10 th Annual African Vaccinology Course (AAVC) Cape Town 10 November 2014
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1 Operational Challenges of Vaccination Programmes in Africa 10 th Annual African Vaccinology Course (AAVC) Cape Town 10 November 2014 Johann van den Heever: NDoH EPI Manager
2 Outline Challenges of a Vaccination Systems Environment in Africa Challenges of the 5 Operational Components of Vaccination Systems Challenges of the 3 supportive elements of vaccination programmes in Africa Conclusion & way forward
3 Challenges of a Vaccination Systems Environment Health sector reforms Increasing complexities Vaccination systems Health Systems Macroeconomic changes External Debt National structural changes New partners External environment
4 Operational components of Vaccination systems Vaccine Supply & Quality Temperature chain & Logistics Service Delivery Data & Surveillance Advocacy & Communication
5 Five operational components (1) 1. VACCINE SUPPLY & QUALITY 2. Vaccine-Preventable Disease priorities: traditional vaccines and additional Country-specific vaccine preventable diseases e.g. meningitis, yellow fever Target populations: children/adolescents/mothers/others Budget: Self-financed/GAVI supported: PAHO like procurement for Africa? Forecasting vaccine needs: schedule & doses; vaccine presentation (single/multi-dose); routine & outbreak response Tender processes & procurement of vaccines: timelines/vaccine pipelines Vaccine utilisation monitoring, including wastage Immunisation safety: quality monitoring: National Control Laboratory
6 Five operational components (2) 2. EQUIPMENT, TEMPERATURE CHAIN & LOGISTICS Temperature chain: maintaining & monitoring optimal ranges; monitoring equipment & back-up energy supplies Available storage capacity: targets, schedules (doses required), usage/wastage (estimates vs. take-off) Transport: Methods & frequency of supply, Number of units & facilities to supply; frequency of delivery; Monitoring & maintaining optimal temperatures during delivery Stock management of vaccines: systems; Equipment (fridges/storage rooms); monitoring devices & methods Dry storage/ other materials (syringes (types), needles, etc.) Waste disposal: routine, for supplementary activities & during outbreaks: environmental & safety concerns Maintenance of equipment: Cold rooms/fridges: Type, maintenance & inventory, monitoring, replacement strategy & budget
7 Five Operational Components (3) 3. DATA & SURVEILLANCE DATA SYSTEM Targets (?including private vaccinations sector), Indicators & monitoring of performance (routine & supplementary) against disease prevalence/incidence Recording, collating, analysis, reporting & feedback: electronic or paper-based Record keeping and reporting to National & UN bodies (JRF) SUPPORTS ALL COMPONENTS SURVEILLANCE SYSTEM set-up (public & private) & monitoring (weekly active surveillance timeliness & completeness of reporting, including zero reporting) of VPDs & Safety monitoring: AEFIs Laboratory testing & classification of cases (NPEC) Laboratory containment (NTF) Overseeing elimination & eradication processes (NCC, ICCC, ARCC & IMB / Independent Monitoring Board) Record keeping and reporting to National & UN bodies (Annual Polio Eradication Reports to ARCC)
8 Five Operational Components (4) 4. ADVOCACY, COMMUNICATION & SOCIAL MOBILISATION: Information-Education-Communication materials & methods (including Health Information & Communications) on global, regional and countryspecific disease prevalence and incidence: health workers and the public Personal communication: vaccine hesitators Interpersonal communication: partners Social mobilisation: community participation, within socio-political and cultural norms and standards Political and media advocacy & information Intersectoral collaboration
9 Five Operational Components (5) PROGRAMME AND SERVICE DELIVERY: CORE, GUIDED BY Global Vaccine Action Plan: WHO, UNICEF MDGs/SDGs WHO AFRO Region, sub-regional strategies & guidelines Country Health Strategies & priorities: E.g. National Development Plan: Vision 2030 National Strategic Plan National Service Delivery Plan Annual Performance Plan with indicators 16 Key MDG countdown interventions Provincial & District Health Plans RTH Booklets/Child Health Cards & Vaccination Monitoring Charts
10 Five Operational Components (5) 5. SERVICE DELIVERY (continued) Policies (& recommendations from NITAG (National Immunisation Technical Advisory Group), guidelines, standard operating procedures Training, monitoring, evaluation & supervision Needs identification: informed by Reviews, Surveys Supportive partners
11 Five Operational Components (5) 5. SERVICE DELIVERY: To ensure quality & safety of Programmes Strategies and activities in administering vaccines: integrated vs. stand-alone Budget: self-financed/gavi-supported Static/fixed and Outreach/mobile Services & methods of transport Routine (keep-up) and Catch-up immunisation drive: (those who do not attend routinely): Child Health Days; Periodic Intensification of Routine Immunisation (PIRI) Supplementary Immunisation Activities (SIA)/Campaigns: to minimise the number of susceptibles (unvaccinated & under-vaccinated): large number of cohort, in a large geographical area, over a short time period, in order to interrupt transmission (definite start & finish) New vaccine introduction timelines
12 Five Operational Components (5) 5. SERVICE DELIVERY: To ensure quality & safety of Programmes Strategies and activities in administering vaccines: Reach Every Child in Every household in every District & Community (RED/REC) Strategy Continuous vaccine availability Safe vaccination practices Surveillance: AEFI & pharmacovigilance ACSM to improve acceptability Improving accessibility: Every day is an immunisation day no missed opportunities Improving data quality
13 3 Supportive elements of a Vaccination system Operations 1. Vaccine Supply & Quality 2. Logistics 3. Data & Surveillance 4. Advocacy & Communication 5. Service Delivery Management
14 Supportive Elements of a Vaccination System (1) 1. MANAGEMENT Policy formulation Setting of Standards: Standard Operating Procedures, Guidelines Planning & Micro-planning: CMyP Sharing information & collaboration with Development- & Operations partners Quality Assurance Monitoring & Evaluation: Supportive Supervision
15 Supportive Elements of a Vaccination System (2) 2. STRENGTHENING HUMAN & INSTITUTIONAL RESOURCES Staffing of programmes: self-reliance vs. reliance on development partners Ensuring adequate African resource capacity, Management training & development within a competitive world Supportive Personnel administration/management & development Institutional support: provide technical information, operational research support and capacity, etc.
16 Supportive Elements of a Vaccination System(3) 3. SUSTAINABLE FINANCING Adequate budgeting for integrated EPI activities Effective management of available financial resources Increased allocation of financial resources in the long term, based on work study recommendations
17 The delicate nature of vaccination systems in Africa
18 Knowledge, Skills & Practicing produces Confidence
19 Acknowledgements WHO NDoH, South Africa
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