REMO) of Kasai (see Fig 30 below) ,,)' ( _l Nodules (9/o) no I o l-9 o l0-r9 o 20-39 o 40-100 ffi aernite corr { \'' :r,i,i No CDTI area l To be refined Rivitres t)urccs: donnae\ oncho du Cde & lusc, AIhca Data Smnler. Wru I Pnnted on ls Jme le7. Am HQ. Ousdougou PreFcc par WHO/(lDTfrealthMap en collah)mtion avec TDR pw APOC 5.3.2. Background information The Project seeks to establish CDTI in the regions of the two Kasai: Eastern Kasai with a land square of 154,741km2 and Western Kasai covering 170,302 km2 . The combined population of the two regions is estimated at 10,210,900 people, out which 3,043,667 will be targeted for CDTI. JAF4.7 Page 32 In the Project area, ivermectin distribution has been in operation since 1989 and I4,45I persons were treated in 1996 despite the country civil challenges.Figure 30 shows the detailed REMO results of Kasai. 5.3.3. Summary budget Table 14 below summarizes the five year budget as submitted by the NOTF of the Democratic Republic of Congo and Fig.31 indicates the trend of the cost per person to be treated from 1999 to 2003. Table 14 Five year Summary Budget of the Kasai CDTI Project proposal as submitted by the NOTF (US $) 253 000 280, 000 l.lt 195,874 83s,964 250, 000 0.3 162,494 1,765,387 150, 000 0.08 93,074 2, 649, 259 r00, 000 0.04 55 764 3,043,667 60, 000 0.02 34,864 3,043, 667 840, 000 0.28 542,070 Fig.31: Trend of cost per person to be treated from 1999 to 2003 1.20 't.00 \, 0.80 \*"' or*t"' 0.60 \ l 0.40 \ 0.20 MOIUNGOO 0.08 0.10 0.00 1999 2000 2001 2002 20003 JAF4.7 Page 33 5.3.4. TCC comments and recommendations TCC, after review, considered that this was a well-documented Project proposal providing detailed implementation plans and treatment objectives for each year. Accordingly, future monitoring and evaluation of this Project should be fairly straightforward. However, like its accompanying National Plan, the proposed budget is not adequately justified even though it must be said that the unit cost of treatment in this Project is among the lowest observed so far (US $ O.ZZ in Year 1, down to US $ O.Ot in Year 5). TCC recommended that the Kasai Project proposal be approved for funding and its budget be revised with respect to both capital and running costs. 5.3.5. Approval of the proposal and ratification by JAF Based on the recommendations of the TCC, the CSA has approved in October 1998: (r) the CDTI Project proposal of Kasai; (ii) the 1999 budget for the above proposal of 195,874 US $ to be paid from the APOC Trust Fund, with the understanding that APOC Management will review carefully this budget and communicate the amended amount to the NOTF of Democratic Republic of Congo on behalf of the CSA. This approval is herewith presented to JAF for ratification. 6. GABON 6.1. General Rapid Epidemiological Assessment (REA) of Onchocerciasis in Gabon (see Fig 32 below) Fig 32: GABON Legend Rapid Epidemiological Assessment (REA) ! Limites nationales ffi racs Rividres Nodules (%) o .00 to .00 1.00 to 9.00 o 10.00 to 19.00 o 20.00 to 39.00 o 40.00 to 100.00 r------lKM 0 50 100 JAF4.7 Page 34 6.2. National Plan and CDTI Project proposal 6.2.L. Background information Gabon, with a total population of 1,014,976 people in 1993, covers a landsquare of 267,667 km2 and is divided into 47 administrative divisions ("departements"). There have been some experiences with ivermectin distribution in the Project area since 1991 but it was a vertical programme based on mobile strategy which could not treat more than an average of 1500 persons per year. The proposed Project seeks to establish CDTI in 13 departements comprisingT40 communities. The population targeted for treatment in the Project is estimated at 168,500 persons. REMO is not completed yet, but there appears to be six foci of onchcoerciasis where prevalence varies from 10 to 88% . On completion of REMO the target population for mass treatment will be adjusted and CDTI areas well defined. 6.2.2. Summary budget Table 15 summarizes the five year budget as submitted by the NOTF of Gabon and Fig.33 shows the trend of cost per person to be treated between 1999 and 2003 . Table 15: Five year summary budget of Gabon CDTI Project as presented by the NOTF (US $) 108,000 271,834 2.s2 137, 500 168, 500 157, 013 0.93 70,513 168, 500 132,592 0.79 39,342 168, 500 r25,259 0.74 34,342 168, 500 160, 091 0.95 25, 008 168, 500 846,789 s.03 306, 705 JAF4.7 Page 35 Fig.33: Trend of cost per person to be treated from 1999 to 2003 3.00 2.50 2.00 o 1.50 f 1.00 0.50 [Ep APOC 0.00 1 999 2000 2001 2002 20003 a APOC --.-|\,OH/NGDO +Total 6.2.3. TCC comments and recommendations TCC recommended the approval for funding of the Gabon CDTI Project proposal and requested the Management of APOC to ensure that the Government financial commitment will be effective, and CDTI is implemented right from the beginning of the Project. The proposed budget must be revised accordingly. Detailed comments and recommendations of the TCC are described in sections 4.2.1 & 4.2.2 of doc. JAF4.5. 6.2.4. Approval of the proposal and ratification by JAF Based on the recommendations of the TCC, the CSA has approved in October 1998: (i) the National Plan and the CDTI Project proposal of Gabon (ii) the 1999 budget for the above proposal of L37,500 US $ to be paid from the AP0C Trust Fund, with the understanding that APOC Management will review carefully this budget and communicate the amended amount to the NOTF of Gabon on behalf of the CSA. This approval is herewith presented to JAF for ratification. JAF4.7 Page 36 B REVTEW OF Trm FrRST YEAR PROGRESS REPORTS OF ELEVEN (11) APPROYED PROJECTS AND IMPLEMENTATION PLAN FOR THEIR SECOND YEAR Table 16 List of the I I Projects and summary of their second year budges approved by the CSA for fundins in 1998 Tyolo & Mwanza 198,665 152,701* Kisoro, Kasese, Hoima & Masindi 163,555 110,494* Cross River State 226,736 223,220*,t Kaduna State 200,400 91,475** Kogi State 161,243 131,822** Taraba State 243,522 165,025*{' NOTF/HQ Support 160,125 263,354xx NOTF/HQ Support 157,815 96,666xx Northern Sector 262,657 97,461** NOTF/HQ Support 195,687 92,193*,r Mahenge focus 141,492 107,597*x 11 Projects (8 CDTI + 3 HQ) 2,111,897 1,531,852 * Budget already approved ** Budget to be revised (down scaled) according to TCC recommendations The first year Progress reports and proposals for the second year budgets (see table 16 above) for the following Projects in Malawi, Uganda, Nigeria, Sudan and Tanzania were reviewed by the TCC during its fifth and sixth sessions of March and August 1998 (see docs.JAF4.4 paragraph 3 and JAF4.5, paragraph 2). The recommendations made by the TCC may be summarized as follows: 7. THYOLO AND LWANZA CDTr PROJECTS (MALAWT) 7.1. Review of the first year progress report TCC noted that, though the first instalment of US$ 15,000 was only released in October 1997 and a further US$ 15,000 in November, the NOTF should be congratulated on training 141 Health Surveillance Assistants, which was more than planned. TCC also noted with satisfaction that the nation wide REMO was completed, although refining is needed and planned in the western part of the country (see section 3.1 of doc.JAF4.4). JAF4.7 Page 37 7.2. Review of the second year budget proposal Based on the recommendations made by the TCC during its 5h session in March 1998 (see section 3.1 of doc.JAF4.4), the APOC Management, in consultation with the NOTF/Malawi, has reduced the second year budget submitted by the NOTF from US$ 19I,622 to US$ 152,701. 7.3. Approval ofthe first year progress report and the second year budget proposal In view of the above, the CSA has approved in April1998, continued support to the CDTI Project in Thyolo and Mwanza foci in Malawi as well as the revised second year budget of US$ 152,701to be paid from the APOC Trust Fund. This approval is herewith presented to JAF for ratification. 8. PHASE I (KISORO, KASESE, HOIMA, MASINDI) CDTI PROJETCT (UGANDA) 8.1. Review of the first year progress report TCC, after review, noted that the report did not reflect the good work which the Management of APOC reported that the NOTF of Uganda had performed. With respect to the role of the NOTF Secretariat and its corresponding budget line items, TCC reminded the NOTF that its prime function is that of coordinating and not implementing (see section 3.2 of doc.JAF4.4). 8.2. Review of the second year budget proposal Based on the recommendations made by the TCC (see section 3.2 of doc.JAF4.4), the Management of APOC has reduced the second year budget submitted by the NOTF from US$ I43,790 to US$ 110,494. 8.3. Approval ofthe first year progress report and the second year budget proposal In view of the above, the CSA has approved in April 1998, continued zupport to the CDTI Project in Kisoro, Kasese, Hoima and Masindi foci in Uganda as well as the revised second year budget of US$ L10,494 to be paid from the APOC Trust Fund. This approval is herewith presented to JAF for ratification. 9. CROSS RIVER STATE CDTI PROJECT (NIGERIA) 9.1. Review of the first year progress report TCC after review, considered that overall this was a well written report with some interesting observations and recommended its approval. However TCC, was of the opinion that, to strengthen future implementation of that Project, the following actions will have to be taken: (i) NOTF should enhance and sustain advocacy at all levels of policy makers (ii) APOC should create a forum of NOTFs for intervention on trans-border cooperation (iiD NOTF should streamline the procedures for disbursement of APOC funds to Project sites. JAF4.7 Page 38 9.2. Review of the second year budget proposal TCC has reviewed the second year budget of the amended Cross River State CDTI Project proposal submitted by the NOTF and recommended that the following requirements are met before funds for year 2 are released to the Project: (D The NOTF must submit the proposal with a full 5-year projection and a complete 5- year budget (beginning with 1997). (ii) The resubmitted revised 5-year budget should reflect the budget approved for the first year and refer to the new revised budget approved for the second year. 9.3. Approval ofthe first year progress report and the second year budget proposal Notwithstanding the above, CSA, has approved in October 1998 the first year progress report of the Cross River State CDTI Project as well as the second year funding of that Project. It is understood that the APOC Management will carefully review the second year budget of US $ 223,220 and communicate to the NOTF the revised amount on behalf of the CSA (see section 2.1.1 of doc.JAF4.5 ). This approval is herewith presented to JAF for ratification. 10. KADLINA STATE CDTI PROJECT (NIGERIA) 10.1. Review ofthe first year progress report TCC recommended the approval of the first year progress report of this Project as well as the proposed implementation plan for the second year. Further release of funds to the Project, however, should be deferred until the following conditions have been met : (D The Management of APOC should obtain clarification on the inconsistencies in treatment figures and other related data; (iD a full and satisfactory financial report must be completed and sent to the Management of APOC; L0.2. Review of the second year budget proposal TCC has reviewed the second year budget of the Kaduna State CDTI Project and recommended that fuller explanations of the treatment objectives and budget line items should be given to APOC Management. 10.3. Approval ofthe first year progress report and the second year budget proposal Based on the recommendations of the TCC, the CSA has approved in October L998 the first year progress report of Kaduna CDTI Project and the budget for the second year of US $ 911475, with the understanding that APOC Management will carefully review the second year budget and communicate to the NOTF the revised amount on behalf of the CSA. This approval is herewith presented to JAF for ratification. JAF4.7 Page 39 11. KOGI STATE CDTI PROJECT NIGERIA) 11.1. Review ofthe first year progress report The report is for a project approved in 1997 to treat only five of the 21 LGAs in Kogi State. TCC noted that during its sixth session, it was to review a "new" proposal from Kogi State to expand CDTI treatrnent strategies into the remaining 16 LGAs. TCC decided that the current Kogi Project and the "new" proposal are to be viewed as the same Project. TCC noted the marked increase in treatrnents provided in Kogi State in 1997 and the progress made in advocacy efforts including radio and TV usage. TCC recommended the approval of the first year progress report and the proposed Project expansion (see section 2.1.3 of doc.JAF4.5). 11.2. Review of the second year budget proposal TCC has reviewed the second year budget ofthe proposed project expansion and requested the Management of APOC to obtain clarification on the following and adjust the budget accordingly: (i) the second year budget of the amended Project was the same as the one put forward in the first proposal in 1997; (ii) the need for purchase of additional capital equipment in Year 2 which resulted in a Year 2 cost of the Project much higher than most second year budgets of APOC supported projects; (iiD the high costs of technical assistance greater than any other Project proposal 11.3. Approval ofthe first year progress report and the second year budget proposal Provided clarification is obtained as suggested above and the budget of US$ 131,822 is revised to the satisfaction of the Management of APOC. The CSA has approved the first year progress report and the proposed project expansion as well as the second year funding of that project. This approval is herewith presented to JAF for ratification. L2. TARABA STATE CDTI PROJECT (MGERIA) 12.1. Review of the first year progress report TCC commended the Nigerian Ministry of Health, CBM and MITOSATH for carrying out and implementing a well devised CDTI programme from July 1997 to 30 June 1998, and encouraged the "Taraba partners" to continue to keep up this excellent work. Therefore, TCC recommended for approval the f,irst year progress report of Taraba State CDTI Project. However, some issues needed clarification: (i) TCC requested the reason for lower Ministry of Health involvement in mobilization efforts; (ii) TCC would like the NOTF to provide information on alternative strategies to treat communities in LGAs facing communal crisis. JAF4.] Page 40 L2.2. Review of the second year budget proposal TCC has reviewed the second year budget of Taraba State CDTI Project and recommended the approval of year 2 activities, after the following budget-related issues have been adequately addressed to the satisfaction of the Management of APOC (see section 2.1.4 of doc.JAF4.5 for more details): (i) TCC looks forward to seeing a reduction in travel costs as the Project evolves; (iD The second year budget is decreased for activities such as training and education while it is increased for travel and capital equipment. TCC requested justification for this as training and education are integral to the project's long-term success and sustainability. 12.3. Approval ofthe first year progress report and the second year budget proposal Notwithstanding the above, CSA has approved the first year progress report of the Taraba State CDTI Project as well as the second year funding of that Project. It is understood that the Management of APOC will review carefully the second year budget of US $ 165,025 and communicate to the NOTF the revised amount on behalf of the CSA. This approval is herewith presented to JAF for ratification. 13. NOTF HEADQUARTERS SUPPORT PROJECT (MGERIA) 13.1. Review ofthe first year progress report TCC regretted that the coordinating activities of the NOTF/HQ were not sufficiently highlighted, mainly the role of this office in supporting, facilitating, and strengthening the implementation of individual CDTI Projects. Similarly, there was no mention in the report of the "tremendous help provided by the Zonal offices both to the Projects and the NOCP/HQ" few details were provided on what that help actually entailed. The report was fairly silent on the specific role played by the two structures (Zonal offices and NOCP HQ) in the support of the Project proposals that was rejected by the TCC, especially those from high priority areas (e.g. Benue State) (see section 2.1.5 doc.JAF4.5). 13.2. Review of the second year budget proposal of the NOTF/HQ TCC has reviewed the second year budget of the amended NOTFiHQ Project proposal and requested APOC Management to insist on a more transparent budget, and obtain all needed clarification on the relative costs of the NOTF/HQ and Zonal offrces in the proposed budget. The following issues needed to be addressed before the release of funds: (i) The WHO office in Nigeria was currently supporting 4 out of the 6 zonal offices in Nigeria. For the sake of integration and cost effectiveness, this support should be taken into account in the request for APOC support to the Zonal offices. (ii) In addition to the need of transparency regarding HQ and Zonal costs, many budget line items need to be reviewed. (iiD TCC's concern over the proposed budget related not only to the fact that it was unacceptably high, in spite of clear advice given to the NOTF in that respect by APOC Management during the Markurdi meeting but also to the unlikelihood of it being sustained at the end of APOC support (see section 2.1.5 of doc.JAF4.5 for more details). JAF4,7 Page 41 13.3. Approval ofthe first year progress report and the second year budget proposal Provided the proposed budget of US$ 263,354 is revised as recommended by the TCC, and provided APOC Management is satisfied with the detailed financial reporting of first year activities, the CSA has approved the first year progress report and the second year budget of the Nigeria NOTF/HQ. This approval is herewith presented to JAF for ratification. 14. NOTF/HEADQUARTERSSUPPORTPROJECT (SUDAI\I) 14.1. Review of the first year progress report TCC noted that no separate report was available for Sudan NOTF/HQ activities. However, it was clear that in addition to its administrative and overall coordinating role, the HQ was closely involved in ivermectin distribution among displaced people (1-2 million) around Khartoum and the Sundus focus in East Sudan. This was confirmed by APOC Management who informed the Committee that far more had been achieved by the NOTF/HQ even in the Northern sector Project area than was reflected in the progress report submitted to the TCC. The TCC recommended that another report, outlining the activities of the NOTF/HQ during the first year be provided and sent to the APOC Management. 14.2. Review of the second year budget proposal of the NOTF/HQ With respect to the proposed second year budget, TCC requested further clarification on the high cost for project personnel and for air travel. This may be justified in view of the prevailing war situation and the need for coordination of the Northern and Southern Sectors projects. 14.3. Approval of the first year progress report and the second year budget proposal Notwithstanding the above, CSA has approved the second year supg)rt of the NOTF/HQ and the corresponding budget of US $ 96,600, with the understanding that APOC Management will carefully revise the budget and communicate to the NOTF/Sudan, the revised amount on behalf of the CSA. This approval is herewith presented to JAF for ratification. 15. NORTHERN SECTOR CDTr PROJECT (SUDArg 15.f. Review ofthe first year progress report TCC, after review of the first year progress report, noted that all activities took place against a backdrop of ongoing severe famine in many endemic areas of the country where people needed food more than Mectizan'. TCC considered with interest that many objectives such as training workshop, training of CDDs, community mobilization,... were reached and even surpassed. This was a remarkable achievement. I5.2. Review of the second year budget proposal TCC reviewed the second year budget of the amended Northern Sector CDTI Project proposal submitted by the NOTF and requested, as for the HQ support budget, the review or further clarification on the very high cost for Project personnel and for air travel (see section 2.2.1. of doc.JAF4.5). JAF4.7 Page 42 15.3. Approval of the first year progress report and the second year budget proposal Based on the above recommendations and provided another report outlining all the achievements during the first year is produced and sent to the Management of APOC, the CSA has approved the second year funding of the Northern Sector Project of US$ 97,46L. The APOC Management is also requested to carefully revise the budget and communicate to the NOTF, the revised amount on behalf of the CSA. This approval is herewith presented to JAF for ratification. 16. NOTF/HEADQUARTERSSUPPORTPROJECT(TANZANTA) 16.1. Review of the first year progress report TCC, after review, considered that the report of the HQ activities was not adequate and should be resubmitted in accordance with the guidelines provided by the Management of APOC, with a greater attention to details (see section 2.3.1 doc.JAF4.s). t6.2. Review of the second year budget proposal of the NOTF/HQ TCC requested clarification of the status of the agreement regarding the NGDO staff member and re-emphasized that the contribution should be time limited and consonant with the policy of diminishing technical assistance contribution to HQ office support as defined by the TCC at its third session. TCC is also of the opinion that the audit cost was too high. Nevertheless, TCC considered that the second year budget levels were acceptable. 16.3. Approval ofthe first year progress report and the second year budget proposal Based on the recommendations of the TCC, the CSA has approved the continuation of the support to the NOTF/HQ's proposal and the corresponding second year budget of US $ 92,193. The APOC Management is urged to ensure the continuation of the activities. However, the NOTF/Tanzania is requested to resubmit a well-documented and justified first year progress report. It is also understood that the second year budget will be revised and that the revised amount will not be released before a resubmission of a satisfactory first year progress report. This approval is herewith presented to JAF for ratification. t7. MAr{ENGE CDTI PROJECT PROPOSAL (TANZANIA) L7.L. Review of the first year progress report As for the HQ's support proposal, TCC considered that the first year technical report of Mahenge CDTI Project was not acceptable in its present form and should be resubmitted following the reporting form prepared by the APOC Management (section 2.3.2 of doc.JAF4.5 gives the reasons for the TCC's views). L7.2. Review of the second year budget proposal TCC considered that no justification was given for the proposed second year budget and that the request for another vehicle could not be justified. L7.3. Approval ofthe first year progress report and the second year budget proposal Notwithstanding the above, the CSA, as for the NOTF/HQ's support proposal, has approved the continued implementation of the Mahenge CDTI Project. To that effect, the NOTF/Tanzania is JAF4.7 Page 43 requested to resubmit a well-documented and justified first year progress report as well as a full justification for the current second year budget of US$ L07,507 . 18. FINANCIAL MANAGEMENT OF THE ABOVE ELEVEN (11) PROJECTS TCC during its 6d'session of August 1998, reckoned that financial information available to its members on the above APOC-funded Projects at the time of review, while informative, were not always sufficient to assess the "financial soundness" of these Projects (see section 6.1 of doc.JAF4.5). However, at the time of writing the current report (September 1998), detailed financial reports were sent to the APOC Management by the NOTFs of Malawi, Uganda, Nigeria, Sudan and Tanzania. Overall, the Management found that the NOTFs followed the guidelines provided by the finance officers of OCP and APOC and that the accounting is done according to WHO regulations. Further, most of the justifications provided for the expenditures incurred are acceptable if one takes into account the fact that this is the first experience of these NOTFs in this area. Appropriate feed-backs from the Management were sent to the NOTFs which have so far addressed the issues raised by the WHO finance off,rcers. It appears however, that more training of the accountants and the national coordinators is needed.