I Dr Lawrence Osei EPI Consultant Summarv Between 18th June and Lst July 1993, at the instance of the Programme Director and the Chiefs of EPI and Devolution, I undertook a trip to Ghana to collect data needed for effective take off of devolution in Ghana. Even though not all the required data were available, certain important contacts were made which hopefully would propel people into action. Promises were made by certain key personnel to provide the remaining data within the shortest possible time. I 2 UPDATE OF IVERMECTIN DISTRIBUTION IN GHANA 1.0. Introduction Onchocerciasis which used to be a big public health problem in some 11 West African countries is no longer a major health threat in the sub-region. This is due to successful control by the Onchocerciasis Control Programme (OCP). To maintain this success, it has been found necessary to involve the participating countries more actively than has hitherto been done. To this end, it has been found necessary to gather certain vital statistics regarding onchocerciasis control in the various countries. Such data, among other things would help proper planning of activities aimed at maintaining the low prevalence rates achieved through the OCP. At the instance therefore of the Programme Director and the Chiefs of EPI and Devolution, OCP, I undertook a mission to Ghana to gather data relating to onchocerciasis control in the country. 2.0, Terms of reference To obtain a map of Ghana showing: l. AII fixed (health) centres and posts where ivermectin is or is intended to be given. ii. Zones where ivermectin is distributed by Non-Governmental Organisations (NGOs) and in each case indicating which NGO is involved. iii. To investigate the outcome of AFRO-MEMORANDUM on "Support for workshops in epidemiology for District Health Teams in OCP participating countries sent to Ghana. iv. To investigate factors militating against effective public Health Training in Ghana. v To collect data on nodule examination undertaken at the onchocerciasis chemotherapy research centre, Hohoe. vl. To bring back an up-dated Devolution document of Ghana. 3.0. Data collection methodolory. Between June 18th and July 1st 1993, I undertook a mission to Ghana to gather data relating to the above terms of reference. In all,32 people from 8 of the 10 Regions of the I J country were interviewed. The regions covered were : 1. Upper East Region. 2. Norther Region 3. Brong Ahafo Region 4. Greater Accra Region 5. Western Region 6. Central Region 7. Volta Region 8. Eastern Region. In addition a meeting was arranged by the National onchocerciasis Control Secretariat (NOS) at which I met and was briefed by representatives of various NGOs currently engaged in ivermectin distribution in the country. Present also at the meeting *"r. ,"prrsJntatives of NGOs who, even though have not started ivermectin distribution, intend to do so in the near future. See Appendix 1 for the list of people interviewed from various parts of the country. Attempts were made to interview the following people without success. 1. Hon. Colonel (rtd) Obimpeh, Minister of Health, Ghana. 2. Dr Ken Aryeetey, National Co-ordinator of onchocerciasis control - out of the country. 3. Dr Kofi Ahmed, head of epidemiology division, Ministry of Health, Ghana. 4.0. Outcome of the mission. 4.1. Map of Ghana showing fixed health centres and posts where ivermectin is or is intended to be given. After consultation with Dr Adamafio, director incharge of public health services and Mr J.K. Fosu, Chief Executive, NOS, a map of Ghana showing fixed health centres and posts where ivermectin is supposedly given or intended to be given was given to me (appendix 2). Unfortunately this map was received at the last minute and it was not poriiUt" to cross check from a random sample of these centres, which of them do actually iee onchocerciasis cases. The national Co-ordinator could be made to undertake this exercise at a latter date. My tour in the country had however already taken me to certain hospitals where enquiries had been made regarding onchocerciasis treatment. Impressive among the lot was Assin Fosu Catholic Hospital where about 2000 cases of onchocerciasis are treated every year. These cases come from the surrounding villages along three important river basins and their tributaries. These rivers are Pra, Okye and Brupia. 4 St. Martin De pores Hospital in Ekwei, a border town between Ghana and C6te d'Ivoire, also sees a number of cases from along Amanzule and Ankobra river basins. An ophthalmologist at Takoradi Hospital sees a number of patients with onchocercal eye problems referred from Effia Nkwanta Hospital, Sekondi or from nearby Health ientres. These patients are usually from villages along the tributaries of river Prah. Other hospitals which see cases are Tarkwa Hospital (from along the tributaries of river Ankobra) Kibi Hospital (tributaries of river Ayensu and river Densu) and Bawku (river Volta). Aodm Hospital does not see cases at all. An issue of concern, however, is the non availabiity of Health Centres or Posts in the Kulpawn and Sissili river basin areas (see map, appendix 2) for passive ivermectin distiibution. Since these are problem areas attempts should be made to cover them effectively. In the meantime, an NGO must be made interested to cover the area. However a nore permanent solution to adequately cover the area with ivermectine distribultion should be sought. 4.2. Zones where ivermectin is distributed by NGOs Sight Savers and Lions club of Ghana are currently involved in ivermectin distribution, either alone or in conjunction with NOS. (See appendix 3 for areas they cover). Other NGOs wishing to get involved with ivermectin distribution in the near future are Assemblies of God, Adventist Development and Relief AgencylGhana (ADRA) and Friends of Oncho International. 4.2.1.. Sight Savers Sight Savers, under the directorship of Dr Richard T. I-e Mesurier is engaged in community self treatment in the western region. About 70 community based distributors were trained in January t992 to undertake the ivermectin distribution. The training was 3-4 days long and was undertaken by Dr Pacqud of Sight Savers, Mali. Each community distributor is in charge of about 2-4 villages, and his activities are overseen by a District Supervisor. A district Supervisor has a number of community distributors under his care. A Regional Co-ordinator, who supervises the activities of the district co-ordinators has been appointed and paid a per diem by Sight Savers to enable him perform effectively. The Regional Co-ordinator is currently in the person of Mr Wesley Kudom, a Principal Technical Officer of the Medical Field Unit. According to Mr. Kudom, community registers are being compiled. The supervisors of the community distributors in conjunction with the latter will assemble information covering their respective villages for submission to the Regional Co-ordinator, who in turn will send a regional report to the NOS in Accra. 5 One big problem faced by Sight Savers in the discharge of their duties is the poor road network ofthe Region. This poses a problem to the Supervisors in reaching the target villages under their supervision. As a result, returns coming in from the field are not very encouraging. 4.2.2. Volunteer One volunteer was visited. He is in the person of Mr Raymond Nyalegbedzi, a school teacher in charge of two villages, Bonsaso I and Bonsaso 2 on the river Bonsa. The villagers were very happy about the work being done by this volunteer. 4.2.3. District Co-ordinator Mr A.K. Acquah, a technical officer of the MFU and district co-ordinator was also visited. His problem has been regular supply of ivermectin for his village volunteers. The matter has bLen referred to NOS, which has promised to ensure regular ivermectin supply. 4.2.4. Other activities by Sight Savers Sight Savers have trained some co-ordinators in the Central region as well. They are prepared to train people for other NGOs who want such help for effective ivermectin distribution. 4.3.0. Lions club The president of the lions club, Dr. Victoria Tonugble said they have volunteers who need training to distribute ivermectin in the Eastern Region. Sight Savers has agreed to organise a training session for them. The distribution is to start in the Suhum-Kraboa- Coaltar area very soon. The club hopes to undertake control of yaws as well in the region. This intention has been communicated to the minister of Health .(see appendix. 4). 4.4.0. ADRA ADRA has agreed to undertake ivermectin distribution in the Central Region in conjuction with the Ministry of Health. The representative of ADRA indicated, however, that their earlier proposal to their heaquarters in the USA requesting funds to distribute ivermectin in Ghana was returned to them for review which has been done and are now awaiting response. Meanwhile, ADRA is thinking of alternative avenues and points of intervention in the programme in the Central Region. This is contained in a letter addressed to the writer (see appendix 5). 6 4.5.0. Friends of Oncho International (FOI) The representative of FOI indicated that the organization is still in its formative stages. He regretted, however, that even though a letter has been written to the Ministry of Health about their intention to distribute ivermectin, they are yet to receive the reply which will facilitate mobilization of funds from the United States for the purpose. The Chief Executive of NOS assured him that he would contact Dr. Adamafio for the reply to be effected as early as possible. The FOI representative indicated further that the organization was trying to attract medical doctors into their membership.