Current Status of Immunization Service Delivery in Africa

Mary HarveyAFR/SD/HRD

SOTA/PHN MeetingJune 13, 2002

Nearly one million vaccine preventable deaths occurring annually in the Region

Measles 454.000

Hib 100.000- 160.000

Hepatitis B related diseases

150,000

Pertussis 106.000-199.000

MNT 110,000

Yellow Fever 20,000-30,000

Meningococcal diseases 30,000-50,000

Reported DTP3 Coverage by Epidemiological Block Africa Region, 1994 – 2000

0

20

40

60

80

100

Central Eastern Southern Western Spec. Situ Regional

1994 1996 1998 2000

Special Sit.

Changing Environment of EPI

Disease Control Initiatives

• Polio Eradication

• Measles Control/Elimination

• Neo-Natal Tetanus Elimination

Polio Funding Trends by Region1996-2001

$99,379,000

$1,259,000

$900,000

$26,309,000

$36,551,000Africa

Asia NearEast

Europe andEurasia

LAC

GlobalBureauProjects

Sources: USAID Bureau of Global Health and Polio Eradication Initiative

Total Funding Amount = $164,398,302

Polio Eradication : progress made

1999 2000 2001

# of polio endemic countries 17 10 6

AFP cases

Reported 5009 5810 6568

Wild polio viruses confirmed 246 147 44

Proposed Revisions – May 20USAID PEI Results Framework

Stabilize World Population and Protect Human Health in

a Sustainable Fashion

Stabilize World Population and Protect Human Health in

a Sustainable FashionAgency GoalAgency Goal

USAID-PEI Strategic Objective:

Global Polio Eradication

USAID-PEI Strategic Objective:

Global Polio Eradication

Critical Assumptions:— USAID supports the World Health Assembly resolution on global polio eradication— Successful global eradication depends upon continued support from all partners — Polio immunization can one day be stopped— Transmission of poliovirus can be interrupted— Polio-related activities will continue until 2010

Selectedimmunization

support systems, at the national and sub-national levels

in the public and private sectors,strengthened

to achieve and maintain

polio eradication

Improved quality, detailed and

timely planning andimplementation for supplemental polio

immunization (including NIDs, SNIDs, mopping

up) and, when appropriate, other

interventions or vaccines

Improved Acute Flaccid Paralysis

(AFP) surveillance and response system that is integrated withsurveillance for other infectious

diseases

Timely documentation and use of information

to continuously improve the quality of polio

eradication immunization and

VPD-control activities

Build EffectivePartnerships

StrengthenSelectedSystems

SupportSupplementalImmunization

ImproveSurveillance

Improve Information Collection and Use

First-level Results

Support the global eradicationof polio and related actions to

maintain immunity by the year 2007, in selected countries and regions,

in ways that contribute to thedevelopment of sustainableimmunization and disease

control programs

Effective partnerships to support the implementation of polio eradication, immunization, and vaccine preventable disease-(VPD) control programs established and operational

Note: Italics represent proposed revised language.

Take Home Messages

• Maintain Heads of States and Health Ministers involvment-We are close to achieving the goal but the work is not yet done anywhere in Africa!

• NIDS will need to continue every two to three years after 2005 and polio eradication has been certified, IF ROUTINE COVERAGE for polio 3 is less than 90%

• Document experiences of implementation of district performance contracts and potentials for other health interventions

• Strengthen sub-regional EPI coordinating structures (bi-laterals, rotating chairmanship)

• Use infrastructure built for polio eradication to expand support to other disease control activities

Measles Mortality ReductionWHO/UNICEF Goals

• Reduce the number of measles deaths by half by 2005

• Achieve and maintain interruption of indigenous measles transmission in large geographical areas with established elimination goals

• Review progress in 2005 with other partners

Recommended Strategies• Providing the first dose of measles vaccine

to successive cohorts of infants

• ensuring that all children have a second opportunity for measles vaccination

• enhancing measles surveillance with integration of epidemiological and laboratory information

• improving the management of every measles case including vitamin A supplementation .

Take Home Messages

• USAID recognizes that measles causes significant morbidity and mortality

• Based on the data, USAID strongly supports intensified efforts to reduce measles transmission and disease burden

• USAID supports a balanced and comprehensive approach to effective measles control, which is consistent with and contributes to delivery of primary health care services.

MNT Elimination: Attaining a true rate of NT <1/1000 live birth/year/districtMNT Elimination: Attaining a true rate of NT <1/1000 live birth/year/district

Strategies for attaining elimination

•TT Supplemental immunization activities in high risk areas with 80% coverage in CBAW

•Clean delivery practices of 70%

•Active surveillance for NT

Countries’ MNT Elimination Status in the African RegionCountries’ MNT Elimination Status in the African Region

Potentialité Eliminated

NT near Elimination

With POAs

No POAs

Other Initiatives

• GAVI

The Global Alliance for Vaccines and Immunization

Mission:

“ To save children’s lives and protect people’s health through the widespread

use of vaccines”

Country5 years

Immunization Services Support

3 years Injection safety support

5 years New and Under-used

vaccine Support

1 Angola2 Benin 2,768,000 3 Burkina Faso 4,410,000 4 Burundi 2,662,000 407,000 14,239,000 5 Cameroon 5,556,000 C6 Central African Rep.7 Chad8 Comoros 165,000 R9 Côte d’Ivoire 3,859,000 6,454,000 10 DR Congo11 Djibouti12 Eritrea 930,000 1,768,000 13 Ethiopia 19,130,000 3,508,000 14 Gambia 489,000 147,000 3,167,000 15 Ghana 3,359,000 37,980,000 16 Guinea 2,585,000 R 944,000 17 Guinea Bissau

Country5 years

Immunization Services Support

3 years Injection safety support

5 years New and Under-used

vaccine Support

18 Kenya 11,113,000 69,913,000 19 Lesotho 517,000 R R20 Liberia 2,804,000 499,000 21 Madagascar 4,277,000 11,628,000 22 Malawi 28,721,000 23 Mali 4,100,000 1,514,000 24 Mauritania25 Mozambique 3,291,000 12,086,000 26 Niger 5,027,000 R27 Nigeria 53,020,000 C28 Rwanda 4,108,000 20,293,000 29 São Tome 30,000 R30 Senegal 3,983,000 937,000 R31 Sierra Leone 2,352,000 372,000 32 Somalia33 Sudan 8,968,000 2,260,000 34 Tanzania 6,499,000 23,750,000 35 Togo36 Uganda 9,343,000 1,445,000 50,618,000 38 Zambia 2,959,000 680,000 24,184,000 36 Zimbabwe 3,220,000 CTOTAL 125,611,000 5,694,000 243,206,000

GAVI at the National Level

• Concepts– Coordination among all partners supporting

immunization (ICC or other)- ICC has additional role to play

– Focus support on consolidated national 5 year plan and annual workplans

– Monitoring and evaluation through shared instruments

– Support and intra-country coordination available through Regional Working Groups

GAVI At The National Level

• Upcoming areas of attention– Completion of application for available support– Support for implementation of national annual

plans (participation in ICC and provision of TA)

– Data Quality audits - improved district level reporting

– Enhanced financial planning & completion of Financial Sustainability Plans

Countries Activities funded Observations

•MALI

($429,000 in Jan 01)

•Microplanning workshop

•Funds for EPI operations for 13 districts

•District microplans approved by ICC

•Performance contract signed with districts

•GHANA

($265,400 in Dec 00)

•Procurement of motor bikes, copiers

•Training / microplanning /data management

•VF for infrastructure and not recurrent costs

•Checks through Audit

GAVI/VF have already reached the districts : a critical factor for success

CHALLENGES

Maintain all partner commitments to EPI in the Region HIGH on their Agenda.

Keep Countries commitment to EPI and maintain a significant funding for EPI from national Budget

It is difficult to get all partners working together, but there is no better way way to succeed

Take Home Messages

CHALLENGESUSAID should nurture the

development of Competent and Functional ICCs to Support EPI and its MYIP: Participate in the ICC, Support, Monitoring and Evaluation activities.

Respond to increasing demand for Technical Assistance in Countries

Encourage support for improving safety of injections and encourage timely introduction of HepB, Hib and Yellow Fever Vaccination

Take Home Messages