nm STRICTL CONFIDENTIAL 1 NM INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT INTERNATIONAL DEVELOPMENT ASSOCIATION Tuesday, January 9, 1990 Washington, D.C. The meeting of the Executive Directors was convened at 10:14 a.m. in the Board Room, 1818 H Street, N.W., Washington, D.C., Mr. Barber B. Conable, Chairman, presiding. MILLER REPORTING CO., INC. 507 C Street, N.E. Washington, D.C. 20002 (202) 546-6666 nm STRICTLY CONFIDENTIAL 3 CONTENTS ITEM PAGE 5 Other Business: (Cont'd.) Oral Report on River Blindness (Onchocerciasis) Control Programme 57 MILLER REPORTING CO., INC. 507 C Street, N.E. Washington, D.C. 20002 (202) 546-6666 STRICTLY C NFIDENTIAL rim 57 MR. CONABLE: Yes. Now, I would like to ask Mr. Agueh, the Division Chief for the Africa 5, Population and Human Resources Operation Division, to report to us on the results of the Tenth Annual Joint Programme Committee hearing on the Riverblindness Control Program. This was held at The Hague on December 4 to 7. As you know, the Bank has been heavily involved in the riverblindness control program in various ways. And we would like to have a report on this particular Joint Programme Committee meeting, if you would, Mr. Agueh. MR. AGUEH: Thank you. Mr. Chairman, Members of the Board: Each year we report to you on progress of the West African Riverblindness Control Program, for which the Bank is a leading sponsor and major donor. Our report is timed to present the results of the annual meeting of the Program's Governing Council, as you said, the Joint Programme Committee or JPC. On behalf of the Bank, I attended the Tenth Session of the JPC in The Hague during December 4 - 7, 1989. MILLER REPORTING CO., INC. 507 C Street, N.E. Washington, D.C. 20002 (202) 546-6666 STRICTLY CDNFIDENTIAL nm 58 Fifteen years have passed since the program began and, according to current plan, the program may have about another decade to go. The meeting in The Hague provided an important opportunity for looking back on past achievements and ahead on prospects for and ways of bringing the program to a successful and orderly completion. I would like in this presentation to review the highlights of the meeting in The Hague and our assessment of the outlook for the future of the program. But allow me to start with an update on the progress of the program's control efforts. Reports at the meeting in The Hague confirmed the striking progress the program is making in controlling riverblindness. In the original seven-country area, which contains 20 million people, the objective of eliminating riverblindness as a disease of public health and socio- economic importance will be substantially achieved by the end of this year. This has been accomplished by controlling the vector -- a fiercely-biting savanna blackfly -- which transmits the parasitic worm that causes blindness. Blackfly larvae are destroyed through aerial spraying of breeding sites in fast-flowing rivers. This vector control method MILLER REPORTING CO., INC. 507 C Street, N.E. Washington, D.C. 20002 (202) 546-6666 STRICTLY C NFIDENTIAL rm 59 employs only larvicides which have been screened and deter- mined to be environmentally safe by an independent ecological committee. The parasite reservoir has now virtually disappeared throughout the population in the central portion of the original area, where control operations were first initiated in the mid-1970s. As a result, the program will be able to cease control operations in 80 percent of the original area by the end of 1990. It will also phase out operations over the next four years in the remaining portions of the original area where control efforts commenced after 1976. In addition, the program is well on its way to establishing control in the neighboring so-called extension areas, where 10 million inhabitants live. Complete coverage of these areas, including parts of four additional countries, is expected to be achieved this year. Operations in these so-called extension areas have already cut off sources of re- invading blackflies which had been transmitting riverblindness back into the original area. A new drug, called ivermectin, which kills the infant worms that cause blindness, is now being employed to complement vector control. MR. CONABLE: This is within the human body. MILLER REPORTING CO., INC. 507 C Street, N.E. Washington, D.C. 20002 (202) 546-6666 STRICTLY C NFIDENTIAL rm 60 MR. AGUEH: Yes. Although ivermectin is not an effective substitute for vector control in halting transmis- sion of the disease, it can alleviate sickness and prevent blindness if administered to individuals on a biennial basis. Large-scale field trials have now demonstrated that ivermectin is safe and acceptable to the target population. It is being distributed to about 250,000 people in the most severely infected communities where the risk of impending blindness is high. Turning now to the highlights of The Hague meeting, with viable control tools at hand and much of the hard scientific evidence in, the JPC in The Hague addressed the question of how best to bring the program to an effective and lasting conclusion. Experience to date demonstrates that fourteen years of continuous larviciding will eliminate the parasite reservoir in the population and preclude future transmission of the disease. This has been the experience of the program to date and is supported by extensive operational research. Therefore, the program's independent Expert Advisory Committee recommended continuing vector control in the extension area for a total of fourteen years in order to conclude the program successfully. MILLER REPORTING CO., INC. 507 C Street, N.E. Washington, D.C. 20002 (202) 546-6666 STRICTLY C )NFIDENTIAL a1m 61 The donors and beneficiary countries support, in principle, this recommended change in the program time frame. Implementing this recommendation will mean extending the program beyond 1997, the previous target date for the program's conclusion, until about the year 2004. However, after 1997, the program will be phasing out, and both the area covered and the expenditures required would be greatly reduced from current levels. As part of the preparation for the next and concluding stage of the program, an external review will be carried out to provide an outside view on the program's result and prospects, to help further improve the program's operation, and to draw lessons from its achievements which might have applicability to other projects and programs. Sustainability of the program's achievement over the long-term is an important topic, which was also discussed in The Hague. A prerequisite for phasing out the program is to build up capacities within the beneficiary countries to detect any recurrence of riverblindness and to suppress it, and this process is known as devolution. Preparation for devolution is underway in the countries of the original area, and progress has been encouraging. Burkina Faso began to implement its devolution MILLER REPORTING CO., INC. 507 C Street, N.E. Washington, D.C. 20002 (202) 546-6666 STRICTLY C NFIDENTIAL nim 62 plan in 1989. Plans for Mali and Niger were presented at the JPC and approved at the meeting. Capacity building for devolution is also occurring in the extension area countries, where agencies and staffs of the governments concerned are actively involved in program operations. Turning to the financial aspect, the estimated cost for the program's third six-year phase which ends in 1991 is about $180 million U.S. This breaks down to approximately $1.00 per person protected per year, which is a fairly low cost in terms of disease control. Last year we reported to you that the program faced a financial shortfall for the third phase of $14 million U.S. At the meting in The Hague, this shortfall has been reduced to $4 million U.S. We are now confident that the remaining funding can be obtained. The success in reducing the shortfall has been due to an extensive fund-raising effort by the Bank and the remarkable and unrelenting commitment by the 23 donor countries and international agencies who finance and support the program. At The Hague meeting, three new donors, Luxem- bourg, the Republic of Korea, and the Calouste Gulbenkian Foundation, joined the program. In addition, Belgium, the Federal Republic of Germany, the Netherlands, Norway, the MILLER REPORTING CO., INC. 507 C Street, N.E. Washington, D.C. 20002 (202) 546-6666 STRICTLY C NFIDENTIAL rum 63 United Kingdom and the United States pledged supplemental increases, nearly doubling the sum of their previous commit- ments for 1990. The Bank pledged $2.5 million U.S. for 1990, as you had approved in the FY90 budget. We also indicated that the Bank would endeavor, subject to your approval, to maintain $2.5 million U.S. for 1991. At this level, the Bank's share is 8 percent of total donor contributions, which is slightly less than the 10 percent the Bank provided in the mid-1980s. In conclusion, let me stress the fact that the program has made major strides toward achieving lasting control over riverblindness throughout much of West Africa, and is having important humanitarian and development impacts. The program is well recognized as an example of successful regional and international cooperation. Looking to the future, the program has a system in place, the experience, the expertise, and the tools required to defeat riverblindness. Local capabilities are being strengthened to ensure the long-term sustainability of its achievements. With continuing donors' commitment and effective follow-through, we feel confident that the disease can b virtually eliminated from the 11-country region in West Africa in about another decade. MILLER REPORTING CO., INC. 507 C Street, N.E. Washington, D.C. 20002 (202) 546-6666 STRICTLY CONFIDENTIAL nM 64 Thank you, Mr. Chairman. MR. CONABLE: Thank you, Mr. Agueh. Onchocerciasis is a terrible disease and has wreaked havoc in that area. But it is reassuring to know that progress is being made. And it is also reassuring to know that the prediction is that we don't have to continue this program indefinitely, because it is a very expensive program, despite the reality that if we didn't have it, taking care of the people afflicted with riverblindness would cost a lot more. I think it is a matter of some reassurance to have this report. Mr. Funna wants to say something. And I would like to call on anyone who would like to make any comment or ask any questions about Mr. Agueh's report. Mr. Funna. MR. FUNNA: Thank you very much, Mr. Chairman. Just a brief line to re-echo a comment which you yourself have just made, Mr. Chairman, namely that onchocer- ciasis is indeed a very serious problem for the sub-region. We think, however, that the involvement of the Bank and other donors has had quite an impact. Clearly, the question of building capacity to MILLER REPORTING CO., INC. 507 C Street, N.E. Washington, D.C. 20002 (202) 546-6666 STRICTLY C)NFIDENTIAL rim 65 promote devolution would be critical for the sustainability of the effort. It is expensive, but we think that we are beginning to see results. We would like to thank Mr. Agueh for what we consider to be a very reassuring statement, and we hope that we can continue the effort, because it is certainly a very serious one for the people of the West African sub-region. Thank you. MR. CONABLE: Thank you very much. Monsieur Milongo. MR. MILONGO: (Interpreted from French.) Thank you very much, Mr. Chairman. Allow me also to very much thank Mr. Agueh for the statement that he has just read to us, and express my great satisfaction at the progress that has been achieved in the fight against onchocerciasis. I would like also to support the pursuit of this program and thank the donor countries that have enabled that program to be implemented in the first place. Mr. Chairman, I would also like to ask for the statement to be distributed to us, if that were possible. Thank you. MR. CONABLE: Yes. Mr. Agueh, would you please do MILLER REPORTING CO., INC. 507 C Street, N.E. Washington, D.C. 20002 (202) 546-6666 STRICTLY C NFIDENTIAL rnm 66 that? It is a rather extensive statement, a lot to absorb. Mr. Graham-Harrison. MR. GRAHAM-HARRISON: Thank you, Mr. Chairman. I too would like to express appreciation for the statement, and it is very good to hear of the encouraging progress that has been made and, as you say, there seems there may be a need for this program to continue indefinitely. There was just one point I wanted to raise. I think I recall reading that some problems have arisen really as a result of the success of the program in terms of increased pressure on the land, which had previously been protected. MR. CONABLE: Yes. Some land wasn't protected. It was simply uninhabitable because of the presence of these blackflies. But what about that? Is there a surge into these areas to use land now, Mr. Agueh? MR. AGUEH: One of the original intents of the program is to make available relatively fertile land in river valleys which were under-populated or empty. And as the program is showing its result, the expected population - ~ movement has indeed occurred towards these areas. The dimension of the program is the so-called socio-economic development aspect where by we try to work MILLER REPORTING CO., INC. 507 C Street, N.E. Washington, D.C. 20002 (202) 546-6666 STRICTLY CONFIDENTIAL nm 67 with the Government on planning an orderly development of these oncho-freed areas. And one of the specific topics we are working on with them is precisely these land settlement issues. We have an extensive review of the situation in the various countries, which is due in the coming month and will be discussed with the Government. The purpose is to establish guidelines whereby settlement of these areas will be environ- mentally safe. Right now there are a number of activities already occurring with the assistance of major donors. An example is the development of the Magooni (Phonetic) Region in Mali which we, the Bank, are supporting and, as part of this operation, we are indeed making sure that the environmental safeguards will be provided. Also throughout the countries, we are working with the Government on land management and resource management projects, again with a view to providing the kind of environ- mental measures, environmental protection measures needed in this fragile ecological environment. MR. CONABLE: Mr. Graham-Harrison. MR. GRAHAM-HARRISON: I wasn't entirely clear from that whether problems, as opposed to potential problems, are MILLER REPORTING CO., INC. 507 C Street, N.E. Washington, D.C. 20002 (202) 546-6666 STRICTLY CbNFIDENTIAL rm 68 actually issued. I mean, are we in a sense ahead of the game or are we -- MR. CONABLE: You asked about land pressures. Was there a land rush going on that could result -- MR. GRAHAM-HARRISON: Was damage actually resulting or is it something that will happen if action isn't taken? MR. AGUEH: Yes. The pressure is more in the area of origin. If I take the case of Burkina, we have tremendous pressure on the Mosi (Phonetic) Plateau. But in the area of settlement, given the attraction, we have to be ahead of the game. And the study I mentioned is precisely designed to get the facts and the prescription needed to be ahead of the game. MR. CONABLE: I think Mr. Graham-Harrison is concerned with the orderliness of the planning process, to be sure that we don't have inequities and injustices and environmental degradation going on as a result of an unplanned rush for land that previously has been uninhabitable and inexploitable. Mr. Coady, did you want to ask along this line also or some other line? Yes. MR. COADY: This is just to welcome the very good progress in this area. Upon joining the Bank, I reviewed a number of video tapes on all areas of the Bank. One of them MILLER REPORTING CO., INC. 507 C Street, N.E. Washington, D.C. 20002 (202) 546-6666 STRICTLY C NFIDENTIAL rum 69 included riverblindness, and it was quite a moving tape. MR. CONABLE: It is one of the best tapes the Bank made. That is the source of my information about it too, Mr. Coady. I quite agree. MR. COADY: And so, we quite welcome and this Chair both bilaterally and multilaterally supports this effort. Thank you. MR. CONABLE: Thank you very much. Any other comments or questions? (No response.) MR. CONABLE: We appreciate the report, Mr. Agueh. Thank you very much. MILLER REPORTING CO., INC. 507 C Street, N.E. Washington, D.C. 20002 (202) 546-6666