Subsequent to previous meetings held over the last two years this, the second meeting of the Programme Committee, was convened to deliberate upon and endorse the findings and recommendations of the meeting of Advisory Group Coordinators which met in Nairobi, 15-17 October 1996. The function of the committee being "to define and regularly review the purposes and strategies of the Programme and to guide and review its activities and progress".

The PAAT Committee (Programme against African Trypanosomiasis) met in FAO, Rome, from 4-5 December 1996. Dr. T. Fujita, Director, Animal Production and Health Division, welcomed participants on behalf of the Director-General of FAO, stressing the importance of the Programmes objectives to the betterment of the socio-economic plight of the rural poor in the many affected areas of sub-saharan Africa. He also confirmed the FAO support to this initiative which was somewhat unique in that the Programme structures developed facilitated and enhanced the constant and close collaboration and inter-action between donor representatives and technical/executive advisers.

These sentiments were endorsed by Dr. Y. Cheneau, Chief, Animal Health Service, who reminded the meeting of the appreciable effort devoted to the Programme by the International Organisations concerned. He emphasised the considerable range of scientific and technical expertise that had now been brought together within the structures developed and urged all participants, particularly those representing the donor community, to avail of the resources available in order to more effectively address the problem of African Trypanosomiasis in the broader context of rural development.

The relevance of the Programme Committee and of the Programme itself to agriculture and rural development in sub-sahara Africa was also re-emphasised by Dr. Masiga, Director, OAU/IBAR, who, in his closing statement, confirmed the commitment of IBAR to the objectives of the Programme. He further advised of the intention to review the organisation of the International Scientific Council for Trypanosomiasis and Control (ISCTRC) forum in order to comply with new Programme structures and needs.

Professor P. Holmes and Mr. K. Katondo served as Chairman and Vice-Chairman respectively. The rapporteurs were Drs. J. Slingenbergh and R. Dwinger with Mr. B.S. Hursey as the Secretary. The list of participants is attached as Annex 1.

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Previous meetings held under the name of PAAT, originally known as the Programme to clarify and solve the problem of African trypanosomiasis, agreed that the overall goal of the programme was to "solve the trypanosomiasis problem within the broader context of food security, human health, rural development and sustainable agriculture". These meetings coupled with the efforts of the joint secretariat, in establishing the outlines structures and representation necessary to achieve this aim, had also developed a level of cooperation and collaboration, between all those involved, to facilitate further progress.

This second meeting of the Programme Committee had four main purposes; 1) to report on previous activities and achievements, 2) to deliver presentations on the key topics of the deteriorating sleeping sickness situation across the continent and the development of strategies for identifying priority areas for tsetse control, 3) to make decisions on the recommendations of the advisory group coordinators and 4) to indicate the programmes' priorities for the next two years.

The provisional Agenda was adopted with the amendment that Integrated Disease Management (IDM) be considered as a separate item and not included under the heading of Programme focus and Direction.

The actions undertaken and the progress achieved since the first meeting of the Programme Committee were enumerated as follows.

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- The publication and distribution of the Programme Memorandum, in English, together with a draft logical framework. This was undertaken by joint funding of FAO and IAEA. A French version will be produced in early 1997.

- The publication and distribution of the Tsetse and Trypanosomiasis Information Quarterly Vol. 19 (1997) in both English and French. This activity was undertaken through FAO with contributory funding from IAEA and the EC funded Regional Tsetse and Trypanosomiasis Control Programme (RTTCP) based in Harare.

- The updating of the FAO National Liaison Officers network throughout all infested countries in Africa so they become more actively involved in the Programme.

- The establishing of the network of Technical and Scientific Advisory Group Coordinators and the convening of their first meeting in Nairobi, October 1996, under the auspices of OAU/IBAR.

- The identification of a provisional list of research and programme priorities within each advisory group as a basis for further refinement.

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- The modification of FAO Statutory Bodies to the Programme for the Control of African Animal Trypanosomiasis and Related Development to facilitate the convening of PAAT meetings.

- Highlighting the new PAAT initiative to Ministerial level officials representing tsetse infested countries in Africa, and eliciting their collaboration, through its inclusion as an agenda item on the FAO Regional Conference for Africa, Bobo-Dioulasso, July, 1996. As a follow-up to this a letter had been sent to all FAO Country based offices in Africa requesting the Representatives to bring to the attention of Ministries of Agriculture the existence of PAAT, its structures, aims and objectives. Positive responses have been received from several countries.

- Initiating the collaboration required between Secretariat organisations for an effective revision and amalgamation of existing structures to meet the needs of PAAT. Specifically the inclusion of Programme matters on the agenda of the OAU/IBAR organised ISCTRC, to be held in Maputo, September, 1997.

- The issuing of Research and Development contracts to external parties in order to further the aims of the Programme. A notable outcome of these actions was the report of a study on " Towards identifying priority areas for tsetse control in East Africa", which was presented to the committee meeting as a background document.

- Initiatives towards establishing modern communications links with remote field workers have been undertaken by WHO through the healthnet satellite facility.

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Sleeping sickness foci, of varying significance, are recorded in all 36 tsetse infested countries. Very limited surveillance is undertaken in a few countries, monitoring an estimated 3 to 4 million of the total population of 55 million considered to be at risk. These surveys regularly report some 20 000 to 25 000 cases of the disease each year. The extrapolation of these figures to the total of 55 million persons at risk give estimates that, in real terms, some 300 000 cases may occur annually and that the present situation, particularly in the Central Africa Region, may be approaching the epidemic proportions experienced in the 1930's. Current epidemics are mostly confined to countries in Central Africa, Zaire, Angola, Sudan and Uganda. Reports of lesser important occurrence of the disease are also being received from Ghana, Burkina Faso, and more recently Ethiopia and Tanzania.

In recognition of the urgency of addressing the situation and in achieving an adequate level of surveillance WHO, in conjunction with affected states and limited donor contribution, has assisted in developing a global coordination programme to facilitate and promote collaboration between endemic countries. Within this programme priorities have been identified as the need for technical support at the national level, increased and targeted surveillance, institutional strengthening, assurance on the availability of drugs to meet the needs of emergencies, dissemination of information at all levels and the development and promotion of regional actions.

The committee expressed their concern over the situation and stressed the need for a clear understanding of the geographical distribution and intensity of the disease. Such information could be provided through a well designed surveillance system, which would also contribute to early warning and early reaction for the implementation of control actions. They were also concerned by the unsatisfactory situation regarding the shortfalls in drug availability. DFMO is no longer produced, mainly because of the high cost of treatment, estimated at $500 to $600 per person. Factors contributing to the resurgence of active disease foci are believed to be include national instability and population movements.

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Results were presented on progress made in the collection, collation and analysis of data towards an improved understanding of trypanosomiasis impact on natural resource utilisation, agricultural production and farming. These may be used as a basis for indicating the priority areas for tsetse control at regional and national levels. Focus was placed on recent studies undertaken to facilitate decision making on the strategies to be adopted in the proposed European Union funded regional programme for East Africa (Consultants report: "Towards identifying priority areas for tsetse control in East Africa; FAO, 1966).

The meeting appreciated that although the data generated by such analysis was only as good as the information available, the potential of the approach was convincingly demonstrated and warranted continued support. In this context the need for an intensification of geo-referenced data collection at the field level was emphasised, with the recommendation that future programmes and projects ensure the necessary support. The meeting also stressed the need for standardisation and compatibility between data systems to ensure effective collaboration and coordination between the various institutes and organisations involved in these activities.

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Recommendation 1
"That the secretariat, together with the Programme Committee, consider ways to establish an e-mail network to improve communications between the coordinators, the secretariat and advisory groups to enhance the functioning of the Programme."

WHO hope to partially solve the problem of e-mail networking through the use of "Healthnet", an NGO operated network. The possibilities of extending this to meet the needs of the programme should be further investigated by the secretariat. The basis on which the network should be established is the lists of Coordinators and the FAO national liaison officers. The meeting was also informed that the proposed EC funded regional programmes could, once implemented, make provision to assist in communication strengthening between participating countries.

Recommendation 2
" The Programmes' logical framework should include a system for monitoring and evaluation, with well defined OVIs. This should be drafted by the secretariat for acceptance by the Programme Committee".

The recommendation was endorsed on the basis that the programme show tangible benefits over time with recorded means to verify the progress. It was left with the secretariat to draw upon the voluntary assistance and experience of RTTCP personnel and to draft the proposal. A subsequent decision was that this exercise be finalised through a logical framework workshop involving members of the Programme Committee.

Recommendation 3
"In specific cases funds should be made available to enable coordinators to attend meetings and to gather the required information in their areas of responsibility".

Although sympathetic to the need to support the activities of donors the consensus of the meeting was that the provision of funds should in this case remain as a responsibility of the secretariat organisations, the countries concerned and/or with national/regional donor supported programmes. The issue remains to a large extent unresolved, the exception being in SADC countries where RTTCP funds may be made available to facilitate the travel of Southern African based coordinators. The regional office of the RTTCP will follow-up in consultation with the secretariat.

Recommendation 4
"The programme information, collation, analysis and dissemination of data functions, as provided by FAO, require major strengthening in the form of human resources for data management".

The meeting recorded their full support to these activities and of the value of the results which facilitate decisions as to where funds and effort may be focused to achieve maximum benefit. It was further agreed that, as recommended by the coordinators meeting, the central focus of these activities should be FAO who, in close collaboration with WHO, should ensure the inclusion and amalgamation of data on sleeping sickness.

In appreciation of the expertise required and of the demands that these activities would place on the resources available to the secretariat discussion then turned to the mechanisms for implementation. Two alternatives were identified: i) an Associate Professional Officer (APO) to be seconded to the programme secretariat at FAO by one of the donor countries or, ii) the provision of extra-budgetary support for the recruitment of a high level experienced and qualified data management Officer for a period of up to 30 months. It was concluded that the secretariat should define in greater detail the work proposed, the inputs required and the objectives and outputs to be realised. On the basis of this information requests for extra-budgetary support could then be submitted to potential partners for further consideration.

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Recommendation 5
"The factors which determine and influence the sustainability of tsetse control in various scenarios of cost-recovery, land tenure, farming systems, ecological and socio-cultural conditions should be further investigated and clarified. This should be initiated through the secretariat".

The meeting agreed in principle to the concerns raised by this recommendation and to the responsibilities vested in the secretariat in this respect. The matter was raised again later in the meeting due to its close association with economic situations and the options for devolution of control responsibilities to the beneficiaries and for privatisation.

Recommendation 6
"Effective surveillance systems should be initiated to clarify the worsening sleeping sickness situation in a number of foci, and to facilitate the prediction of further epidemics".

The meeting, in agreeing with the recommendation, stressed that it be amended to include disease prevention. It was also cautioned that due to the dramatic recrudescence of the disease in many areas, the resurgence of a number of historic foci, particularly in Ethiopia and Tanzania, the regional EC programme for East Africa should also address the human disease through surveillance and prevention measures.

In the ensuing discussion on the actions being taken and the problems being experienced in those countries where Sleeping sickness is now endemic, or near epidemic levels, concern was expressed over the inability of certain states to initiate and sustain active surveillance and implement the necessary control measures. It being noted that in Zaire disease prevalence of over 70% was now being recorded in some villages. The Committee agreed to give its support in encouraging the investment of bilateral aid to the countries concerned, in particular Zaire and Angola.

Recommendation 7
"It is recommended that the development of strategies for tsetse control programmes take into account all available technical options and thus enhance approaches to Integrated Disease Management".

The meeting fully endorsed the recommendation whilst at the same time emphasising the need to agree on an appropriate definition of the term" Integrated Disease Management". This topic was then discussed, in more detail, later in the meeting.

Recommendation 8
"The meeting recommends that funding for the World Acaricide Resistance Reference Centre (WARRC) be assured to address concerns over the possible development of insecticide resistance in tsetse ( and ticks as a result of tsetse control operations ) and to facilitate the integration of tsetse with tick and tick borne diseases control".

This recommendation was tabled based on technical concerns over the increasing popularity of insecticides, mostly in "pour-on" formulations, for tsetse control and their increasingly haphazard application as many veterinary services were losing the capacity to exercise supervision over their use. The committee therefore, recognised the crucial role of standardised procedures for monitoring of drug resistance in both tsetse and other target species, such as ticks and screw-worm flies, and expressed concern over the imminent closure of WARRC due to lack of funds. It was recommended that the various possibilities for retention of this facility be investigated, i) that suitable regional centres be identified and, ii) that IAEA consider its incorporation into the new Codex Alimentaris Centre once this has been constructed in Vienna iii) an approach be made to the WHO Pesticides Unit (WHOPES) of the Division of Control of Tropical Diseases where similar work is presently being done by one of their reference centres.

Recommendation 9
"The programme should utilise its resources to investigate the feasibility, and pursue the progressive privatisation, of tsetse and trypanosomiasis operations".

Although the subject was accepted as an important issue that needed to be addressed the meeting was divided on their views as to the practical possibilities for, and the advisability of, moving in this direction. Animal trypanosomiasis control using drugs was one area where privatisation may more easily be achieved. However, it was felt by many participants that tsetse control may be most effectively delivered by well planned and organised schemes that would demand public sector involvement. It is therefore, seen as a question of obtaining the optimal balance between private and public sector involvement. In conclusion it was agreed that the issue be the subject of further study within the secretariat and advisory groups. Their findings to be presented to the next Committee meeting in the form of a Position paper.

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Discussion focused on the list of priorities produced by the meeting of advisory group coordinators and shown as an annex to the Nairobi Meeting report (October 1996). Participants noted the preliminary listing of priorities as appropriate to the progress of the programme whilst, in view of the long list produced, tasking the secretariat to ensure the circulation of these amongst advisory groups in order that the list may be reduced to more manageable and realistic proportions. Committee members expressed satisfaction with the guidance being given and with the opportunities to move away from funding research that may have limited practical application. In this regard the involvement of control workers in the identification of priorities was especially welcomed. Suggestions were made to include i) assessing the impact that control may exert on uninfested areas by relieving human congestion and ii) the development of new drugs to combat sleeping sickness.

It was concluded that the secretariat will produce a reduced priority research list, through the coordinators, by March 1997. A justification should also be provided for all the proposed activities retained.

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The priority areas, on which the programme should focus over the next biennium were put to the meeting, by the secretariat, as being the following:

a) The production of the position papers recommended by the Nairobi meeting

b) The strengthening of advisory group/coordinators interactions through improved communications

c) Concentration on the research and development priorities as selected from the Nairobi list

d) Clarification of priority areas for disease control intervention in the context of rural development

e) Strengthening the interaction of PAAT with regional programmes

f) Strengthening sleeping sickness surveillance

g) Assessment and development of pour-on techniques

h) Guidelines on the definition and implementation of Integrated Disease Management (IDM)

Of the above items a), b) and c) are already ongoing whilst f) has been planned within the WHO global coordination programme. Suggested methodologies have been described in a WHO document entitled " Epidemiological surveillance and Geographic Information Systems". Full implementation will depend on the development of adequate human resources at the field level and the funds available to procure the equipment supplies and materials required.

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In the deliberations that ensued the meeting recommended that the issues of IDM and privatisation were of considerable priority and warranted inclusion in the list of position papers to be produced. During these discussions the significant interventions and issues raised are recorded as follows. IDM should be considered at the levels of integrating Tsetse with Tick and Tick borne diseases control and joint actions to control human and animal trypanosomiasis through the appropriate mix of techniques. It is important that Chief Veterinary Officers, and others concerned, be aware of the ways in which actions against one disease may promote or retard progress in the control of others. The authors identified for the two additional papers were Drs. A.Thiermann (USDA/APHIS) and H.Herren (ICIPE) for the one on privatisation and Drs. B.Perry (ILRI) and B.Bauer (CIRDES) for Integrated Disease Management.

The position papers commissioned should assist in identifying areas of need and weakness which would ensure that research efforts may be targeted to assist in specific directions.

The development of policies at regional level must be based on considerations of governments policies and priorities related to rural development and population welfare.

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The techniques available for disease and vector control all have various advantages and disadvantages. They should be fully described and costed in order that they may be assessed as to their suitability for specific needs.

The PAAT should ensure that mechanisms exist to support regional programmes through the provision of technical and scientific expertise and advice. Such interaction is considered essential for the successful attainment of regional objectives. There must be interaction and communication and in the latter regard the Tsetse and Trypanosomiasis Information Quarterly is very useful.

Coordination between donors and funding organisations is poor and needs to be improved. Enhanced collaboration during project development and design would greatly benefit endemic countries. Projects would have a better coverage and be more cost effective. Also it would avoid conflicting approaches in project implementation as has been the case recently in Ethiopia. There is a need for the PAAT to establish a higher profile in order to attract a wider participation of all those involved in rural development and, in particular, those involved in trypanosomiasis surveillance and control, and to encourage the submission of proposals to the PAAT for peer review. Participants to the meeting agreed to provide to the secretariat details of the relevant activities and proposals undertaken by their institutes and/or organisations. WHO and FAO also agreed to a similar exchange of information.

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The re-organisation of the biennial ISCTRC will be considered by the next meeting of the Executive Committee in order that it may more directly support the work of PAAT. Consideration is being given to bringing together, at the time of the next ISCTRC meeting, Maputo, September 1997, the following meetings;

- coordinators to the advisory groups

- two IAEA Research Coordinators meetings

- FAO National liaison officers.

- WHO Programme Coordinators meeting

Additionally during the ISCTRC itself the commissioned position papers will be presented and discussed during plenary session whilst it is proposed that one day be devoted to the presentation and discussion of the programme.

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i) The meeting endorsed the observation made at the Coordinators meeting regarding the need for the logical framework of PAAT to be revised and to include OVIs on which progress of the programme may be evaluated. These should be drafted within the first quarter of 1997.

ii) The conclusions and recommendations of the Advisory Group Coordinators meeting, Nairobi, October 1996, were unanimously endorsed.

iii) The secretariat was delegated responsibility to investigate and take action towards improved communications through e-mail links between technical/scientific advisors and focal point liaison officers in Africa. The results of this investigation should be made available to PAAT Committee members as soon as possible.

iv) The two additional position papers to be presented at the next ISCTRC meeting will address the issues of a) Integrated Disease Management and, b) The roles of the private and public sectors in Integrated Disease Management with specific reference to trypanosomiasis control. These papers should not only reflect the personal expertise and experience of the authors but should draw upon the collective experience available to the programme. To achieve this, regional programmes and organisations should be asked to contribute.

v) The secretariat, on the basis of information provided by coordinators, should review and selectively reduce the list of priorities annexed to the report of the coordinators meeting. This should be undertaken in the first quarter of 1997 and the final list should include a justification of those retained.

vi) The travel necessary to facilitate the work of coordinators may be made available by the EC regional programmes, to the extent possible and within the funds available.

vii) The responsibilities of the secretariat to coordinate the collection and collation of geo-referenced data will be assisted through the attendance of a representative at regional programme workshops.

viii) To facilitate information exchange, particularly at the level of donors, the secretariat should investigate the possibilities of not only establishing an e-mail network but also a specific internet website.

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