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A Comprehensive Policy framework for the National Immunization Programme Dr Nihal Abeysinghe, [M.B.,B.S., MSc, M.D.] Chief Epidemiologist, Ministry of Health

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Page 1: A Comprehensive Policy framework for the National Immunization Programme Dr Nihal Abeysinghe, [M.B.,B.S., MSc, M.D.] Chief Epidemiologist, Ministry of

A Comprehensive Policy framework for the National Immunization Programme

Dr Nihal Abeysinghe,[M.B.,B.S., MSc, M.D.]Chief Epidemiologist,Ministry of Health

Page 2: A Comprehensive Policy framework for the National Immunization Programme Dr Nihal Abeysinghe, [M.B.,B.S., MSc, M.D.] Chief Epidemiologist, Ministry of

Immunization Programme Sri Lanka : Vaccines used at present

BCG for Tuberculosis Oral polio for Poliomyelitis DPT / DT for Diphtheria, Pertusis

[Whooping Cough] & Tetanus Measles Rubella Tetanus Hepatitis B Japanese Encephalitis

Page 3: A Comprehensive Policy framework for the National Immunization Programme Dr Nihal Abeysinghe, [M.B.,B.S., MSc, M.D.] Chief Epidemiologist, Ministry of

Present status of the Immunization Programme, Sri Lanka

Dramatic reduction in illness, disability & death from

Poliomyelitis (0) since 1994Diptheria (0) in 2005Tetanus (25) / Neonatal Tetanus (0)Whooping Cough (32)Measles (24)

Childhood tuberculosisJapanese EncephalitisRubella

Very high vaccine coverage > 95%

Page 4: A Comprehensive Policy framework for the National Immunization Programme Dr Nihal Abeysinghe, [M.B.,B.S., MSc, M.D.] Chief Epidemiologist, Ministry of

Decision Making Process Evidence based decision making

Epidemiology Unit recognizes the needs Makes addition to the surveillance system Carries out burden & cost studies Proposes to the Advisory Committee on Communicable Diseases

Reviewed & approved by the Advisory Committee on Communicable Diseases [ACCD]

Discussion with a wider group of stakeholders; [“Immunization Summit-held on 5th January 2007”]

Negotiate for funding & convince the Finance Ministry Acquire logistics, other facilities & prepare the field staff Develop a communication strategy Develop plans for Continuous follow up, Monitoring & Evaluation

Page 5: A Comprehensive Policy framework for the National Immunization Programme Dr Nihal Abeysinghe, [M.B.,B.S., MSc, M.D.] Chief Epidemiologist, Ministry of

0

10

20

30

40

50

60

70

80

90

100

74 75 77 79 81 83 85 87 89 91 93 95 97 99 01 03 05

Year

Cove

rage

(%)

DPT3 Measles MR OPV3 HepB3

Strength of the Sri Lankan EPI : Number of Years Taken to Reach Over 90% Coverage Following Introduction of a New Vaccine

Page 6: A Comprehensive Policy framework for the National Immunization Programme Dr Nihal Abeysinghe, [M.B.,B.S., MSc, M.D.] Chief Epidemiologist, Ministry of

Present Challenges

Sustaining high coverage Achieving eradication & elimination targets Ensuring vaccines of assured quality Introducing new vaccines Strengthening the capacity for surveillance of

Vaccine-preventable diseases & Adverse Events following immunizations

Ensuring financial sustainability for the immunization programme

Strengthening Primary Health care system

Page 7: A Comprehensive Policy framework for the National Immunization Programme Dr Nihal Abeysinghe, [M.B.,B.S., MSc, M.D.] Chief Epidemiologist, Ministry of

Cost Considerations in the National EPI

Introduction of a new

vaccine is always

considered within the

framework of the National

EPI, not separately

Total cost

Vaccine

Injection supplies

Other routine recurrent

cost

Cold chain equipment

Transportation

$-

$2.0

$4.0

$6.0

$8.0

$10.0

$12.0

2007 2008 2009 2010 2011

Mill

ions

Traditional Vaccines New and underused vaccines

Injection supplies Personnel

Other routine recurrent costs Cold chain equipment

Other capital equipment

Page 8: A Comprehensive Policy framework for the National Immunization Programme Dr Nihal Abeysinghe, [M.B.,B.S., MSc, M.D.] Chief Epidemiologist, Ministry of

Policies that would help us to achieve the desired status

Equity and equality Ownership, partnership and responsibility

Government Other stakeholders International organizations

Accountability publicly accountable for the policies, goals,

strategies and actions Assured quality, safe products and services

Internationally recognized standards of quality, safety, and services are delivered according to best practices.

Page 9: A Comprehensive Policy framework for the National Immunization Programme Dr Nihal Abeysinghe, [M.B.,B.S., MSc, M.D.] Chief Epidemiologist, Ministry of

Policies that would help us to achieve the desired status

Adaptability to local needs and circumstances

commitment of all responsible stakeholders to appropriately adapt to the local needs and circumstances.

Sustainability through technical and financial capacity building

All stakeholders including the government should work collectively, to ensure financial and technical self reliance with continuing, incremental infrastructure building.

Policies and strategies based on evidence and best practices The choice of policies, strategies and practices should be based on

evidence from surveillance, monitoring and evaluation, operational research, diseases burden and impact assessments, and economic analyses

Page 10: A Comprehensive Policy framework for the National Immunization Programme Dr Nihal Abeysinghe, [M.B.,B.S., MSc, M.D.] Chief Epidemiologist, Ministry of

Key Strategies

Implementing the comprehensive Multi Year Plan & annual plans

Reaching children in “difficult to reach areas” Ensuring quality vaccine supply & accessories Improving quality services by enhancing the

service facilities, vaccine storage capacity & surveillance of Adverse Events Following Immunization

Creating a Community demand Introducing new vaccines to combat ‘emerging’

new VPD with financial sustainability plans Regular reviewing of the programme

“What works & What not”

Page 11: A Comprehensive Policy framework for the National Immunization Programme Dr Nihal Abeysinghe, [M.B.,B.S., MSc, M.D.] Chief Epidemiologist, Ministry of

Key Strategies

Ensuring financial sustainability Improving National regulatory authority activities by

regular discussions Promoting operational research : Disease Burden

studies Improving management of human resources Strengthening laboratory capacity Strengthening capacity for data management Planning for immunization in complex emergencies Develop & implement a comprehensive communication

strategy Include immunization in epidemic preparedness plans Define & delegate responsibilities to stakeholders

Page 12: A Comprehensive Policy framework for the National Immunization Programme Dr Nihal Abeysinghe, [M.B.,B.S., MSc, M.D.] Chief Epidemiologist, Ministry of

Thank you

Epidemiology UnitMinistry of Health