World Health Organization · 1st edition, 2025 · 54 pages
Practical guidance for establishing, operating and sustaining national onchocerciasis elimination committees to support elimination programmes.
- Issuer
- World Health Organization
- Edition
- 1st edition, 2025
- Audience
- NOEC chairs and members, national programme managers, health ministry officials, implementation partners
- Evidence
- Expert consensus informed by country experiences and WHO guidelines
- Reviewed
- 17 Oct 2026 · GMJ
What this guideline says
GMJ summary
This WHO handbook provides comprehensive operational guidance for national onchocerciasis elimination committees (NOECs) – expert advisory bodies that support health ministries in achieving elimination of river blindness. It addresses the full lifecycle of NOECs: establishing them with appropriate legal frameworks and membership (10–15 multidisciplinary experts including epidemiologists, entomologists, parasitologists and social scientists); operating them through strategic planning, data review, cross-border coordination and surveillance oversight; and using available tools for mapping, monitoring and advocacy.
The handbook emphasizes NOECs’ core technical responsibilities: interpreting epidemiological and entomological data by transmission zone, recommending when to stop mass drug administration (MDA) based on evidence of transmission interruption, advising on enhanced interventions where needed, supporting 3–5 year post-treatment surveillance, and ultimately helping countries prepare elimination dossiers for WHO verification. It provides specific guidance for managing co-endemicity with lymphatic filariasis and loiasis, cross-border collaboration, and integration with broader NTD programmes.
Drawing on successful country experiences from Nigeria, Uganda, Ethiopia, Democratic Republic of Congo and others, the handbook offers practical tools including meeting agenda templates, memoranda of understanding for cross-border work, transmission zone classification systems with colour-coded maps, and tables comparing observed versus predicted prevalence trends. As of 2024, 25 of 31 onchocerciasis-endemic African countries had established NOECs.
Key points
For clinicians — doses and thresholds as stated in the guideline
- NOECs should meet at least annually and comprise 10–15 experts (epidemiologist, biostatistician, entomologist, parasitologist, social scientist, public health specialist, laboratory specialist, GIS specialist) appointed by the health ministry with an independent chair
- NOECs classify areas into seven transmission zones: non-endemic; unknown/needing OEM; ongoing transmission under MDA; suppressed transmission; suspected interrupted transmission; under post-treatment surveillance (3–5 years); and eliminated
- First-line (high-risk) survey villages are located within 5–10 km of black fly breeding sites with no intervening villages; second-line villages are within 15 km radius of first-line villages, as vector flight range rarely exceeds 15 km
- Post-treatment surveillance lasts 3–5 years after stopping ivermectin MDA and includes entomological monitoring (fly catching for 12 calendar months starting at least 24 months post-MDA cessation), serological surveys, and clinic-based treatment of migrants from endemic areas
- In areas co-endemic with loiasis, implement test-and-not-treat (TaNT) for migrants from Loa loa endemic areas to prevent serious adverse events in individuals with high Loa loa microfilarial loads
- Cross-border collaboration requires: synchronized MDA timing, joint monitoring teams, shared data repositories, memoranda of understanding between health ministries, registration of migrant populations, and coordination of surveillance activities across borders
- NOECs recommend enhanced interventions (twice-yearly treatment, vector control, micro-planning, intensified supervision, coverage surveys, alternative treatments) when observed prevalence substantially exceeds predicted prevalence based on ONCHOSIM modelling
- Elimination dossiers for WHO verification must include: demographic context, health system structure, historical endemicity documentation, intervention strategies with coverage data, post-treatment/post-elimination surveillance results (serological, entomological, maps), management of co-endemicity and special populations, partnership details, and bibliography of peer-reviewed publications
Onchocerciasis transmission elimination status by colour code
Table extracted from the guideline
| Colour | Category | Action required |
|---|---|---|
| Red | Endemic (MDA not started) | Start MDA |
| Orange | Endemic (under MDA) | Continue MDA |
| Yellow | Unknown (under LF MDA) | Conduct iTAS during LF TAS |
| Light green | Suspected transmission suppressed | Continue MDA and conduct monitoring surveys |
| Green | Suspected transmission interrupted | Conduct impact assessment surveys |
| Blue | Under Post Treatment Surveillance | Conduct Surveillance |
| White | Non-endemic | No action needed |
| Grey | Endemicity unknown or hypoendemic | Conduct OEM |
Source: World Health Organization, National Onchocerciasis Elimination Committees: A Handbook for Expert Advisory Groups in Africa. Reproduced in summary form.
From the guideline
Verbatim
“The flight range of onchocerciasis vectors, when seeking a blood-meal, is unlikely to exceed 15 km under normal circumstances.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked extensively on national disease control programmes and WHO technical advisory processes, I recognise the universal value of the NOEC governance model presented here, even for countries not endemic for onchocerciasis. The structure – an independent expert committee with clear terms of reference, ministerial mandate, multidisciplinary membership and formal data review authority – mirrors the effective advisory mechanisms Georgia has used for hepatitis C elimination and tuberculosis control. The most transferable recommendation is the systematic classification of geographical areas by intervention status with colour-coded mapping and the discipline of comparing observed epidemiological outcomes against model predictions to identify areas requiring enhanced intervention. One implementation caveat for any national programme adapting this model: maintaining committee independence while securing sustainable government funding and political commitment requires careful institutional positioning, ideally with the committee established by ministerial decree and renewed periodically, but with members selected for technical expertise rather than administrative convenience.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 17 Oct 2026
Applicability
Georgia and the South Caucasus
While Georgia is not endemic for onchocerciasis, this handbook offers valuable structural lessons for national disease elimination programmes in the South Caucasus. The governance framework – establishing expert advisory committees with clear terms of reference, multidisciplinary membership, ministerial mandate for data review, and formal reporting channels – is directly applicable to Georgia’s ongoing elimination efforts for other communicable diseases. The emphasis on cross-border collaboration, systematic surveillance during post-intervention phases, integration of co-endemic disease programmes, and documentation standards for international verification aligns with Georgia’s experience in hepatitis C elimination and tuberculosis control. National programmes in the region managing any elimination agenda would benefit from adapting the NOEC operational model: regular technical advisory meetings, transmission zone mapping with standardized colour-coding, comparison of observed versus modelled outcomes, and formalized cross-border memoranda of understanding with Armenia, Azerbaijan and Turkey.
Questions this guideline answers
Quick answers
What is the primary role of a national onchocerciasis elimination committee?
NOECs provide independent technical advice to health ministries on onchocerciasis elimination, including: interpreting epidemiological and entomological data; recommending where and when to stop ivermectin mass drug administration based on evidence of transmission interruption; advising on enhanced interventions for persistent transmission; supporting development of national strategic plans and guidelines; overseeing 3–5 year post-treatment surveillance; and helping prepare country dossiers for WHO verification of elimination. The committee serves as the expert oversight body while the national programme team (led by the programme manager/coordinator) serves as the secretariat.
How should survey sites be selected for onchocerciasis impact assessment?
Site selection requires understanding vector ecology, disease epidemiology and local geography. First-line (high-risk) villages are located within 5–10 km of black fly breeding sites on rivers and tributaries, with no other villages between them and the breeding sites; these are selected every 30–50 km along main rivers to ensure all endemic areas are represented. For each first-line village, a second-line village is chosen within a 15 km radius of the first-line village and within 15 km of known breeding sites, reflecting the typical flight range of onchocerciasis vectors seeking blood meals. Topographical maps (scale 1:250,000 or digitized apps) should be used, with exclusion of unsuitable zones (areas without significant human population or environmentally unsuitable for vectors).
What activities are required during the 3–5 year post-treatment surveillance period?
Post-treatment surveillance after stopping MDA includes: identifying and training health facility staff, community health workers and community drug distributors in passive and active surveillance; providing ivermectin to primary health centres for clinic-based treatment of migrants from endemic areas; prospecting breeding sites and conducting entomological monitoring (fly catching for 12 calendar months starting at least 24 months after stopping ivermectin, with species identification to distinguish vector from non-vector black flies); serological sampling in communities near fly-catching points; health education through radio, posters, community sessions and social media; and joint cross-border supervision at least twice yearly. In areas co-endemic with lymphatic filariasis, post-treatment surveillance is suspended until LF is eliminated.
How should cross-border onchocerciasis transmission zones be managed?
Effective cross-border collaboration requires: determining the elimination status of border areas (baseline endemicity, treatment coverage, current transmission status) and sharing this data between countries; establishing joint meetings at country, state/province and district levels with synchronized training, MDA timing and surveillance activities; forming joint monitoring and evaluation teams; developing high-level memoranda of understanding between health ministries (Annex 4 provides a template); identifying, registering and mobilizing community drug distributors working with migrants on both sides of borders; monitoring population movement and integrating migrants into MDA; using interpreters where border communities speak different languages; and maintaining flexible strategies in areas with security challenges, including recruiting migrants as community drug distributors for displaced populations.
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- Issuer
- World Health Organization
- Type
- Manual
- Edition
- 1st edition, 2025
- Status
- Current
- Published
- 2025-10-14
- Languages
- English
- Scope
- Onchocerciasis elimination committee establishment, operation and governance in African endemic countries
- Audience
- NOEC chairs and members, national programme managers, health ministry officials, implementation partners
- Pages
- 54
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-011500-2
- Evidence
- Expert consensus informed by country experiences and WHO guidelines
- Record history
- Created 17 Oct 2026 · updated 17 Oct 2026 · next check Apr 2027
World Health Organization. National onchocerciasis elimination committees: a handbook for expert advisory groups in Africa. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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