UNICEF Programme Updates

Transcription

1 UNICEF Programme Updates Vaccine Industry Consultation November 2016 UNICEF/UNI199159/Panday Heather Deehan, Chief, Vaccine Centre on behalf of Robin Nandy, Principle Advisor, Immunization

2 Outline UNICEF main areas of work in immunization Actions taken in each area of work of GVAP Conclusions and Way Forward

3 UNICEF areas of work UNICEF/NYHQ /DORMINO

4 UNICEF s Mission & GVAP

5 UNICEF major areas of work in support of GVAP Goals Areas of work for UNICEF in immunization Polio eradication and MNT elimination Coverage with equity tactics for reaching marginalized communities 1. Achieve a world free of poliomyelitis 2. Meet global and regional elimination targets 3. Meet vaccination coverage targets in every region, country and community 4. Develop and introduce new and improved vaccines and technologies 5. Exceed the Millennium Development Goal 4 target for reducing child mortality Accelerated disease control (Measles, Rubella, Meningitis, YF) Communication for immunization Immunization supply chain management Immunization system strengthening and finance Procurement and supply management Data for immunization (e.g. JRF, WUENIC, home based records, ) And other Divisions (e.g. Communication, Partnerships, Emergencies, ) Supply Division Program Division Other Divisons

6 Update of actions taken in response to GVAP assessment UNICEF/UNI196303/Georgiev

7 41 Countries eliminated MNT between 2000 & Aug 2016 *(Plus Ethiopia except Somali region and 16 regions out of 17 in Philippines) leaving 18 countries yet to eliminate MNT MNTE not eliminated Indonesia, Niger and Equatorial Guinea validated this year More than 145 million Women of Reproduction Age (WRA) received more than 2 doses of TTCV thru SIAs Source: WHO/UNICEF Database Date of slide : 08June 2016 Map production: Immunization Vaccines and Biologicals, (IVB), World Health Organization eliminated from Aug 2016 eliminated before 2000 not applicable The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved

8 Global measles and rubella elimination - update Annual reported measles cases and MCV1* and MCV2** coverage, During , estimated 79% reduction in measles mortality Over 17 million measlesrelated deaths averted

9 Humanitarian emergencies: Two-third s of the world s unimmunized children live in countries affected by armed conflict DPT3 coverage percentage estimates during Source: WHO UNICEF estimates DPT3 coverage inequity among poorest and richest wealth quantiles Yemen Syria Yemen Syria Iraq South Sudan Achievements: In Syria, accelerated vaccination campaigns reached 1.3 million children who have missed out on routine vaccination, especially those in besieged and hard-to-reach areas. Many of these children, born since the conflict began, have never been vaccinated. In Yemen, UNICEF & partners supported vaccination campaigns immunized 2.4 million children against measles and rubella in January and 4.6 million children against polio in April In Libya, the first nationwide polio immunization campaigns in two years was completed in April. UNICEF shipped 1.5 million doses of vaccines to Tripoli. Over 36 million children are being reached with polio vaccinations across Pakistan, where polio cases have dropped 65 percent since Iraq DPT3 Coverage (%) During , UNICEF & partners supported emergency immunization campaigns against measles for more than 23 million children in Iraq, Syria and Yemen. Source: UNICEF MICS

10 Humanitarian emergencies: Yellow fever Response and achievements: A total of 966 cases have been confirmed in Angola and Democratic Republic of the Congo since Dec 2015 Over 17 million people have been vaccinated Three countries have reported yellow fever cases exported from Angola Angola: No new confirmed cases since 23 June. Mass reactive vaccination campaigns in areas with confirmed local transmission. A preventive phased vaccination campaign targeting approximately 5 million people was launched on 15 August. As of 24 August, 2.98 million people had been vaccinated DRC: 75 confirmed cases. A preventive vaccination campaign was launched on 17 August. The campaign aims to immunize over 11 million people. As of 24 August, 6.9 million people have been vaccinated in Kinshasa (91.3% of the target population). Due to shortage of vaccine the vaccination campaign in Kinshasa used the fractionated dose strategy, which is administered at onefifth of the standard vaccine dose, and is only recommended by SAGE for use in an emergency situations with limited vaccine availability.

11 Vaccine Financing Solutions for Immunization UNICEF is supporting countries in improving vaccine sustainability and financing via the following workstreams: Impact on Countries Pre-Financing Delayed Grants and MoH Budgets Expansion of the Vaccine Independence Initiative ( VII ) in 2015 to accommodate increasing pre-financing needs and to avoid stock-outs. ~$57m worth of transactions pre-financed in 2015 (across all commodities) bopv (in preparation for the Switch ) and GAVI co-financing obligations also pre-financed for multiple countries; Nigeria $21m credit line for Routine Immunization to avoid stock-out in Addressing cash flow timing gaps Increasing Gov t Fiscal Space Advocacy for mobilization of domestic resources for immunization supplies. Support country-owned budgeting and sustainability initiatives. Focus on unit costing and underlying forecasting for supplies in addition to disbursement practices. Facilitating access to commercial markets and development of structured finance models. Convening of the commercial financing workshops to expand financing toolkit available to Countries. Expanding work to focus on improving access to hard currency. Increasing availability of funds / budgets Special Contracting With partners including GAVI and BMGF, utilizing special contracting instruments to significantly reduce prices (and therefore iimproved sustainability). In Penta, achieved approximately MICs-GAVI price parity. Lower prices, secured quantities, etc.

12 Immunization Supply Chain Management (iscm) Objective: Availability of potent vaccines and efficient use of resources within the supply chain. Examples of achievements: Launched joint WHO & UNICEF statement on strengthening immunization supply chains through the comprehensive Effective Vaccine Management process and working with WHO through the iscm Hub to upgrade the EVM Assessment; Supported countries in implementing EVM requirements and minimum standards with a specific on temperature monitoring and cold chain management; Strengthening national accountability mechanisms that oversee supply chains, i.e. national logistics working groups; Launched a set of e-learning modules to strengthen individual s capacity on vaccine management; Implementing a new USD 50 M GAVI Cold Chain Equipment Optimization Platform; Conducting global and regional capacity building workshops of EPI staff

13 GVAP Strategic Objective 2: Definition & indicators Demand Vaccine Hesitancy: Accept some, delay some, refuse some Acceptance Enough for SIAs, not RI Refuse all vaccines Demand is the actions of individuals and communities to seek, support, and/or advocate for vaccines and vaccination services. Piloted GVAP SO2 indicator: Number of countries that reported implementing activities in previous year to stimulate and/or sustain individual and community demand for vaccines and vaccination services. (Question submitted for JRF) SO2 Indicator #2 Coverage: DTP3 and MCV1, Source: WUENIC SO2 Indicator #3 Dropout: DTP1 compared to DTP3, Source: WUENIC SO2 Indicator #4 Timeliness: MCV1 - Source: MICS/DHS (TBD)

14 Driving & sustaining demand for vaccination Seek (Individuals) Governments and supply-side actors are responsible for fostering demand in two ways: stimulating (promoting, generating) and sustaining Demand includes three primary actions: Support (Community) Sustain (Decision makers) seeking (individual behavior) supporting (expressing a social norm) advocating (organized action to influence decision-makers) Demand is a behavior requiring more than acceptance and is not directly measurable as coverage.

15 Assump tion Pillars, main interventions and approaches Goals Vision Inter-agency partners framework for C4I: In Progress Management Supply Chain Data Communication for Immunization Health Workforce Surveillance Service Delivery All eligible children and adolescents realize their right to immunization Individuals and communities seek support and/or advocate for immunization as a right and responsibility Governments invest in long-term strategies and systems to achieve and sustain full coverage with equity (GVAP strategic objectives 1,2,3,4,5 & 6) Community Engagement Participation of communities in REC microplanning Track and follow up with eligible children and adolescents Resolve barriers to access and uptake Civic accountability mechanisms (mtrac, U- Report) Advocacy Equip EPI program managers to make evidence-based investment cases for RI, demand promotion, and REC Partner with and empower influencers and CSOs to shape policy dialogue and decision making about EPI Social Mobilization Generate demand, shift norms, and build coalitions through local media, traditional structures, influencers, CBOs and CSOs Engage CHWs and influencers to motivate caregivers and mobilize eligible children and adolescents Social and Behavior Change Communication Inform and motivate all caregivers to fully vaccinate every eligible child Empower peers and local influencers to promote vaccination as a norm, duty and right Capacity building and Motivation Build MoH/EPI capacity in REC and communication for immunization Train HWs and CHWs in interpersonal communication Share knowledge & facilitate learning exchange Principles: Evidence informed, Scalable, Sustainable, Measurable and Accountable Comprehensive Communication for Immunization Strategies are funded and reflected in annual EPI plans, cmyps, HSS programming

16 An Important Professional Development Series Immunization elearning Initiative Courses Available Now: One orientation course. The three core courses may be completed in any order. Immunization staff, consultants, and partners can Immunization Staff Orientation Get up-to-date on immunization systems and protocols Improve the effectiveness of partner support Three mini-courses that can completed in less than one hour. One advanced minicourse. Align knowledge with colleagues Complete in any order Start and stop without losing progress Satisfy PDP goals Earn a certificate A vaccine cold chain course for technical staff working in ISCM.

17 Geographical (state) Mother's Education Wealth quintile Birth order Urban/Rural Gender Data to address inequities in immunizations (Nigeria example) Types of Solutions inequities Geographic Socioeconomic - Urban poor - Migrants - Rural remote - Nomads - Ethnic groups - Religious groups - Security deprived - etc RED approach Community based approaches - SMS reminders - Community registration and defaulter tracing - Community participation - Dialogue & Understating life style - Adaptation of services to community needs - etc Service delivery - communication Nigeria DHS 2013

18 Expanding & innovating for the urban poor 50+% of world s population live in cities estimated to increase to 66% by 2050 (mostly in Africa & Asia) Urban setting Denominator problem Catchment areas not adhered to Legality of settlement Population mobility Social distance Example - UNICEF Urban Slum Project in Jakarta Leveraging UNICEF capacity in health technology and community engagement (RapidPRO) Mapping urban slum communities in Jakarta, building on OpenStreetMap to improve identification Community Health Worker register infant through house to house engagement, including parents mobile phone number RapidPRO sends automated SMS message to remind mothers when immunization are due Using SMS to report results of regular rapid card checks in urban slum communities to track progress

19 Conclusions & way forward UNICEF/PFPG /Lynch

20 M & E Programme Areas Actions Approaches Goals Achieve results through partnership Vision UNICEF Health Strategy for Guided by the Convention on the Rights of the Child (CRC) & the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), and in line with the Sustainable Development Goals (SDGs) and Every Woman, Every Child (EWEC) A world where no child dies from a preventable cause, and all children reach their full potential in health and well-being End preventable maternal, newborn & child deaths Address inequities in health outcomes Promote the health and development of all children Strengthen health systems, including emergency preparedness and resilience Promote integrated, multi-sectoral policies and programs Advocate for every child s right to health Influence government policies Strengthen service delivery Empower communities Support data capture, evidence generation, and use Engage with partners Expand available resources Support evidence-based policymaking and financing Promote scale-up of effective interventions/ innovations Share knowledge & promote southsouth exchange Build capacity of management and health providers Support programmes, including service provision, in particular at community level and in emergencies Strengthen supply chain systems Engage for social and behaviour change Generate demand Strengthen accountability Maternal, newborn, and child health (focus on equitable access to quality primary health care) Older child and adolescent health (focus on public policies and supportive environments) Proposed actions and program areas represent global "menu" to be tailored to country context by country offices Measurement, Learning and Accountability

21 UNICEF priorities for the remainder of 2016 & beyond Develop a agency wide roadmap for immunization, with a view to: Ensuring greater alignment with global efforts (e.g., GAVI processes, GVAP goals and global eradication/elimination goals) Adopting an integrated, systems approach and alignment with UNICEF s new Health Strategy Exploring multidimensional, context specific barriers to coverage & equity in priority countries including measurement to track progress Driving the demand agenda to match supply side initiatives Identifying key indicators and milestones to track progress Continuing support to all elimination and eradication goals Leveraging polio resources to enhance routine immunization Both technical and advocacy aspects

22 UNICEF/SUDA2014-XX228/Noorani