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AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC)
REPORT OF THE THIRTY-SECOND SESSION OF THE TECHNICA L CONSULTATIVE COMMITTEE (TCC)
Ouagadougou, 07-11 March 2011
DIR/COORD/APOC/REP/TCC32 26/08/2011
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TABLE OF CONTENTS
Acronyms............................................................................................................................................................... iv
Opening: Agenda item 1.........................................................................................................................................1
Adoption of the Agenda: Agenda item 2.................................................................................................................1
CSA – matters arising from the 130th and 131st sessions: Agenda item 3...............................................................1
Matters arising from the Joint Action Forum (JAF) 16th session/decisions: Agenda item 4...................................2
Matters arising from the 36th and 37th NGDO Meetings: Agenda item 5...............................................................3
Follow-up of the key recommendations of the thirty-first session of TCC: Agenda item 6...................................4
Meeting of health professionals on the CDI Curriculum and Training Module: Agenda item 7............................4
Feasibility of elimination of onchocerciasis infection and interruption of transmission in Africa: Agenda item 8.........................................................................................................................................................5
a) Conceptual and operational Framework of onchocerciasis Elimination with ivermectin treatment and recent results........................................................................................................................................5
b) Consultative workshop on Guidelines of epidemiological evaluation and therapeutic coverage survey:........................................................................................................................................................5
c) Entomological studies: Advisory Group, plans, tools and activities..........................................................6
d) Development of a rapid antibody-based diagnostic test for onchocerciasis:.............................................7
Macrofil and Research: Agenda item 9...................................................................................................................7
a) Update on Moxidectin................................................................................................................................7
b) Update on the availability of the DEC patch test........................................................................................8
Update on spatial analysis of RAPLOA data and maps predicting the prevalence of Loa loa in sub-Saharan Africa: Agenda item 10...........................................................................................................................................8
Report of the External Mid-Term Evaluation: Agenda item 11..............................................................................9
a) On elimination.............................................................................................................................................9
b) Strengthening health systems in Africa........................................................................................................9
c) CDDs..........................................................................................................................................................10
d) Co-implementation......................................................................................................................................10
Review of Operational Research Proposals: Agenda Item 12...............................................................................11
i. Model for mapping epilepsy using the Community-based distributors (CDD) network - Cameroon.....11
ii. Effect of onchocerciasis control on prevalence of epilepsy: a community based study in a hyper-endemic area in West Uganda..................................................................................................................11
iii. Assessing low female participation and opportunities for increasing their involvement in community directed treatment with ivermectin in Zamfara State, Nigeria..............................................12
iv. Increasing community participation in community-directed treatment with ivermectin in communities in Benue State, Nigeria.......................................................................................................13
v. Feasibility and equity effects of integration of community-directed treatment with ivermectin into PHC for the control of onchocerciasis in Enugu state, south east Nigeria...............................................14
vi. Determining optimum timing for ivermectin mass distribution for elimination of onchocerciasis (Ondo State).............................................................................................................................................14
vii. Identifying sustainable ways of motivation community-directed distributors in Imo State, Nigeria.......14
Outcome of the CDTI implementation in Ghana: Agenda item 13.......................................................................15
Country visits by the TCC members: Agenda item 14.........................................................................................15
Status of community database of APOC: Agenda item 15 ...................................................................................15
Technical Review Committee Reports: Agenda item 16......................................................................................16
NIGERIA ..........................................................................................................................................................16
CAMEROON....................................................................................................................................................16
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UGANDA .........................................................................................................................................................17
Remarks by the Technical Advisors to APOC Management: Agenda item 17....................................................17
i. Health system strengthening:...................................................................................................................17
ii. Elimination of onchocerciasis:.................................................................................................................17
iii. Financing of APOC:.................................................................................................................................18
iv. Partnership:..............................................................................................................................................18
v. Advocacy and Success stories:.................................................................................................................18
vi. Conflict and post-conflict countries:........................................................................................................18
vii. Co-implementation and Integrated NTD Management:...........................................................................18
Joint APOC/MDP mission to investigate SAE management in North and South Ubangi CDTI Project in DRC: Agenda item 18.....................................................................................................................................................19
Report on the financial management of APOC funded Projects: Agenda item 19...............................................21
Report on the review by the APOC Management of 1st, 2nd, 3rd, 4th, 5th, 6th and 7th, 8th, 9th, 10th, 11th and 12th year progress reports and subsequent year’s budgets: Agenda item 20................................................................21
Review of new Project Proposals and 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th and 11th year Annual Technical Reports on the implementation of CDTI and Vector elimination projects. Recommendations on the 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th and 10th year implementation of projects: Agenda item 21......................................................22
Introduction to the review exercise: Summary budget of operational research proposals submitted...................22
BURUNDI.............................................................................................................................................................22
Bururi CDTI Project (Burundi) 5th year Annual Technical Report...................................................................22
Cibitoke-Bubanza (Burundi) 2010 6th year Annual Technical Report..............................................................23
Rutana CDTI Project (Burundi) 5th year Annual Technical Report..................................................................23
CAMEROON........................................................................................................................................................23
Adamaoua 1 CDTI Project (Cameroon) 6th year Annual Technical Report.....................................................23
East Province CDTI Project (Cameroon) 6th year Annual Technical Report...................................................24
Far North Province CDTI Project (Cameroon) 6th year Annual Technical Report...........................................24
South Province CDTI Project (Cameroon) 6th year Annual Technical Report.................................................24
COTE D'IVOIRE..................................................................................................................................................25
Cote d'Ivoire CDTI Project (Comoe, Bandama, Sassandra, Cavally and their affluents) 3rd year Annual Technical Report...............................................................................................................................................25
DEMOCRATIC REPUBLIC OF CONGO...........................................................................................................26
Ituri CDTI Project (DRC) 4th year Annual Technical Report...........................................................................26
Kasongo CDTI Project (DRC) 5th year Annual Technical Report....................................................................26
Katanga-Nord CDTI Project (DRC) 6th year Annual Technical Report...........................................................26
Katanga-Sud CDTI Project (DRC) 5th year Annual Technical Report (re-submission)...................................27
Katanga Sud CDTI Project 6th year, 2010, Annual Technical Report, DR Congo...........................................27
Rutshuru-Goma CDTI Project (DRC) 4th year Annual Technical Report........................................................28
ETHIOPIA ............................................................................................................................................................28
East Wollega CDTI Project (Ethiopia) 6th year Annual Technical Report.......................................................28
Gambella CDTI Project (Ethiopia) 6th year Annual Technical Report.............................................................29
West Wollega CDTI project (Ethiopia) 6th year Annual Technical Report......................................................29
GHANA ................................................................................................................................................................30
Ghana 2nd Year Annual Technical Report........................................................................................................30
LIBERIA ...............................................................................................................................................................30
South-East CDTI Project (Liberia) 5th year Annual Technical Report.............................................................30
South-Western CDTI Project (Liberia) 5th year Annual Technical Report.......................................................30
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NIGERIA ..............................................................................................................................................................31
NOCP/HQ CDTI (Nigeria) Project 12th year Annual Technical Report...........................................................31
SIERRA LEONE..................................................................................................................................................32
Sierra Leone 4th year Annual Technical Report................................................................................................32
SUDAN.................................................................................................................................................................33
East Bahr El Ghazal CDTI Project 5th year Annual Technical Report.............................................................33
East Equatoria CDTI Project 4th year Annual Technical Report......................................................................33
Upper Nile CDTI Project 4th year Annual Technical Report............................................................................34
West Bahr El Ghazal CDTI Project 4th year Annual Technical Report............................................................34
West Equatoria CDTI Project 5th year Annual Technical Report.....................................................................34
SSOTF CDTI Project 4th year Annual Technical Report..................................................................................35
TANZANIA ..........................................................................................................................................................35
Morogoro Focus CDTI Project (Tanzania) 6th year Annual Technical Report.................................................35
NOTF/HQ Project 11th year Annual Technical Report.....................................................................................36
Review of the 7th, 8th, 9th, 10th, 11th, and 12th year Annual Technical Reports..................................................38
CENTRAL AFRICAN REPUBLIC (CAR)..........................................................................................................38
CAR CDTI Project 9th year Annual Technical Report 2010............................................................................38
CHAD ...................................................................................................................................................................38
Chad CDTI Project 11th year Annual Technical Report...................................................................................38
CONGO.................................................................................................................................................................39
Congo Extension CDTI Project 7th year Annual Technical Report..................................................................39
Congo CDTI Project 10th year Annual Technical Report.................................................................................39
DEMOCRATIC REPUBLIC OF CONGO (DRC)...............................................................................................40
Ueles CDTI Project (DRC) 8th year Annual Technical Report.........................................................................40
ETHIOPIA ............................................................................................................................................................41
Bench-Maji CDTI Project (Ethiopia) 7th year Annual Technical Report.........................................................41
North Gondar CDTI Project (Ethiopia) 7th year Annual Technical Report......................................................41
Kaffa Shekka CDTI Project (Ethiopia) 9th year Annual Technical Report.......................................................42
Illubabor CDTI Project (Ethiopia) 7th year Annual Technical Report..............................................................42
Jimma CDTI Project (Ethiopia) 7th year Annual Technical Report..................................................................43
Meketel CDTI Project (Ethiopia) 7th year Annual Technical Report...............................................................43
LIBERIA ...............................................................................................................................................................44
Northwest CDTI Project (Lofa Bong, Nimba and Montserrado) 9th year Annual Technical Report...............44
MALAWI ..............................................................................................................................................................44
Malawi Extension CDTI Project 9th year Annual Technical Report.................................................................44
Thyolo and Mwanza CDTI Project (Malawi) 11th year Annual Technical Report...........................................45
TANZANIA ..........................................................................................................................................................45
Tanga CDTI Project (Tanzania) 9th year Annual Technical Report.................................................................45
Other matters: Agenda item 22.............................................................................................................................45
CDC representative...........................................................................................................................................45
Tribute to Dr Rene Le Berre.............................................................................................................................46
Presentation by the North Katanga CDTI project Coordinator.........................................................................46
Date and place of thirty-third session of the TCC: Agenda item 23.....................................................................46
Closure of the session: Agenda item 24................................................................................................................46
Annex 1: List of participants.................................................................................................................................47
Annex 2: Annotated Agenda.................................................................................................................................52
Annex 3: Follow up of the key recommendations of 31st session of TCC...........................................................56
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Acronyms AAF Administrative & Finance Assistants AfDB African Development Bank APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective CBO Community-Based Organisation CDD Community-Directed Distributor CDI Community-Directed Intervention CDTI Community-Directed Treatment with Ivermectin CMFL Community Microfilarial Load CSM Community Self Monitoring HKI Helen Keller International DEC Diethylcarbamazine DMO DRC
District Medical Officer Democratic Republic of Congo
ECOWAS Economic Community of West Africa States FLHF Front Line Health Facility FCT Federal Capital Territory HR Human Resource HSAM Health Education Sensitization Advocacy Mobilization HQ Headquarters HW Health worker IEC Information, Education, Communication IPM Independent Participatory Monitoring IRSP Institut Régional de Santé Publique JAF Joint Action Forum LF Lymphatic Filariasis LGA Local Government Area MDP Mectizan® Donation Program MF Microfilaria MOH Ministry of Health MOHSW Ministry of Health and Social Welfare NGDO Non-Governmental Development Organization NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task-Force NTD Neglected Tropical Diseases PAB Plan of Action and Budget PNLO Programme Nationale de Lutte Contre l’Onchocercose PHC Primary Health Care RAPLOA Rapid assessment procedure of Loa loa SAE Severe Adverse Events SHM Stake Holder Meeting SIZ Special Intervention Zone SS SightSavers TCC Technical Consultative Committee (of APOC) USAID United States Agency for International Development UTG Ultimate Treatment Goal WHO/AFRO World Health Organization, Regional Office for Africa WHO/NTD Neglected Tropical Diseases – department within WHO cluster of
communicable diseases (WHO/NTD)
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Opening: Agenda item 1 1. The Director of APOC, Dr Uche Amazigo warmly welcomed all the participants to Ouagadougou and acknowledged the presence of friends from the Center for Disease Control, Atlanta, Bill and Melinda Gates Foundation and PATH. She informed the meeting that five people had been invited as technical advisers to assist Management at this critical phase of the programme as it moves from control to elimination. Dr Amazigo highlighted the fact that knowing elimination is feasible is not enough and that there were many challenges ahead including political, scientific, technical, administrative and financial. These five technical advisors Prof Abiose, Dr Boussinesq, Dr Njepuome, Dr Ilunga and Dr Zaramba are attending the TCC to offer guidance on epidemiological and entomological evaluations and health system strengthening. Dr Amazigo mentioned that the external evaluators had pointed out that APOC is a lead agency to help strengthen health systems. The role of these technical advisers is to guide Management through the CDI process. 2. Dr Tshinko Bongo Ilunga, former Health Division Manager at the African Development Bank, was recognised for the succesful resource mobilisation efforts he made on behalf of APOC when he was at the Bank. Dr Amazigo thanked Dr Julie Jacobson, the CDC team, WAHO, TDR, MDSC, the representative of the WHO country representative for Burkina Faso, colleagues from the countries, representatives of technical review committees in countries and Dr Hans Remme who has remained a strong advocate for onchocerciasis control and building capacity in onchocerciasis control. 3. The Chair welcomed participants and stated that the fundamental role of the TCC was to provide technical guidance to APOC. He added that the challenges were many especially with the added responsibility of co-implementation and the current world economic crisis that had already cast a shadow on many health programmes. He stated that the people in the room truly reflected the partnership, which is the backbone of the programme, and that they are a testimony that the partnership is getting stronger. He mentioned that in the last month many international meetings had discussed the issue of elimination and that now is the time to streamline all the different agenda and outcomes of the many meetings. The Chair congratulated Prof Abiose for being accepted into the Hall of Fame in Nigeria. The full list of participants is appended as Annex 1. Adoption of the Agenda: Agenda item 2 4. The agenda was adopted with minor changes. The final agenda is appended as Annex 2. INFORMATION
CSA – matters arising from the 130th and 131st sessions: Agenda item 3 5. Dr Amazigo reported on CSA 130 held 05-07 October 2010 at WHO/AFRO Regional Office in Brazzaville, Congo and CSA 131 held on 06 and 10 December 2010 in Abuja, Nigeria. The main points arising from discussions of the two meetings were:
(i) Intensify resource mobilization by visits to donors and partners to brief them on the current evolution of the programme and discuss the need for an increased budget;
(ii) To look at the financial implications of the recommendations of the External evaluation
team. Three advisory groups were set up to discuss the future of APOC, co-implementation and the shift from control to elimination. These groups have been working since January 2011 and the results of their work will be discussed at the next CSA meeting in March in Paris when a decision will be taken on the people to work on the three topics as recommended by JAF;
(iii) CSA should propose a rapid solution to the MDSC financial situation to ensure
sustainability of surveillance activities on Onchocerciasis and report back to JAF 17.
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6. TCC thanked APOC management for the update and decided that the future of APOC will be discussed under other agenda items. Matters arising from the Joint Action Forum (JAF) 16th session/decisions: Agenda item 4 7. TCC was informed that JAF16 was well attended by Ministers of Health of countries, donors, NGDOs and other partners. The following decisions were highlighted:
(i) An analysis and plan of how to reach the remaining untreated population of 20 million should be presented to JAF 17;
(ii) APOC should provide technical and financial support for the finalisation of integrated
mapping of priority NTDs and elaboration of strategic plans;
(iii) JAF urged WHO to continue their efforts to conclude the legal agreement with the DEC patch manufacturer and encouraged countries to review related dossiers that WHO will provide to them;
(iv) JAF decided that APOC should undertake research to determine the reason for the
occurrence of positive cases (after 20 years of treatment) and advised that entomological surveys should be undertaken as quickly as possible to determine the next steps;
(v) JAF requested countries to ensure that treatment should cover the entire transmission zones
in such areas and this would require strengthened cross-border collaboration;
(vi) JAF endorsed further research by APOC in post-conflict countries as a means of identifying other approaches to increase treatment coverage;
(vii) JAF endorsed the external evaluation report and approved its recommendations subject to
outcomes of the Closed Door session held by (MOH, Donors and NGDO). Finally, APOC was encouraged to closely link its efforts with WHO to scale up community based chemotherapy for NTDs;
(viii) WHO/NTD concurred with the technical analysis made by the APOC mid-term evaluation
in 2010 on the need to focus on consolidating the present achievements in onchocerciasis control and not to “become the lead institution to manage multiple diseases;”
(ix) JAF encouraged the NGDO Group to seek other funding opportunities independent of the
APOC Trust Fund;
(x) JAF requested that MDSC prepare a budget and a business plan for 2011 exploring alternative funding sources and should submit it to CSA. It was advised that MDSC should position itself as a leading institution on disease surveillance activities in Africa and propose its services to other NTD surveillance within the continent;
(xi) JAF approved the additional funding for Phase II and Phasing out period (PAB 2012 –
2015 & PAB 2012-2013; and
(xii) The Seventeenth Session of JAF will be held in Kuwait in December 2011.
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8. TCC thanked APOC management for the update and raised the following concerns:
(i) TCC recommended that a small group should be set up to discuss the issue of the Vina Valley and approaches to onchocerciasis control with the Carter Center to resolve the cause of confusion currently prevalent in Cameroon;
(ii) TCC also encouraged APOC management to use the platform of JAF 17 in Kuwait to
increase awareness of onchocerciasis and advocate for new funding opportunities among Arab countries;
(iii) TCC recommended that MEC/TCC guidelines should be followed when treating
onchocerciasis in hyper and meso-endemic areas and if hypo-endemic areas are treated in transmission zones for purposes of elimination then care should be taken in areas endemic for loiasis and no treatment should be given in such areas if the prevalence of loiasis is 40% or greater.
Matters arising from the 36th and 37th NGDO Meetings: Agenda item 5 9. TCC was presented with the recommendations of the 36th session of the NGDO Coordinating Group for Onchocerciasis Control which took place on 23rd September 2010 in Atlanta, USA alongside the 1st session of the NGDO/NTD Network, and the 37th session of the Group held from 2-4 March 2011 in Ouagadougou, Burkina Faso. The outcome of the meetings were:
(i) Three working groups were formed: 1) NGDO co-financing of identified research topics 2) Group advocacy to governments in order to bridge the information gap on the role of NGDOs, 3) the way forward for funding of onchocerciasis control activities amongst the NGDOs;
(ii) The attainment of the goal of elimination of infection and interruption of transmission in
additional selected foci is more likely to be feasible by 2020 than 2015;
(iii) The Group recommended that APOC adopts a more proactive approach in telling its success stories and of the efficacy of ivermectin treatment, by engaging third parties;
(iv) The Group noted an urgent need to improve communication between relevant partners
working in NTD control to avoid duplicate funding;
(v) The Group recommended the continued support for surveillance and decision-making with respect to stopping ivermectin treatment in Ex-OCP countries;
(vi) The Group welcomed the good news regarding the action plan for elimination of
onchocerciasis in Yemen and encouraged CSSW, government and other partners to sensitise potential donors to implement the plan;
(vii) The progress report on onchocerciasis control through ivermectin distribution would be
presented to the 64th session of the World Health Assembly (WHA), 2011. The Group encouraged NGDO members working in endemic countries to advocate to their respective Ministers of health for their full support of the report;
(viii) The next NGDO meeting will take place along side the 2nd session of the NTD NGDO
Network 20-22 September 2011 in Nairobi, Kenya.
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10. TCC thanked Dr Ukety for the concise presentation and raised the following issues.
(i) There are many lessons to be learnt from the experience of ex-OCP that could be beneficial to APOC;
(ii) Given the financial constraints APOC is working with NGDOs to provide support; (iii) TCC suggested that the NGDO group should include in their report a table of follow-up on
recommendations and actions to be carried out similar to that of the TCC report. Follow-up of the key recommendations of the thirty-first session of TCC: Agenda item 6 11. The actions below have either been initiated or completed by APOC Management as a follow up to recommendations of TCC31.
(i) Strategic and technical issues, (ii) CDTI projects and technical issues, (iii) Others matters.
12. TCC thanked APOC management for the actions taken and made the following suggestions:
(i) As some recommendations would need more than six months to be implemented the table of recommendations and follow up actions should have four sub headings; 1) implemented 2) not implemented 3) on going and 4) observations on what has not been executed;
(ii) Re-orientate and sensitize countries so they see SHM and CSM as an integral part of the CDTI process so that sustainability could be achieved;
(iii) APOC should find a way of selling CSM and SHM to other programmes as an integrated activity;
(iv) Cameroon TRC should adopt the same reporting format as Nigeria and Uganda. (v) The need to have additional Technical Advisor in DRC; (vi) With regards to the Closantel issue, TCC/APOC should prepare a paper on the efficacy of
ivermectin and not on Closantel. The paper could be published on the APOC website. 13. The full presentation of the implementation of the TCC31 recommendations is attached as Annex 3. Meeting of health professionals on the CDI Curriculum and Training Module: Agenda item 7 14. Dr Fobi presented an update on the Curriculum and Training Module for the CDI strategy for Faculties of Medicine and Health Sciences, underscoring that a total sum of US $186,367 has been disbursed to 13 universities to support the integration of CDI strategy into their curricula. The TCC was also informed of the meeting held from 3-5 November 2010 in Nairobi, which deliberated on the use and inclusion of the Community-Directed Intervention (CDI) strategy in the curricula for the training of medical professionals from 9 Eastern and Southern African countries. The meeting was attended by forty-four participants from sixteen Universities, Medical and Nursing schools. It was noted that in all 18 universities in West and Central Africa, 16 in East and Southern Africa and 12 in Sudan have agreed to pre-test the CDI module. However there are still numerous challenges: there is a need for a training manual and a CDI text book and need to follow up on universities. 15. TCC received the update with satisfaction and made the following comments:
(i) It is critical to develop a textbook on CDI to ensure that the training is uniform; (ii) To continue advocating for CDI to be adopted in the curriculum of medical institutes by
underlining its core value to strengthen the PHC.
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Feasibility of elimination of onchocerciasis infection and interruption of transmission in Africa: Agenda item 8
a) Conceptual and operational Framework of onchocerciasis Elimination with ivermectin treatment and recent results.
16. Dr Hans Remme updated the TCC on the results of evaluations and on preparations for stopping ivermectin treatment where elimination is feasible, including the conceptual framework and guidelines. 17. TCC thanked APOC management and Dr Remme for the update on the current situation of elimination where feasible (Refer to TCC29/30). TCC made the following observations:
(i) With regards to difficulties associated in defining transmission zones, it was observed that an accurate GIS data-layer for population density, especially in rural areas would be a big advantage and would allow estimates of the number of additional people that would require treatment to be estimated;
(ii) Regarding the reliability of kriging maps, it was explained that kriging interpolates point
prevalence data and predicts onchocerciasis distribution and prevalence based on a spatial regression analysis. It does not indicate the probability of a particular level of prevalence and its accuracy depends on the number and distribution of data points in a given area;
(iii) On the issue of stopping treatment in areas of co-endemicity of lymphatic filariasis (LF)
and onchocerciasis, it was noted that in areas considered feasible for elimination, the long-term ivermectin treatment at high levels of therapeutic coverage would most likely have already eliminated LF but that data needs to be collected to confirm this;
(iv) The Committee emphasised the desirability of entomological studies along with
epidemiological evaluations based on nodule prevalence and skin-snip data. Entomological evaluations are being given priority, especially to identify areas at risk of reinvasion/re-infestation with infected flies.
18. It was concluded that elimination in some African countries is now proven rather than just being considered feasible but caution should be taken regarding the message given to donors as all APOC projects are still in Phase 1 of the conceptual framework and increased funding would be required to take projects through to Phase 3.
b) Consultative workshop on Guidelines of epidemiological evaluation and therapeutic coverage survey:
19. Dr Afework presented an update on the workshop held 1-3 March 2011, Ouagadougou, Burkina Faso which aimed to review and adopt 1) the treatment coverage survey protocol; 2) the epidemiological evaluations guideline; and 3) to select epidemiological evaluation sites for 2011. The workshop adopted the definition of therapeutic coverage as: 'the proportion of people treated with ivermectin (according to height) divided by the population size of the village estimated after annual census carried out by the Community-Directed Distributor of the drug''. The presentation underscored that the presence of LF and onchocerciasis co-endemicity was a major challenge in the stopping of onchocerciasis treatment (an example in Senegal). TCC was informed of the 8 countries identified for epidemiological evaluation in 2011, namely: Cameroon, CAR, Congo, Ethiopia, Malawi, Nigeria, Tanzania and Sudan. 20. Dr Afework also described the methodologies for onchocerciasis epidemiological evaluations. For LF there is a need to identify implementation unit (IU) two sentinel sites for every IU (usually a District) and each sentinel site should have a population of at least 500 people. Also spot-check sites with similar characteristics but at a far distance from sentinel sites. There are guidelines of characteristics listed for sentinel sites and Dr
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Afework made a comparison of the techniques used for sampling and described a flow diagram of the steps involved in testing. 21. TCC thanked Dr Afework and made the following observations:
(i) Although a nation-wide REMO was carried out in Mozambique, there was a need to complete the mapping; however this should be approached from the Malawian side of the border;
(ii) APOC should provide guidance on the method of reporting the results of the skin snip tests back to the population;
(iii) To increase the number of epidemiologists if an Onchocerciasis/Lymphatic filariasis
survey was considered essential;
(iv) APOC should look into the possibility of conducting research to assess the impact of ivermectin treatment on Loa loa;
(v) With regards to conducting onchocerciasis/lymphatic filariasis co-surveys, a working
group was tasked to discuss (1) the preliminary impact of carrying out the co-survey; (2) the applicability, feasibility and the benefit, (3) if compatible, to suggest when and where to conduct the survey. The working Group was made up of Drs Afework, Jacobson, Philippon, Ogoussan and Biritwum;
(vi) The Group concluded that the two surveys had many differences in their approach and
methodology so it would not be feasible or practical to integrate them. Only activities such as co-surveying for coverage would be feasible although for onchocerciasis, the river basin and high risk area must be included.
c) Entomological studies: Advisory Group, plans, tools and activities
22. Dr Yameogo presented the initial preparation of the plans to undertake entomological studies to assess Transmission Zones to the Committee. He underscored that the study would comply with the requirements of the conceptual and operational framework for assessing trends towards elimination of infection and interruption of transmission. The study is to assess the feasibility of interruption of transmission of O. volvulus by Simulium flies in areas under ivermectin treatment alone, or associated with focal vector elimination. The specific objectives are three-fold:
(i) To put in place technical structures and administrative procedures to facilitate the implementation of the study;
(ii) To set appropriate catching points for the assessment of the level of infestation of S. damnosum spp. and S. neavei by O. volvulus; and
(iii) To determine the level of infection of blackflies with O. volvulus in the sites retained for entomological evaluation.
23. An ad hoc Working Group of (12) has been set up with well defined Terms of Reference; Seven entomological evaluation sites have been identified in 5 countries and the first meeting of the Working Group will be held from 28-30 March 2011 in Ouagadougou, Burkina Faso. 24. TCC thanked Dr Yameogo for the update, noting that these were useful studies in the phase of elimination.
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d) Development of a rapid antibody-based diagnostic test for onchocerciasis: 25. Dr Domingo presented a project by PATH to develop a rapid, field-friendly diagnostic test for Onchocerciasis for use in regions moving towards elimination. Specifically, PATH provided details of its product development strategy and project timeline for the development of an antibody detection test to an Onchocerca volvulus antigen (Ov16). The presentation provided (i) a background on PATH and how it engages with the public and private sector to develop sustainable products; (ii) a description of the Ov16 diagnostic test: the rationale, the supporting data and a historic perspective of the test development and (iii) a summary of the project timeline and key deliverables. 26. In conclusion to the presentation, it was clarified that identifying the appropriate use of the Ov16 test and developing the necessary evaluation plan to obtain accurate performance data for the intended use will require early and continuous engagement with APOC, the TCC and the MDSC. In the questions and answers session, several subjects were discussed by the TCC including at what phase of the elimination timeline should the test be used (to support transition from Phase 1 to Phase 2 and for Phase 3 was suggested), concerns about specificity arising from exposure to O. ochengi, clarification of the fact that this test detects both current and past infections (it is not restricted to active infections), what is the overall strategy to make the test available, and has PATH started considering the regulatory hurdles, amongst other subject matters. It was concluded that the way forward was close engagement with the APOC TCC for the design of the evaluation studies, and an invitation was extended to PATH to provide updates on the development process as appropriate. 27. TCC thanked Dr Domingo for his presentation on the development of the OV16 diagnostic test for onchocerciasis by PATH and the process that would be involved in its eventual commercialisation. TCC remarks:
(i) TCC noted that the OV16 test has been used in Uganda and Sudan but the results of these tests, which could contribute to the development of the OV16 test by PATH, had not yet been published. TCC highlighted that the OV16 test would be useful in surveillance during the post elimination phase and would be used to detect recrudescence of infection in children;
(ii) To explore the possibility of PATH evaluating the test in collaboration with MDSC;
(iii) These evaluations should be designed to determine the adequacy of the tests specificity,
sensitivity and its suitability for use in the Phase of surveillance in elimination in which prevalence of onchocerciasis is low;
(iv) To provide regular update on progress of the development of the OV16, and to attend
future sessions of TCC meetings. Macrofil and Research: Agenda item 9
a) Update on Moxidectin
28. Dr Kuesel reported to TCC that the Phase 3 study had completed enrolment. Final data should be available by the end of 2012. The paediatric study protocol has not yet been finalized and thus the study cannot be conducted this year in time to enrol school-age children during summer vacation. Since a paediatric dose is a prerequisite for community study treatment with moxidectin and no funds are available for finalisation of community study site selection and preparation, the community studies will also be further delayed. 29. In the Phase 2 study, 2 mg, 4 mg as well as 8 mg moxidectin killed microfilariae faster and at a higher percentage than ivermectin. 6 months after treatment with 8 mg moxidectin, skin mf levels were still undetectable and 12 months after treatment they were still well below the lowest level achieved with ivermectin around 3 months after treatment. The histopathology data 18 months post treatment show that a
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single dose of moxidectin does not kill or sterilize all macrofilariae but no other correlation between indicators of macrofilariae viability or reproductive activity and skin microfilaria levels was found. Nearly all subjects treated with ivermectin or moxidectin had Mazzotti reactions. A statistically higher percentage of subjects treated with 8 mg moxidectin than ivermectin experienced pruritus, rash, postural tachycardia, asymptomatic postural hypotension and symptomatic postural hypotension (SSPH). No significant non-Mazzotti adverse reactions were detected. 30. The TCC noted that the data are very encouraging since a drug with the efficacy of 8 mg moxidectin would have a much higher impact on transmission than ivermectin and would thus be of considerable advantage for onchocerciasis elimination. The lack of correlation between macrofilaria histopathology data and skin microfilaria data is not surprising given the timing of the nodulectomies (18 months post treatment), the small number of nodules and macrofilariae available for examination and the fact that many data, especially those regarding reproductive status, are only semi-quantitative. Re-examination of the nodule sections to estimate the age of the worms and the number of microfilariae in the uteri of female macrofilariae and the nodule tissue should be conducted. The Mazzotti reaction profile is consistent with the efficacy observed and does not raise concern for mass treatment. 31. TCC thanked Dr Kuesel for the update and made the following recommendations:
(i) TCC strongly supports continuation of development of moxidectin considering that it will be of particular value for endemic areas which initiated onchocerciasis control relatively recently and that onchocerciasis control is currently dependent on a single drug;
(ii) TDR was requested to report back to TCC on Pfizer's engagement in moxidectin
development and to provide an updated plan of activities for the availability of moxidectin to control programmes including funding of remaining clinical and community studies;
(iii) TDR needs to ensure that further delays in development are avoided and the safety of
moxidectin in subjects with Loa loa is evaluated.
b) Update on the availability of the DEC patch test 32. TCC was informed that the regulatory aspects are still being negotiated with Lohmann and these are linked with Good Manufacturing Practices (GMP) requirements. WHO/TDR would update the Committee on the outcomes. Update on spatial analysis of RAPLOA data and maps predicting the prevalence of Loa loa in sub-Saharan Africa: Agenda item 10 33. APOC undertook large scale mapping of loiasis in 11 potentially endemic countries using a rapid assessment procedure for loiasis (RAPLOA) that uses a simple questionnaire on the history of eye worm. The RAPLOA surveys were conducted in two phases:
• Phase 1: 2002 – 2006: during this period, RAPLOA surveys were conducted in areas that were earmarked for ivermectin treatment for onchocerciasis control by APOC and that were located in areas that were potentially endemic for loiasis. Only areas that were meso or hyper-endemic for onchocerciasis were targeted.
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• Phase 2: 2008 – 2010: with the increasing expansion of NTD programmes that included the distribution of ivermectin for the elimination of lymphatic filariasis, there was an urgent need by country programmes and partners to have a better knowledge of the distribution of loiasis throughout the African region, including in areas that were not targeted for onchocerciasis control. After it was mandated by its board, APOC undertook to complete the RAPLOA surveys in the areas outside the onchocerciasis endemic areas not yet covered by RAPLOA surveys.
34. In February 2011, APOC Management proceeded to an in-depth analysis of all RAPLOA data available. A geo-statistical analysis method called kriging applied to the data collected in 4798 sampled villages generated a contour map of eye worm prevalence, providing the first global map of loiasis based on actual survey data. This map showed high risk levels of loiasis in 10 countries where an estimated 14.4 million people live in high risk areas. 35. Following this analysis a draft paper entitled “The geographic distribution of Loa loa in Africa: results of large-scale implementation of the Rapid Assessment Procedure for Loiasis (RAPLOA)” has been prepared and submitted to PLoS NTDs for publication. 36. TCC thanked APOC management for the excellent news of the RAPLOA mapping and made the following remarks:
(i) This was very exciting, long awaited data, and APOC must now look for ways to share this data as it will be most useful for LF and other NTD Programmes to help them avoid SAEs. Countries that intend to treat in hypo-endemic areas can go ahead and treat with confidence, now they have the RAPLOA map;
(ii) TCC suggested adding a white rectangle to the legend, denoting areas on the map
which were not surveyed. Report of the External Mid-Term Evaluation: Agenda item 11 37. TCC was updated on the major recommendations of the External Mid-term evaluation. It was underscored that:
a) On elimination:
(i) APOC should continue the mapping of the state of each transmission zone and include additional entomological and epidemiological studies;
(ii) Activities targeting elimination should be limited to localised project; (iii) It is important that APOC manages the expectations of countries and communities
regarding the stopping treatment process, elimination and co-implementation; (iv) Need for a comprehensive communication strategy for 2015 and beyond; (v) A multi-disciplinary team of experts should be put together to develop a comprehensive
strategic plan with full normal costing and a risk scenario for the development of resource needs;
(vi) A new memorandum of understanding needs to be developed and signed between countries.
b) Strengthening health systems in Africa:
(i) Guidelines for Community Health Systems strengthening within the framework of the
Ouagadougou declaration should be tabled at the next WHO Regional Committee for Africa to be adopted by all countries for implementation. The Regional Committee should be asked to support the introduction of CDI curricula developed into Medical institutes.
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c) CDDs:
(i) To undertake comprehensive research to explore the dynamics of existing CDDs including incentive and sustainability options.
d) Co-implementation:
(i) APOC should not be the lead institution for managing NTDs; (ii) The partnership is likely to be put under severe strain under the emerging NTD agenda
and the scramble for new funding. 38. APOC management was thanked for the update of the core recommendation of the external mid term evaluation. TCC conclusions:
(i) TCC recommended setting up a task force to draft ToRs calling for research proposals on the demand for incentives for CDDs/CDTI projects and to look into budgeting. The task force was composed of Prof Mamadou Traore (Chair), Drs Yebakima, Yumkella, Thiede and Prof Braide. The result of that work on suggested research on the requirement for and type of incentives for CDDs was presented by Dr Thiede as follows:
Dr Thiede's Comments on suggested research on the requirement for and type of incentives for CDDs 39. In the light of the move towards the elimination of onchocerciasis it becomes obvious that a stable (i.e. efficient and sustainable) institutional and managerial framework needs to be in place building on the existing successful structures. Given resource constraints, the efficiency of ivermectin distribution and treatment is a critical objective. This requires optimisation of all procedures and programme components. The contribution of CDDs to the effectiveness of ivermectin distribution is critical. However, this is but one component of a complex set of interconnected programme components. 40. Socio-economic and socio-cultural issues are intermeshed. There is a whole set of issues that may require additional research in order to define the optimal pathway towards the elimination of onchocerciasis in Africa. This pathway can only be efficient, sustainable and (inter-regionally) equitable if it takes into account the local peculiarities. Ultimately, this is one component of assessing the overall resource requirements for the elimination programme. 41. With regard to the effectiveness of CDTI, the appropriate (local) requirements for setting incentives for (voluntary) community health workers require further investigation. The local requirements may vary dramatically with the local context (geographical, cultural etc.). A particular focus should be placed on social capital/social coherence, possibly involving a mapping exercise. 42. Interdisciplinary research addressing this particular issue (among a set of other issues involving the expertise of social scientists and economists) should be invited. However, successful research on this issue should follow a common framework. Research should ideally not be conducted in the form of disconnected local projects but rather follow a common and adequate conceptual framework developed by (or at least, sanctioned by) APOC/the TCC. 43. A Request for Proposals should be issued, clearly outlining detailed objectives and a suggested methodological approach. The RFP could be addressed to “unidentified” experts. There is also an opportunity to support international cooperation with local experts. The opportunity should not be missed to use the exercise as such for project strengthening. The task force recommended that:
(i) It was thought prudent to seek the communities’ opinion on issues regarding incentives;
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(ii) A need to advocate to country MOH to adopt a policy on incentives into their health policy. The Committee underscored the merit for Government to be the lead on the issue of incentives and not APOC;
(iii) In view of the fact that APOC has introduced the CDI module into the curriculum of Universities, TCC supported the idea of involving African medical and science universities in operational research.
Review of Operational Research Proposals: Agenda Item 12
i. Model for mapping epilepsy using the Community-based distributors (CDD) network - Cameroon
Reviewers comments and conclusions: 44. The objectives of this proposal are to put in process a mapping system using the CDD network – based on census data from CDDs. The researchers would compare results of an epileptic patient census conducted by CDDs with results from a research team and would look for a correlation between epilepsy prevalence and onchocerciasis. The methodology described is based on using data collection tools and census of communities carried out by trained CDDs. 45. There is a large research team involved and TCC questioned the allowances being given to them. The reviewers requested more information on the following:
(i) Explain the national strategy for epilepsy control; (ii) Give figures and their sources which show that the three districts are hyper-endemic for
epilepsy and onchocerciasis; (iii) Give the level of prevalence of onchocerciasis from REMO before CDTI in the zone; (iv) It is necessary to explain why the validation of census data by CDDs will be done in 5
communities and how these communities will be chosen; (v) Explain how you will obtain the prevalence of onchocerciasis from health records? (vi) Justify the allowances to be given to the research team – the CDDs will get CFA3000 lump
sum; The PIs will get CFA30,000 per day for 1 month. The proposers should indicate if these are official rates.
46. In conclusion, the proposal is relevant, scientific level is high, the methodology is acceptable. 47. TCC accepted the proposal with a reduction of the budget and asked APOC’s two epidemiologists to provide guidance on the third objective.
ii. Effect of onchocerciasis control on prevalence of epilepsy: a community based study in a hyper-endemic area in West Uganda.
Reviewers comments and conclusions: 48. There is no Background in the proposal. The investigators have reviewed some literature under the heading Rationale and Objective but this does not adequately and logically highlight the research problem. The investigators should provide a comprehensive background, including a thorough review of literature leading to a statement of the research problem. A budget of US $20,000 was requested. 49. The objective which is stated under the heading Rationale and objective should be shortened without losing content. The rationale is not clearly stated. Investigators should strengthen the argument and
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demonstrate justification in more clear terms. The hypothesis, given only in the summary, is valid and testable, but should be recast more directly. Methodology:
(i) The methodology is mostly satisfactory but the team should use a punch and not disposable scalpels in taking skin snips;
(ii) There is no indication of how data collected will be processed and analysed. The investigators should provide a clear data analysis plan;
(iii) The investigators should indicate how confounding variables (nutrition, other diseases etc) will be addressed.
Ethical considerations:
(i) A copy of the ethical clearance certificate should be attached to the proposal. In view of participation of community members in door-to-door survey, investigators should indicate how confidentiality on subjects with epilepsy will be maintained to avoid stigmatization?
(ii) The budget should be moved from the first page to the end of the proposal. The budget is not detailed enough and justification should be given for each item/activity.
Recommendation: 50. TCC accepted the proposal subject to the requests made above. The investigators should address the issues highlighted and resubmit to the reviewers for final review. 51. The research proposal was provisionally accepted. Recommendation to APOC 52. APOC management should produce and circulate an announcement on grants obtainable from APOC. This should include procedure for applying and format of proposal.
iii. Assessing low female participation and opportunities for increasing their involvement in
community directed treatment with ivermectin in Zamfara State, Nigeria. Reviewers comments and conclusions: 53. This is an important area of research and the team should be supported to implement it. The reviewer(s) provided comments (using track changes) in the proposal for consideration of the proposers. 54. The proposers should provide the current geographical and therapeutic coverage of the study area. Research questions should be focused. For example, the following questions would seem relevant to the topic of research:
(i) What role do women play in CDTI? (ii) What barriers do women face in engaging in CDTI activities? (iii) How can women’s participation be enhanced?
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55. The objectives should be refined in line with the above. It was not clear why the three study areas were selected– a rationale should have been provided.
(i) Sample size calculation: this is presented but it is not clearly stated whether this is for the purposes of the HHS tool or the structured interview schedule presented in the annex.
(ii) Study instruments: How many IDIs? Who are the ‘young males and females’ referred to in the proposal?
(iii) How will be the 10 FGD communities be determined? (iv) Data collection: Who will collect the data? Take advantage of secondary data. (v) Data analysis: How will the IDI data be analysed? (vi) Budget: The budget requested (US $10000) is acceptable. (vii) Annexures: IDI guide is not provided.
Recommendation: 56. TCC provisionally accepted the proposal with the understanding that the researchers will make the changes before implementation of the study. 57. Resubmit the proposal to APOC management but also send it to the proposal reviewers.
iv. Increasing community participation in community-dir ected treatment with ivermectin in communities in Benue State, Nigeria.
58. This proposal was first submitted to the NOCP in January 2010. The research would use Participatory Rural Appraisal (PRA) tools to investigate reasons for challenges to increasing community participation and propose strategies for strengthening it in Benue CDTI project.
Reviewers comments and conclusions:
(i) Literature review is scanty; (ii) Background information on Benue state and the CDTI programme would have helped the
reviewer understand the situation better; (iii) The low coverage rate is mentioned as a problem but is not backed up by data which could
have been obtained from the project or NOCP; (iv) Information on indicators of community participation is available in Annual Technical Reports
and should have been obtained from the project and used to define the problem; (v) The skill levels of mid-level workers on how to engage with communities should also be
included since this is cited as a constraint; (vi) Regarding the study design and methodology, the proposers had given a detailed study design
but could place more emphasis on existing indicators for monitoring CDTI rather than developing new ones. The budget was modest;
(vii) The proposal did not convince the reviewer that low community participation is a problem in Benue CDTI project and therefore needs to be researched unless we choose to use APOC’s internal knowledge to confirm this.
59. TCC accepted the proposal conditionally, subject to provision of data to confirm presence of low community participation. The researchers are advised to use information available in the Annual Technical Reports. TCC confirmed that the problem is real but the proposers did not provide the supporting data and should do so. The Community part is poor and TCC asks for more information to justify the proposal.
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v. Feasibility and equity effects of integration of community-directed treatment with ivermectin into PHC for the control of onchocerciasis in Enugu state, south east Nigeria.
60. The TCC reviewers found the objective to be poorly constructed with a weak rationale behind it. If the objective was to compare NTD and CDTI this would be acceptable but looking at integration of the two is not useful. 61. TCC did not accept the research proposal.
vi. Determining optimum timing for ivermectin mass distribution for elimination of onchocerciasis (Ondo State).
62. Objective: This proposal was to undertake a comparison of the impact of timing of MDA on infectivity of Simulium damnosum before and after peak transmission. It would be a two-year collaborative study with MDSC and the Nigerian Institute of Medical Research. 63. The budget requested was US $27,000. 64. TCC reviewers noted that no information was provided regarding ethical clearance. They were concerned that the proposers would require the community to carry out treatment at a time which was not of their choosing. Conclusion: 65. The experiment is feasible and of interest although it may not give a significant result. The outcome could provide information on times of peak transmission that would contribute to the optimal timing of drug treatment. The TRC in Nigeria approved the proposal. 66. TCC recommended that, as the proposal had not been seen by entomologist members of TCC, the decision on the proposal should be deferred and the decision will be given later (up to 12 April) by email to APOC management, copy to TOR and Professor Homeida, TCC Chair (from Drs Yebakima and Philippon). The budget must be reduced to $20,000. 67. APOC management will in future ensure that all Operational Research Proposals are sent to all TCC members whether they are reviewers or not.
vii. Identifying sustainable ways of motivating community-directed distributors in Imo State,
Nigeria
Objective: 68. To find ways of giving incentives to CDDs to maintain distribution without affecting the sustainability of CDTI. Conclusions: 69. Although the idea is good, the design of the study is unclear, using participatory rural appraisal (PRA). It was not clear what interventions will be used. The budget requested was US $9800. 70. Dr Thiede also volunteered to review the proposal. PRA may not be an appropriate technique to use. If the team is competent we could support them. Unfortunately little information was given on the research team (no CVs).
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71. TCC agreed that Dr Thiede would review the proposal and give his comments as soon as possible. Outcome of the CDTI implementation in Ghana: Agenda item 13 72. Dr. Nana-Kwadwo Biritwum reported to the Committee on CDTI implementation in Ghana. Onchocerciasis control activities commenced in 1974 using aerial larviciding. In 1987, mobile teams started to distribute ivermectin and eventually in 1998 CDTI was introduced. The programme has adopted a bi-annual treatment in the river basin areas as a result of (1) poor geographic and therapeutic coverage; (2) recent drug efficacy studies indicating non-responsiveness to ivermectin treatment; and (3) areas with unsatisfactory epidemiological and entomological situations identified through REMO surveys. TCC was also informed of entomological and epidemiological surveillance activities that were carried out in 2010. Some major challenges facing the programme were (1) timing of the treatment cycle for implementation of twice yearly treatment; (2) competing programmes at regional and district levels; (3) apathy among regional and district staff; (4) the need for advocacy for political commitment at the highest level; and (5) cross-border issues. Suggested solutions to these challenges included (1) strengthening advocacy with stakeholders; (2) collaborating with partners to build capacities for effective management of onchocerciasis/NTD surveillance; (3) and addressing black fly nuisance activities. 73. TCC commended the Ghana Programme on its progress, thanked the presenter for the update on CDTI status and encouraged them to train more technicians for surveillance activities. Country visits by the TCC members: Agenda item 14 74. A mission to Congo, Brazzaville from the 26 February to 4 March 2011, was undertaken by Dr A. Yebakima to advocate for increased and effective disbursement of government financial contributions to onchocerciasis control projects in the country. Visits were made to 2 health districts, and discussions were held with the Mayor, area chiefs, health workers, CDDs, Minister of State and Coordinator for Socio-cultural affairs, the Minister of Health, the Health adviser to the president of the Republic, officials from the Ministry of health and Finance, Parliamentarians and the Director General for Scientific Research. 75. A working session was also held with WHO-AFRO at Djoue in Brazzaville to discuss blackflies nuisance. 76. Outcomes of the meeting:
(i) The PLNO should prepare a document on the parliamentary discussions and distribute to all parliamentarians;
(ii) Provide support for advocacy at all levels; (iii) Parliamentarians will intervene with the Government; (iv) Some parliamentarians agreed to support CDTI activities in the field by providing bikes
and other things. 77. TCC commended Dr Yebakima for the high level advocacy as exemplary and encouraged other members to carry out high policy advocacy during country visits. Status of community database of APOC: Agenda item 15 78. TCC was updated on the status of the APOC community database. The main objectives of developing the database was to strengthen the data flow from the community level up to NOTF secretariat; to adopt a standard CDTI reporting tool; install a user friendly computerised data entry system; and build sustainable data collection and management system at country level. Data entry training has been carried out in most of the APOC countries to build capacity at national level. The community database is also a significant monitoring tool used to assess community level therapeutic coverage; Gender disaggregate data; and access of communities to health facilities. Significant concern sited were record keeping; use of standard reporting forms
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by all projects; delay in reporting; and insufficient computer skills. Solutions to imminent problems: provide a UNIQUE code to each CDTI community; projects to report annually using the community UNIQUE Code; and continue data management workshop. 79. TCC thanked APOC management for the establishment of the database as a useful tool for maintaining programme data and for Programme management. Technical Review Committee Reports: Agenda item 16 NIGERIA 80. Professor Eka Braide, Chair of Technical Review Committee (TRC), Nigeria, presented the report of the TRC6 meeting held in Calabar, February 14-18, 2011. During the meeting, six Technical Reports from Cross River, Edo, Delta, Niger, Yobe and Plateau states were reviewed and accepted. The national coordinator and zonal facilitators presented updates on advocacy and monitoring activities conducted by NOCP and ZOTF. The only operational research proposal reviewed was referred back to the investigators for more input. Kogi State Coordinator, in a presentation, listed poor coverage and low compliance as reasons for unsatisfactory results observed during epidemiological evaluation conducted recently. The project was advised to map out a strategy to improve the quality of implementation in areas with poor coverage and low compliance. Key Challenges observed from the Technical Reports and presentations included inadequate supervision and monitoring as well as non- implementation of the sustainability plans. Project-specific recommendations for improving the report and quality of CDTI implementation were made and communicated to the projects. The Committee requested APOC to provide one vehicle each for the NOCP and the four Zonal offices. This and adequate capacity building at the Zonal level, will improve the quality of monitoring and supervision. 81. TCC accepted the report; acknowledged the usefulness of TRCs and recommended that more countries be encouraged and assisted to set up TRCs. CAMEROON 82. Dr Aboutou presented the TRC report from Cameroon. The fourth TRC meeting of Cameroon was held in January 2011 and was attended by the Director of Disease Control, who is also the head of the NOTF. Nine Annual Technical Reports were reviewed from projects 7-12 years old. These reports were reviewed prior to the meeting, and subsequently presented and discussed at the meeting and a decision was taken by the committee. Delegates from the Department of Public Health were unable to attend due to a cholera outbreak, although they had been requested by TCC31 to take part in these meetings. One representative was able to attend the opening of the meeting only. TCC had also asked the TRC of Cameroon to give an explanation of why some old projects hadn’t yet reached 100% geographical coverage. The reason given for this is that it is difficult to access some communities. TRC clarified that there had been no double funding for mapping; USAID has supplied funds for mapping trachoma and LF and APOC had financially and technically supported mapping of Loa loa. Funds from APOC were also used for mapping where there were gaps for schistosomiasis. 83. The following projects were reviewed:
� Adamaoua 2 for 2010 – Accepted � Centre 1 CDTI Project year 9 – To be resubmitted after the corrections and
amendments requested have been made. � Centre 2 year 8 CDTI Project – Accepted although it was noted that there was a
problem concerning management of Mectizan; attrition of CDDs was also a serious problem. � Centre 3 CDTI Project year 11 – Accepted � North CDTI Project 11th year – Rejected � North West CDTI Project 7th year project – Accepted � West CDTI Project 10th year – To be resubmitted � South West 1 CDTI Project 11th year – Accepted � South West 2 CDTI Project 11th year – Accepted
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84. No operational research proposals were submitted for review with Annual Technical reports but three proposals were received directly by the Technical Review Committee. These have been sent to reviewers but not in time for review by the TRC and they will therefore be presented at TCC33 in September 2011. 85. Overall recommendations of the TRC to Projects in Cameroon were:
(i) Improve the ratio of CDDs: population and strengthen community participation; (ii) Strengthen advocacy and supervision at all levels; (iii) Activate operational research by involving teachers of FMSBs; (iv) Verify the quality of data collected at all levels; (v) Take measures to prepare for a shift from control to elimination.
86. TCC accepted the report and thanked Dr Aboutou for her presentation. UGANDA 87. No report was given from the TRC/Uganda as the representative was unable to attend the TCC meeting. Remarks by the Technical Advisors to APOC Management: Agenda item 17 88. The team thanked APOC management for inviting them to the TCC and acknowledged the Chair and TCC members for rich data and very informative presentations. The spirit of partnership is evident in the attendance and participation and is to be commended. The advisors remarks:
i. Health system strengthening:
a. The Group recognised the great need for APOC to sustain efforts at transforming health systems and ensure that oncho-surveillance activities go beyond national onchocerciasis control programmes, NTDs and become integrated into the National Integrated Disease Surveillance Systems (IDS) and subsequently, into the National Demographic and Health Surveys.
b. The Group commended APOC for developing the CDI Curriculum but advised that it should
be 'owned' by the Ministry of Health of each country in order to facilitate the devolution of the curriculum to the appropriate school of health technology or agencies that have the mandate to train front line health workers.
c. It was suggested that the curriculum document should be presented at the next Regional
meeting of the Ministers of Health in Africa.
d. Noting that SHM and CSM are integral components of CDTI, the Advisors suggested that the TRC should ensure that country work plans mandatorily include these two activities and should always show the target set and achievements made in these areas.
e. The implementation of these components of CDTI is crucial for programme sustainability well
beyond APOC’s lifetime.
ii. Elimination of onchocerciasis:
a. Regarding the “feasibility of elimination of onchocerciasis infection and interruption of transmission in Africa”, the Group appreciated the work done so far on the conceptual and operational framework, epidemiological surveys and initial consultation and preparations for the entomological studies.
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b. As APOC transits from control to elimination, they recalled that countries had submitted their exit strategy plans. In light of the new disposition of APOC, it is pertinent that these documents be reviewed and revised accordingly.
iii. Financing of APOC:
a. APOC Management should take full advantage of JAF17 in Kuwait to mobilise new partners and donors, especially from the Middle East region, to contribute to APOC Trust Funds.
b. Strong appeal to national governments to allocate more funding to the onchocerciasis
programme from the national budget, especially now that the programme is moving from control to elimination.
c. Arab philanthropists should be identified in the Region and encouraged to donate to the onchocerciasis programme as was done in Nigeria during the JAF16.
d. APOC management should recruit a competent media person to increase advocacy and
publicity of JAF17.
iv. Partnership:
a. In the spirit of partnership and declaration on harmonization and alignment, there is a need for country leadership and ownership.
b. There must be mutual respect in the partnership. The incidence in the Vina Valley should be
sorted out as soon as possible to avoid possible misunderstanding within the APOC partnership.
v. Advocacy and Success stories:
a. Advocacy for the onchocerciasis programme should urgently be increased at all levels. b. Success stories must be written and disseminated at all levels, both political and technical. c. An experienced and good communication expert should be recruited in this regard.
vi. Conflict and post-conflict countries:
a. DRC and Southern Sudan, must be specifically targeted b. APOC should seek more NGDOs to get involved in these countries. c. Need for more regular cross border/inter-country meeting of these onchocerciasis-endemic
countries. d. Regular inter-country visits by programme managers should be encouraged for the purpose of
sharing experiences.
vii. Co-implementation and Integrated NTD Management:
a. There is an urgent need for a cost-benefit analysis study on integrated NTD control to be carried out. This will allow APOC management to confidently embark on integrated management or co-implementation of NTD programmes.
b. The experiences of Ghana, Tanzania and Uganda, that are already co-implementing will be
useful for future co-implementation efforts.
c. The appointment of an NTD contact person in APOC is welcome and NTD Coordinators/TAs at country level should be encouraged, as should the move to integrated management of NTDs.
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d. APOC Management should implement all JAF16 recommendations.
e. Assistance to countries to do disease mapping should be provided.
f. The mapping of Loa loa in the African region will go a long way to assist the implementation of both Onchocerciasis and Lymphatic filariasis programmes.
89. On behalf of APOC management, Dr Amazigo, thanked the advisors and reiterated the commitment of APOC to implement the recommendations and conclusions to the best of the programme's ability. Joint APOC/MDP mission to investigate SAE management in North and South Ubangi CDTI Project in DRC: Agenda item 18 90. Following the mass distribution of Mectizan in 2009, the Ubangi Nord CDTI Project experienced a number of severe adverse events with 5 deaths. This situation led to a mission conducted in December 2010, to provide assistance to the project in providing better management of SAEs. The project, situated in a zone where access to health facilities is difficult, follows the strategy recommended by MEC/TCC regarding the mass distribution of Mectizan in zones co-endemic for onchocerciasis and loiasis. The project is to be congratulated for the work done and the experience acquired which will help to serve the national Programme. Sensitisation and mobilisation of the population, although well conducted, lacked specific messages on the strong possibility of more SAEs and their management at community level. It was also noted a lack of continuous supervision by the coordination of the project and direction of mobilisation and sensitisation activities of the populations led by nurses. 91. As far as the medical management of SAE cases in 2009, despite the adoption of the MEC/TCC recommendations, there were inadequacies in terms of good and systematic nursing and this was at the heart of the problems that would have led to the deaths in 2009. Cases of deaths from SAEs in 2009 had suffered bedsores after admission in health centres. The standards of health care were insufficient and variable. The absence of systematic nursing files illustrated the problem with nursing that had passed unnoticed by the medical staff. 92. The lack of micro-planning of management of SAEs and of planning meetings at the level of the Health zones also adversely affected the good management of SAEs. The mission proposed that the project continues mass distribution of Mectizan and applies the specific recommendations provided to them in the mission report. It was observed that management of SAEs improved in 2010 with no deaths among the 15 cases of SAEs reported. 93. TCC thanked the team for undertaking this mission and for their report and recommended APOC to resume technical and financial assistance to the project upon implementing the following:
1. Identify high risk zones not yet treated in the Ubangi area and extend to the following areas of DRC co-endemic for Oncho and Loa loa:
Ubangi area - a. Ubangi Nord (ZS Bili, Karawa) b. Ubangi Sud (Bogose Nubea, Tandala, Ndage, Mbaya, Mawuya)
Other areas of DRC: c. Uele (Pawa, Wamba) d. Tshopo (Yahuma, Basoko) e. Ituri (Laybo, Biringi, Rimba, Logo)
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2. Resume the MDA for 2011 according to TCC/MEC guidelines in area co-endemic for oncho and Loa loa: 11 health zones in Ubangi Nord 16 health zones in Ubangi Sud
3. Consider financial assistance to the 2 projects SAE management plan using the action plan for each health zone already drafted by the health zone team and make a provision for: - Motivation for nurses in charge of caring for SAE patients; - Nursing form or nursing record forms (mandatory use).
4. Train all health professionals in the area of the two projects:
- Reinforce the importance of good nursing during the health staff training on SAE management; - Instruct Health services to make a nursing record mandatory for all nurses caring for SAE patients;
a. In health zone and areas: 1. Dr. of the zone 2. Nurses supervisors 3. Director of nursing
b. Referral Centres and hospitals 1. Attending physician 2. Nurses (Inf. Traitant) 3. Lab technician 4. Dietician (Nutritionist)
c. Communities 1. CDD 2. The community leaders
5. Activities timeline: Distribution period based on community schedule 6. Kit of SAE management available in each referral centre and in hospitals 7. Supervision & Monitoring of distribution 8. Logistic use plan 9. Sensitisation & mobilisation of community members
a. Surveillance b. Early detection of cases c. Need to have family support for possible admitted cases (training)
10. Technical support a. APOC and MDP technical assistance b. CBM technical assistance c. DRC PNLO (SAE focal point & technical assistance) d. Temporary advisors
11. System of notification of SAEs (ongoing reporting with communication means ) 12. All the above activities should start in April 2011
94. The committee decided that TCC should also look at the costing and the role of partners who are going to give technical support. Members of the community should also be informed of what they need to do since SAEs generally start in the home. Training of relatives in managing encephalopathy is very important.
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MANAGEMENT OF THE APOC TRUST FUND Report on the financial management of APOC funded Projects: Agenda item 19 95. TCC was provided with an update of the budget approved by JAF16. The total approved budget for 2011 is US $27.585 Million, for the implementation of 118 Projects + 4 ex OCP Countries.
(i) Forecast budget for 116 projects, plus 4 ex-OCP countries for 2011 – US $14,475,570; (ii) As of 1st March 2011 US $13,109,430 of the forecast budget of US $14,475,570 has been
released to projects; this represents 90% of the approved budget; (iii) The funds released to 4 ex-OCP countries in 2010 totalled US $706,417.
96. The meeting was informed of exceptional authorization granted for the release of funds to country/projects during 2011 despite monthly delay in receipt of country/project returns. 100 percent of the expected PABs for subsequent year 2011 PABs were received, reviewed and approved by APOC management. 97. TCC thanked APOC management for the financial update and made the following observations:
(i) With the change from control to elimination and the possibility of an increased rhythm of activities, there is a need to develop a strategy to sensitise financial managers on the negative impact of delayed financial reports on programme implementation and potentially on donor funding;
(ii) TCC noted some improvement in the reporting but encouraged APOC to consider the
problem of late financial returns on a country specific basis;
(iii) TCC recognised the need to collaborate and communicate with high level management in the MOH concerning delays in submission of financial reports so that sanctions could be put on officers not submitting their returns;
(iv) TCC proposed continued training of financial clerk as well as an attempt to inculcate a
culture of reporting.
Report on the review by the APOC Management of 1st, 2nd, 3rd, 4th, 5th, 6th and 7th, 8th, 9th, 10th, 11th and 12th year progress reports and subsequent year’s budgets: Agenda item 20 98. TCC members were informed that as of 8/3/2011, 116 out of the expected 118 PABs had been received, treated and DFCs prepared for them. There were no PABS under review and finalisation, while 2 PABs had either not been received or were for projects not launched. 99. A total of 611 monthly returns were expected as of 28/2/2011 but only 202 had been received, 409 (67%) were pending. 100. Major highlights:
(i) It was also noted that financial certification was achieved for 9 countries and significant progress made on training on new financial procedures (project teams and NGDO personnel).
101. TCC Conclusions:
(i) With regards to the four ex-OCP countries currently supported by the APOC Trust Fund, TCC recommends that funding should not stop in 2012 as originally decided but should continue until 2015 because these countries are still in need of support;
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(ii) Efforts should be made to find a way to inform higher levels at the ministry of the funds provided by APOC;
(iii) In view of the shift from control to elimination, there is also a need to consider support for
the other ex-OCP countries. Review of new Project Proposals and 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th and 11th year Annual Technical Reports on the implementation of CDTI and Vector elimination projects. Recommendations on the 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th and 10th year implementation of projects: Agenda item 21 Introduction to the review exercise: Summary budget of operational research proposals submitted. 102. Seven operational research proposals were received by APOC management for review and the budget requested per country was as follows:
Nigeria (5) US $70,430 Uganda (1) US $20,400 Cameroon (1) US $19,469
Total US $110,299 REVIEW OF ANNUAL TECHNICAL REPORTS BURUNDI Bururi CDTI Project (Burundi) 5th year Annual Technical Report 103. The recommendations of TCC30 have been satisfactorily addressed. Overall, the report is well presented. 104. They should avoid creating too many tables, but instead follow the numbering format of APOC as this will facilitate the review by TCC. The ratio of CDDs to the population treated is good. Efforts at mobilisation are remarkable. One of the challenges of this project is the strong rate of absenteeism (21,368 people) in the town of Rumonge. The financial contribution of the State is still too low (US $1,623 released in 2010 from a provisional budget of US $18,320). 105. TCC encourages the project team to continue with its efforts and accepted the report with the following recommendations and suggestions for improving project implementation: Project related:
(i) Include a geographical map indicating the location of the project; (ii) Give more precision on the quantity and the quality of human resources; (iii) Be more precise with the annual training objectives; (iv) Do not put tables in the analytical summary; (v) Respect the format of APOC, especially regarding the numbering of tables; (vi) Give precise information on the actions taken to reduce the still too high level of
absenteeism in Rumonge. Is it possible to consider door to door treatment?
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Cibitoke-Bubanza (Burundi) 2010 6th year Annual Technical Report 106. The Project is in a good state, clearly well led, in terms of the principles and methodology of CDTI, and in a spirit of integration that is translated into action. The results are well analysed and suggestions are put forward to solve the weaknesses that have been identified. This project is well positioned for future studies on the feasibility of elimination. The points calling for compliments or solutions are underlined in the table. 107. TCC accepted the report with the following recommendations and suggestions for improvements that should be provided in the next report:
(i) A detailed presentation of the sustainability plan should be included, which will give, in a
more useful way, the results and observations coming from community self-monitoring, from the evaluation of sustainability and updated data;
(ii) An exhaustive presentation of the problem of “motivation” of CDDs and of solutions envisaged;
(iii) A presentation of the prospects of extension of the integration of other community programmes, including the methods for joint evaluation of results of activities already in progress.
Rutana CDTI Project (Burundi) 5th year Annual Technical Report 108. The report is well written providing ample details concerning the sustainability plan, the recommendations identified and their implementation. It is a project at an international border and must therefore address cross-border problems. The project is to be congratulated for the ratio of CDDs to community members (1:152) and for the strong participation of women CDDs. 109. TCC accepted the report with the following recommendations and suggestions for improving project implementation: Report related:
(i) Provide complete and coherent information regarding the sustainability plan and its recommendations;
(ii) Re-do tables 10 and 16; (iii) The project should address discrepancies in the funding and the status of equipment that
was reported; a vehicle was provided by APOC in Sept. 2005.
Project related: (i) Continue to intensify advocacy to obtain the means of transport for co-implementation
from a source other than APOC; (ii) Improve therapeutic coverage to at least 80%.
Recommendation to APOC:
(i) APOC management should show cross-border areas that are of concern at the next TCC meeting and provide a working paper to TCC indicating what CDTI activities are taking place on either side of the border, especially with respect to elimination.
CAMEROON Adamaoua 1 CDTI Project (Cameroon) 6 th year Annual Technical Report 110. The report is well written. The project has improved progressively with respect to certain indicators (notably the increase in numbers of CDDs, and the ratio of CDDs to the persons treated). The increase in release of funds from the financial contribution of the Government is commendable. TCC congratulates them for it.
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111. TCC accepted the report with the following recommendations and suggestions for improving project implementation: Project related:
(i) Give more precise information on the results of advocacy; (ii) Indicate the measures envisaged for the treatment of 30 nomadic Bororo communities; (iii) Check the percentages given and the ratios on pages 16 and 19; (iv) Give more details on the sustainability Plan which had been announced for January 2010 in
the preceding report. East Province CDTI Project (Cameroon) 6 th year Annual Technical Report. 112. This project has developed a sustainability plan. The numerous recommendations are being progressively implemented. It is now necessary to address these recommendations and evaluate their implementation regularly, with a view to being able to demonstrate elimination of onchocerciasis in this zone. The rates of therapeutic coverage are good. One of the very important challenges remains getting the communities to take effective responsibility for CDTI, notably at the level of community supervision. The report is well written. 113. TCC accepted the report with the following recommendations and suggestions: Recommendations to the PLNO:
(i) Explain the reduced number of health staff involved in CDTI; (ii) Readjust the dates for the calendar of activities on pages 12 and 13; (iii) Give more precise information on the outcome of community mobilisation; (iv) Give justification for the training being planned from 2010 to January 2011; (v) Give precise financial information enabling the cost per treatment to be evaluated.
Far North Province CDTI Project (Cameroon) 6 th year Annual Technical Report 114. This report was well written allowing the indicators to be used to evaluate the project’s performance. Although the project exists in an area with seasonal movements of the population for economic reasons, the rate of absenteeism is well controlled. 115. TCC accepted the report with the following recommendations and suggestions: Report related:
(i) Mention the currency used in Tables 13a, b, c; (ii) Complete and add the Table of expenditure for the year of the Report.
Project related:
(i) Implement and follow-up the recommendations of the Sustainability Plan and document the experiences of implementation.
South Province CDTI Project (Cameroon) 6 th year Annual Technical Report 116. The report is succinct, clear and exhaustive with few errors and little need for supplementary questions. Despite the difficulties of the environment, the project’s progress in all domains is very clear and has resulted in particular in the continued improvement of community participation and of coverage. The project seems well grounded, with a good likelihood of following up this success; the weak areas, where inadequacies or threats have been identified, analysed and solutions proposed. This efficient management in a focus presenting all the difficult factors characteristic of sub-equatorial forest areas may serve as a model for other similar projects in APOC countries.
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117. TCC accepted the report with the following recommendation:
(i) Take precautions with newly treated patients because some SAEs could appear even after the sixth year.
COTE D'IVOIRE Cote d'Ivoire CDTI Project (Comoe, Bandama, Sassandra, Cavally and their affluents) 3rd year Annual Technical Report 118. For the second time, the report contains partial data: the treatment results for three districts are missing and they are incomplete for 19 other districts over a total of 54 included in the CDTI. This is due to the unrest in the country during the pre-election period at the end of 2010. 119. The report is well written and shows a good control of the strategy by the project coordination but its presentation should be in line with standardized norms to facilitate its evaluation. 120. The CDTI progress is noticeable in terms of the mobilization of authorities, understanding and populations’ support, thanks to an intensive sensitization and supervision activity. The progress is slow because, from the second year, the project was extended to the entire country and also because of the unequal quality of first line health services, and the poor integration of CDTI in the periphery that require a continuous training and supervision effort. 121. The continuation of epidemiological and entomological surveys is highlighted and encouraged, particularly in the north and north-east border areas. It is recommended to take an interest in the progression of blinding onchocerciasis and its savanna vectors in the forest area of Côte d’Ivoire. 122. APOC Management, in collaboration with the coordinator of the project, should examine the possibility of collecting the missing data, develop and analyze a report that is complete, and think of the possibility of adopting a report submission calendar compatible with the conditions of the implementation of CDTI. NB: this report was evaluated despite the fact that it was incomplete, due to the exceptional situation in Côte d’Ivoire that considerably hampered the CDTI exercise in 2010. 123. TCC accepted the report with the following recommendations and suggestions :
(i) A special attention should be paid to cross-border areas between Côte d’Ivoire and Ghana, and
between Burkina Faso and Côte d’Ivoire ; (ii) Ghana will coordinate the activities with the National coordinators of the neighboring
countries and will report to TCC ; (iii) TCC accepted the report as a partial report, while expecting a complete report to be
forwarded to them. 124. TCC reaffirmed its support to the colleagues in Côte d’Ivoire in light of the current situation of social unrest.
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DEMOCRATIC REPUBLIC OF CONGO Ituri CDTI Project (DRC) 4th year Annual Technical Report 125. This project, in its 4th year of APOC financing and third year of Mectizan distribution, has no NGO partner. The project is to be congratulated for having reached 81% therapeutic coverage. In general the report is well written allowing the performance of the project to be appreciated. 126. TCC accepted the report with the following recommendations and suggestions: Report related:
(i) Keep the summary succinct and avoid repetition. The summary should be coherent with the rest of the text, if an issue has not been described in the text it should not appear in the summary;
(ii) Complete table 5 as indicated; (iii) Provide more information on the operational research (quarter or half a page); (iv) Provide figures on the treatments for additional interventions such as LF and soil-
transmitted helminths; (v) State the objectives expected to be reached.
Project related: (i) Intensify advocacy for financial contributions and their effective disbursal; (ii) Maintain the minimum of 80% therapeutic coverage; (iii) Conduct CSM; (iv) Submit a plan of sustainability to APOC; (v) Continue advocacy to look for the support of an NGO partner in DRC; (vi) On the issue of population increase, bring this to the attention of the project and ask them
to give the UTG.
Kasongo CDTI Project (DRC) 5th year Annual Technical Report 127. This is a project in its 5th year of APOC financing and which has distributed ivermectin 4 times. 128. TCC accepted the report with the following recommendations and suggestions for improving project implementation:
Project related:
(i) Increase geographic coverage to 100% and therapeutic coverage to a minimum of 80%; (ii) Repair the vehicle and motorbikes.
Report related: (i) Include a table showing the villages sampled indicating the level of prevalence; (ii) TCC strongly requests that all precautions should be put in place to manage SAEs.
Katanga-Nord CDTI Project (DRC) 6 th year Annual Technical Report 129. The Report is well written and well presented with many graphs and photos. The authors have made efforts to analyse the information in order to explain the data and trends observed. However, there are details which are perhaps not necessary. The report may be reduced to the essential elements. The CDTI project is characterised by a linear improvement in performance over the years despite the distances that have to be covered. Overall, the project has shown good performance.
(i) Good rates of therapeutic and geographical coverage; (ii) Satisfactory involvement of women in CDTI;
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(iii) Good ratio of CDDs to the population to be treated.
130. TCC accepted the report with the following recommendations and suggestions for improving project implementation: Project related:
(i) Improve the financial contribution of the Government for CDTI; (ii) Improve the rates of release of the budget which has been allocated; (iii) Conduct CSM in the third district; (iv) Put in place some operational research projects, particularly to investigate reasons for
absenteeism and the low therapeutic coverage in DRC; (v) With regards to an NGDO partner it was noted that Lions Club commitment to support the
project for 5 years is coming to an end as this is the 5th year. The Committee underscored the need for the project to look for a new NGDO if possible, perhaps for NTD co-implementation.
Recommendation to APOC:
(i) TCC requested APOC to provide maps of the areas of co-endemicity of Onchocerciasis and Loa loa before the presentation of reports of projects that are in these areas.
Katanga-Sud CDTI Project (DRC) 5 th year Annual Technical Report (re-submission) 131. The report is well written, concise and clear. The authors have taken note of the recommendations of TCC and corrected the inconsistencies that caused the previous report to be rejected. The performance of the project is average with low rates of therapeutic coverage; the treatment is done at a period which is not convenient for the population; CSM has never been undertaken. There are, nonetheless, some positive facts, such as the strong involvement of women in CDTI, a female coordination team; the ratio of 1 CDD to 143 persons treated; the support of the provincial government and the release of the whole budget allocated by the State. 132. TCC accepted the report with the following recommendations and suggestions: Report related:
(i) Fill correctly the table giving the UTG; (ii) Indicate precisely the stocks of drug left over from previous MDA campaigns; (iii) Give precise information on whether the human resources available are adequate for
implementation of the programme; (iv) Indicate the contributions of communities to CDTI.
Project related:
(i) Improve therapeutic coverage; (ii) Plan activities for the periods which are most convenient for the population; (iii) Start the process of CSM and evaluation of sustainability; (iv) Multiply initiatives for co-implementation and integration of CDTI in PHC System; (v) Reinforce advocacy to attract an NGO partner; (vi) Take advantage of the presence of the School of Public health to initiate operational research
activities. Katanga Sud CDTI Project (DRC) 6 th year Annual Technical Report 133. This CDTI project has been financed for 6 years by APOC but is only in its 4th year of mass distribution of ivermectin. The project is situated at the frontier with Tanzania and Zambia. The project is to be congratulated for having reached a geographical coverage of 100%. The report is well written with all the elements necessary for the review being clearly provided.
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134. TCC accepted the report with the following recommendations and suggestions: Project related:
(i) Maintain the good performance indicators, especially: • The ratio of CDDs to the population to be treated; • Improve participation of women CDDs to more than 35%; • Improve therapeutic coverage to more than 80%; • Extend CSM to all the communities; • Continue advocacy for vehicles and motorbikes and other equipment; • Intensify advocacy towards having oncho activities included in the Development Plans for
the Province.
Recommendation to APOC: (i) APOC should provide advice on the zone to refine the information on REA and RAPLOA as
this is a project on the border with other countries (Zambia and Tanzania). Rutshuru-Goma CDTI Project (DRC) 4th year Annual Technical Report. 135. The report is well written, concise and understandable. The project’s performance is average with low rates of therapeutic coverage; a low ratio of CDDs to inhabitants and treatment which is carried out at periods which are not convenient to the populations. 136. TCC accepted the report with the following recommendations and suggestions: Report related:
(i) Respond to all sections of the report format, even when there have been no activities by giving reasons for this;
(ii) Give precise information concerning the stocks of drug remaining from previous years' distribution campaigns.
Project related: (i) Reinforce advocacy to obtain a significant financial contribution from the State; (ii) Improve treatment coverage; (iii) Improve the ratio of CDDs to inhabitants; (iv) Plan distribution activities for periods more convenient for the populations; (v) Extend activities for CSM and sustainability; (vi) Initiate activities for co-implementation and integration of CDTI with NTD control.
ETHIOPIA East Wollega CDTI Project (Ethiopia) 6 th year Annual Technical Report 137. The report seems to have been prepared in a hurry and this has introduced some errors into the calculations. Also, vital information required to evaluate performance, especially after the project has had a sustainability evaluation was missing. This makes it difficult for reviewers to assess performance. It is recommended however that this report be accepted because CDTI activities seem to have been carried out but the report should provide missing information. 138. TCC accepted the report with the following recommendations and suggestions: Report related:
(i) The report should be rewritten, to provide missing information on advocacy; (ii) The level of implementation of post sustainability plans and other missing information in the
report should be provided.
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Gambella CDTI Project (Ethiopia) 6 th year Annual Technical Report 139. Although the project is doing well, one gets the impression of a lack of seriousness in report writing. Otherwise, this is a fairly small project that is doing well in spite of challenges of remoteness and few health workers in the project area. 140. TCC accepted the report with the following recommendations and suggestions: Report Related:
(i) Reporting period is January to December not January to September; (ii) Include reasons and outcome of advocacy; (iii) Comment on the use of the media; (iv) Comment on community response to sensitisation and mobilisation; (v) Provide information on refusals and absenteeism (Table 7); (vi) Provide information on wasted and expired drugs. If none, please fill in zero in the table.
Project Related:
(i) Training on how to conduct CSM; (ii) Improve on Male: Female CDD ratio; (iii) Replacement of equipment following 5th year sustainability evaluation; (iv) Need for timely release of APOC trust fund; (v) Need for internal monitoring by NOTF; (vi) Implement sustainability plans and report progress in subsequent Annual Technical Reports; (vii) How could the migratory populations be reached with ivermectin? It is suggested that the
project team learns from an operational research study of nomads and ivermectin conducted in Nigeria to help them reach 80% therapeutic coverage.
Recommendation to APOC:
(i) The report of Operational research undertaken in Nigeria on ivermectin treatment for Nomads should be shared with other Projects as it could provide advice on dealing with similar situations.
West Wollega CDTI project (Ethiopia) 6 th year Annual Technical Report 141. This is an acceptable report. The team has maintained high coverage and should be encouraged. The CDD: population ratio of 1:94 should also be commended and the project is encouraged to maintain this performance. 142. TCC accepted the report with the following recommendations and suggestions:
Report related:
(i) Table 2 is incomplete (this was the case with the previous report); (ii) Table 5 is also incomplete; (iii) Address the contradiction between 4.1 and 4.2 – was sustainability evaluation done or not?
Project related:
(i) Address the high number of absentees in Wabera, Kebe and Horo; (ii) The team should conduct CSM – although people were trained no activity was implemented; (iii) All supervisors should use the supervision checklist. Mechanisms should be put in place to
ensure that this is done; (iv) The team should be encouraged to undertake Operational Research by taking advantage of
resources available through APOC.
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Recommendations to APOC: (i) There is need to replace the equipment if this has not been done; (ii) Provide information to the programme team on the availability of OR funds; (iii) Ensure timely release of funds; (iv) Clarify issues regarding exchange rates with the team.
GHANA Ghana CDTI Project 2nd year Annual Technical Report 143. The Ghana Project has made impressive gains over the last three years. Overall geographic and therapeutic coverage rates are close to recommended targets of 100% and 80% respectively. The project is carrying out two rounds of treatment to improve on coverage rates but there is need to reschedule timelines for the first and second rounds. The interval is too short between the two rounds, which will have implications for quality. 144. TCC accepted the report with the following recommendations and suggestions:
Project related:
(i) Follow through with CSM and SHM activities at community level, (ii) Put a sustainability plan in place.
LIBERIA South-East CDTI Project (Liberia) 5 th year Annual Technical Report 145. The project has achieved 100% geographical coverage and therapeutic coverage over the 80% threshold (82%). It is likely that there would be a good chance of higher coverage rates if distribution was done in the dry season. The Project should give due attention to the quality of training delivered to CDDs and to sustainability issues. 146. TCC accepted the report with the following recommendations and suggestions: Report related:
(i) Cross check and correct the following errors: • Calculation of the percentage of communities with members who are CDTI
supervisors (511 out of 639= 80% and not 69%); • Calculation of total numbers of CDDs; The total based on the figures given =1749 and
not 750. Project related:
(i) Increase efforts to reduce the number of communities with less than 80% therapeutic coverage, especially in Grand Gedeh and Sinoe Counties;
(ii) Improve the quality of training of CDDs; (iii) Pay attention to sustainability issues.
South-Western CDTI Project (Liberia) 5 th year Annual Technical Report 147. Compared to previous reports and performance, the project has made a lot of improvement in both reporting and project performance. The increase in geographical coverage, increase in the number of health staff trained in CDTI and the implementation of internal monitoring are all commendable accomplishments. 148. TCC accepted the report with the following recommendations and suggestions:
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Report related: (i) Table 2: reconcile the sum of meso and hyper-endemic population with the total meso and
hyper-endemic population; (ii) Explain the increase in the number of communities from 1267 (previous year) to 1449 in the
current year; (iii) Report on the outcome of advocacy meetings; (iv) Report on the implementation of the recommendations of internal monitoring by NOTF in the
next annual technical report; (v) Give details of the correct figures for the population numbers and for details of Mectizan
tablets, requested, supplied, used, lost and remaining. Cross check because the report states that 5 million tablets were asked for – 1.5 million were provided and 3.25 million were used.
Project related:
(i) Train more health staff in CDTI and aim for 100% coverage; (ii) Increase the number of communities with community supervisors and improve the Male:
Female CDD ratio; (iii) Improve on the CDD to population ratio and aim to achieve 1 CDD to 100 population; (iv) Streamline the ordering of drugs to tally with the need of the project; (v) Conduct CSM and SHM training; (vi) Repair/replace the project vehicle and motorcycles; (vii) Carry out the fifth year sustainability evaluation; (viii) Implement recommendations of the internal monitoring and report progress in the next
meeting. NIGERIA NOCP/HQ (Nigeria) Project 12 th year Annual Technical Report 149. The project responded to all concerns raised by TCC29 and the TRC of Nigeria by the following:
(i) They increased supervision on individual projects – coordinated the work, and held many advocacy meetings;
(ii) Increased number of CDDs by 43% (from 110,710 to 158,684); (iii) Zonal coordinators now attend TRC; (iv) Visited most projects to assess sustainability plans.
The Coordinating Role of HQ:
150. This is evident from the report with a number of meetings with NOCP, UNICEF and other NGDOs with government state and LGs officials. This has strengthened the good working relationships of the project with different partners, yet the government’s release of counterpart funding is still below the required level.
Therapeutic Coverage (TC):
151. The report gives the treatment indices of all 32 projects. Though generally good, therapeutic coverage is still below the 80% mark in 13 projects. The NOTF should encourage these projects to raise the level to 80%. The UTG should be recalculated yearly to cover all the population to be treated. The quoted UTG is below the treated population – reasons to be given (26,704,224 vs 25,449,249). It is of concern that 5 projects have not reached the 100% geographical coverage. Effort should be made to look into the reasons for this failure.
CDDs:
152. Despite an increase in CDDs training the ratio of CDDs to population is still high at 1:285.
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TRC:
153. Review of projects in country has been a successful exercise in Nigeria. This should be encouraged and strengthened. This, in addition to the review meeting, should improve performance.
Participatory monitoring:
154. None done in any of the 32 projects.
Co-implementation / Integration:
155. There is little information on the co-implementation. The map showing areas of integration in plateau and Nassarawa (Carter Center assisted projects). It is known from publications and newsletters that good activities on integration are taking place. This should be repeated and analysed by HQs. Up-scaling if successful should be encouraged. Moreover, the HQ is not showing any steps towards elimination, especially some of the projects are being studied with Community MFS studies. Such activities should feature in the HQ reports. 156. TCC accepted the report. SIERRA LEONE Sierra Leone CDTI Project 4 th year Annual Technical Report 157. This report was well-written. A few errors are noted below which should be addressed by the team. 158. TCC accepted the report with the following recommendations and suggestions: Report related:
(i) Harmonise the fonts in the report; (ii) Complete table 13 on finances (there are inconsistencies that should be addressed); (iii) Although the team ticked the space for “5-year sustainability plan” – this is a 4th year report –
this should be corrected. Project related:
(i) Intensify advocacy and provide a more informative report on advocacy activities (e.g. how many people were reached and the outcomes);
(ii) Train village supervisors; (iii) Find mechanisms of encouraging women’s participation in CDTI activities – the proportion of
female CDDs should be increased; (iv) Increase therapeutic coverage to over 80%. Currently, apart from Kenema all districts are
below the recommended coverage; (v) Feedback from supervision should be channelled to reach the communities and frontline health
facilities; (vi) Train communities and conduct CSM.
159. TCC noted that capital equipment for the project is being replaced.
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SUDAN East Bahr El Ghazal CDTI Project (Southern Sudan) 5 th year Annual Technical Report 160. The post-conflict situation of this country has a negative influence on project operations as evidenced in integration, sustainability, community involvement, HR capacity and changes in project boundaries. The project is however, making steady progress. 161. TCC made the following recommendations and suggestions for improving the Project: Report related:
(i) The Report must be endorsed by all partners as required; (ii) Indicate the source of population figures; (iii) Table 3 on population census data is not clear. It is indicated that an update of the census was
not carried out and yet dates are provided. Project related:
(i) Submit a research proposal on CDD attrition as recommended by TCC29; (ii) Attract more NGDO partners – e.g. from Sightsavers, Carter Centre, World Vision; (iii) Train all existing health staff in CDTI; (iv) Train more females as CDDs and as Community Supervisors; (v) Investigate the lower coverage rate of Tonj County and take corrective action; (vi) Seek for creative ways of reaching pastoralist communities (e.g. mobile CDDs, collaboration
with health facilities in areas they migrate to); (vii) Continue improving geographical coverage to reach 100% and therapeutic coverage to reach
80%, as required by APOC; (viii) Conduct a year 5 sustainability evaluation; (ix) Fill the two vacant post of County Oncho Supervisors.
162. TCC accepted the report. East Equatoria CDTI Project (Southern Sudan) 4 th year Annual Technical Report 163. This is a concise and well written report showing the consistent commitment of project implementers through advocacy, innovation and community engagement. 164. TCC accepted the report with the following recommendations and suggestions:
Report related:
(i) Project should ensure that reports are endorsed by the relevant partners; (ii) The Project should clarify why Table 7 of the report indicated that no one was absent but 2.6.2
gave reasons for absenteeism. The same applies to reporting on refusals; (iii) Crosscheck the total population of Torit County in columns 7 and 8 of table 2; (iv) Explain how annual training objectives for Health centre/post staff trained were determined in
order to explain 226.8% achievement over the set target. Project related:
(i) Sustain advocacy for absorption of CDTI staff and CDTI into the Health service system; (ii) Ensure early commencement of distribution to allow for high coverage and reduction in the
length of the distribution period; (iii) As earlier recommended by TCC 30, conduct operational research on whether or not a kindred
system exists in the project and possible use of it in CDD selection and distribution.
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Recommendation to APOC: (i) APOC should consider the replacement of the project vehicle and motorcycle for improved
monitoring and supervision.
Upper Nile CDTI Project (Southern Sudan) 4 th year Annual Technical Report 165. This is a well written report. The team has responded to the issues raised by TCC 29 and therapeutic coverage has gradually increased from 13.5% at the inception to the current level of 56.1%. 166. TCC accepted the report with the following recommendations and suggestions:
Project related:
(i) Efforts should be invested in increasing the proportion of health staff involved in CDTI activities. This is essential given the increasing number of community members due to the changes in the political structures;
(ii) Increase the training of CDDs to meet the increasing population and to reduce the ratio of CDD to population (1:344);
(iii) Suggestions made in this report on improving sensitization (e.g. use of churches and training of county-level supervisors) should be put in practice;
(iv) Plan for OR and take advantage of the financing possibilities at APOC; (v) Continue advocacy activities with the government to ensure the recognition of CDTI and its
eventual inclusion in the PHC. Recommendation to APOC:
(i) Plan for and implement sustainability assessment (this was supposed to be done at the end of year 3 of implementation).
West Bahr El Ghazal CDTI Project (Southern Sudan) 4 th year Annual Technical Report 167. A well written report which shows commitment of programme implementers evidenced in improved programme performance especially in treatment coverage but poor Government commitment. 168. TCC Accepted the report with the following recommendations and suggestions:
(i) Provide information on Government financing; (ii) There is a need for participatory monitoring of the project since it is already in year 4; (iii) Train more CDDs to reduce CDD :Community ratio; (iv) Improve community participation through CSM and SHM; (v) APOC should consider the possibility of having 2 additional staff working as focal persons for
North Bahr El Ghazal and Warrap and both these should report to the project coordinating officer based in West Bahr El Ghazal state. The option of having 3 separate CDTI projects instead of having a single huge one can also be explored for better programme management and supervision.
West Equatoria CDTI Project (Southern Sudan) 5 th year Annual Technical Report 169. The project demonstrates a steady progress in its 5 years of operation. The attainment of Geographic Coverage (GCR) of 100% in a post-conflict situation is especially commendable although the Treatment Coverage (TCR) is still lagging behind. No financial contribution from the government and this is likely to continue being the case for the foreseeable future given the challenges in Southern Sudan. 170. TCC accepted the report with the following recommendations and suggestions:
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Report related: (i) The section on supervision (2.9) is copied and pasted from the East Bahr El Gazal report or
vice versa. This is not acceptable; (ii) Financial data for 2008 and 2007 of exactly the same which is unlikely. Please confirm if this
is the case and if not, provide accurate data; (iii) Report on independent participatory monitoring under section 4.1 and not under section 6. (iv) The report must be endorsed before submission to APOC.
Project related:
(i) Implement TCC29 recommendation to conduct census; (ii) SSOTF to approach and interest other NGDOs to join in and support oncho activities; (iii) Increase the number of health staff involve in CDTI and follow up on the plan to involve
school teachers, youth groups, women groups; (iv) Follow up the decision to absorb the project coordinator and other CDTI staff into government
employment; (v) CDD: population ratio is still high. Train more CDDs and seek creative ways to address the
problem of CDD attrition; (vi) Investigate and address the issue of high refusals; (vii) Report on the recommendations of the independent participatory monitoring and report on
progress on implementing the recommendations; (viii) Conduct 5th Year Sustainability Evaluation.
SSOTF Project (Southern Sudan) 4th year Annual Technical Report 171. The performance of this project has improved significantly. Before 2008, geographical coverage ranged from 3 to 27%. There was a steep increase in geographic coverage to 69.8% in 2008 and to 87.7% in 2009. Even though therapeutic coverage is only 54%, the prospect for further improvement looks good. 172. The decision by APOC to appoint a Technical Adviser for South Sudan is yielding results. Recommendation to the SSOTF:
(i) Put mechanisms in place so that projects send financial returns to APOC on time. This will facilitate the release of funds early enough to allow drug distribution to take place during the dry season.
173. TCC accepted the report. TANZANIA Morogoro Focus CDTI Project (Tanzania) 6 th year Annual Technical Report 174. This was a well written report reflecting successful implementation of CDTI activities. Community involvement in supervision is impressive. Significant progress has been achieved in integration, gender balance and funding by Government and other partners. It is noteworthy that attrition is low despite the lack of monetary incentives. 175. TCC accepted the report with the following recommendations and suggestions:
Report related:
(i) Provide information on: • The reasons for, and outcome of, advocacy; • The UTG; • The number of tablets remaining;
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• The cost per treatment; • The CDD population ratio; • The Male:female CDD ratio; • Monitoring and evaluation.
Project related:
(i) Train all health staff in project area on CDTI; (ii) Retrain all involved in CDTI on record keeping; (iii) Upscale CSM and SHM; (iv) Conduct Operational Research on some of the challenges; (v) Implement sustainability evaluation plan.
NOTF/HQ Project (Tanzania) 11 th year Annual Technical Report General comments: 176. The CDTI reporting format has been used although the NOTF/HQ should report activities of coordination of CDTI, like Advocacy at Federal Level, problems generally facing most (all) programmes or project under their (HQ) wing, sustainability of Mectizan procurement and distribution and issues of this nature. It is suggested that TCC should advise on an NOTF/HQ format. 177. In the report, Tanzania HQ tried to summarise each project individually which, whilst informative, is redundant as it will appear on each project's CDTI report. 178. Questions not relevant to the NOTF/HQ include:
(i) What are the causes of absenteeism and refusals? These may be different between Tanzanian CDTI projects;
(ii) Has any CSM been done in the project area? (iii) The equipment under Section 3: Support to CDTI. As it is not a CDTI project, should they
report on equipment of all CDTI projects or only the NOTF? (iv) The NOTF Report should provide an overall summary of what the CDTI projects are doing.
Review of the Report: 179. Follow-up on TCC recommendations. Although they filled the response column, despite repeated requests from TCC, there is still no compliance on certain concerns e.g. in the recommendation from TCC 28. “Ensure that the TCC format is not altered”; the same also appears in TCC 31. 180. Other responses to some TCC recommendations were not convincing e.g. to the request to explain why the UTG is higher than the total population. 181. Similarly the response to the TCC recommendation: “Conduct a census” Response: Is the census done by CDDs? There is a change in the figures for the total population. This was unsatisfactory.
(i) Therapeutic coverage was mostly above 80%, however, no percentage UTG was given in the
Executive Summary. The total population of all 17 CDTI project areas varies from one year to the other. It reached 2,111,847 in 2006 fell thereafter: Reasons to be given. Between 2009 and 2008, there was a swing of 221,718 which was not satisfactorily, explained. Census is said to be done by CDDs every year!
(ii) Table 2.6.5 does not show the number of persons treated each year except for 2009 (Data
should be provided). The table on page on Mectizan does not give clear information on where Projects requesting Mectizan get it from (Kilombero to Ileje).
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(iii) Mectizan and other drugs for NTD control are now ordered by the National Lymphatic Filariasis Elimination Programme What is the role of the NOTF HQ?
(iv) The number of tables required = ATO x 2.2, why 2.2.?
182. The NOTF is responding to recommendations of TCC 28 and 29 with delays. The Project should explain these delays related to changes in management at the NOTF. They are not responding to TCC recommendations in a way that clarifies the questions of TCC reviewers. Other observations:
(i) Female CDDs are almost equal to male CDDS. The NOTF should be congratulated (Refer to table 6).
(ii) What is meant by LF, STH, and Trachoma when they come under the column headed “Type of training”, and when CDD or health workers were ticked (√) does this mean they were given all types of training?
(iii) What would political leaders benefit from training in data collection or CSM? Intervention by Dr Nanai 183. The National professional Officer for Tanzania, Dr Nanai, was allowed by the TCC Chair to make an intervention in support of the NOTF Report as follows:
a. Onchocerciasis control in Tanzania is implemented through 7 APOC supported CDTI projects which
have been operational in the country in phases since 1997. These projects have been serving more than 4,500 oncho-endemic communities found in 17 districts and 5 regions of the country.
b. Tanzania embarked on NTD co-implementation in 2009. The first phase of co-implementation
began in the 5 APOC supported regions through APOC and USAID funding. Co-implementation expanded from distributing ivermectin only in oncho-endemic communities to multi-drug distribution for other Preventive Chemotherapy (PCT) targeted diseases including lymphatic filariasis, schistosomiasis, trachoma and soil-transmitted helminths in all communities in both the onchocerciasis-endemic and non oncho-endemic Districts of the 5 regions.
c. This expansion is coordinated through the integrated NTD country programme with NTD
coordinators at all levels. The NOTF and disease specific managers and officers form part of the integrated secretariat. Activities co-implemented include, among others, advocacy, training, community drug administration through CDI, supervision and data collection. A report is submitted to APOC every year through the NTD Coordinator, MOHSW. Some of the missing information noted by TCC in the NOTF report was submitted to APOC and USAID through the integrated NTD reports for 2009 and 2010.
d. Dr Nanai requested TCC to review this additional report from NTD in this meeting and allow
submission of an integrated report involving NOTF/NTD activities in future TCC reviews. Recommendation: 184. TCC requires a supplementary report on the progress with co-implementation from countries in which the APOC Trust Fund has invested funds for expanded co-implementation rather than having a new format. TCC should insist on using headquarters format. They should be describing what HQ are doing and giving an overview of all the projects. 185. TCC agreed to accept the NOTF report.
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Review of the 7th, 8th, 9th, 10th, 11th, and 12th year Annual Technical Reports CENTRAL AFRICAN REPUBLIC (CAR) CAR CDTI project 9th year Annual Technical Report 186. The report is better written than in March 2010. There is less inconsistency in the data. The coordination team gave acceptable responses to the recommendations of TCC 31. 187. Nonetheless, the performance of the project is very weak. The report has been written and endorsed only by the Coordinator. As in March 2010, the results presented are very incomplete because not all the treatment reports were yet available to the National Coordination team. This time the reason is that general elections disturbed the collection of treatment reports from the villages; in 2010, this was due to the problem of insecurity. The coordinator thought that in February 2011, after the elections, all the reports would have come to the National Coordination and that a definitive report would be provided to the next APOC TCC meeting. 188. TCC recommended that the report be rewritten and the final report to be submitted to TCC in September 2011. CHAD Chad CDTI Project 11 th year Annual Technical Report 189. The report is well written and detailed. The essential elements for understanding the situation are presented in the analytical summary; the addition of a map of the country with the CDTI zone being indicated would, however be appreciated. 190. The project in its 11th year covers 7 Regional Health Areas (there are a total of 22 in the country), 19 districts, 246 health zones and 3250 villages. The Total population is 1,905,121 people. 1,542,377 people were treated in 2010 by 14,201 CDDs (a ratio of 1CDD/108 persons treated). The average therapeutic coverage was 81% (this has been stable for 3 years); 13 health districts (out of 19) have a therapeutic coverage equal to or greater than 80%. No refusals have been notified. 191. Numerous training activities have been implemented at different levels: district health workers, FLHF/health centre health workers and CDDs. 188. Sensitisation has been a major activity with 17 radio broadcasts, publicity banners, T-shirts and town criers. Thanks to the support from APOC, 3 supplementary activities were undertaken in 2010: a trans-boundary meeting, collection of community data, NTD mapping. There has been very good financial contribution from the Government. There is good integration of CDTI in the health system and CDDs have been engaged in other programmes. The presence and availability of a Technical Adviser added to the strength of the Project. 189. TCC congratulates the Project for the financial contribution of the Government of Chad to the fight against onchocerciasis. 190. TCC accepted the report with the following recommendations and suggestions: Recommendations: 191. With regard to elimination of oncho being envisaged by the country, an effort must be made with regard to some of the indicators:
(i) Provide precise information on the area of the zone covered by the project and include a map showing the project’s position;
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(ii) Check table 4 as the figures of CDDs are not compatible with those in the text or in Table 5; (iii) Check the inventory of drugs and reconcile the figures given with the numbers actually
received; (iv) Re-do the Tables for financial contributions and expenditure so that the headings match; (v) Take action regarding the inadequate numbers of treatment registers; (vi) Encourage all communities to do CSM; (vii) Regularly undertake monitoring and evaluation each year; (viii) Follow-up efforts to maintain a good level of therapeutic coverage.
CONGO Congo Extension CDTI Project 7 th year Annual Technical Report 192. The report is well written, concise, understandable and well presented. The authors have done much interesting analysis to explain the data and the trends observed. Overall, the Project has performed well.
(i) Good rates of therapeutic and geographical coverage; (ii) Good integration in the health system; (iii) Satisfactory involvement of women in CDTI; (iv) Good involvement of community leaders.
193. The coordination must continue its efforts to:
(i) Improve the rates of release of Government funds allocated to the project; (ii) Conduct CSM in the communities; (iii) Accelerate the process of co-implementation.
194. TCC accepted the report. Congo CDTI Project 10 th year Annual Technical Report 195. The Report is well written. Responses have been made to the recommendations of TCC30. 196. This is a Project of 10 years which reaches 797,172 people, 748 communities (133 in a hyper-endemic zone; 615 in a meso-endemic zone) and 5 departments, all situated in the southern part of the country. In 2010, the geographic coverage was 100% and the therapeutic coverage was 81.2% (81% in 2009). The goal was 669,624 and 647,005 have been treated. 1602 CDDs (1222 men and 380 women) were mobilised for CDTI; only 27.4% of communities had women CDDs. The rate of attrition of CDD is very high in some zones (47% in MFouati; 48% in Kingoué; 49.5% in MFilou; 58.5% in Yamba). The ratio of CDDs/population treated is still much too high: 1CDD/844 persons in the urban zone (this ratio was 1/775 in 2009); 1CDD/222 in the rural zone. 197. The rate of refusals and absenteeism was also high, notably in the urban area of Brazzaville (Makélékélé and MFilou). 198. The involvement of sub-prefects and local NGOs for mobilising communities is very strong. CDTI is integrated in the activities of other programmes: joint use of equipment, involvement of some CDDs in other Programmes. 199. As regards NTDs, mapping of loiasis, LF, schistosomiasis and soil-transmitted helminths are being undertaken or have been completed. 200. TCC expressed once more its concern over the sustainability of this Project in view of the low financial contribution of the Government.
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201. The current activities are benefiting from the financial support of APOC and OPC. It is hoped that advocacy missions initiated by APOC management will soon bear fruit. These missions have among others allowed the sensitisation of Parliamentarians, the Ministry of Health, Minister of State responsible for Socio-cultural affairs. 202. TCC accepted the report with the following recommendations and suggestions: Report related:
(i) Give details of the area of the zone covered by the project; (ii) Re-do Table 14 (financial support) as it doesn’t correspond with the text on page 48 (…the
Government funds budgeted for CDTI were not released in 2010); (iii) Be more precise regarding the concept of “community” in an urban zone (for example the 130
communities in Makélékélé!). Project related:
(i) It is necessary to undertake an in depth reflexion with other partners to find an effective solution for the problems of CDDs in urban areas;
(ii) Follow-up efforts to mobilise people to undertake operational research; (iii) Advocacy initiated by APOC management must be followed up; (iv) Follow-up efforts to reduce the rate of attrition of CDDs.
DEMOCRATIC REPUBLIC OF CONGO (DRC) Ueles CDTI Project (DRC) 8 th year Annual Technical Report 203. The report has some weaknesses at the level of presentation and analysis of the situation as well as some calculations on the number of people treated (to be re-done); but the progress with coverage is good taking into account factors working against it such as loiasis, insecurity, weakened health services, unstable finances, lack of incentives for CDDs of whom the ratio in relation to the population to be treated does not show any improvement. 204. TCC accepted the report with the following recommendations and suggestions: Report related:
(i) Give information on the climate in relation to the seasonality of agricultural activities (period of the rainy season);
(ii) Give more hydrological and hydrographic information (season of floods, relative importance of watercourses, by water basin, areas of rapids, their distance from places where people live and where there are human activities);
(iii) Provide information on the existing situation of onchocerciasis before treatments and the communities and health services perceptions of the disease;
(iv) Give information on the health care services that benefit the populations at different administrative levels of the country;
(v) In terms of population, does the figure of 1,152,347 correspond to the total population or to the population of the meso and hyper-endemic communities? Are there only meso-endemic villages in the District of Faradje?
Project related: (i) Is distribution of Mectizan done throughout the rainy season? If yes, what is the rationale for
that? (ii) A special effort must be made to improve the ratio of CDDs to the population and to develop
all forms of incentives to maintain and increase motivation of the CDDs;
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(iii) Fill the gap of information regarding the holding of CSM meetings, the quantity and quality of human resources, and the quality of management of SAEs;
(iv) Improve feedback of data and other information; (v) Provide a more detailed list of equipment that better indicates the state of the materials; (vi) Undertake advocacy for better financial contributions from the Government or from other
partners that would complement or replace that of the NGO and APOC; (vii) Develop co-implementation of CDTI with other community health interventions.
ETHIOPIA Bench-Maji CDTI Project (Ethiopia) 7 th year Annual Technical Report 204. The report is comprehensive and informative. 205. TCC accepted the report with the following recommendations and suggestions: Report related:
(i) TCC recommended that the reporting period should span through 12 months (January to Dec). The authors report compliance with this recommendation, however this report under review spans from January to October 2010. Please clarify;
(ii) Take steps to minimize drug wastage; (iii) The project is mature and yet it would seem no community self monitoring is done. The project
should initiate action for community self monitoring; (iv) Improve on performance with regards to timeliness of financial reporting; (v) The project reports expenditure of about US $2000 for community self-monitoring, which
conflicts with the information provided under section 2.8. Content under section 2.8 suggests that NO CSM was done – Please clarify.
Project related:
(i) Even though therapeutic coverage is still below the 80% threshold, the prospect for reaching the threshold is promising. Aspects worth paying attention to increase coverage: Treatment to be scheduled during Jan- April timeline, described as optimal timeline for treatment;
(ii) In this regard, APOC and the Project should look into and address factors hindering timely release of funds.
North Gondar CDTI Project (Ethiopia) 7 th year Annual Technical Report 206. This report is incomplete (especially section 4) and sketchy in many parts. Tables 2 and 4 are either incomplete or have misinformation. 207. TCC accepted the report with the following recommendations and suggestions: Report related:
(i) Review table 2 and 4 for accuracy; (ii) Review the definition of community which is termed as a “development unit” (this is not a
standard definition of community); (iii) The information on mobilisation and sensitisation is deficient – need for more information
regarding the processes, people reached and outcomes; (iv) Complete sections 4.1 and 4.2 which are blank.
Project related: (i) Increase coverage to at least 80% in all sites; (ii) Address the high levels of absentees, refusals and drug wastage in Metema.
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Recommendations to APOC:
(i) Timely release of money is essential for country teams; (ii) It is important to explain why the funds released are lower than those approved for 2009 and
2010. This is because there are difficulties in separating financial data. Kaffa Shekka CDTI Project (Ethiopia) 9 th year Annual Technical Report 208. This project has made good progress over the years. Coverage has been good and funding has been provided from the MOH (District and Zonal). Project activities are fully integrated into PHC. However, no information is given on monitoring and evaluation. 209. TCC accepted the report with the following recommendations and suggestions:
Report related:
(i) Address all past TCC recommendations; (ii) Use new reporting format; (iii) Improve on executive summary; (iv) Provide information on the outcome of advocacy, monitoring and evaluation, suggestions for
improving sensitisation and mobilisation. Project related:
(i) Train more CDDs; (ii) Retrain all involved in CDTI on record keeping; (iii) Explain how CSM was done without training; (iv) Conduct training on CSM and SHM in all communities after training; (v) Conduct Operational research on challenges; (vi) Reduce number of wasted and expired drugs; (vii) Conduct sustainability evaluation and prepare sustainability plan. If this has not been done
already. Illubabor CDTI Project (Ethiopia) 7 th year Annual Technical Report 210. The report contains salient points. Even so, the project needs to take the following points into account to improve on the content of the report:
(i) TCC 29 recommended that the reporting period should span on 12 months (January to Dec). The authors report compliance with this recommendation, however the report under review spans from January 2009 to November 2010. - 23 months. No justification for this is provided;
(ii) The annual training objective for health workers to be trained tallied with the actual number trained; that is 537. Yet the percentage of achievement was computed as 84.8%. The reason for this is not clear, it should be 100%;
(iii) According to table 7 in the report, there are no refusals or absentees. Yet in the narrative, it is implied that some potential beneficiaries skipped treatment because the period of distribution coincided with other activities – farming, trade etc. Others refused treatment because of minor side effects;
(iv) There is need for further clarification on the content of table 7; (v) It would appear that all 3,894 communities carry out self-monitoring. But it is not clear, what is
involved. How was monitoring done? What kind of information was found? How was information channelled back to health authorities? What corrective actions were taken?
211. TCC accepted the report.
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Jimma CDTI Project (Ethiopia) 7 th year Annual Technical Report 212. This is a mature project that is doing well. Commendable work on training and conducting CSM and SHM and like all Ethiopian projects, integration is strong. A more structured reporting and details on advocacy are required. 213. TCC accepted the report with the following recommendations and suggestions:
Report related:
(i) Indicate the TCC session that made the recommendations addressed; (ii) Table 2 – reconcile the total population figures and the meso/hyper-endemic totals; (iii) Reasons and outcomes of advocacy should be provided when advocacy has been undertaken; (iv) Include a comment on adequacy of staff in terms of numbers and skills/knowledge under the
capacity section of the report; (v) Confirm if there were zero refusals and absentees; (vi) Useful to know if government funding contribution was for salaries or for recurrent
expenditure. Report Project:
(i) Address the issue of very low participation of women; (ii) Develop an operational research to assess factors hindering the participation of women in the
project area; (iii) Implement the recommendation for internal monitoring to be carried out and report progress in
the next Annual Technical Report; (iv) Implement Sustainability Plans and report progress in subsequent Annual technical reports.
Recommendation to APOC:
(i) APOC should consider removing mid-term sustainability evaluation from the report template since this is no longer being done.
Meketel CDTI Project (Ethiopia) 7 th year Annual Technical Report 214. The Project is doing well particularly with respect to sustainability related activities including integration and in-country funding. However there is missing information resulting from non-use of the new format. 215. TCC accepted the report with the following recommendations and suggestions:
Report related:
(i) Use the new reporting format; (ii) Provide the following missing information in the next report:
• Reasons for advocacy; • Outcome of advocacy; • Community response to advocacy; • Suggestions for improving advocacy; • % of communities with female CDDs; • Cost per treatment; • Absentees and refusals;
(iii) Address the following past TCC recommendations: • Diversify channels used for sensitisation, mobilisation and health education; • Address problem of late submission of reports and arrange for, and take advantage of regular
review meetings at all levels to obtain reports; • Conduct monitoring and evaluation and prepare sustainability plan.
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Project related: (i) Involve Kebele leaders in all CDTI activities at Kebele levels; (ii) Conduct advocacy at Kebele level; (iii) Use checklist for supervision at all levels; (iv) Implement recommendations from Monitoring and Evaluation; (v) Conduct CSM and SHM.
LIBERIA Northwest (Lofa Bong, Nimba and Montserrado) CDTI Project (Liberia) 9 th year Annual Technical 216. This is a well written report and an improvement from the submission of 2009, which was rejected. Efforts to improve CDTI project performance through advocacy, planned treatment coverage and WHO/APOC direct technical assistance to Lofa, Nimba and Bong County health teams to increase their competencies are commended. Report related:
(i) The report should be resubmitted when outstanding treatment data is available, (ii) Provide information on the process of stopping treatment in Monrovia.
Project related:
(i) Train and re-train more programme managers and CDDs to improve the quality of CDTI implementation;
(ii) Ensure early retrieval of outstanding treatment data and commencement of year 2011 treatment.
Recommendation to APOC:
(i) Confirm that year 2009 report was re-submitted to APOC as recommended by TCC 31; (ii) Confirm if project has been evaluated for sustainability; (iii) Consider the replacement of the projects old capital equipment, especially vehicle and
motorcycle to improve supervision. 217. TCC recommends that the report is accepted but a revised report should be resubmitted to APOC management when complete data are available. MALAWI Malawi Extension CDTI Project 9 th year Annual Technical Report 218. This is a well written report. It captures the programme activities and presents them in appropriate detail. The team should be commended for this. 219. TCC accepted the report with the following recommendations and suggestions:
Project related:
(i) The team should increase the number of communities implementing CSM; (ii) The team should be encouraged to document its experiences of co-implementation because of
the multiple conditions being addressed by use of CDTI.
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Thyolo and Mwanza CDTI Project (Malawi) 11 th year Annual Technical Report 220. This is a well written report of a Project that is doing well. The Project is commended for its capacity building initiatives carried out for different programme personnel to improve the quality of CDTI implementation in addition to training on cyto-taxonomy and Entomology supported by APOC. 221. TCC accepted the report with the following recommendations and suggestions: Report related:
(i) Provide information on NGDO support on table 13 a-c. (Referring to another project report for the explanation is unacceptable).
Project related:
(i) Efforts should be made by the project to reduce number of absentees; (ii) Increase the number of communities carrying out community self-monitoring; (iii) Sustain and continue to improve the quality of CDTI implementation in the project.
General recommendation to APOC:
(i) Provide feedback on the research protocol submitted by the team on ITN availability survey. TANZANIA Tanga CDTI Project (Tanzania) 9 th year Annual Technical Report 222. The project is doing well and the report is well written. Excellent integration into PHC. Financial contributions are being provided from the districts and integration into NTDs strengthens sustainability prospects. Stable regional and district administration has ensured retention of skills and continuity. It is not clear from the report how the project is ensuring that integration into NTDS does not negatively affect the project as recommended by TCC 30. Co-implementation is in its second year and Tanzania does provide other countries a case study on co-implementation. 223. TCC accepted the report with the following recommendations and suggestions:
Report related:
(i) Government financial contribution is reported in Tanzania shillings – please convert and report in US$ for better understanding by other people;
(ii) Table 12 should have been updated with information on new equipment since this was known; otherwise it gives the impression that most equipment are Warn out (WO).
Project related:
(i) Explore the possibility of attracting an NGDO partner; (ii) Ensure that treatment takes place before the farming season to reduce on the number of
absentees as reported; (iii) The average number of tablets per treatment appears lower than average – please confirm and
ensure that correct dosages are being given by CDDs. Other matters: Agenda item 22 CDC representative 224. Ms A. Moore of CDC expressed her views on the TCC meeting, which she attended for the first time on behalf of CDC. She commented on the level of detail and discussion and considered that this would account for the success of the Programme. CDC is particularly interested in the elimination aspect of the Programme
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and will be looking at new tools to enable decisions to be made regarding stopping treatment: These tools include Blackfly traps and serological diagnostic tests (OV16) and CDC would also be looking at guidelines for stopping treatment. Tribute to Dr Rene Le Berre 225. A tribute to Dr Rene le Berre who passed away in December of 2010 was presented by Dr Philippon. As an entomologist, his tenacity for scientific research instigated initiative approaches to fight onchocerciasis that led to the campaign to launch the Onchocerciasis Control Project in West Africa in 1974. His historic meeting with the late Robert McNamara, President of the World Bank, in 1972, was a landmark for the fight against onchocerciasis in Africa as a disease of health importance and an obstacle to socio-economic development. He was honoured as a living legend in the moves to improve public health and the fight against poverty. TCC observed one minute of silence in his honour. Presentation by the North Katanga CDTI project Coordinator 226. Dr Rogers Galaxy Ngalamulume presented a retrospective analysis of ivermectin treatment outcome of 3 onchocerciasis provincial projects, from 2006 to 2009 (North Katanga, Kasongo and North Ubangi). The study attempted to determine the incidence of SAEs post-ivermectin treatment; to describe the demographic and clinical profile and outcomes of SAEs, and to discuss their implication for the control strategy. 227. The study conclusion:
(i) Incidence of SAEs was 1/10.000 treated persons over 4-years; (ii) North Ubangi: the highest incidence of SAEs and the highest lethality rate; (iii) Overall therapeutic coverage was < 65%; (iv) Treatment acceptance is decreasing in North Katanga and North Ubangi.
Recommendations: (i) North Ubangi should not scale up CDTI to new communities; (ii) Joint national-provincial team should supervise ivermectin treatment campaign in strict
application of Mectizan Donation Program guidelines in all provinces; (iii) Information, education and communication should be intensified on acceptance of ivermectin; (iv) Qualitative research should be done to study the populations perception of ivermectin.
Date and place of thirty-third session of the TCC: Agenda item 23 228. The 33rd Session of TCC will take place in Ouagadougou from 12 to 16 September 2011. 229. The Report (Conclusions and recommendations of TCC 32) was reviewed and adopted. Closure of the session: Agenda item 24 230. Dr Amazigo thanked TCC members again for their coordinated and coherent support to improve research to promote evidence based decision-making and hence positive outcomes. She thanked APOC staff for their support as a team, and reiterated that working together provided the momentum enabling the Programme to progress. She hoped that the same dedication and practice would continue so as to ensure that elimination on infection and interruption of transmission in Africa is achieved. 231. The TCC Chair, Professor Mamoun Homeida, thanked all TCC members, observers and invited guests for their active participation in the 32nd TCC meeting. He also paid homage to Dr Amazigo in her final TCC session and thanked her for her relentless commitment to fight onchocerciasis in Africa. He wished every one a safe trip and declared the session closed.
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Annex 1: List of participants
32nd SESSION OF THE TECHNICAL CONSULTATIVE COMMITTEE Ouagadougou, 7-11 March 2011
TCC MEMBERS 1. Prof. Mamoun Homeida, President, University of Medical Sciences & Technology (UMST), PO Box 12810,
Khartoum, Sudan - Fax: (249 183)224799 - Tel: (249 183)227599 - Email: [email protected] 2. Prof. Mamadou Souncalo Traoré, Département d’Enseignement et de Recherche en Santé publique, FMPOS,
BP: E810, Bamako, Mali, Mobile: (223) 66 75 9051, Tel. Home: (223) 20206868 ; Fax (223) 20229658 ; Email: [email protected]
3. Dr Kisito Ogoussan, Associate Director, Onchocerciasis, Mectizan Donation Program, 325 Swanton Way,
Decatur GA, 300 30, USA - Tel: 1 404 687 5633, Fax: 1 404 371 1138, Email: [email protected] 4. Dr André Yébakima, Entomologiste médical, Centre de Démoustication, BP 679 - 97200 Fort-de-France,
Martinique; Tel.: (00 596) 596 59 85 44 - Fax: (00 596) 596 70 26 46 - Email: [email protected] and [email protected]
5. Dr Johnson Ngorok, Deputy Regional Director; SightSavers International (SSI), PO Box 34690, 00100 GPO,
Nairobi, Kenya – Tel: +254 20 60 69 70 – Mobile: +254 722 56 78 97 - Email: [email protected] 6. Dr Bernard Philippon, 35 Avenue Jean Moulin, Paris, France - Tel : (00331) 40 44 94 04/ (00331) 44 12 41
90 - Fax : 44 12 23 01- Email: [email protected]; [email protected] 7. Dr Fatu Yumkella, Managing Director, Dalan Development Consultants (DDC), 12A King Street, The Maze,
Wilberforce, P.O. Box 491, Freetown, Republic of Sierra Leone – Phone: 232-33-851405, 232-76-627878, 232 77 641736 - Email: [email protected]; [email protected] – Website: www.dalanconsult.com
OBSERVERS 8. Dr Michael Thiede, Consultant, «Health Economics and Policy», Lohengrinstr, 25, 14109 Berlin, Germany.
Tel : +49 30 8105 4066 ; Email : [email protected]; [email protected] TECHNICAL ADVISERS 9. Prof. Adenike ABIOSE, Nigeria NTD steering Committee Chair, Sightcare International, P.O. Box 29711,
Secretariat Main Office, Ibadan, Oyo State, Nigeria; Tel: +234(0) 8037865702; Email: [email protected]
10. Dr Samuel ZARAMBA, Former Director of Health Services, P.O. Box 825, Kampala, Uganda – Tel:
+256712436990 – Fax: +256414340881 – Email: [email protected] 11. Dr Ngozi NJEPUOME, Nigeria NTD Steering Committee Member, Regia Resources INT LTD 13 Gwela
Street, Wuse, Abuja – Nigeria – Tel: +234 (0) 8056010207 – Email: [email protected]
48
12. Dr Michel BOUSSINESQ, Institut de Recherche pour le Développement (IRD), UMI-233, 911 avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France, Tel: +33 675139151-Email: [email protected]
13. Dr Tshinko B. ILUNGA, Public Health Specialist, 25 B.P. 229, Abidjan 25, Côte d’Ivoire; Tel: (+225)
06913132; Fax: (+225) 22430602 – Email: [email protected] WHO/GENEVA 14. Dr Tony Ukety, Responsible Officer, NGDO Coordination Group for Onchocerciasis Control, World Health
Organization (WHO), 20 Avenue Appia, 1211 Geneva 27, Switzerland; Tel: +41-22-791-1450; Fax: +41-22-791-4772; Email: [email protected]
15. Ms Juliet Ochienghs, APOC Focal Point, WHO/HQ, 20 Avenue Appia, 1211 Geneva 27, Switzerland, Tel:
+41-22-791-2580, Fax: +41-22-791-4772, Email: [email protected] 16. Dr Annette KUESEL, Scientist, WHO/TDR, 20 Avenue Appia CH-1211 Geneva 27, Switzerland, Tel: +41
22 791-1541 – Fax: +41 22 791 4774 – Email: [email protected] WAHO 17. Dr Doulaye Sacko, Coordonnateur de Vision 2020, Organisation Ouest Africaine de la Santé, 01 B.P. 153,
Bobo-Dioulasso, Burkina Faso - Tel: (226) 20 97 57 75 – Fax: (226) 20 97 57 72 Email: [email protected]; [email protected]
BILL AND MELINDA GATES FOUNDATION 18. Dr Julie Jacobson, Senior Program Officer, The Bill & Melinda Gates Foundation, P.O. Box 23350 Seattle,
WA 98102, USA – Tel: +1 206 770 1672 – Fax: +1 206 494-7039 – Email: [email protected]
CDC 19. Dr Anne Moore, CDC, Medical Epidemiologist, Parasitic Diseases Branch, 4770 Buford Highway, MS F-22,
Atlanta, GA 30341, USA, Email: [email protected] 20. Dr Paul Cantey, LCDR US Public Health Service, Medical Epidemiologist, Parasitic Diseases Branch,
DPDM/CGH/CDC, 4770 Buford Highway, MS F-22, Atlanta, GA 30341, USA, phone 770-488-4507, fax 770-488-7761 - email: [email protected]
PATH 21. Dr. Gonzalo Domingo, Senior Research Scientist, PATH, PO Box 900922, Seattle, WA 98109, USA, Tel:
206-3024741 - FAX 206.285.6619, - Email: [email protected] INVITED 22. Dr Hans Remme, 120 Rue des Campanules, 01210, Ornex, France - Tel: 33645457404; Email:
[email protected] 23. Prof. Ekanem Braide, Chairperson of the Nigeria Technical Review Committee, Federal University Lafia,
Nasarawa State, Nigeria - Tel.: 234 80 41 68 42 - Email: [email protected]
49
24. Dr Nana-Kwadwo Biritwum, Programme Manager, Neglected Tropical Diseases Control (NTD), Ghana Health Service, P.O. Box MB-190, Accra, Ghana – Tel: +233 302 935922; +233 935923– Email: [email protected]; [email protected]
25. Dr Rogers Galaxy Ngalamulume, Disease Control, CDTI Manager, North Katanga, Democratic Republic of
Congo, Tel. Tel:+ 243816860426, Email: [email protected] 26. Dr Aboutou Rosalie Louise, Coordonnatrice Adjointe du Programme National de lutte contre
l’Onchocercose, Ministère de la Santé Publique, Secrétariat Exécutif du GTNO, B.P. 155, Yaoundé, Cameroun, Tel/Fax : (00237) 22 22 69 10, Cell: +237 99965410 – Email: [email protected]
WHO/TANZANIA 27. Dr Alphoncina Masako Nanai, National Professional Officer, Neglected Tropical Diseases, World Health
Organisation, P.O. Box 9292, Dar-es-Salaam, Tanzania; Tel. 255 222113005; Fax: + 255 222 113180; Email: [email protected]; [email protected]
WHO/OUAGADOUGOU 28. Dr Etienne Traoré, Representative of WR/Burkina Faso, 1487 Avenue d’Oubritenga, 03 B.P. 7019,
Ouagadougou, Burkina Faso, Tel: (226) 50 30 65 65, Email: [email protected] WHO/IST/OUAGADOUGOU 29. Dr Alhousseyni Maiga, Representative of IST Coordinator, 1487 Avenue d’Oubritenga, 03 B.P. 7019,
Ouagadougou, Burkina Faso, Tel: (226) 50 30 65 09, Email: [email protected] WHO/MDSC 30. Prof. Evariste Mutabaruka, Director a.i., MDSC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50
34 29 53, Fax: (226) 50 34 28 75, Email: [email protected] 31. Dr. Laurent Toé, Responsible Officer, Molecular Biology Laboratory, MDSC, P.O. Box 549, Ouagadougou,
Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, Email: [email protected] 32. Dr. Yiriba Bissan, Medical Entomologist, MDSC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50
34 29 53, Fax: (226) 50 34 28 75, Email: [email protected] 33. Dr. Aimé G. Adjami, Molecular Biology Laboratory, MDSC, P.O. Box 549, Ouagadougou, Burkina Faso,
Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, Email: [email protected] 34. Mr Moussa Sanfo, MDSC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50
34 28 75, Email: [email protected]
WHO/APOC
35. Dr Uche Veronica Amazigo, Director, APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34
29 53, Fax: (226) 50 34 28 75, Email: [email protected] 36. Dr Laurent Yaméogo, COORD/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53,
Fax: (226) 50 34 28 75, Email: [email protected]
50
37. Dr Mounkaïla Noma, Chief, Epidemiology and Vector Elimination Unit (CEV/APOC), P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, Email: [email protected]
38. Mr Honorat Zouré, BIM/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax:
(226) 50 34 28 75, Email: [email protected] 39. Dr Afework Hailemariam Tekle, EPI/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34
29 53, Fax: (226) 50 34 28 75, Email: [email protected] 40. Dr Grace Fobi, COP/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226)
50 34 28 75, Email: [email protected] 41. Mrs Zainab Akiwumi, ACO/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53,
Fax: (226) 50 34 28 75, Email: [email protected] 42. Mr K. Bénoît Agblewonu, BFO/APOC,P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53,
Fax: (226) 50 34 28 75, Email: [email protected] 43. Mr Tendainashe Siwombe, ITO/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53,
Fax: (226) 50 34 28 75, Email: [email protected] 44. Mr Issaka Niandou Yacouba, ISO/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29
53, Fax: (226) 50 34 28 75, Email: [email protected] 45. Dr Raogo Augustin Kima, TRAD/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29
53, Fax: (226) 50 34 28 75, Email: [email protected] 46. Dr Stephen Leak, Technical Officer/APOC, Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53,
Fax: (226) 50 34 28 75, Email: [email protected] 47. Mr Assi Aké, Technical Officer/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53,
Fax: (226) 50 34 28 75, Email: [email protected] 48. Mrs B. Savadogo, AHR/APOC, Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50
34 28 75, Email: [email protected] 49. Mr Edward Lloyd-Evans, APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax:
(226) 50 34 28 75, Email: [email protected] 50. Mr Daouda Diop, Gender Specialist APOC, P.O. Box 549 Ouagadougou, Burkina Faso, Tel: (226) 50 34 29
53, Fax : (226) 50 34 28 75, Email: [email protected] 51. Dr Léonard Mukenge, EPI/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax:
(226) 50 34 28 75, Email: [email protected] 52. Mr Ibrahim Touré, AO/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax:
(226) 50 34 28 75, Email: [email protected] 53. Mr Yaovi Aholou, Programme Officer, Meetings/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel:
(226) 50 34 29 53, Fax: (226) 50 34 28 75, Email: [email protected]
51
INTERPRETERS 54. Mrs Safiétou Barry, 09 BP 526 Ouagadougou 09, Burkina Faso, Tel: (226) 70214114, Email:
[email protected] 55. Mr André Nikiéma, 01 BP 922, Ouagadougou 01, Burkina Faso, Tel : (226) 50 33 03 12, Mobile : 78 80 90
53, Email: [email protected]; [email protected] 56. Mr Djerma Sita, 01 BP 1771, Ouagadougou 01, Tel 50342310 / 50344326, Mobile: 70200058, Email:
[email protected] 57. Mr Nagabila Oumarou, 03 BP 7038, Ouagadougou 03, Burkina Faso, Tel: 70263332, Email:
52
Annex 2: Annotated Agenda
AFRICAN REGION
African Programme for Onchocerciasis Control (APOC) 01 B.P. 549, Ouagadougou 01, Burkina Faso Tel: (226) 50342953; 50342959; 50342960; 50343645/46 Fax: (226) 50342875; 50343647
TECHNICAL CONSULTATIVE COMMITTEE Thirty-second session
Ouagadougou, 07 to 11 March 2011
PROVISIONAL ANNOTATED AGENDA REV.2
DAY I – Monday 07 March 2011
1. Opening
2. Adoption of the Agenda
09H00-09H30
09H30-09H40
Information
3. CSA: matters arising from the 130th and 131st sessions (Dr Amazigo) 09H40-10H00
Tea Break 10H00 - 10H15
09:00-11:15 4. JAF: Matters arising from the 16th session: decisions (Dr Amazigo)
5. NGDOs: Matters arising from the 36th and 37th sessions: Recommendations only (Dr
Ukety)
6. TCC: follow-up of the key recommendations of the thirtieth session (Dr Yameogo)
10H15-10H35
10H35-10H55
10H55-11H15
Strategic and technical issues
7. Meeting of health professionals on the Curriculum and Training Module for the CDI
strategy (Dr Fobi)
8. Training on Onchosim (Drs Noma/Mukenge)
9. Feasibility of elimination of onchocerciasis infection and interruption of transmission in
Africa:
(i) Conceptual and Operational Framework of Onchocerciasis Elimination with
Ivermectin treatment and recent results (Dr Remme)
11H15-11H40
11H40-12H15
12H15-13H00
Lunch Break 13H00- 14H45
(ii) Consultative workshop on Guidelines of epidemiological evaluation and therapeutic coverage survey (Dr Afework)
(iii) Entomological studies: Advisory Group, plans, tools and activities (Dr Yameogo)
15H00-15H45
15H45-16H30
Tea Break 16H30- 16H45
11:15-18:15
(iv) Elimination of O. volvulus infection: New diagnostics of PATH (Dr Gonzales)
10. Macrofil and Research:
(i) Update on Moxidectin and Target Product profile for drug for Onchocerciasis
control via mass treatment (Dr Kuesel)
(ii) Update on the DEC patch test and Lohmann
16H45-17H15
17H15-17H45
17H45-18H15
53
DAY II – Tuesday 08 March 2011
Reviews
11. Update on spatial analysis of RAPLOA data and maps predicting the prevalence of loa
loa in sub-Saharan Africa (Mr Zoure)
12. Report of the External Mid-term Evaluation (Dr Amazigo)
14. Outcome of the CDTI implementation in Ghana (Dr Biritwum)
08H30-09H00
09H00-09H30
09H30-10H00
Tea Break 10H00 -10H15
15. Country visits by TCC members (Dr Yébakima) 10H15-11H00
16. Status of community database of APOC 11H00-11H30
18. Remarks by Technical Advisors to APOC Management 11H30-12H00
08:30-12:25
20. Report on the financial management of APOC funded projects (Mr Agblewonu) 12H00-12H30
Management of APOC Trust Fund
Lunch Break 12H30- 14H45
21. Report on the review by the APOC management of 1st, 2nd, 3rd, 4th, 5th, 6th,7th 8th, 9th, 10th and 11th year progress reports and subsequent year budgets (Mr Agblewonu)
15H00-15H30
22. Review of new Project Proposals and 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th and 11th year Annual Technical reports on the implementation of CDTI and Vector elimination Projects. Recommendations on the 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th and 10th year implementation of the projects
Introduction to the review exercise: Summary budget of submitted proposals (Mr Agblewonu)
15H30-15H50
22.1 Bururi CDTI Project (Burundi) 5th year technical report 15H50-16H10
22.2 Cibitoke/Bubanza CDTI Project (Burundi) 6th year technical report 16H10-16H30
Lunch Break 16H30- 16H45
12:25-18:15
22.3 Rutana CDTI Project (Burundi) 5th year technical report
22.4 Côte d’Ivoire CDTI Project (Comoe, Bandama, Sassandra, Cavally et leur affluents) 3rd year annual technical report 22.5 South Western CDTI Project (Liberia) 5th year technical report
22.6 South East CDTI Project (Liberia) 5th year technical report
22.7 NOTF/HQ (Nigeria) CDTI project 12th year Technical report
16H45-17H05
17H05-17H25
17H25-17H45
17H45-18H05
18H05-18H25
54
DAY III – Wednesday 09 March 2011 19. Joint APOC/MDP mission to investigate SAE management in North and South Ubangi
CDTI Project in DRC
08H30-09H00
22.8 Ituri CDTI Project (DRC) 4th year technical report
22.9 Kasongo CDTI Project (DRC) 5th year technical report
22.10 Katanga Nord CDTI Project (DRC) 6th year technical report
09H00-09H20
09H20-09H40
09H40-10H00
Tea Break 10H00- 10H15
22.11 Katanga Sud CDTI Project (DRC) 5th year technical report (Re-submission)
22.12 Katanga Sud CDTI Project (DRC) 6th year technical report
22.13 Rutshuru-Goma CDTI Project (DRC) 4th year technical report
22.14 East Wellega (Ethiopia) CDTI Project 6th year technical report
22.15 Gambella CDTI Project (Ethiopia) 6th year technical report
22.16 West Wellega CDTI Project (Ethiopia) 6th year technical report
22.17 Adamaoua CDTI Project (Cameroon) 6th year technical report
22.18 East Province CDTI Project (Cameroon) 6th year technical report
10H15-10H35
10H35-10H55
10H55-11H15
11H15-11H35
11H35-11H55
11H55-12H15
12H15-12H35
12H35-12H55
Lunch Break 12H55- 14H45
22.19 Far North Province CDTI Project (Cameroon) 6th year technical report
22.20 South Province CDTI Project (Cameroon) 6th year technical report
22.21 Ghana CDTI Project 2nd year technical report
22.22 Sierra Leone CDTI Project 4th year technical report
22.23 East Bahr El Ghazal CDTI Project (South Sudan) 5th year technical report
15H00-15H20
15H20-15H40
15H40-16H00
16H00-16H20
16H20-16H40
Tea Break 16H40-16H55
08:30-18:15
22.24 East Equatoria CDTI Project (South Sudan) 4th year technical report
22.25 Upper Nile CDTI Project (South Sudan) 4th year technical report
22.26 West Bahr El Ghazal CDTI Project (South Sudan) 4th year technical report
22.27 West Equatoria CDTI Project (South Sudan) 5th year technical report
22.28 SSOTF/HQ (South Sudan) 4th year technical report
16H55-17H15
17H15-17H35
17H35-17H55
17H55-18H15
18H15-18H35
DAY IV – Thursday 10 March 2011
22.29 NOTF/HQ (Tanzania) 11th year technical report
22.30 Morogoro Focus (Tanzania) CDTI Project 6th year technical report
17. Technical Review committees of Cameroon, Nigeria and Uganda:
(i) Report of the Task Force of Cameroon (Dr Aboutou)
08H30-08H50
08H50-09H10
09H10-10H00
Tea Break 10H00- 10H15
08:30-18:30
(ii) Report of the Task Force of Uganda (Dr Mbulamberi)
(iii) Report of the Task Force of Nigeria (Prof Braide)
Summary of 7th, 8th, 9th, and 10th year technical reports (Dr Fobi)
10H15-11H00
11H00-11H45
11H45-12H45
55
Reports reviewed by TCC member on line - Summary to be presented by Dr Fobi on Thursday 10th March 2011
1. CAR CDTI Project (CAR) 9th year technical report 2. Chad CDTI Project 11th year technical report 3. Congo Extension CDTI Project 7th year technical report 4. Congo CDTI Project 10th year technical report 5. Uélés CDTI Project 8th year technical report 6. Bench-Maji CDTI Project (Ethiopia) 7th year technical report 7. North Gondar CDTI Project (Ethiopia) 7th year technical report 8. Kafa-Sheka CDTI Project (Ethiopia) 9th year technical report 9. Illubabor CDTI project (Ethiopia) 7th year technical report 10. Jimma CDTI Project (Ethiopia) 7th year technical report 11. Meketel CDTI Project (Ethiopia) 7th year technical report 12. Lofa, Bong, Nimba & Montserrado 9th year technical report 13. Malawi Extension 9th year technical report 14. Thyolo & Mwanza (Malawi) 11th year technical report 15. Tanga CDTI Project (Tanzania) 9th year technical report
Rapporteurs: Dr S. Leak Ms Juliet Ochienghs Mrs Z. Akiwumi
Lunch Break 12H45- 14H45
13. Review of operations research proposals
23. Other matters
(i) Presentation by the North Katanga CDTI Project Coordinator (Dr Rogers Ngalamulume)
15H00-16H00
16H00-16H30
Tea Break 16H30-16H45
24. Date and place of the thirty-third session of the TCC
25. Preparation of the report: Report (Conclusions and Recommendations of TCC32)
16H45-17H00
17H00-18H30
DAY V – Friday 11 March 2011
08:30-12:30 Adoption of the report (conclusions and recommendations) if TCC32 08:30-10H00
Tea Break 10H00- 10H15
Adoption of the report (conclusions and recommendations) of TCC32
26. Closure of the session
10H15-12H00
12H00-12H30
56
Annex 3: Follow up of the key recommendations of 31st session of TCC Recommendations of TCC 31 on Strategic and technical issues (1)
Subject/Topic Action to be taken Status of implementation
Update on nation-wide Onchocerciasis mapping in Ghana (para. 20)
i. TCC stressed that it was imperative that a representative from Ghana should attend TCC32 and present the results of CDTI implementation in the country.
Agenda item 13 of TCC32 will deal with this.
TCC country visits (para. 20)
ii. The procedure for TCC visits to countries should be reviewed as should the expected outcome of such visits
APOC Management would appreciate guidance from TCC on procedures and expected outcome of the visits.
One advocacy visit has been undertaken for increased financial contribution of government.
Studies to be conducted to evaluate economic benefits of co-implemented control activities. (para. 20)
iii. Dr Mariko will recommend a health economist to carry out the study on the economic benefits of co-implementation.
No recommendation received from Dr Mariko but World Bank team was informed and requested to assist in this study
Feasibility of elimination of Onchocerciasis transmission in Africa (para. 20)
iv. APOC management should follow up on the certification of vector elimination and interruption of transmission with the relevant committee at WHO-HQ
Contact made with those who organized the previous certification meeting but concrete arrangement still need to be made.
Post APOC 2015 (para.20)
v. The issue of the future of APOC will be considered by the external evaluation team but the TCC needs to make a specific recommendation to CSA on the matter.
TCC members will elaborate on the matter
Paper on Closantel (para. 27)
TCC recommended that a response to a paper on Closantel should be re-submitted to another journal.
TCC members will elaborate on the subject
Mapping of the distribution of NTDs (para. 28)
TCC expressed satisfaction with the update of the mapping exercise and suggested the possibility of APOC having an NTD Officer at APOC.
A working group on co-implementation was set up by the CSA. The outcome might help implement this recommendation
Issues related to TRC observations/ Nigeria (para. 30)
i. Projects should continue implementation of CSM and efforts should be made to find other methods of scaling up CSM and SHM e.g. by devolving the activity to communities (Village Development Committees/Village Health Committees);
ii. APOC management: Professor Braide should visit either Cameroon or Uganda to share the experiences of the Nigerian TRC.
The recommendation was shared with the NOTF/Nigeria
Not yet implemented
57
National Plan of Action for Onchocerciasis Control in Post-conflict districts of Kitgum & Pader in Northern Uganda (Para. 31)
Recommendations to the NOTF/Uganda for an improvement of the proposal: i. The proposal could have described how the issue of
inaccessibility will be overcome in order to reach distant populations with ivermectin;
ii. Clarify the fact that drugs will be provided free of charge; iv. Build on the experience of cross-border collaboration for
Guinea worm and polio eradication that already exists between southern Sudan and Uganda;
v. A risk analysis and assessment was not included; vi. Need for a letter of endorsement from the NGDO
committing to provide counterpart funds. Recommendations to APOC management: i. The proposal is accepted ii. The budget should be reviewed and analysed further by
APOC management; iii. APOC to liaise with the MoH and the NGDO to
streamline the activities and budget line.
Recommendations shared with the NOTF
Follow up actions being taken should be accelerated
Technical Review Committee Report, Uganda: (para. 34)
i. TCC appreciated the Child Day Plus (CDP) model but expressed concern that the CDI strategy and philosophy in Uganda were not being implemented properly.
ii. TCC noted the need to produce guidelines on how to integrate CDI into Child Days Plus and other interventions for PHC.
The concern was shared with the NOTF/Uganda Not yet implemented. Suggestions from TCC are welcomed
Task Force on the review of technical reports
Cameroon: (para. 35)
1) TCC emphasised that all regional delegates should be invited to attend the TRC meeting as this will give them a better understanding of the projects and also the opportunity to draw lessons from projects with better performance.
2) TCC requested the TRC to provide further explanations for why some projects did not achieve 100% Geographical Coverage.
3) TCC strongly recommended that reporting should keep to the TCC technical reporting format
The recommendations were shared with the NOTF/ Cameroon
Task Force on the review of technical reports
Cameroon: (para. 35)
4) TCC was informed of the various funding provided for the NTD mapping exercise. It was agreed that to avoid double funding the MOH would share with APOC information on all funds for mapping, as well as details on funding gaps.
5) The involvement of CDDs in other health interventions is posing huge constraints. There was consensus by the Members for the need to devise ways and means to tackle the situation.
6) APOC Management was requested to provide all TCC members with the report of a study carried out on CDD motivation and issues related to incentives in APOC countries.
Information and documents shared with APOC Not yet implemented but suggestions will be appreciated The report will be made available
58
Subject/Topic Action to be taken Status of implementation
Epidemiological situation of onchocerciasis in the Vina valley, North Cameroon. (para. 47)
(i) APOC should prepare a book on the successes of CDTI and elimination;
(ii) TCC recommended that nodule rates should be thoroughly checked whilst skin snips are done;
(iii) TCC endorsed the recommendation that capacity building should be increased in countries;
(iv) Regarding coverage, surveys should be continued every year and the information kept for epidemiological evaluations;
(v) The weighted contribution of lower coverage rates needs to be determined;
A focal person and a team of writers are to be appointed Taken into account in the protocol This is part of APOC objective It is being analyzed to take into account all implications Resource persons to be identified
Update on special analysis of RAPLOA data and maps predicting prevalence of Loa loa. (para. 47)
(i) The Committee requested MDP to provide Prof Diggle with updated data on cases of severe adverse events SAEs;
(ii) The Committee also noted that the Mectizan Expert Committee/TCC recommendations for the treatment of Onchocerciasis with Mectizan in areas co-endemic for onchocerciasis and loiasis are in need of revision;
(iii) APOC to train more people in RAPLOA using available expertise;
(iv) The Committee requested that APOC follow up with Prof Diggle to provide criteria for determining appropriate sampling size including distances between sampling points.
MDP will advise Would suggest a small working group for this Implemented Criteria provided and collaboration with Prof. Diggle continue
Review of operational research proposal (para.79)
1. “Migratory pattern of the nomadic Fulani herdsmen and their default and uptake of ivermectin in Ardo Kola LGA, Taraba State, Nigeria” Proposers: Prof A.E. Idyorough, Prof H.B. Mafuyai, Mrs Francisca Olamiju and Dr E. Apake.
TCC recommended the proposal be re-submitted to APOC
TCC recommendation shared with NOTF/Nigeria with all details
2.”Effect of onchocerciasis control on the prevalence of epilepsy: A community-based study in a hyper-endemic area in West Uganda” Kizito Mugenyi, C. Kaiser, T. Rubaale, G. Asaba, E. Tukesiga, J. Okech Ojony, G. Kabagambe and W. Kipp
TCC recommended that the research proposal be circulated to all members and re-submitted at the next TCC
Dr Leak for latest info
Mainstreaming gender in APOC funded projects (para. 80)
(i) While Gender mainstreaming is valuable, CDTI principles which give communities the mandate to select CDDs should be respected;
(ii) Gender data sets to be disaggregated by other variables (age, education, marital status)
(iii) In order to better understand the characteristic of CDDs, Gender mainstreaming should be viewed more broadly and not limited to women;
(iv) More in-depth analysis should be done to establish whether there is a relationship between gender and programme outcomes, for example coverage rates.
The advice is well noted and the Gender specialist is working on it.
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Subject/Topic Action to be taken Status of implementation
Independent Participatory Monitoring (para. 84)
i. APOC management to use the COMBI approach for enhancing community ownership and sustainability;
ii. The NOTF has the responsibility to monitor implementation of recommendations.
CAO/APOC would elaborate on this The reports were shared with the NOTF for implementation
Financial management of APOC funded Projects (para. 89)
(i) TCC recommended that APOC management should notify the NOTF as soon as they have instructed Kuala Lumpur to release the funds to the project;
(ii) TCC also suggested that the NOTF should be informed about the receipt of funds before the funds are used. APOC Management was tasked to write a letter informing the project coordinator that the money cannot be utilised until the NOTF has been notified;
(iii) It was also suggested that APOC should be copied in the correspondence so that the projects are aware that they will be monitored;
(iv) There should be systematic coordination between WHO/KL, APOC, NOTF and CDTI Project managers;
(v) APOC management will discuss the possibility of developing an additional document which could be used to monitor the flow of funds from KL to the projects;
(vi) TCC requested TRCs to facilitate timely submission of financial returns.
Being implemented More follow up is necessary This is a process that is being negotiated between the entities To be discussed by representatives of TRCs
Review of technical reports
Cameroon (para 94)
North West Province
1. Implement the commitment made to treat the 18 communities with difficult access in 2010.
2. Increase the number of CDDs to improve the ratio of CDDs/pop.
3. Urgently develop a plan of sustainability (this seems to be urgent after 6 years of project implementation)
NOTF was informed NOTF was informed and the representative of the TRC could respond
Cote d’Ivoire (para 98)
- The management team should rapidly acquire epidemiological and entomological competence
- An extension plan is needed for villages that have not yet been treated.
Requests submitted are being analyzed by APOC Management Plan made and extra funds obtained from SSI through APOC Management
DRC
Bas-Congo CDTI Project
Katanga Sud
- TCC recommended that additional effort needs to be made to raise the level of therapeutic coverage. (para 101)
- Strengthen management capacity of the new Project coordinator. (para 104)
NOTF informed and TAs are involved in the efforts The Coordinator participated in training sessions on, Onchosim and on financial management
Lualaba CDTI project (para 106)
TCC recommended that efforts should be made to improve coverage, CDD/population ratio, the rate of disbursements of the State budget, and attract NGDO partners
Recommendation shared with the NOCP
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Subject/Topic Action to be taken Status of implementation
Mongala CDTI Project (para 109)
Recommendation to the project: Reduce the rate of absenteeism and attrition of CDDs, develop sustainability plan
Recommendation to APOC Management: to provide technical and financial assistance and advocate for a better financial participation of the Government.
No conclusive action for the moment
Ubangui Nord CDTI project (para 118)
Kasai (para 157)
- APOC should revise the budget upwards, including the budget for equipment, and assist the Project coordination through advocacy at a higher level towards the national authorities and the NGDO.
- Continue to assist this project.
Actions were taken
Ubangui Sud CDTI project (para 124)
(i) TCC suggests that APOC management and MDP are assigned to make a special presentation on the causes, situation and management of SAEs in these two project areas and the report should be circulated before 1st December. Meanwhile there will be no treatment in that area;
(ii) TCC should endorse a letter to the Minister of Health and Director will do one to bringing this situation to his attention;
(iii) APOC will also make a presentation to March TCC 2011 on this subject. The Audit should include:
• case studies; • details of management and; • health facility status (human resources and material –
package provided through APOC); • facilities for transporting patient to the health facility.
Missions undertaken in December
- The missions have changed the situation;
- The presentation could
be made on Thursday
Liberia:
South-western CDTI project (para 140)
South East
(i) The sustainability evaluation which was due to take place should be postponed since project performance clearly shows that it is not sustainable;
(ii) The project team should be encouraged and supported to undertake operational research.
(iii) APOC management should visit Liberia to investigate problems in the field and organise CDTI training as soon as possible.
The recommendations were shared with the NOTF and Implementation undertaken with the support of the TA
All projects Recommendations and suggestions for improving reporting and project implementation.
Messages were made available to all NOTFs