participatory country exchange on strengthening routine ... · participatory country exchange on...

Participatory Country Exchange on Strengthening Routine Immunization. Co-organized by GAVI West-African Sub-regional Working Group and BASICS II. April 22-24, 2004. Dakar, Senegal. Robert Steinglass, Lora Shimp, Jules Millogo, and Tara Watson. (2004) English and French Zip files.

Abstract: This “Country Exchange” was a highly-participatory opportunity for country teams (consisting of MOH staff and their in-country partners) to learn from one another. Countries described their experiences in overcoming common problems and shared their best practices in strengthening routine immunization services. Countries discussed not only what was done, but how it was done and the impact these efforts are having on improving immunization coverage at sub-national levels. This helped other countries to customize their own solutions and approaches. The Country Exchange provided a forum for regional and global partners (UNICEF, WHO) to receive information on what is being accomplished in the field.

English

1. General Documents 2. Presentations 3. Presentation Summaries 4. Small Group Discussion Notes 5. Rapporteur Notes 6. Country Workplans

Français

1. Général documente 2. Presentations 3. Résumés de présentation 4. La petite discussion de groupe note 5. Rapporteur rapporte 6. Workplans de pays

Integrating Routine Immunization with Other Child Survival and Disease Control Initiatives

Group 1 1. According to the list of key practices (16), integration happens in the home 2. Given the number of intermediaries and the current incentives system, program

sustainability will be a problem. Over time, worker morale will decline. 3. Program investment is considerable thanks to the partners' efforts. Sustainability is a

concern. 4. MAP must be [?], which has a cost, [?] the intermediate and national levels in system

operations to make it sustainable. Group 2

1. Add HIV/AIDS to principle 1, even if it is mentioned in principle 2 2. Program complementarity 3. Key principles of integration include basic training and involving other ministries 4. Method of approach: begin with a pilot program in a few districts. Then expand to

scale 5. Continue to think about 'how to make integrated oversight effective' at different

levels (national and provincial) 6. It is important to ensure tight coordination between partners for the integrated

approach Group 3 1. A single management structure and a single service for all child follow-up programs:

saves money and labor 2. Shorten certain training programs, like IMCI 3. Train doctors 4. Get an idea of integration's extent in the high regions Issues to resolve 5. Inclusion of essential mobilization efforts at the IMCI level 6. Poor supervision and lack of resources Group 4 1. Integration should focus on operations level rather than higher level 2. Integration requires identifying small doable actions 3. Involve the community in key integration efforts 4. Include IMCI in medical and paramedical curricula 5. Involve the private sector in the 'champion community' approach Group 5 At the central level, coordination and collaboration require strong, efficient leadership

- Issues to reflect on: expand inter-agency committee's terms of reference and push it to include other programs in its schedule, such as malaria and nutrition, etc.

Do not lose sight of the fact that only compatible programs will be included Group 6 1. Ministry of Health is driving this and is making the case to all partners to adopt

integration 2. So as to highlight the preventive aspects, we have started to talk more about IMCI

rather than PCISE (local DRC adaptation of IMCI), which deals more with clinical aspects

3. In keeping with best practices, the community has been involved in setting priorities and a guide has been drafted and made available.

4. Members of the community have been trained for integration and all medical and nursing schools have introduced IMCI in their curricula …. [ ?]

The group recommends that Madagascar take care not to turn trained RC into paramedical staff. The group hopes that vertical financing by program will come to an end in Madagascar so that all partners will fund the integration packet according to the action plan drafted by the district. Group 7 1. Integration should be [?] to a minimum package; otherwise, if we try to integrate

many activities in one package the quality may be compromised. 2. Integration avoids loss of communities’ working hours, since they get many services

at once. 3. Integration adds effect to performance (synergize) because activities complement

each other. 4. Missed opportunities will be reduced to a minimum if we integrate activities. 5. Integration is cost effective, since it allows optimum use of funds. Group 8 Integration is very good. The benefits are obvious with limited work force at the facility/district level, and with limited resources. However problems include: • No integration at the higher level normally • Programmes are donor-driven • Non availability of the essential package needed for integrated services (eg. vaccines,

drugs etc) Suggestions: 1. Integration should extend to the policy making levels 2. Use a programme that has funding as an in road for integration of other programmes

3. Training modules for the health workers need to be integrated and made less cumbersome. Forms/tools should be integrated

4. Need for careful planning on the process of integration, including supply and logistics

Session Topic __ Revitalizing Vaccine Logistics at All Levels Your Country ___ Ethiopia_________________ Name of Note Taker __Efrem ___________________ What activities are already planned to address this topic?

Priority activities to be added to address this topic

How will each activity be implemented?

What organisations will provide support for each activity?

• Shortage of refrigerator spare parts

• Shortage of vaccine • Timely reporting of stock

(monthly) • Problem in distribution of

vaccine

• Train health workers on management of cold chain

• Timely forecast • Training in logistics

management • Use private agencies to

distribute vaccines

• Obtain spare parts by requesting from UNICEF

• Contract private agencies • Provide vaccine according to

forecast • Prepare modules • By contracting private

agencies • By contracting their cars

• MoH, UNICEF. Private agencies

• UNICEF, MoH • UNICEF, MoH, NGOs • UNICEF, MoH, WHO, NGOs,

private agencies

Thème de session _____ Monitorage et utilisation des données _____________________ Votre Pays ___________ Guinée____________________________ Nom de preneur de notes Dr. Djénou SOMPARE_________________________________________________ Quelles sont les activités déjà planifiées pour faire face à ce thème?

Les activités prioritaires à ajouter pour faire face à ce thème

Comment chaque activité va être mise en œuvre (prochaines étapes)?

Quelles sont les organisations qui vont appuyer chaque activité?

• Renforcement de la stratégie mobile et avancée dans tous les districts, particulièrement dans les 7 districts à faible taux de couverture vaccinale

• Renforcement de la

supervision formative dans tous les districts, particulièrement dans les 7 districts à faible taux de couverture vaccinale

• Finalisation et mise en oeuvre du PIC

• Stratégie avancée : dotation en carburant et en motos des CS

• Stratégie mobile:

- appui du district (logistique) aux equipes des CS

- appui de la communauté aux équipes des CS a travers les relais

• Supervision formative:

- révision des modules et guides de supervision;

- formation / recyclage des équipes cadres de districts

• Tous les partenaires

APPLICATION DE LAPPLICATION DE L’’AAPAAP POUR RENFORCER LE PEV DE POUR RENFORCER LE PEV DE

ROUTINE EN GUINEE ROUTINE EN GUINEE EXPERIENCEEXPERIENCE DANS DEUX DISTRICTS SANITAIRESDANS DEUX DISTRICTS SANITAIRES

((DABOLA ET KOUROUSSADABOLA ET KOUROUSSA))

Dr Abdourahmane SHERIF, Coordinateur National du PEV/SSP/MEDr Abdourahmane SHERIF, Coordinateur National du PEV/SSP/MEDr Dr DjDjéénounou SOMPARE, Directeur du PEVSOMPARE, Directeur du PEVDr Mamadou Adama DIALLO, Conseiller PEV Dr Mamadou Adama DIALLO, Conseiller PEV -- BASICSII BASICSII -- GuinGuinééee

RAPPEL DU PROCESSUS DRAPPEL DU PROCESSUS D’’AAPAAP

Obtenir et maintenir lObtenir et maintenir l’’accord de tous les partenaires et accord de tous les partenaires et acteursacteursDDééfinir la performance dfinir la performance déésirsirééeeDDéécrire la performance actuellecrire la performance actuelleDDééfinir lfinir l’é’écart de performancecart de performanceIdentifier les causes profondes de lIdentifier les causes profondes de l’é’écart de performancecart de performanceSSéélectionner des interventions correctiveslectionner des interventions correctivesMettre en Mettre en oeuvreoeuvre les interventionsles interventionsFaire le suivi et Faire le suivi et éévaluer la performancevaluer la performance

PRINCIPAUX FACTEURS INFLUENPRINCIPAUX FACTEURS INFLUENÇÇANT LA ANT LA PERFORMANCEPERFORMANCE

Les Attentes par rapport au travailLes Attentes par rapport au travail

Le Feedback sur la performanceLe Feedback sur la performance

LL’’Environnement de travail et les OutilsEnvironnement de travail et les Outils

La motivation des travailleursLa motivation des travailleurs

LL’’Appui OrganisationnelAppui Organisationnel

Les Connaissances et CompLes Connaissances et Compéétencestences

JUSTIFICATIONJUSTIFICATIONLancement du PEVLancement du PEV--SSPSSP--ME en 1988ME en 1988Paquet minimum dPaquet minimum d’’activitactivitéés dont activits dont activitéés de vaccinations de vaccinationÉÉvolution de la couverture vaccinale (5% volution de la couverture vaccinale (5% àà 78 % d78 % d ’’enfants enfants complcomplèètement vaccintement vaccinéés)s)Revue du PEV en Novembre 2000 rRevue du PEV en Novembre 2000 réévvèèle fort taux le fort taux dd’’abandons (DTC1abandons (DTC1--DTC3)DTC3)VolontVolontéé politique dpolitique d’’amamééliorer les performances du PEVliorer les performances du PEVEngagement des PartenairesEngagement des Partenaires

PROCESSUSPROCESSUS DE MISE EN PLACE DE MISE EN PLACE DE LDE L’’AAP EN AAP EN GUINGUINÉÉEE

Formation A l’AAP

AutorisationMSP

Memo d’entente

BASICS/PRIME

Identificationsites

Orientation Partenaires et

acteurs

Recensement des besoins en performance

Juin2001 Aout 2001 Septembre 2001 Mai 2002 Décembre 2002 Avril 2003

interventions

Planification des

RECENSEMENT DES BESOINS EN RECENSEMENT DES BESOINS EN PERFORMANCE (RBP) PERFORMANCE (RBP)

OBJECTIFS ET CIBLESOBJECTIFS ET CIBLESObjectif GObjectif Géénnééral:ral:

RRééduire les taux dduire les taux d ’’abandon DTC1abandon DTC1--DTC3DTC3

Objectifs SpObjectifs Spéécifiquescifiques1.1. Evaluer les performances actuelles Evaluer les performances actuelles

des vaccinateurs des CS de Dabola et des vaccinateurs des CS de Dabola et KouroussaKouroussa

2.2. DDééterminer les terminer les éécarts de performance carts de performance et leurs causes fondamentaleset leurs causes fondamentales

3.3. Collecter des donnCollecter des donnéées de base sur la es de base sur la qualitqualitéé et let l’’utilisation des services de utilisation des services de vaccinationvaccination

4.4. Proposer des interventions Proposer des interventions appropriappropriéées pour combler les es pour combler les éécarts de carts de performanceperformance

CiblesCibles

1.1. Agents vaccinateursAgents vaccinateurs2.2. Superviseurs directs(CCS)Superviseurs directs(CCS)3.3. Superviseurs de districtsSuperviseurs de districts4.4. Superviseurs rSuperviseurs réégionauxgionaux5.5. Superviseurs nationauxSuperviseurs nationaux

METHODOLOGIE METHODOLOGIE -- 11Atelier dAtelier d’’orientation des agents vaccinateurs, orientation des agents vaccinateurs, chefs de centres de santchefs de centres de santéé, superviseurs de , superviseurs de districts et de rdistricts et de réégion.gion.Appui techniqueAppui technique : projet PRIME II / Dakar, Avril : projet PRIME II / Dakar, Avril 20022002Elaboration des performances dElaboration des performances déésirsiréées des es des agents vaccinateurs dans les domaines deagents vaccinateurs dans les domaines de ::

CounselingCounseling et activitet activitéés communautairess communautairesVaccination et sVaccination et séécuritcuritéé des injectionsdes injectionsGestion des vaccins et des donnGestion des vaccins et des donnééeses

METHODOLOGIE METHODOLOGIE -- 22

Recensement besoins en performance des Recensement besoins en performance des agents vaccinateurs (Dagents vaccinateurs (Déécembre 2002)cembre 2002)Analyse des donnAnalyse des donnéées des d’’enquête (Janvierenquête (Janvier--FFéévrier 2003)vrier 2003)

Session Topic Managing RED Work______ Your Country _________ Nepal Name of Note Taker ___ Hari Krishna Shah ___________________ What activities are already planned to address this topic?




• To increase DPT3 coverage up to 80% and reduce drop out rate to less than 10% by 2007 in 13 low performing districts

• District orientation • VDC orientation in every VDC • 1 day training for district EPI

team and HFI • Counseling for Village Health

Worker (VHW), Maternal Child Health Worker (MCHW), on recording, reporting and self monitoring

• Workshop will be held on national level with CHD and partners to develop a work plan

• Child Health Division will support and conduct workshop

• WHO, UNICEF, GAVI, USAID

will fund • District Development

Committee, District Public Health Officer, and Village Development Committee will support implementation of program

Participatory Country Exchange on Strengthening Routine Immunization - Co-organized by GAVI West African Sub-Regional Working Group and BASICS II -

Day One – 22 April, 2004

Chairperson: Dr. Matthieu Kamwa Day One Rapporteur: Dr. Michel Othepa

08:00 - 08:30 Registration

Introduction: General Information 08:30 - 08:40 Welcome Remarks by Mr. Brad Barker/USAID-Senegal, Dr. Celestino

Costa/UNICEF, WHO Representative, Col. Cheikh Fall/Ministry of Health 08:40 - 08:50 Presentation of Participants (Dr. Millogo) 08:50 - 09:00 Keynote Remarks (Dr. Kamwa) 09:00 - 09:20 Meeting Objectives and Agenda (Dr. Millogo) 09:20 - 09:30 Questions on Agenda 09:30 - 09:40 Announcements (Rokhaya Sembene/Tara Watson)

Session 1: Improving Planning and Implementation at District Level 09:40 - 09:50 Introduction (Mr. Robert Steinglass)

09:50 - 10:20 Implementation of the Reaching Every District Strategy: How to Make the package Work Operationally (Dr. Bakolalao Randriamanalina/Dr. Aimé Randriamanalina, Madagascar)

10:20 - 10:30 Questions and Answers

10:30 - 10:50 Coffee Break

10:50 - 11:20 District Performance Improvement and Capacity Building (Dr. Abdourahmane Sherif, Guinea)

11:20 - 11:30 Questions and Answers 11:30 - 12:00 Small Working Group Discussions on Making RED Work and District

Performance Improvement and Capacity Building

12:00 - 13:00 Lunch

13:00 - 13:40 Country Working Groups on Making RED Work and District Performance Improvement and Capacity Building

13:40 - 14:10 Performance-Based Contracts to Stimulate District Performance (Dr. Youssouf Konate, Mali)

14:10 - 14:20 Questions and Answers 14:20 - 14:50 Small Working Group Discussions on Performance-Based Contracts

14:50 - 15:30 Country Working Groups on Performance-Based Contracts


Session 2: Integration of Routine Immunization with Other Programs 15:50 - 16:20 Integrating Routine Immunization with Other Child Survival and Disease Control

Initiatives: Opportunities and Challenges (Mr. Benjamin Andriamitantsoa/Dr. Josoa Ralaivo, Madagascar)

16:20 - 16:50 Madagascar Video on “The Champion Community Approach”

16:50 - 17:00 Questions and Answers 17:00 - 17:30 Small Working Group Discussion on Integration of Initiatives 17:30 - 18:00 Country Working Groups on Integration of Initiatives 18:00 Wrap-up

Day Two – 23 April, 2004

Chairman: Dr. Celestino Costa Day Two Rapporteur: Dr. Mbaye Seye

08:30 – 08:50 Report Out from Day One Discussions (Dr. Michel Othepa)

Session 3: Improving Planning at Health Facility Levels, Including Stronger Links with Communities

08:50 - 09:20 Community Problem-Solving and Strategy Development (CPSSD) (Dr. Megere, Uganda)

09:20 - 09:40 Questions and Answers 09:40 - 10:00 Small Working Group Discussions on CPSSD


11:00 - 11:30 Effective Monitoring and Use of Data at Sub-District Level to Increase Immunization Coverage (Dr. Diarietou Sow Sall, Senegal)

11:30 - 11:40 Questions and Answers 11:40 - 12:10 Small Working Group Discussions on Effective Monitoring

12:10 - 13:10 Lunch

13:10 - 13:50 Country Working Groups on Effective Monitoring

Session 4: Synergy, Partnership and Financial Sustainability

13:50 - 14:20 Making an ICC “Functional” (Dr. Jean Marie Mbuya Mbayo, Democratic Republic of Congo)

14:20 - 14:30 Questions and Answers 14:30 - 15:00 Small Working Group Discussions on ICC


15:20 - 16:00 Country Working Groups on ICC

16:00 - 16:30 New Vaccine Introduction and Financial Sustainability (Dr. K.O. Antwei Agyei, Ghana)

16:30 - 16:40 Questions and Answers 16:40 - 17:10 Small Working Group Discussions on New Vaccine Introduction and

Financial Sustainability 17:10 - 17:50 Country Working Groups on New Vaccine Introduction and Financial

Sustainability

17:50 Wrap-up 18:00 Marketplace Display of Technical Materials

18:30 Reception

Day Three – 24 April, 2004 Chairperson: Dr. Jules Millogo Day Three Rapporteur: Dr. Souleymane Kone

08:30 - 08:50 Report Out From Day Two Discussions (Dr. Mbaye Seye)

Session 5: Logistics and Injection Safety

08:50 - 09:20 Planning for Injection Safety Beyond Immunization Services (Dr. Mugyenyi, Uganda)

09:20 - 09:40 Questions and Answers 09:40 - 10:10 Small Working Group Discussions on Injection Safety


10:30 - 11:00 Revitalizing vaccine logistics at all levels (Dr. Emmanuel Odu, Nigeria) 11:00 - 11:20 Questions and Answers 11:20 - 11:50 Small Working Group Discussions on Revitalizing Vaccines Logistics 11:50 - 12:40 Country Working Groups on Revitalizing Vaccines Logistics

12:40 - 12:50 General Report Out 12:50 - 13:30 Official Closing

- Vote of Thanks - WHO Representative - Dr. Celestino Costa/UNICEF - Mr. Brad Barker/ USAID-Senegal - Col. Cheikh Fall/Ministry of Health

13:30 Lunch

Thème de session _____ Résolution de problème communautaire et stratégie_____________________ Votre Pays ___________ Mali____________________________ Nom de preneur de notes GUNIDO__________________________________________________ Quelles sont les activités déjà planifiées pour faire face à ce thème?




• Harmonisation des modules de formation des relais

• Formation des relais

villageois

• Impliquer les relais villageois formés au module harmonisé

• Suivi et motivation de relais

• Keneya Crivar (?) et ATN

Session Topic __Community Problem Solving and Strategy Development Your Country ___Ethiopia_________________ Name of Note Taker __Kassa_HAILU ___________________ What activities are already planned to address this topic?




• Health workers conference • Review meeting bi-annually

• Create networking with community, donor agencies and government

• Advocacy

• By organizing task force and mapping activity areas to avoid overlap

• Consultation meeting for health workers

• Create linkage of health workers with community

• Conduct meetings • Produced and deliver

IEC/BCC materials

• MoH • Regional health bureaus • NGOs and organizations • Community itself • MoH • Community • Local councils • NGOs

Session Topic ___ Making RED Work / District Performance Improvement_________________________________ Your Country ___ Ethiopia___________________________________ Name of Note Taker __Wilkins___________________________________________________ Objectives (specific to topic and your country)

Barriers/Constraints to achieving objectives

Solutions for overcoming constraints

Activities already planned (and date)

Priority activities to be added to achieve objectives

What organisations will provide support

• RED in 3 districts pilot

• Well performing districts may see extra funds and lower performance

• Give money to well performing districts

• Community involvement: religious leaders, training health workers

• microplanning

• Looking for funds • Advocacy

• Microplanning • Resource manipulation • TOT

MoH, NGOs, WHO, UNICEF

• Create task force at district level (ICC), head district, political leaders, any organization in health sector, disaster teams, capacity building ministry

• Competing meeting • Make meetings short and rare

• Set up meeting • Funds stationery • Write terms of reference

(health sector) • Issue invitation

• Prepare terms of reference for task force

• Prepare schedule

MoH, NGOs, WHO, UNICEF, other sectors

• GAP assessment of workers at community level

• Improve motivation

of health workers

• Time consuming, expensive

• Low salary • Financial regulationes

• Involve people working nearby

• Incentives for Saturday • Mobile teams • Incentive to live in

remote areas • Special training for

locals (1 yr) as lay nurses

• Immediate supervisors should do

• Prepare checklist or questionnaire

• Allocate budget

MoH, NGOs, community

Effective Monitoring and Use of Data at Sub-District Level to Increase Immunization Coverage

Groups 1,2 & 3 Consensus points on the Senegalese presentation: Bonus system for the health center that posted the best performance in routine vaccination Turn in data during meeting or in feedback bulletin, which will foster competitive spirit Usefulness of monitoring all the health centers to assess their specific performance Interest in data sharing with regional governors, given the advent of decentralization Community involvement in follow-up is an interesting experience New displays of vaccination coverage rates makes data more accessible [ ?] oversight can weaken oversight in other ways

Group 4 Effective Monitoring of Use of Data at District Level to Increase Immunization Coverage • Useful approach; need to guard against data falsification • Coverage survey needs to be performed to aid decision on winning team/district. Community based

data validation is a cheaper alternative • Community to be involved in planning and monitoring to enhance compliance and data reliability on a

sustainable basis • Feedback to every lower level up to the community, including political leaders, is a good approach Group 5 • Monitoring reflects performance in the field. The process is appreciable because it provides feedback

and opportunities for improvement in service delivery. Care is, however, needed to ensure that people are not tempted to manipulate figures. The real situation must be presented.

• Monitoring coverage should incorporate the monitoring of incidence of disease burden of VPD, eg. measles, etc.

• Feedback bulletin should have wide circulation and be for both technical and administrative staff Group 6 Community involvement can be achieved by [its] attendance at monitor meetings Sustainability dependent on level of community organization (administrative structures, etc) Given the cost of publishing bulletin, it should be included in the district action plan. Shorten the

number of the bulletin's pages. Evaluation system is needed to ensure that criteria are being met Offering incentives to health centers can be a catalyst for change Theatre troupes and mass media should not be systematically used. Take advantage of festivals and

mass rallies to get the message across Group 7 Good model for use of committees / communities and health care centers Financing ― renewal of logistical equipment is key to success of EPI Sustaining incentives system and financing it will have to be worked out Feed back system is noteworthy as well

Participatory Country Exchange on Strengthening Routine Immunization

Day 2 Report Chairperson: Dr. Celestino Costa Author: Dr. Mbaye Seye Work began with welcoming remarks by the session's chairperson, who thanked and encouraged the participants as well as covered the day's agenda. He then ceded the floor to the previous session's minute-taker, who, in exhaustive fashion, summarized topics covered, questions asked, and responses provided. There were 2 sessions planned for the 23rd of April. The first dealt with Planning Improvement at the Health Center with Community Involvement; the second covered Synergy, Partnership, and Financial Sustainability. 1. Community Problem-Solving and Strategy Development (CPSSD) (Uganda)

Dr. Megere from Uganda made the first presentation on the topic 'Problem Solving and Community Strategy Development', 'Experience Sharing at the National Level', 'How to Strengthen Routine Immunization Services'. Dr. Megere covered the following points:

Low immunization coverage rates and associated causes Possible methods of resolving the problem Methods of problem solving and community strategy development Relationship between health care workers and the local community

- The speaker developed this point further by noting methods of educating the adult population; the notion of problem solving; the need to avoid pitting culture against medicine (be mindful of both but encourage dialogue with the community to solve problems)

The speaker also shared with attendees certain observations made through community dialogue. These observations, presented in the form of lessons learned, showed the need for health care workers to foster dialogue with communities so as to identify problems and appropriate solutions. In conclusion, the speaker stressed the importance of follow-up to build on progress made through dialogue. Progress worth noting includes:

Better understanding of services offered through the vaccination program More community involvement in monitoring vaccination efforts Increase in vaccination rates in targeted regions

Questions raised and answers provided included:

Q: Do the graphs display monthly or yearly data? A: The graphs show monthly data

Q: What is the framework for information sharing between health care staff and

the local communities? A: Uganda has a decentralized health care system where the health care staff sit

in on all committee meetings. Q: How do you encourage community involvement in vaccination efforts? A: Through that community's leaders and through committee involvement. Q: How were denominators and targets chosen ? A: They were obtained through the Ministry of Planning's last population census

in 2002.

Q: What is the profile of the target population ? A: The target population is sedentary.

In conclusion, the speaker highlighted the positive results of the program which is beginning to influence other health campaigns. He noted that this approach is not unique to health campaigns and is applicable to other development programs. This presentation was followed by small group discussions to share experiences.

2. Effective Monitoring and Use of Data at Sub-District Level to Increase

Immunization Coverage (Senegal)

Drs. Diariétou Sall and Hanne gave the second presentation on monitoring and data use to improve immunization coverage at the district level. Following are highlights:

Situation diagnosis: Presentation and situation analysis showing low immunization rates

Insufficient, or non existent, feedback Absence of micro planning

Implementing a problem-solving approach has meant:

Improved training of health care staff Increased community involvement through micro planning sessions Establishing a mechanism for feedback at various levels

Results are promising and include:

Creation of prize for best health center, which fosters spirit of competition and motivates health care staff

Improvement of immunization coverage and more community involvement

The presentation mentioned a few problems, such as: Upkeep and replenishment of rolling stock as well as social mobilization

In her conclusion, the speaker noted that some of the problems may be resolved in part with RED assistance and through rigorous data management at all levels of the health care system. Much like the previous speaker, Dr. Hanne highlighted the Podor district's experience with the production and use of feedback bulletins. The bulletin contains 5 key indicators to measure the performance of districts and health centers. The 5 indicators are as follows:

Completeness Rapidity Accumulated vaccination rates Drop out rates Loss rates

The feedback bulletins are produced every three months, presented and debated during coordination meetings, and followed by recommendations to be implemented so as to improve vaccination efforts.

Questions following the 2 presentations included:

Q: What is the incentive mechanism in place to motivate health care staff? A: Committees have been created to select performance criteria for the best

health center. Incentives vary from a TV set to a TV/VCR combo awarded to the health center, not the health worker.

Q: Who is responsible for designing and financing this feedback bulletin? A: A partner (CVP/PATH) designed and financed the first bulletins. The district

now finances the bulletin, and intends to do so permanently. The bulletin costs 1000 CFA per copy, and the health council is committed to continue financing it.

Q: How do you ensure access? A: Through an extensive network of community intermediaries working

collaboratively with the health center and searching for children who have not completed their vaccination series.

3. Making an ICC “Funcational” (DR Congo)

Dr. Mbayo from the DRC moderated the second session, entitled " Synergy, Partnership and Financial Sustainability", which fell under the rubric of "Making Inter-Agency Coordination Committees Functional". Topics covered include:

Creating an inter-agency coordinating committee during extreme emergencies

Organization and role of committee Objectives and operations of committee Performance results Challenges that committee faces

Q: Is the annual plan part of a multi-year plan? A: Yes, a five-year plan has been developed, which allows the committee to

implement the yearly action plan while not losing sight of broader goals. Q: How did the committee continue its operations during wartime? A: The health system is well established in the country. The committee

continued to function, and its efforts were approved by all parties. Q: Why does the provincial committee perform so poorly ? A: The Health Ministry does not have direct contact with the provincial

committee, which impedes communication between the Ministry and the committee. However, despite poor routine PEV results, the immunization campaign organized in the provinces has been successful.

Other comments:

When a health care system is well organized and well established, it can withstand the disorder and shock of war. Partners lobbied on behalf of the Ministry, and that is why the warring factions, in a moment of national consensus, supported health-related efforts (e.g. NIDS).

4. New Vaccine Introduction and Financial Sustainability (Ghana)

Dr. K O Antwei of Ghana gave the final presentation, which closed the day. The presentation, which touched on the introduction of new vaccines and financial sustainability, highlighted the following points:

Sector financing and partner involvement GAVI aid plan Administering vaccines, injection safety, and outreach efforts Financial viability plan Challenges to ensuring continuity

Questions on this presentation:

Q: Have stocks of pentavalent been depleted? A: To date, stocks have not been depleted. Our concern centers more on the cost

of the vaccines and their renewal. Q: Was a cost benefit analysis completed before introducing the new vaccines? A: We are interested in such an analysis that we hope to complete before long.

Q: What guarantees has the government given that it will continue to support the

Financial sustainability plan (FSP)? A: This year the government provided 15% of the funds to purchase vaccines and

has promised 25% next year. We are extending GAVI funding over ten years so as to allow the government to continue its part in the vaccination effort.

The day, which was already quite busy, ended with the 'Marketplace Display of Technical Materials', a screening of a Malagasy video, and a sumptuous reception hosted by BASICS, which I was unable to attend because of this report that I just read to you.

Thème de session _____ Implication de la communauté_____________________ Votre Pays ___________ Guinée____________________________ Nom de preneur de notes Dr. Djenou SOMPARE__________________________________________________ Quelles sont les activités déjà planifiées pour faire face à ce thème?




• Finalisation et mise en oeuvre du PIC

• Organiser un atelier de finalisation

• Tenir la réunion de

validation avec le CCIA • Diffuser le PIC

• Identifier les participants à l’atelier

• Élaborer le budget • Programmer la tenue • Tenir l’atelier

• OMS, UNICEF, BASICS II, GTZ, PRISM, GAVI, USAID, etc

Dr Djiaratou SOW SALL MCD District Thiès 1

MONITORAGE ET MONITORAGE ET UTILISATION DES DONNEES UTILISATION DES DONNEES

POUR AMELIORER LA POUR AMELIORER LA COUVERTURE VACCINALE COUVERTURE VACCINALE

DANS LE DISTRICT DANS LE DISTRICT SANITAIRE DE THIES SANITAIRE DE THIES

(SENEGAL)(SENEGAL)


PLANPLAN••

PRESENTATION DISTRICTPRESENTATION DISTRICT

••

CONTEXTECONTEXTE••

APPROCHE RESOLUTION PROBLEMESAPPROCHE RESOLUTION PROBLEMES

––

AmAméélioration gestion des donnlioration gestion des donnééeses––

Planification des activitPlanification des activitééss––

Suivi/ SupervisionSuivi/ Supervision––

RRéétro informationtro information

••

RESULTATSRESULTATS••

COMMENTAIRESCOMMENTAIRES

••

CONCLUSIONCONCLUSION


PRESENTATION DISTRICTPRESENTATION DISTRICT

••

Population totale en 2003: 425 021 Population totale en 2003: 425 021 HbtsHbts••

Cible PEV (2003): 19 548 Enfants 0 Cible PEV (2003): 19 548 Enfants 0 ––

11 mois11 mois

••

1 centre de sant1 centre de santéé

(Hôpital district)(Hôpital district)••

35 postes de sant35 postes de santéé

publics / 56 Unitpublics / 56 Unitéés de s de

vaccinationvaccination


CONTEXTECONTEXTE

••

Au plan NationalAu plan National

––

Revue externe du PEV Revue externe du PEV Faiblesse couvertures vaccinalesFaiblesse couvertures vaccinales

––

Relance du PEV : reconstitution active des donnRelance du PEV : reconstitution active des donnéées (an 2001)es (an 2001)

––

Instauration rInstauration rééunions bimestrielles de coordination avec les unions bimestrielles de coordination avec les

districtsdistricts

––

Monitorage des performances des districtsMonitorage des performances des districts


CONTEXTECONTEXTE••

Au niveau DistrictAu niveau District–– Recueil des donnRecueil des donnééeses

–– DifficultDifficultéés mas maîîtrise cibletrise cible–– Fiches de pointage absents ou non conformes Fiches de pointage absents ou non conformes –– Graphiques muraux dGraphiques muraux d’’auto monitorage absentsauto monitorage absents

–– Transmission des donnTransmission des donnééeses–– Faiblesse promptitudeFaiblesse promptitude–– DonnDonnéées transmises sans analysees transmises sans analyse


CONTEXTECONTEXTE

••

Analyse des donnAnalyse des donnéées au niveau districtes au niveau district––

Faibles Couvertures vaccinalesFaibles Couvertures vaccinales

En 2001: BCG= 42 %; DTC3= 40 % ; VAR= 42 %En 2001: BCG= 42 %; DTC3= 40 % ; VAR= 42 %

––

RRéétro information informelle non systtro information informelle non systéématismatiséée e ––

DDééficiencesficiences

dans la planification opdans la planification opéérationnelle rationnelle

des activitdes activitééss


APPROCHE RESOLUTION APPROCHE RESOLUTION PROBLEMESPROBLEMES

••

Gestion des donnGestion des donnééeses––

Harmonisation ciblesHarmonisation cibles

––

Utilisation systUtilisation systéématique TACOJOmatique TACOJO––

Suivi promptitude des donnSuivi promptitude des donnéées (date limite)es (date limite)

––

Mise en place graphiques muraux des Mise en place graphiques muraux des couvertures vaccinales (mensuelles)couvertures vaccinales (mensuelles)

––

Analyse des donnAnalyse des donnéées au niveau opes au niveau opéérationnelrationnel



••

Planification des activitPlanification des activitééss––

Renforcement compRenforcement compéétences des agentstences des agents

––

AmAméélioration de llioration de l’’offre de services (accessibilitoffre de services (accessibilitéé, , accueil,CIP, saccueil,CIP, séécuritcuritéé))

––

Ateliers de micro planification communautaireAteliers de micro planification communautaire––

Recherche active des perdus de vueRecherche active des perdus de vue

––

Renouvellement chaRenouvellement chaîîne du froidne du froid––

AmAméélioration logistique roulantelioration logistique roulante

––

Renforcement de la mobilisation sociale autour du Renforcement de la mobilisation sociale autour du PEVPEV



••

Suivi/ SupervisionSuivi/ Supervision––

Grille de suivi/ supervision intGrille de suivi/ supervision intéégrgrééee

––

RRéégularitgularitéé

suivi/ supervisionsuivi/ supervision

••

RRéétro information tro information ––

Agents de santAgents de santéé

(supervisions, r(supervisions, rééunions mensuelles unions mensuelles

de coordination)de coordination)––

Leaders : rencontres Leaders : rencontres éélus locaux; CDDlus locaux; CDD

––

Restitution communautaireRestitution communautaire


RESULTATSRESULTATSEvolution couvertures vaccinales 2001 à 2003 dans le district de Thiès

0

10

20

30

40

50

60

70

80

90

BCG DTC3 VAR FJ VAT2+

2001 2002 2003


RESULTATSRESULTATSEvolution comparée des couvertures cumulées en DTC3 (2001-2002 -2003 et

premier trimestre 2004)

0

20

4060

80

100

Janvier

Mars Avril Mai

Ju inJu ille

t

Sep tembreOctobre

Novembre

2001 2002 2003 2004


COMMENTAIRES (I)COMMENTAIRES (I)

••

Points fortsPoints forts––

AdhAdhéésion du personnel impliqusion du personnel impliquéé

dans la vaccinationdans la vaccination

––

Engagement de la CommunautEngagement de la Communautéé::••

Relais, Relais,

••

ComitComitéés de Sants de Santéé, , ••

Leaders dLeaders d’’opinionsopinions


COMMENTAIRES (II)COMMENTAIRES (II)

••

Points forts (2)Points forts (2)––

Instauration dInstauration d’’un systun systèème dme d’é’émulationmulation

Niveau Central: coordination bi mensuelle avec Niveau Central: coordination bi mensuelle avec classement des Districtsclassement des DistrictsNiveau District: coordination mensuelle avec classement Niveau District: coordination mensuelle avec classement des postes de Santdes postes de Santéé et meilleures performances et meilleures performances rréécompenscompensééeses


COMMENTAIRES (II)COMMENTAIRES (II)

••

Points forts (2)Points forts (2)--

Renouvellement ChaRenouvellement Chaîîne du froidne du froid

--

Dotation en motos de certains postes de SantDotation en motos de certains postes de Santéé--

Appui de la DI, Basics, Plan, OMSAppui de la DI, Basics, Plan, OMS

••

ContraintesContraintes--

CoCoûûts de lts de l’’IEC/Mobilisation sociale (troupe IEC/Mobilisation sociale (troupe ththééâtrale, âtrale, éémissions radios)missions radios)

--

Logistique: VLogistique: Vééhicule pour lhicule pour l’é’équipe mobile, 10 PS quipe mobile, 10 PS nn’’ont pas de motoont pas de moto


COMMENTAIRES (III)COMMENTAIRES (III)

••

Contraintes (2)Contraintes (2)--

Absence de personnel pour la maintenanceAbsence de personnel pour la maintenance

--

Absence de plan de renouvellement du matAbsence de plan de renouvellement du matéérielriel

••

PerspectivesPerspectives--

Appui dans le cadre du REDAppui dans le cadre du RED

--

Plan annuel PEVPlan annuel PEV--

Sources de financement multiplesSources de financement multiples


CONCLUSIONCONCLUSION••

LL’’amaméélioration des couvertures vaccinales lioration des couvertures vaccinales nnéécessite un processus continu dcessite un processus continu d’’analyse des analyse des donndonnéées lies liéés s àà

la mise en la mise en œœuvre des activituvre des activitéés.s.

••

Les informations doivent être utilisLes informations doivent être utiliséées pour es pour identifier les problidentifier les problèèmes,cibler les interventions, mes,cibler les interventions, planifier les activitplanifier les activitéés et mesurer les progrs et mesurer les progrèèss

TITRE DE PRESENTATION: _______Intégration du PMA_______________________________________________ VOTRE PAYS: _________________RDC___________________ NOM DU PRENEUR DE NOTE: _____Dr. Jean KASEYA_______________________

Objectifs (spécifiques à

présenter et de votre pays)

Contraintes pour réaliser les objectifs

Solutions apportées aux contraintes

Activités déjà plannifiées (et date)

Activités prioritaires à ajouter pour réaliser les

objectifs

Quelles organisations vous appuient?

• Mettre en oeuvre le PMA de façon intégrée dans au moins 50 ZS

• Absence d’un comité de pilotage opérationnel

• Mécanismes de complémentarité non définis

• Formation de base non intégrée des acteurs

• Financement non- intégré des activités

• Sensibilisation des autorités gouvernementales et partenariats pour l’organisation des formations et le financement des acteurs dans la logique d’intégration

• Adoption du paquet d’intégration

• Élaboration des messages intégrés

• Mettre en place un comité de pilotage

• Définir les modalités de collaboration interet intra-sectionnelle

• Former les équipes de terrain

OMS, UNICEF, USAID, BASICS, SANRU, CRS, PNURR

TITRE DE PRESENTATION: Amélioration de Performance de District ______ VOTRE PAYS: _________________Sénégal___________________ NOM DU PRENEUR DE NOTE: _____Faye Papa COUMBA_______________________

Objectifs (spécifiques à la présentation de

votre pays)





objectifs


• Augmenter (de 12 à 26) le nombre de district ayant atteint au moins 80% couverture en DTC3

Ressources financières: • Insuffisance • Difficultés de

mobilisation Ressources humaines: • Insuffisance • Faible capacité

managériale Logistique: roulant Implication communautaires

• Augmentation offre de service

• Formation personnel • Renouvellement

logistique roulante et chaîne de froid

• Identification districts

• Analyse situationnelle – Elaboration de microplan de districts avec la participation de la communauté

• Mise à disposition ressources

• Appui logistique • Mise en oeuvre dans

les districts • Suivi / évaluation /

supervision • Réunion trimestrielle

• Appui logistique (équipes mobiles de vaccination)

• Formation: personnel relais communautaire

• Mobilisation ressources additionnelles

• Amélioration de complétude

OMS, UNICEF, GAVI, BASICS/USAID, CVP, Banque Mondiale, ONG locales et internationales, comités de santé

Thème de session ____Utilisation des Données pour Améliorer la CV____ Votre Pays _________ DR Congo ________________________________ Nom de preneur de notes ______Vlio YOLANDE_____________________________________________ Quelles sont les activitéd dejà planifiées pour faire face à ce thème?




• Reproduction / distribution des outils de collecte des données

• Briefing des équipes des

BCZS sur l’utilisation de ces outils

• Vulgarisation des

directives

• Former les équipes BCZS et des AS sur l’analyse des données

• Faire le plaidoyer pour la

mobilisation des ressources additionnelles (transport, fonds)

• Tenir les réunions de

monitorage au niveau des AS et des BCZS

• Assurer la

retroinformation à tous les niveaux

• Par le noyau des formateurs au niveau des ZS

• Organisation des réunions

au niveau du CCIA local • Réunions mensuelles et

semestrielles dans les AS et les BCZS

• A travers le feuillet de

retro information semestrielle du BCZS vers les AS

• Feuillet du retro

information central vers provincial et BCZS

• UNICEF, OMS, BASICS, SAMRU, CRS, MEMISA, GTZ, PMURR

Planning for Injection Safety Beyond Immunization Services Group 1 1. Include the therapeutic sector in the injection safety system

- Akin to what is happening in the vaccination arena, especially with private and public entities

2. Set up a diverse, representative injection safety committee 3. Get the message out to the public and health care providers on injection safety 4. Draft and publish written directives for health care providers 5. All countries must undertake an assessment of injection safety and draft an injection safety policy 6. Ministry of Health must take leadership role in injection safety and secure financing from partners for

system sustainability Group 2 1. Injection safety policy must include the following points:

- Situation analysis ( therapeutic and preventive) - Roles of various actors : public, private, and informal sectors - Implementation: therapeutic and preventive

2. Make the case for the informal sector 3. Cost / financing, to be included in viability plan ( sustainability = partners' contribution and State's) 4. Task force = diverse, representative

- Membership = selected by countries 5. Raise community awareness about quality care

- Injection process - Risks associated with injections - Waste management

Group 3 1. Establish centralized task force with terms of reference. This entity is very important for mobilizing

partners and resources 2. Negotiation process for setting up task force is a prerequisite 3. Results of the study that revealed the extent of the problem to be used to make case 4. Broad political and social buy-in N.B. Nonetheless, we believe that setting up a task force at the local level (district) could encourage behavior change in the community and among health care workers and partners. Group 4

1. Involve all department in the injection safety effort 2. Operating and dynamic task force which must follow [ *****] 3. It is our duty to make the case to decision makers and to identify the message to convey 4. Exploit opportunities to work with other programs, like the AIDS program 5. Private sector, which attracts [************] must be involved in the process 6. Identify injection security efforts and coordinate where our program acts alone (building incinerators) 7. Draft action plan 8. [********] on aspects of injection supplies Group 5 1. It is vital to involve private sector, especially the informal sector, to resolve issue with inappropriate

use of injections 2. Increase outreach efforts so public can better choose between therapeutic and preventive options 3. Establishing task force is important. It must represent a wide cross section of society and, preferably,

be headed by the Ministry of Health 4. It is important to choose incinerator models carefully, being mindful of where it will be located and of

the biomedical waste to be disposed of. Shared responsibility at all levels is a major component of success

Group 6 1. Moving beyond EPI leadership in injection safety to actual integration of services – as demonstrated

by Uganda model, for example — is critical to health services over all. 2. Stronger government leadership is needed to initiate such integration between EPI/preventive and

curative sectors. (Do not wait for external partners before starting the process) 3. Countries need to plan for oversight/responsibility for health care waste management long term. [ It is

] important to maintain health care waste management as specialized activity (from general waste management). However, depending on the country’s set-up/infrastructure HCWM could be overseen by a MoH (need to ensure proper coordination with Ministry of Environment, local government etc. and have right experts in MoH) or [ an entity] external to MoH (e.g., Ministry of Environment, local government etc.)

A request was made for models to be developed and made available to countries (see above) 4. Community “participation” is important for safe injection practices in curative sector

- Education of community will reduce over demand (over use) of injections - Discourage community/public from retaining used needles and syringes for reuse.

Comments/Questions Q1: Target of Task Force recommendations? A: EPI is secretariat for TF. EPI and clinical services [are] responsible [ for ] ensuring implementation. All other various sectors involved in implementation (eg AIDS control programme, private sector providers via medical and dental council) Q2: What are the ways of ensuring implementation in curative sector? And for expansion beyond pilot districts? A: - eg, integrating budgets of districts with clinical services budgets

- Clinical service budgets for drugs (at district level) to include budget for equivalent quantity of needles and syringes for injectable drugs

- Plans to construct large-capacity incinerators - Guidelines to be distributed to all districts (re post-pilot expansion)

Q3: What has been the impact on clinical services such as ADS? A: - Increased awareness and discussion on plans to switch

- Availability of different size needles and syringes important to plans/discussions Q4: [ What are ] plans to absorb the increase in the tasks relative to EPI (eg, higher numbers of health care workers to be trained, etc)? A: Incorporated in current plans for pilot – ALL health care providers to be targeted. Group 7 1. It is a very important issue but also a great challenge 2. Uganda has a great problem with HIV/AIDS. That’s why it may help their program success, BUT it

may be as effective in other countries 3. If the private sector will not follow the policy, they should be sanctioned 4. Should make the community aware of unsafe injection 5. Supportive supervision 6. Behavioral change of health worker Group 8 1. Difficult for some financial partners, like USAID, to buy in to the idea of a 'common basket'. Hence,

the need to coordinate efforts and [ ?] because it is a good idea. 2. Commissioning a study and analysis for baseline data is a boon for the program. 3. Development is an important step in program management. 4. Waste management … [?] The private sector must be included, even if it is difficult to do so.

5. The presentation is missing applicable directives at the district level 6. There needs to be decentralized forums for dialogue — not unlike the ICC — at all levels to

strengthen partnership and coordinate efforts 7. Set up at the district level a place for waste management

Thème de session ____Logistique: Approvisionnement en Vaccins____ Votre Pays _________ DR Congo ________________________________ Nom de preneur de notes ______Vlio YOLANDE_____________________________________________ Quelles sont les activitéd dejà planifiées pour faire face à ce thème?




• Achat des vaccins (acquisition)

• Élaboration des outils de

gestion • Distribution des outils de

gestion • Microplanification

• Intensifier le suivi des stocks des vaccins au niveau central

• Mettre en place le système

de suivi des stocks aux niveaux provinicial et ZS

• Élaborer le plan de

distribution des vaccins et autres intrants qui prend en compte le niveau opérationnel

• Acquérir d’autres

matériels de chaîne de froid

• Monitorage régulier par la direction et le CCIA technique

• Installation du logiciel de

gestion • Supervision régulière • Atelier de la commission

logistique • Adoption du plan par le

CCIA technique • Plaidoyer • Achat • Distribution selon le plan

de réhabilitation

• UNICEF, OMS, USAID, Rotary, Basics, SAMRU, CRS, MEMISA, MSF B&F, PMURR, GTZ, Autres

Thème de session ____Contrat de Performance____ Votre Pays _________ DR Congo ________________________________ Nom de preneur de notes ______Vlio YOLANDE_____________________________________________ Quelles sont les activitéd dejà planifiées pour faire face à ce thème?




• Expérimentation de l’application en contrat de performance par certains partenaires

• Finaliser les document “contrat de performance”

• Définir les modalités

d’application du contrat de performance

• Appliquer le contrat de

performance selon les modalités définies

• Évaluer la mise en oeuvre

de l’expérience

• Atelier des membres du CCIA technique

• Adoption par le CCIA

stratégique • Réunions du groupe

restreint du CCIA technique et adoption

• Briefing du personnel à

tous les niveaux • Signature • Mise en place des

ressouces • Supervision (suivi) • Ateliers provinciaux • Atelier national

• Mêmes partenaires

TITRE DE PRESENTATION: _______Faire Fonctionner l’ACD______________________________________________ VOTRE PAYS: _________________Guinée_________________ NOM DU PRENEUR DE NOTE: _____Dr. Djenou Somparé_______________________ Objectifs (spécifiques à la présentation de

votre pays)





objectifs

Quelles organisations vous

appuient? • Assurer le

microplanification des activités de vaccination dans 394 CS afin d’atteindre chaque enfant

• Insuffisance quantitative et qualitative du personnel

• Démotivation du personnel

• Faible fonctionnalité des comités de gestion

• Déploiement et formation /recyclage des agents de santé

• Renouveler les «cogest » et les former

• Créer des comités villageois de santé

• Formation / recyclage en gestion du DEV en Mai-Juin 2004

• Mobilisation des ressources locales (finance)

• Elaborer un chronogramme des activités de mise en oeuvre de la microplanification

• OMS, UNICEF, USAID, GTZ, BASICS II, PRISM, ARIVA

• Finaliser et mettre en oeuvre un plan intégré de communication

• Absence de prise en compte du volet communication dans le plan d’action du PEV 2004

• Intégration des activités de communication dans le plan d’action PEV

• Organiser un atelier de finalisation du PIC en vue de son intégration dans le plan d’action du PEV

• Mobilisation des ressources financières à travers le CCIA

Fonds locaux, GAVI

(PIC = plan intégré de communication)

Session Topic Integration of EPI & Other Programs______ Your Country _________ Nepal Name of Note Taker ___ Hari Krishna Shah ___________________ What activities are already planned to address this topic?




• National level meeting between child health division (CHD). Partners had conducted meetings and a consensus had been reached

• To have a policy at national level

• To find an area of integration • To develop an integrated

recording / reporting and supervision form

• Orientation for health

workers and health facilitator in charge of VHWS / MCHWS, statisticians

• To develop a package of

services • Orientation about the forms

for health facility in charge of statisticians and peripheral health workers

• Will conduct a meeting with (CHD) and other donors to find level of integration

• Develop a policy

• Prepare the plan of action

• Child Health Division can advocate with WHO, UNICEF, USAID and other donors

• Health Management

Information Systems (HMIS) will review forms

• Ministry of Health will support

to formulate policy

Mise en œuvre des composantes de l’approche ACD:

Comment faire pour rendre les paquets de travail opérationnels

au niveau des districts

Présenté par l’ équipe de Madagascar, Session 1: 09h50 – 10h 20Dr Bakolalao Randriamanalina / Dr Aimé Randriamanalina

Contexte : année 2002

Insuffisance de la Demande• Taux d’abandon élevé

• Faible implication communautaire

Faiblesse de la Qualité du Système• Système de gestion logistique (vaccins et de pétrole)

• Incohérence des données à tous les niveaux

• Utilisation du service : Faible taux de couverture vaccinale

Place de la Mobilisation Sociale dans les activités

Le défi étant l’engagement communautaire qui est la plaque tournante de l’augmentation de la demande…

1994, mise en place des Services de Santé de Districts (111 SSD) Objectifs:

Assurer la décentralisation administrative, financière et des ressources à chaque niveau, Viser l'accessibilité des services, et en parallèle un transfert de compétence en matière de Planification, Gestion de Suivi et Evaluation (PGSE).

Développement des différents outils de normalisation tels la Politique Nationale de Santé, ainsi que des documents sur les normes et standards.

Introduction du volet de la participation communautaire sous ses divers aspects.

Pourquoi l’approche ACD ?• Faible Implication Communautaire:

– Faible application des stratégies de communication: (Croyances, coutumes, rumeurs , attitudes des parents, problèmes liés à l’offre de service, comportement des agents de santé, ne prenant en compte les poids de la communauté dans le développement de la santé)

• Diminution de la demande– Accessibilité basse et Utilisation faible:

• Augmentation du taux d’abandon• Faible taux de couverture vaccinale

• Application pratique et immédiate des acquis de BASICS/JSI/USAID

• Plan de relance PEV (USAID, UNICEF, OMS, …)

Critères de catégorisation des districts• Catégorie 1: pas de problème

• DTCHép B1 élevé: > 80% = bonne accessibilité• Taux d’abandon (DTCHépB1 et DTChépB3 ) bas <10%= Bonne utilisation

• Catégorie 2: • DTCHép B1 élevé: > 80% = bonne accessibilité• Taux d’abandon élevé: >10% = mauvaise utilisation

• Catégorie 3: • DTCHép B1 bas < 80% = mauvaise accessibilité• Taux d’abandon bas <10% = bonne utilisation

• Catégorie 4:• DTCHép B1 bas < 80% = mauvaise accessibilité• Taux d’abandon élevé > 10% = mauvaise utilisation

• Autres critères:• Poids démographique élevé, et accessibilité géographique

Ciblages des districts ?Catégories1,2,3, or 4 Nombre %

Cat. 4 63 57%Cat. 3 16 15%Cat. 2 25 23%Cat. 1 6 5%TOTAL 110

2002

Objectifs généraux:• Renforcer le système de gestion du programme de

vaccination de routine

• Augmenter le taux de couverture vaccinale nationale en DTC3 Hép B3 en appuyant les districts ciblés

Objectifs spécifiques :Appuyer les districts ciblés à bien gérer et à s’approprier de l’approche

Mettre en œuvre l’approche au niveau des CSB sélectionnés par districts ciblés

Assurer l’extension de l’approche en visant la pérennisation

Mettre l’accent sur l’utilisation des données à tous les niveaux

• Formation sur l’ACD à Dakar de 2 responsables nationaux (Mai 2003)

• Mise en place du Task Force– Groupe technique dont les membres sont des partenaires de

PEV nationaux et internationaux– Mission: Opérationnaliser le plan de relance du PEV– Objectifs:

• Coordonner et réorienter les activités, y compris le renforcement des activités sanitaires à assise communautaire

• Appuyer la mise en œuvre du système de surveillance épidémiologique intégré

• Suivre la mise en œuvre de la généralisation de l’approche ACD

Étapes parcourues

•

Actualisation des connaissances des membres du Task

Force (niveau

national)

•

Information des responsables provinciaux et districts

•

Micro planification au niveau des districts avec les chefs CSB

Étapes parcourues

Micro-planification:Phase préparatoire :• Concertation avec la communauté sur les

points suivants (Formations Sanitaires):– Quels problèmes de santé tentons nous de résoudre?– Quelles sont les solutions à proposer? – Que devrions nous faire pour atteindre nos objectifs?

• Districts:– Analyse situationnelle (carte sanitaire)– Identification des formations sanitaires/communes d’interventions et

des villages pour les stratégies avancées.– Détermination des acteurs-clés– Leadership : chef de la formation sanitaire

–Formation en micro-planification des chefs Formations Sanitaires:

• Orientation vers un engagement et appropriation de l’approche ACD

• Détermination des stratégies et des activités

• Budgétisation

Phase de mise en œuvre

Mise en œuvre de l’approche:– Validation des stratégies et activités (Agent de

santé, autorités et agents communautaires)• Respect et/ou mise en place du comité: Comité de

santé/Comité de gestion:

– Redynamisation des acteurs-clés relais pour faciliter les mobilisations (ONG-Agents Communautaires):

• Marketing vers une adoption de l’approche mobsoc• Recherche active des perdus de vue afin de diminuer les taux

d’Abandon

– Renforcement supervision formative:• Réunion de coordination de toutes les entités

communautaires avec retro-information sur les activités

Loi de l’Offre et de la DemandeAmélioration de l'OFFRE

PEV T.B P.F PALU/MII Nut CPN IST/SIDA

IEC/CCC

Communauté

A.S

Autorités

Responsables (TDR bien définis, formation)

AnimateursCo.San/Co.Ges STRUCTURE COMMUNAUTAIRE

Paquet Minimum d'Activités OBJECTIFS

PERENNISATI

ON

Promotion des

activités préventives

Augmentation de la DEMANDE

STRATEGIE

STRATEGIES: Augmentation de la Demande (Comment acquérir la pérennisation ?)

Adoption de l’approche

Communautaire

Adoption de l’approche

Communautaire

Renforcement du système existant: Co-San/Co-Ges

Renforcement du système existant: Co-San/Co-Ges

Mobilisation des ressources clés: TdR

Mobilisation des ressources clés: TdR

Coordination de des interventions

Coordination de des interventions

Élaboration et utilisation des outils de travail adaptés

Élaboration et utilisation des outils de travail adaptés

Retro-infoRetro-info

Vulgarisation del’approche

Communautaire (FdF)

Vulgarisation del’approche

Communautaire (FdF)

Interventions multilatérales Interventions multilatérales

Appropriation des activités par la communauté

Appropriation des activités par la communauté

STRATEGIES : Amélioration de l’Offre

Gestion des données pour une prise de décision

Gestion des données pour une prise de décision

Amélioration de capacité des responsables

Amélioration de capacité des responsables

Système logistique Système logistique

Suivi & EvaluationSuivi & Evaluation

GénéralisationGénéralisation

Systématisation de programme

Systématisation de programme

Accès au service de qualité ( Perte)

Accès au service de qualité ( Perte)

•Phase post-formation:–Discussion focalisée (retro-information

mensuelle) au niveau de la formation sanitaire

–Supervision formative par l’EMaD–Suivi par le niveau provincial et central

(avancement des activités et indicateurs de performance)

Suivi:

Autres activités:• Développement des capacités du personnel:

3

Gestion du programme PEV à tous les niveaux (SSD, DPS et SdV), • Formation des responsables

– Initiation, et utilisation de l'outil de gestion informatisé des 2 DPS, et 22/42 SSD (responsable PEV, et responsable SIGS).

– Remise à niveau des 16 superviseurs centraux

3

Initiation en Approche ACD, et en MLM des 23/23 SSD de la DPS Fianarantsoa

Résultats (2003)Approche ACD national:–

53 districts relancés : avril 2003

–

21 districts priorisés : Octobre 2003

–

Performance de 36/74 districts rehaussée

–

Financement de 74 Districts assuré

SSD TNR FNR TOTAL %AMELIORES 6 8 14 69,6%INCHANGES 2 3 5 24,9%RETROGRADES 1 0 1 5,5%

9 11 20

Districts d'intervention USAID/BASICS

Résultats 2002 - 20032002

Résultats par district2002

Nombre % Nombre %Néant 1 1% 0 0%cat.1 6 5% 47 42%cat. 2 25 23% 42 38%cat. 3 16 14% 8 7%cat. 4 63 57% 14 13%SSD 111 111

Catégorie 2003

INCHANGES 23 21% 3 16% 6 26%

AMELIORES 79 71% 15 79% 17 74%

RETROGRADES 9 8% 1 5% 0 0%111 19 23

NATIONAL ANTANANARIVO FIANARANTSOA

Résultats des districts FNR & TNR ANTANANARIVO

FIANARANTSOA

2002 2003 Ensemble 2003

Points saillants & Leçons apprisesMéthodologies:– Plan de restitution et de partage– Implication communautaire– Viabilité des principes clés menant la communauté à l’autogestion

du développement sanitaire, stratégies de pérennisation (Loi de l’offre et de la demande)

Supervision des activités communautaires– Suivi formatif des Agents Communautaires– Partage avec les Agents de Santé sur les avancement des activités

communautaires– Amélioration des recherche active des Perdues de vue– Responsabilisation des autorités: Implication appropriation

Points saillants & Leçons apprisesRésultats de l’approche ACD au niveau des 80 communes de 20 SSD:

• Promotion du pouvoir de décision de la communauté• Institution d’un cycle de gestion selon Appréciation Analyse

Action (A.A.A)• Effectivité de la surveillance et du suivi de l’information pour la

décision efficace

Prochaines étapes :1. Extension de l’approche2. Assurer la pérennisation du système de gestion du

programme de prévention:–

Harmonisation des interventions avec le plan communal de développement,

3. Renforcer la mise en place du système d’auto- monitorage/auto-gestion:

–

Suivi & utilisation des données pour action à

tous les niveaux,

–

Intensification de la supervision à

tous les niveaux,

4. Renforcer l’encadrement effectif des animateurs communautaire, vulgarisation de l’approche communautaire

TITRE DE PRESENTATION: _______Faire Fonctionner l’ACD____________________________________________ VOTRE PAYS: _________________RDC___________________ NOM DU PRENEUR DE NOTE: _____Dr. Jean KASEYA_______________________

Objectifs (spécifiques à

présenter et de votre pays)





objectifs


• Rendre disponible les vaccins et autres intrants PEV dans les ZS conformément aux microplans validés

• Insuffisance de ressources

• Intensifier le plaidoyer pour élargir le CCIA avec d’autres partenaires

• Microoplanification (mars 2004)

• Plan de réhabilitation logisitique

• Plaidoyer auprès de nouveaux partenaires et du gouvernement


• Rendre fonctionnelles les structures et organes de participation communautaire dans 50% des ZS de la RDC

• Manque de motivation des membres de ces structures et agences

• Plaidoyer et sensibilisation des communautés

Élaboration de: • Guide de mise en

place des RC • Messages

standardisés • Matériels éducatifs

• Former les RC • Mettre en oeuvre les

mécanismes de motivation des RC appropriés à chaque contexte

• Assurer le suivi


• Améliorer le système de collecte, d’analyse et de transmission des données

• Insuffisance des moyens de communication,de formation et de supervision de qualité

• Absence de feedback au niveau opérationnel

• Plaidoyer pour la disponibilisation des moyens de communication, des fonds du contrat de performance ainsi que ceux de formation et supervision de qualité

• Reproduction et distribution des outils de collecte des données

• Former et sensibiliser le niveau opérationnel dans la collecte, l’analyse et la transmission des données

• Informatiser la gestion des données dans les ZS

• Doter les ZS en moyens de communication

• Intensifier les supervisions de qualité

• Produire le bulletin


TITRE DE PRESENTATION: _______Faire Fonctionner l’ACD / Amélioration de Performance de District______ VOTRE PAYS: _________________Togo___________________ NOM DU PRENEUR DE NOTE: _____Amenyo Bebou AFI_______________________


votre pays)





objectifs


• Améliorer l’accès des populations aux services de qualité

Insuffisance en logistique • Motos • Chaîne de froid Rupture de stock de vaccin Insuffisance de personnel qualifié

• Intensification stratégie avancée

• Location motos • Dotation des FS en

réfrig/congélo • Renforcement du

plaidoyer (avec partenaires)

• Supervision formative • Recrutement du

personnel

Janvier 2004 • Dotation moto (50) Mai 2004 • Formation Mai 2004 • Plan de travail ‘04

• Microplanification des districts (en cours)

• Réunion du CCIA pour la mobilisation des fonds (mai)

OMS, UNICEF, GAVI, Rotary Int’l, ARIVA, Plan Togo, GTZ, UE, partenaires locaux

• Améliorer la participation communautaire

• Comités de santé non fonctionnels

• Mauvaise gestion des ressources du recouvrement de coût

• Radios locales à portée limitée

• Redynamisation des comités de santé et des structures de gestion

• Contrat avec certaines radios locales

• Réunion avec les leaders d’opinion

• Communication de proximité

• Production des supports de communication (boites à image)

• Contrats signés • Emission sur les

radios locales

• Contrat de performance avec les districts à faible CV

OMS, UNICEF, ARIVA, groupements locaux

• Élaboration d’un programme intégré de formation

• Adapter les curricula dans les écoles de formation de base

OMS, UNICEF

TRADUCTION Summary district Thiès presentation (Presentation1 Senegal) The district of Thiès (1 hospital of district and 35 health posts) facing a context of weak EPI performances, weakness of data management (Collect- Analysis - Transmission), default of formal systematic feed back and an inadequate operational planning implement activities targeting the monitoring and use of data to improve the vaccine coverage. These activities consisted primarily to: - put in place harmonized management tools for data - enhance technical skills of health workers - regularize the follow-up and the formative supervision - systematize retro information toward the health workers, the leaders and the

community This approach led to elaborate and implement operational Community micro plans based on performances analysis of health structures, to improve the delivery of services and to set up an emulation system between structures of health. The best health post received gifts at the end of the year in a ceremony chaired by administrative authority The results showed a progressive and constant improvement of the vaccine coverage from 2001 to 2003: the DPT3 coverage passed from 40 % to 65 %. However these results require beyond the monitoring of the data, the retro information and the motivation of the personnel, a strength EPI with a qualified team, an available an performing logistic with a plan of maintenance/renewal and a strong Community based involvement.

Le Contrat de PerformanceLe Contrat de Performance ExpExpéérience malienne pour accrorience malienne pour accroîître la participation tre la participation

communautaire aux activitcommunautaire aux activitéés de sants de santéé

4 mai 20074 mai 2007 Contrat de performance : expContrat de performance : expéérience malienne pour accrorience malienne pour accroîître la participation communautairetre la participation communautaire 22

PrPréésentation du Malisentation du Mali

Algeria

Mali

Niger

Mauritania

Ghana

Guinea

Cote d'Ivoire

Senegal

Burkina Faso

Benin

Western Sahara

Togo

Guinea-Bissau

Gambia

GAO

TOMBOUCTOU

KIDAL

KAYESMOPTI

SEGOU

SIKASSO

KOULIKORO

#SBAMAKO

Population totale : Population totale : 11 029 01711 029 0170 0 àà 11 mois 11 mois : : 441 161441 1619 9 àà 36 mois36 mois :: 1 101 6921 101 692< 15 ans< 15 ans :: 5 106 4355 106 435RRéégions sanitaires : gions sanitaires : 99Cercles sanitaires : Cercles sanitaires : 5858CSComCSCom :: 655655MortalitMortalitéé infantile : infantile : 113 / 1 000113 / 1 000MortalitMortalitéé InfInf--jnvjnv : : 226,9 / 1 000226,9 / 1 000MortalitMortalitéé juvjuvéénile nile : : 128,3 / 1 000128,3 / 1 000


Contexte (1)Contexte (1)

En 2000, En 2000, éévaluation du Plan Opvaluation du Plan Opéérationnel de la rationnel de la RRéégiongion dede Mopti dans le cadre du Mopti dans le cadre du PROgrammePROgramme de de DEveloppementDEveloppement SocioSocio--Sanitaire (PRODESS)Sanitaire (PRODESS)Constat : faiblesse du niveau des indicateurs de Constat : faiblesse du niveau des indicateurs de santsantéé en gen géénnééral dans la rral dans la réégion avec des gion avec des disparitdisparitéés ds d’’un district un district àà ll’’autreautre

DTCP3 = 27 %DTCP3 = 27 %VAR = 32 %VAR = 32 %CPN = 32 %CPN = 32 %Taux dTaux d’’accouchement assistaccouchement assistéé = 17 %= 17 %

Recherche de solutions Recherche de solutions àà cette contrecette contre--performanceperformanceIdIdéée de d’é’émulation des mulation des ééquipes pour amquipes pour amééliorer ces liorer ces taux de couverturetaux de couverture


Contexte (2) Contexte (2)

Plusieurs initiatives ont Plusieurs initiatives ont ééttéé prises au niveau de prises au niveau de cette rcette réégion :gion :

StratStratéégie de Proximitgie de Proximitéé Durable (SOS)Durable (SOS)Approche villageApproche villageCercle de qualitCercle de qualitééContrat de performanceContrat de performance


Contrat de performanceContrat de performance

Contrat de performance = engagement entre :Contrat de performance = engagement entre :ééquipes socioquipes socio--sanitaires et partenaires locaux pour sanitaires et partenaires locaux pour amamééliorer le taux de couverture sanitaireliorer le taux de couverture sanitaireMinistMinistèère de la Santre de la Santéé et ses partenaires pour la et ses partenaires pour la mobilisation des ressources nmobilisation des ressources néécessaires pour cessaires pour ll’’atteinte de ces objectifsatteinte de ces objectifs


PMA contenu dans le Contrat de PerformancePMA contenu dans le Contrat de Performance

VaccinationVaccinationConsultations Consultations PrPréé--NatalesNatales (CPN)(CPN)Planification Familiale (PF)Planification Familiale (PF)Lutte contre le paludismeLutte contre le paludismeLutte contre le SIDALutte contre le SIDA


Etapes de mise en Etapes de mise en œœuvre du uvre du C.PerformanceC.Performance

Phase dPhase d’’information et de sensibilisationinformation et de sensibilisationSSééries de rencontres des partenaires techniques et ries de rencontres des partenaires techniques et financiers aux niveaux national, rfinanciers aux niveaux national, réégional et localgional et localRencontres dRencontres d’é’échange avec lchange avec l’’ensemble des partenaires ensemble des partenaires locaux : Administration, Flocaux : Administration, Fééddéération Locale des Associations ration Locale des Associations de Santde Santéé Communautaire (FELASCOM), Associations de Communautaire (FELASCOM), Associations de SantSantéé Communautaire (ASACO), Conseil de cercle, Communautaire (ASACO), Conseil de cercle, éélus lus communaux et ONG a permis de dcommunaux et ONG a permis de déégager les prioritgager les prioritéés du s du cerclecercle

Phase de collecte des donnPhase de collecte des donnéées es DonnDonnéées PEV pour la micro planification locale en vue de es PEV pour la micro planification locale en vue de prprééparer le micro planification rparer le micro planification réégionalegionaleValidation des documents Validation des documents éélaborlaboréés par les partenairess par les partenairesSollicitation de lSollicitation de l’’engagement des partenairesengagement des partenaires


Etapes de mise en Etapes de mise en œœuvre des uvre des C.PerformanceC.Performance

Phase de micro planification rPhase de micro planification réégionalegionaleÉÉquipes des cercles et rquipes des cercles et réégionalegionaleÉÉquipes dquipes d’’appui : OMS, UNICEF, BASICS 2appui : OMS, UNICEF, BASICS 2

Phase signature de contrats Phase signature de contrats DDééllééguguéé du Gouvernement (Prdu Gouvernement (Prééfet)fet)PrPréésident du Conseil de Cerclesident du Conseil de CerclePrPréésident de la FELASCOMsident de la FELASCOMONG et Partenaires du CercleONG et Partenaires du CercleMaire de la CommuneMaire de la CommuneMMéédecin Chef de Cercledecin Chef de Cercle

Phase de mobilisation des ressources Phase de mobilisation des ressources Engagement des diffEngagement des difféérents acteurs: communes, ASACO/FELASCOM, rents acteurs: communes, ASACO/FELASCOM, cercles, partenaires pour la prise en charge des catcercles, partenaires pour la prise en charge des catéégories de gories de ddéépense : pense : ééquipements et fonctionnementquipements et fonctionnement


Exemple de Contrat de PerformanceExemple de Contrat de Performance

Il sIl s’’agit de lagit de l’’ossature du document ossature du document

ObjetObjetDurDuréée du contrate du contratObjectif du contratObjectif du contratStratStratéégies dgies d’’applicationapplicationMoyens de mise en Moyens de mise en œœuvreuvreSuivi et Suivi et éévaluationvaluationDivers Divers

Gestion des conflitsGestion des conflits


Suivi et Evaluation du Suivi et Evaluation du C.PerformanceC.Performance

Au niveau du Centre de SantAu niveau du Centre de Santéé Communautaire (Communautaire (CSComCSCom))Fiche de suivi et tableau de bordFiche de suivi et tableau de bordMonitorageMonitorage

Au niveau cercleAu niveau cercleSuivi mensuel (fiche de suivi)Suivi mensuel (fiche de suivi)SynthSynthèèse monitorage au niveau cerclese monitorage au niveau cercle

Au niveau rAu niveau réégional gional Suivi trimestriel (fiche de suivi)Suivi trimestriel (fiche de suivi)


Indicateurs de performanceIndicateurs de performanceEn vaccinationEn vaccination

Taux de couverture BCG, DTCP3 et VAR enfants de 0 Taux de couverture BCG, DTCP3 et VAR enfants de 0 àà 11 mois11 moisTaux de couverture VAT2 femmes enceintesTaux de couverture VAT2 femmes enceintesNombre de jours de rupture par antigNombre de jours de rupture par antigèènene

En SIS (SystEn SIS (Systèème dme d’’Information Sanitaire)Information Sanitaire)Ratio de concordance entre rapport mensuel et rapport trimestrieRatio de concordance entre rapport mensuel et rapport trimestriellPromptitude des rapportsPromptitude des rapportsComplCompléétude des rapportstude des rapportsProportion des rapports avec feedProportion des rapports avec feed--backbackProportion de la participation du chargProportion de la participation du chargéé SIS aux rSIS aux rééunions unions planifiplanifiéées par les Associations de Santes par les Associations de Santéé Communautaire (ASACO)Communautaire (ASACO)Indicateurs de CPN, PF, Palu et Sida dIndicateurs de CPN, PF, Palu et Sida dééveloppveloppéés dans ls dans l’’outil de outil de suivi du Programme de dsuivi du Programme de dééveloppement socioveloppement socio--sanitaire sanitaire (PRODESS)(PRODESS)


Analyse comparative taux de CV RAnalyse comparative taux de CV Réégion Mopti / Maligion Mopti / Mali

50

73

118

81

107

94

71

87

27

52

93

61

71 7480 79

32

53

82

61 6064 67 68

0

20

40

60

80

100

120

140

Mopti Mali Mopti Mali Mopti Mali Mopti Mali

2000 2001 2002 2003

Années / Régions

Pour

cent

age

BCG DTCP3 VARSource :Source : DonnDonnéées de routinees de routine


Analyse comparative des taux dAnalyse comparative des taux d’’abandon Rabandon Réégion Mopti gion Mopti

Source :Source : DonnDonnéées de routinees de routine

45

22

34

20

0

5

10

15

20

25

30

35

40

45

50

2000 2001 2002 2003

Années

Pour

cent

age


DifficultDifficultéés rencontrs rencontréées (1)es (1)

PersonnelPersonnelInsuffisance de personnelInsuffisance de personnelInsuffisance de formation du personnel de santInsuffisance de formation du personnel de santéé

LogistiqueLogistiqueExistence de besoins nouveaux non planifiExistence de besoins nouveaux non planifiééssAbsence de systAbsence de systèème dme d’’approvisionnement rapprovisionnement réégulier en gulier en pipièèces de rechange des rces de rechange des rééfrigfrigéérateurs et consommablesrateurs et consommables

Vaccins et consommablesVaccins et consommablesRupture du stock de certains antigRupture du stock de certains antigèènes (BCG, VAR)nes (BCG, VAR)Insuffisance du matInsuffisance du matéériel driel d’’injectioninjection


DifficultDifficultéés rencontrs rencontréées (2)es (2)

Mobilisation socialeMobilisation socialeMise en Mise en œœuvre insuffisante de la recherche active des uvre insuffisante de la recherche active des perdus de vueperdus de vueAbsence dAbsence d’’un plan de communicationun plan de communication

FinancesFinancesRetard dans la mise en place des fondsRetard dans la mise en place des fonds

SISSISNon respect du dNon respect du déélai dlai d’’acheminement des rapports acheminement des rapports ààtous les niveauxtous les niveauxManque de concordance entre les rapports mensuels et Manque de concordance entre les rapports mensuels et les rapports trimestriels dles rapports trimestriels d’’activitactivitéés (RTA)s (RTA)


LeLeççons apprises (1)ons apprises (1)

EntenteEntenteEntre les Entre les ééquipes socioquipes socio--sanitaires, les autoritsanitaires, les autoritéés s administratives et les administratives et les éélus dans le but dlus dans le but d’’augmenter la augmenter la CV de routineCV de routine

Mise en place des ressourcesMise en place des ressourcesTous les Tous les CSComCSCom//CSRefCSRef ont bont béénnééficificiéé dd’é’équipements quipements indispensables pour la vaccinationindispensables pour la vaccinationAdhAdhéésion des communautsion des communautéés pour la prise en charge des s pour la prise en charge des salaires de certains agents et le fonctionnement de la salaires de certains agents et le fonctionnement de la chachaîîne de froid en stratne de froid en stratéégie avancgie avancééee

SISSISAteliers pAteliers péériodiques driodiques d’’harmonisation des donnharmonisation des donnéées es collectcollectéées par niveaues par niveau


Conclusions (1)Conclusions (1)

Contrat de performance permet une plus grande implication Contrat de performance permet une plus grande implication des ddes déécideurs et partenaires locaux de la vaccination dans cideurs et partenaires locaux de la vaccination dans ll’’atteinte des objectifs fixatteinte des objectifs fixéés par tous s par tous RRéésultats obtenus satisfaisants avec diminution forte du sultats obtenus satisfaisants avec diminution forte du taux dtaux d’’abandon DTCP1abandon DTCP1--DTCP3DTCP3Mise en place des Mise en place des ééquipements et mise quipements et mise àà disposition des disposition des ressources pour le fonctionnement grâce aux partenaires ressources pour le fonctionnement grâce aux partenaires ((Etat, GAVI, UNICEF, OMS, CollectivitEtat, GAVI, UNICEF, OMS, Collectivitéés locales et s locales et partenaires locauxpartenaires locaux) ; facteur d) ; facteur dééterminant pour lterminant pour l’’atteinte des atteinte des objectifs fixobjectifs fixéés dans les contrats de performance.s dans les contrats de performance.


Recommandations (1)Recommandations (1)

PersonnelPersonnelFormation / Mise Formation / Mise àà niveau du personnel impliquniveau du personnel impliquéé dans la dans la vaccinationvaccination

LogistiqueLogistiqueBonne gestion des stocksBonne gestion des stocksMaintenance rMaintenance rééguligulièère de la logistique re de la logistique (r(rééfrigfrigéérateurs, rateurs, motos, vmotos, vééhicules)hicules)

Vaccins et consommablesVaccins et consommablesAssurer un approvisionnement rAssurer un approvisionnement réégulier en antiggulier en antigèènes et nes et consommablesconsommables


Recommandations (2)Recommandations (2)

Mobilisation socialeMobilisation socialeÉÉlaborer un plan intlaborer un plan intéégrgréé de communicationde communication

FinancesFinancesMettre Mettre àà la disposition des fonds la disposition des fonds àà temps au niveau temps au niveau opopéérationnelrationnel

GGéénnééralesralesPrPréévoir des ateliers de monitorage/micro planification voir des ateliers de monitorage/micro planification ppéériodiques, afin de corriger les erreurs, lever les riodiques, afin de corriger les erreurs, lever les goulots dgoulots d’é’étranglement observtranglement observéés dans le suivi des s dans le suivi des contrats de performancecontrats de performance

Participatory Country Exchange Workshop, Dakar, 22 -

24 April,2004

Presented by: Dr K. O. Antwi-Agyei, EPI Manager,Ghana

New Vaccine Introduction and Financial Sustainability -

The Ghana

Experience

Ghana

Ghana -

Demography•

Population 2002 -

19.79m (2000

census) : Growth Rate 2.6%•

10 administrative regions

•

110 decentralised districts (Increasing to 140 in 2004)

•

0-11 months -

791,612 (EPI target)

Health Reforms in Ghana•

Health Sector Reforms -

since 1995

•

Medium Term Health Strategy Document published in 1995 to guide health development in medium term

•

First 5-yr Programme of Work (PoW) -

(1997 -

2001)

• Second PoW

(2002 -

2006) started

in January 2002

Funding arrangements - MOH

•

Total Budget needed for five yr period of PoW

estimated

•

Sources of funds:–

Government revenue

–

Internally Generated Funds–

External Partners •

Earmarked funds

•

Pooled donor funds (Health Fund)•

Earmarked and pooled funds placed in separate accounts managed by MoH

Funding Arrangements -

2•

Preparation of 5-year and annual POAs

•

All partners indicate expected amount to be contributed into resource envelope over the five yr period

•

On yearly basis, firm commitments are made by all partners on funds to be released to Health Fund/Earmarked funds

•

MoH allocates funds according to priorities set with Development Partners

New Vaccine and FSP•

New Vaccine (DTP HepB-Hib

vaccines)

introduced in 2002•

Also called “Pentavalent”

/ “Five-in-one”

vaccine

•

GAVI providing 5 year vaccine & Immunisation service support

•

3 year support for injection safety

•

Ghana’s

FSP first submission in 2002

•

Re-submitted in 2003

Introduction of New Vaccine•

Role of GAVI

•

Application submitted in July 2000•

Award granted in September 2000

•

Award for five years (2001-2004)•

Supply of yellow fever vaccine & DPT-

Hep

B-Hib for five years•

Support for strengthening routine EPI

Introduction of New Vaccine•

Disease burden of hepatitis B

•

Affects 30% of world population (HBV)

•

Carriage of HBsAg

8-15% in blood donors -

Ghana

•

Insignificant vertical transmission•

Presence of HB core antibody 90% in adults

Introduction of new vaccine•

Vaccine procurement:

•

Pentavalent vaccine will be used (DPT- HepB-Hib

)

•

Two vials –

DPT-HepB

(recombinant) –

liquid•

Hib –

freeze dried powder

•

Both to be stored in the fridge•

Expansion of cold chain required –

32%

•

Reconstituted before intra-muscular injection

•

First shipment expected in mid October, 2001

Vaccine Administration•

DPT Schedule will be used –

•

6,10,14 weeks; •

birth dose not needed

•

IM injection using AD syringes•

New vaccines started in Dec 2001 in Greater Accra Reg and Nationwide in 2002

•

Targeted at 0-11 months•

Children with DPT1/DPT2 will continue as DPT2-HepB1-Hib1 or DPT3-hepB2-Hib2

Injection safety•

Adequate supplies of injection safety materials ordered

•

Emphasis on avoiding recapping•

Emphasis on using safety boxes

•

Use properly assembled safety box•

Remember! Burn syringes using provided safety boxes

•

Ensure that adequate supplies are available at each level

IEC•

Advocacy –

Regional Co-ordinating

Council , District Assemblies•

Leaflets for health workers and general public and media

•

Media Briefing•

Radio Discussions

•

Launching by Minister of Health

Post introduction evaluation of new vaccine

• The field work for the evaluation was conducted from 1- 8 April 2003 by a team composed of Ghana Health Service staff, WHO (country office, ICP and regional office) and UNICEF (Ghana).

• Major finding – there is overall positive impact of the new vaccine introduction on the immunization system in the country. This includes good immunization safety management standards, satisfactory timeliness, accuracy and completeness of data systems.

But it was at a cost!•

We had to positioning ourselves to develop plans to financially sustain our EPI service

•

How was it done?

The total costs of the program were estimated to be $8.0 million.

Ghana -

Estimated Costs of National Immunisation Program -

2000

8%

8% 9% 6%39%

30%

PersonnelVaccinesSuppliesSoc MobilOther RecurCapital

Estimated Costs of Routine Immunization and NIDs, 2000

($000s)

$0

$500

$1,000

$1,500

$2,000

Personnel VaccinesSupplies Other RecurrentCapital

$0

$500

$1,000

$1,500

Personnel VaccinesSoc Mobil Other RecurrentCapital

The cost of the routine immunization program is $3.7 million and cost of NIDs is $3.9 million.

Routine Immunization NIDs

Estimated annual additional cost for new vaccine

•

Cost of DPT-HepB+Hib -

$3.5m•

Cost of DPT -

$0.14m

•

Cost of routine immunisation prior to introduction of pentavalent-$3.7m

•

100% increase in routine immunisation costs

•

Increased Cost now being borne by GAVI/Vaccine Fund

Sources of funds for EPI Budget

•

Government revenue-Personnel, Costs, recurrent costs

•

Health Fund -

Vaccines & Injection safety materials, other recurrent costs

•

Earmarked Funds -for targeted activities e.g. cold chain equipment, NIDs, Surveillance

Plans for Financial sustainability

•

Additional sources of funds for routine programme : HIPC-Debt relief, Injection safety (GAVI), District Assemblies

•

Sensitisation of Development partners - ICC

•

Expected decrease in pricing of vaccines•

Capacity Building e.g training in vaccine management leading to reduction in wastage

•

Possible extension of GAVI support beyond first five years

FSP Financing

Surviving infants 5 year ISS 3 year INS 5 year NVS Vaccine presentation

Other support

Total 5 year commitment

779.359 3.359.000 741.000 47.094.500 DPT_Heb+Hib, YF

100.000 51.294.500

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 % contribution from GAVI 100 100 85 75 60 40 25 15 0 0 % contribution from MoH

0 0 15 25 40 60 75 85 100 100

•Gradually increasing share from GoG and Health Funds

Phasing out of GAVI / VF contribution for pentavalent

vaccines : the case of Ghana

100% 100%

85%

15%

75%

25%

60%

40%

40%

60%

25%

75%

15%

85%

100% 100%

0%

25%

50%

75%

100%

Prop

ortio

n of

con

trib

utio

n

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Years

End of GAVI/VF support, if no phasing outFrom IDA loan

GAVI / Vaccine Fundcontribution:US$ 47 million

Contribution from Ghana Govt & other sources

Challenges•

Competing health priorities

•

Sustaining GOG’s

commitment•

Beating down cost of vaccines etc

• Introduction of other initiatives etc may compound problem of funding

•

There is no turning back after assuring people of benefits of new vaccine

Summary•

New vaccine successfully introduced in 2002

•

Annual Cost of routine immunisation before New Vaccine -

$3.7m

•

Cost after New Vaccine -

$7.2m pa•

MoH

to source additional funds post

GAVI –

a big task•

Will cost of vaccine reduce?

Thank You

TITRE DE PRESENTATION: _______Intégration du PEV avec des autres programmes_______________________________________________ VOTRE PAYS: _________________Togo___________________ NOM DU PRENEUR DE NOTE: _____Amenyo Bebou AFI_______________________


votre pays)





objectifs


• Développer les principes et supports en vue de l’intégration des programmes (PEV/PCIME/Palu/ surveillance)

• Existence des principes et supports spécifiques à chaque programme

• Mise en place d’un groupe de travail chargé de la coordination

• Document de microplanification intégré au niveau district

• Extension de l’expérience de 5 districts pilotes à tous les districts

• Microplanification intégrée dans tous les districts

• Redynamiser le groupe de travail sur l’intégration des programmes

• Plaidoyer auprès des partenaires sur l’intégration

OMS, UNICEF

• Développer les modules de formation intégrés

• Mulitplicité des modules spécifiques aux programmes

• • Élaboration d’un programme intégré de formation

• Adapter les curricula dans les écoles de formation de base (paramedicale et medicale)

• Élaboration des modules intégrés de formation

• Intégrer les modules dans les curricula des écoles

OMS, UNICEF

Making an ICC “Functional” Group 1 1. The ICC Experience

Need to support and strengthen structures - Technical and strategic level - [?]

2. ICC = national committee and at decentralized level = coordinating committee for implementation, even in Dem Rep of Congo or in particular case, with non-urban entities at the provincial level

3. ICC's yearly work plan - Technical study of file by ICC. Approval by decision makers

4. Administrative act - Its make up and operations

5. Need to coordinate and include [ ?] ≠ interagency coordinating committee for health (ICC/EPI/Foud [Radiole?] AIDS)

Group 2 1. Government ownership of the ICC is vital 2. Signing of MoU with partners and subsequent review of programme in that context is

key 3. ICC must remain flexible to step in if the political situation in the country deteriorates 4. Need to involve other Ministries in the ICC, eg. Finance, Planning 5. Should be called “strategic” not “politic” 6. Technical committees can meet without the Ministries of Health, but not the strategic

one 7. [?] Vital for the management of funds from donors and to follow up on their

disbursement and implementation Group 3 1. It’s a good system of putting the district team to a challenge by the Regional/Federal

level to improve their performance 2. Basic agreement is federal level to support with funds and logistics and district to

show improvement of performance 3. Reward system shouldn’t affect the sustainability or create false expectations of FWs.

It should be carefully planned and built in on-going 4. ICC should be involved from the beginning to ensure all stakeholders involved and to

make sure resources are available in timely fashion

Theme de session _____ Revitalisation de la Logistique Vaccinale____________________ Votre Pays ___________ Togo____________________________ Nom de preneur de notes Amenyo-Bebou AFI__________________________________________________ Quelles sont les activités déjà planifiées pour faire face à ce thème?




• Finaliser l’inventaire de la chaîne du froid à tous les niveaux

• Réviser le système

d’approvisionnement • Élaborer un mécanisme de

maintenance de la chaîne du froid et véhicule

• Construire une chambre

positive et 1 négative au niveau central

• Acquérir un camion

frigorique pour le transport des vaccins

• Mobiliser les ressources nécessaires à la mise en place des vaccins au niveau régional et district

• Inclure les coûts relatifs à l’approvisionnement des vaccins dans les plans de régions et districts

• Faire approuver ces plans

par le CCIA • Mettre les fonds à la

disposition des niveaux concernés

• OMS, UNICEF, Plan TOGO, GTZ

Thème de session _____ Revitalize Vaccine Logistic at All Levels_____________________ Votre Pays ___________ Mali____________________________ Nom de preneur de notes Mouhoum KONE__________________________________________________ Quelles sont les activités déjà planifiées pour faire face à ce thème?




• Implication du secteur privé dans la maintenance de la chaîne froid

• Utilisation du secteur privé

pour la mise en place des appareils de la chaîne de froid

• Utilisation d’équipe mixte

secteur privé-public pour la mise en place des vaccins consommables

• La formation et le suivi • Établissement de contrat

• Atelier régional de formation

• Réaliser 2 supervisions par an

• Coopération bilatérales (Union Europeene, Luxembourg, USAID, GAVI)

• État - GAVI

Thème de session __________Revitalisation de la Logistique Vaccinale à Tous les Niveaux___ Votre Pays _______________ Bénin_________________________ Nom de preneur de notes ___Abdou CHITOU____________________________________ Quelles sont les activitéd dejà planifiées pour faire face à ce thème?




• Assurer la maintenance préventive des équipements de chaîne de froid à tous le niveaux de la pyramide sanitaire

• Assurer la maintenance

curative des équipements de chaîne de froid à tous les niveaux de la pyramide sanitaire

• Étudier les modalités d’approvisionnement en pièces de rechange avec le DIEM

• Formation des agents de santé sur la maintenance préventive

• Rendre disponible à tous les niveaux les consommables d’usage courant a tous les niveaux

• Rendre disponible pour chaque région sanitaire les pièce de rechange des équipements

• Mettre en place un mécanisme d’approvisionnement et de distribution des pièces de rechange à travers le central des médicaments essentiels

• Séance de travail • Atelier de formation au

niveau des zones sanitaires (district)

• Séance de travail

• UNICEF, CARE, AMD • OMS, UNICEF, CAME, AMP

• Formation des formateurs

BASICS II / GUINEA

AAP SUMMARY The Republic of Guinea, which launched its national « Primary Health Care » program in 1988, registered high rates of vaccination coverage until 1994. From that year on, vaccination coverage rates stalled then fell sharply. An external PEV review completed in November 2000 confirmed the decline. Embarrassed by these results, the Ministry of Public Health and its partners welcomed any suggestions for overcoming the problem. Consequently, in 2001, BASICS II and its technical partner, PRIME II, introduced the Performance Improvement Approach (AAP) — an approach used until then in reproductive health and family planning programs — for vaccination-focused heath care providers working in non-urban areas. As a systematic problem solving approach, AAP has been introduced into 2 pilot districts: Dabola and Kouroussa, located respectively in the regions of Faranah and Kankan, in Upper Guinea (a USAID intervention zone). AAP activities include: Organizing an orientation workshop for key actors and decision makers Drafting performance criteria for routine vaccination programs Performance Needs Audit for vaccination providers in the two districts RBP restitution and plans for corrective activities Implementation of remedies Plans for second RBP (underway)

Next steps include: RBP restitution and plans for corrective activities In the short and medium term, the focus is on [scaling to context].

Session Topic ____________Revitalizing Vaccine Logistics at All Levels______ Your Country __________Uganda__________________ Name of Note Taker ____________________Megere ___________________ What activities are already planned to address this topic?




• Developed a vaccine and other supplies distribution plan for the central to district level

• District distribution plan integrated in the district plan

• Trained district and HSD EPI focal persons to manage EPI vaccines and logistics

• Each HSD has a district microplan that includes vaccines and logistics management

• Some HSD have received multi-purpose double cabin pickups for delivery of logistics and supervision

• Introduced vaccine and logistics monitoring tools

• Carry out an EPI training needs assessment

• Procure vehicles for the district to distribute vaccines and logistics

• Procure more vehicles for the remaining HSD and motorcycles for HEIII (sub-counties)

• Train health workers on use of the vaccines supplies management tools and their interpretation

• Train health workers on cold chain maintenance and vaccine handling

• Training health workers on logistics and vaccines forecasting to avoid stock-outs and overstocking

• Strengthen quarterly technical support supervision

• Develop a procurement plan for ICC approval

• Develop a training plan based on the EPI training needs assessment

• Training of regional EPI supervisors

• Support private sector organization/individuals to carry out EPI supervision in conjunction with UNEPI

• Quarterly review meetings

• GAVI • JICA • UPHOLD • UNICEF • WHO • MoH

Using Data to Improve Routine Vaccination Performance

Presentation Summary II ― Senegal The Podor district is located in the north of Senegal, in the region of Saint Louis. It includes 46 vaccination units for a yearly target population numbering 10,536, in a region covering 12,947 square kilometers. Among our routine vaccination activities, two incidents are note-worthy: Monthly coordinating meetings where health centers remit the results of their data

analysis and identify solutions to problems raised 3 times yearly distribution of the feedback bulletin, which targets health center team

members, district heads, and local political and administrative authorities The published analysis focuses on 5 factors: on time collection completeness vaccine coverage rates (DTC3 and VAR) drop out rates loss rates

At the end of 2003, the results were considerable for the district: 1. Completeness: 97% 2. On time collection: 90% 3. Coverage rates:

- DTC3: 80.6% - VAR: 70%

Between May and December of 2003 ― the first and final distributions of the feedback bulletin ― the percentage of high performing health care centers went from 22% to 52%. It is worth mentioning that these two activities made for healthy competition between health care staff, on the one hand, and between communities, on the other. Moreover, the activities pushed participants to solve their own problems.

TITRE DE PRESENTATION: _______Intégration du PEV_______________________________________________ VOTRE PAYS: _________________Bénin___________________ NOM DU PRENEUR DE NOTE: _____Chitou ABDOU_______________________


votre pays)





objectifs


• • • •

• Assurer une prise en charge concertée et globale des activités en faveur de la survie de l’enfant

• Ressources matérielles et humaines limitées

• Harmonisation aux échelons supérieurs difficile

• Mettre en place un cadre de concertation viable (stratégique, finance, et évaluation)

• Réunions bimestrielle et trimestrielle

• Mise en oeuvre du plan stratégique IDSR

• Assurer le financement des activités décentralisées

OMS, UNICEF, USAID

Thème de session _____ Planning for Injection Safety_____________ Votre Pays ___________ Madagascar___________________________ Nom de preneur de notes Aimé_RANDRIAMANACINA______________________________________________ Quelles sont les activités déjà planifiées pour faire face à ce thème?




• Évaluation des sécurités des injections et la gestion des déchets (avril-mai 2004)

• Élaboration de la politique

nationale de le sécurité des injections et de la gestion des déchets

• Mise en oeuvre de la

gestion des déchets (incinérateurs)

• Appui des consultations externes

• Ateliers de validation avec

les autres secteurs concernés (environnement)

• Choix de la méthode

d’incinération

• Analyse des résultats • Mise en oeuvre des

recommandations de l’évaluation

• Concertation avec les

experts

• OMS, USAID • USAID, OMS, UNICEF,

GAVI • OMS, GAVI

Planning for Injection Safety Beyond Immunization Services in Uganda

Injection Safety has been of great concern to the Ministry of Health and the government of Uganda as a result of several studies and injection safety assessments that have shown that:

Many injections are unsafe and have potential to transfer pathogens like HIV and hepatitis There’s one prescription and clients demand for injections That there’s a lack of guidelines and standards for injection safety and there’s inadequate

supply of injection materials. There’s a lack of facilities for collection of injections waste materials

Because of these concerns the Government of Uganda has established Uganda National Injections Safety Taskforce (UNISTAF) to:

Review and harmonise the various programme policies and guidelines on injection safety Build consensus among the key stakeholders and develop policy standards guidelines and

mobilize resources to operationalise the policy and workplan on injection safety and waste disposal

The UNISTAF is composed of the MoH departments, UN agencies, NGO, professional organizations, medical training institutions and other organizations with a stake in the safe disposal of medical waste. A project to move forward the recommendations has been established to pilot the scheme in 4 districts for a period of one year after which an evaluation will be made and the approach scaled up to 4 more districts before eventually scaling up to the entire country. Meanwhile, materials developed – policy standards and guidelines will be availed to all the districts from the start. The interventions of the project will include:

Dissemination of the policy and guidelines Capacity building and sills development of the health workers Awareness creation for behavior change Implementation in logistics managers and improved health care waste management

EVALUATION QUESTIONNAIRE

Participatory Country Exchange on Strengthening Routine Immunization Co-organized by GAVI West African Sub-Regional Working Group and BASICS II

Dakar, Senegal 22-24 April 2004

Please do NOT put your name on this form. Please place the completed questionnaire in the box. Thank you for your feedback. 1. How would you rate the Participatory Country Exchange overall? (Circle one answer.)

Poor – 0 Fair – 0 Average – 2 Very Good – 39 Excellent – 14

2. What worked especially well?

• New information obtained • Exchange of experience • Small group discussions • Informal atmosphere • Cross fertilization between countries • Chairpersons and participants were conducive environment • The practical experience presented by different countries • The country group work was useful • Presentations/Relevant topics • Questions and answers but time allotted was short • The method of work is very relevant for adult participation • Language specific working groups • Change in format after day 1 (re: not having working group and country group after each plenary) • The design of the sessions/program – it was nice to break up the presentations with small group

work • Participatory model for diffusion and working group • Sharing of experiences in specific areas

3. What could have been better? • Group discussion of presentation were good but repeating discussing the same topic in country

group was not very important • Keeping track of questions – some not answered in sessions • Structure of meeting better explained to presenters so that they use their presentation to really set

the stage for the discussions • French handouts could have been translated to English and vise versa • Time constraints • Less countries involved in this type of exchange of learning workshop • Sharing the group work/country work in plenary session • The marketplace – careful selection of materials based on innovative ideas was lacking. Overall

range of materials could have been wider eg photographs etc; community-level monitoring tools. • The time for small working group needed to be extended • The presentations were good as there were interpreters, but the powerpoint handouts to the

participants could have been interpreted for us. No point for you to give us PP handouts in French when you know I don’t understand French

• Time management – Some chairmen were not good disciplinarians

• Questions and answers – More time should be allotted so that participants are clear before moving to working groups

• Elaboration of Country Work plans • It would be preferable to collect discussion points from groups and amend them in plenary • Explain the implementation of projects in more detail, as in the introductory theme of the

workshop 4. “I think the agenda, and its focus on routine immunization, was useful.” (circle one answer)

Strongly disagree – 0 Disagree – 0 Undecided – 2 Agree – 26 Strongly agree – 29

5. “Overall, I think that the presentations informative.” (Circle one answer.) Strongly disagree – 0 Disagree – 0 Undecided – 2 Agree – 34 Strongly agree – 21

6. “I think that the presentations were relevant to the work that I do.” (Circle one answer.) Strongly disagree – 0 Disagree – 0 Undecided – 2 Agree – 27 Strongly agree – 28

7. “The design of the Participatory Country Exchange was conducive to learning.” (Circle one.) Strongly disagree – 0 Disagree – 0 Undecided – 4 Agree – 29 Strongly agree – 22

8. Which parts of the Participatory Country Exchange were especially useful? (You may circle more than one answer.) Plenary presentations - 36 Plenary questions and answers - 29 Small brainstorming discussion groups - 49 Small country-specific working groups - 30 Marketplace display of technical materials - 17

9. Which parts of the Participatory Country Exchange were least useful? (You may circle more than one answer.) Plenary presentations - 1 Plenary questions and answers - 5 Small brainstorming discussion groups - 5 Small country-specific working groups - 16 Marketplace display of technical materials – 11

10. “Organizationally, the Participatory Country Exchange was put together well.” (Circle one) Strongly disagree – 0 Disagree – 0 Undecided – 1 Agree – 33

Strongly agree – 23

11. “My personal goals were met by this Participatory Country Exchange.” (Circle one.) Strongly disagree – 0 Disagree – 0 Undecided – 4 Agree – 40 Strongly agree – 10

12. “The Participatory Country Exchange experiment (in creating a stimulating environment for participants to learn from each other) was a success." Strongly disagree – 0 Disagree – 1 Undecided – 2 Agree – 31 Strongly agree – 23

13. Additional Comments: • It was a great – really “participatory”. • Perhaps more diversity of countries presenting • We seemed to hear a lot from Uganda • It could have been scheduled for at least one week • A lot has been learned for country strategy planning • Inter-organizational participation was very good • To create a network to continue sharing these experiences between participants • A session on improving communication for strengthening Routine Immunization (probably

backed by or based on the marketplace idea) would have been useful. • Time allotted for plenary questions and answers was too short and I think 30mins for presentations

was too long • The interpretation of presentation was very helpful and excellent • On marketplace display: There should be somebody to explain what the materials are all about. If

possible have an interpreter; and give it more time that was allotted • Should be able to foresee the type of materials that will be requires so that participants come with

those • If the male interpreter could improve his speed it may better • More time must be devoted to small group discussions • Generally good • Send presentations by e-mail and the experiences of other countries that were not presented at this

workshop • I greatly appreciated the perspectives of others and this experience permitted me, in taking into

account my context, to better understand the tools to support making the EPI function and to increase and sustain high coverage.

• It would be good to have in plenary the main consensus points that came from the group work (in bullet form, for example) to have information on others’ ideas.

• Need to specify the expected results of the workshop and have consensus on this • Training and reference documents to be organized

Session Topic _________ Logistics and Injection Safety / Revitalizing Vaccine Logistics at All Levels______ Your Country _________ Liberia Name of Note Taker ___ Dr. [?] ___________________ What activities are already planned to address this topic?




• Planning for injection safety: already planned for construction (1) de Monfort incinerator — one per district

• Revitalizing vaccine logistics:

vaccine procurement through UNICEF (on going)

• Vaccine and related supply distribution plan for both routine immunization and SIAs

• Advocacy for putting in place a health waste management policy for the country

• Importation of refractory bricks and cement. Contracting two (2) experienced contractors

• By ICC’s approval

• UNICEF, USAID, WHO • UNICEF, WHO

SAVE THE DATE! SAVE THE DATE! SAVE THE DATE! SAVE THE DATE! Participatory Country Exchange for Strengthening Routine Immunization

- Co-organized by GAVI West African Sub-Regional Working Group and BASICS II - 22 – 24 April 2004 Dakar, Senegal Background Immunization is one of the most cost-effective public health interventions available. Most developing countries have committed themselves to reaching 80% coverage in all districts. A strong routine immunization program is recognized as a prerequisite to achieve and sustain equitable and timely protection from vaccine-preventable diseases, to reach mortality reduction and disease elimination goals, and to prepare the ground for the introduction of new vaccines. While immunization coverage rates stagnated at low levels in many countries in Africa and Asia over the past decade, other countries in these regions have begun to raise coverage effectively, efficiently, and equitably with attention to improved quality. Immunization programs have recently undergone profound changes with a proliferation of initiatives, an assortment of old and new challenges, and an array of new partners and funding mechanisms such as GAVI and the Vaccine Fund. A revival of interest in immunization at global, regional and country levels, together with increased levels of funding, has led some countries to pioneer innovative strategies to improve performance of their routine immunization programs. Some countries have adapted and reinvigorated successful approaches from the past. Strengthening routine immunization services requires good synergy between the MOH and its partners. WHO and UNICEF continue to play the lead roles in directly providing technical support and in facilitating participation of other partners. This “Country Exchange” will be a highly-participatory opportunity for country teams (consisting of MOH staff and their in-country partners) to learn from one another. Countries will describe their experiences in overcoming common problems and share their best practices in strengthening routine immunization services. Countries will discuss not only what was done, but how it was done and the impact these efforts are having on improving immunization coverage at sub-national levels. This will assist other countries to customize their own solutions and approaches. The Country Exchange provides a forum for regional and global partners to receive information on what is being accomplished in the field. This Country Exchange will take place on 22 - 24 April 2004, immediately after the West African Bloc EPI Managers’ Meeting (19 – 21 April). Both meetings will take place in the same venue at the Ngor Diarama Hotel in Dakar. WHO and BASICS will coordinate the sending of invitations for the two meetings. Some participants will be invited to both of the meetings. Learning Objectives of the Country Exchange

Learn, through sharing country experiences and achievements, about implementation of best practices for strengthening routine immunization services

Customize routine immunization strategies and activities to overcome barriers identified at country level

Strengthen partnerships at country level to plan and implement solutions to reinforce

immunization programs Target Countries In order to promote participation and encourage in-depth discussion and planning, the number of countries will be limited. In Africa, field staff from Democratic Republic of Congo, Ethiopia, Ghana, Guinea, Mali, Madagascar, Nigeria, Senegal and Uganda will be invited. BASICS will sponsor the EPI Managers of those countries to participate in both the Country Exchange and the EPI Managers’ Meeting. (Uganda participants will be invited to attend only the Country Exchange.) Target Participants Country EPI managers, and additional program staff in some countries, will be invited to attend, along with their in-country partners (e.g., WHO, UNICEF, USAID, CDC, World Bank, EU, CVP, NGOs, etc.). Staff from regional and global partner organizations will also be invited. Participants should plan to attend for the full three days. Provisional Agenda Topics The topics and precise agenda will be finalized with input from country and partner staff. The number of presentations will be strictly limited to permit the maximum amount of participation. Provisionally, the topics are proposed as follows: 1) Implementing the RED components: How to make the package work operationally in districts (Madagascar: MOH assisted by BASICS) 2) Improving the quality of immunization staffing: performance improvement and capacity building (Guinea: MOH assisted by WHO and BASICS) 3) Effective monitoring and use of data for districts to improve their coverage (Senegal: MOH assisted by WHO and CVP) 4) Working with communities to improve immunization planning, service delivery, and communication (Uganda: MOH assisted by BASICS) 5) Integrating routine immunization with other child survival and disease control initiatives: areas of convergence and challenges (Madagascar: MOH assisted by UNICEF and BASICS) 6) Making an ICC "functional": role of technical and communication sub-committees (DRC: MOH assisted by BASICS and WHO and UNICEF) 7) Implementation and sustainability of new vaccine introduction and the FSP (Ghana: MOH assisted by WHO) 8) Injection safety: for immunization and overall public health (Uganda: MOH assisted by BASICS)

9) Use of district performance-based contracts (Mali: MOH assisted by WHO) 9) Use of district performance-based contracts (Mali: MOH assisted by WHO) 10) Revitalizing vaccine logistics at all levels (Nigeria??: MOH assisted by WHO) 10) Revitalizing vaccine logistics at all levels (Nigeria??: MOH assisted by WHO) Learning MethodLearning Method The success of the “Country Exchange” depends on active participation and the free flow of ideas. The meeting will primarily be organized according to the following cycle:

Meeting Framework

I. Presentation (30 Minutes)

II. Question and Answer Session (10 Minutes)

III. Brainstorming Sessions (30 Minutes)

IV. Country-specific

Working Groups (40 Minutes)inutes)

1. One or two presentations will be given in plenary on a common theme, experience or strategy concerning country or regional experience. Each presentation will typically be 30 minutes to permit more detailed discussion of the “how.”

2. A brief period of 10 minutes for clarifying questions and

answers will follow.

3. Participants will be randomly assigned to “brainstorm” in small breakout sessions lasting about 30 minutes, where the previously presented topic will be discussed in terms of its strengths and weaknesses.

4. Participants will then re-group in country-specific working

groups for about 40 minutes to discuss the applicability of the topic and solutions relevant to their own country. They will identify some “next steps” that could be introduced or scaled up in their respective countries.

Languages English and French. Simultaneous interpretation will be provided. Funding Each partner will be expected to fund its staff. BASICS will cover travel and per diem for EPI Managers from DRC, Ghana, Guinea, Madagascar, Mali, Nigeria and Uganda. For additional information, please contact BASICS For technical information: Robert Steinglass ([email protected]) For administrative information: Tara Watson ([email protected])

mailto:[email protected]

Performance Based Contracts to Stimulate District Performance Group 1 1. Focused on 6 key points: personnel, logistics, vaccines, social mobilization, financing

and resources 2. Personnel must be capable of performing vaccination and managing the program and

there must be political agreement on approach 3. Ensuring financing – have to do financial evaluation; district and community need to

be able to sustain this operationally - Need to take into account all of the associated costs to ensure that contractual

obligations can be met - Base costs (e.g., salary, vaccine purchase) need to be assured before entering into

contracts 4. Challenge: Associating community members with this contract, in terms of

community mobilization of resources and involvement of non-paid volunteers who assist with mobilization and tracking of drop-outs - Requires advocacy with leaders - Communication / IEC with community - System for outreach - Involvement of community in identifying population (local population) (to have a

better idea of target population) - Local teams to liaise with nomadic communities

Group 2

Mali's Example Shows that It Is Very Important Other thoughts:

- Insist on the importance that everyone involved understand the performance criteria

- Need to establish or draft objective and verifiable criteria that all parties accept Example: - Health care worker will offer vaccination services every work day as

a matter of practice - Health care worker will make so many outings each month as part of

a forward leaning strategy - Health committee will pay the cost of his meals during each outing,

etc - Beyond commitments to pay for microplans, what type of bonuses will be

offered? VERY IMPORTANT Group 3 1. Revise the process for making funds available at the national level ( bureaucratic)

- Example: rural committees in Senegal 2. Draft a plan for supplying vaccines 3. Increase involvement of regional levels in the performance contracts

4. Use the number of immunized children as indicators when denominator is unknown Group 4 1. This is a plan to improve performance 2. In order to be a real performance contract:

- Clearly define the various actors - Clearly define the contract's terms of reference, the conditions for the

different actors - Get commitment from different actors on vaccination implementation Example: to prevent vaccine shortages:

- Define the bonuses and penalties for fulfilling or violating contract 3. Performance evaluations require quality data (collection, culling and analysis) 4. Results of other MAP efforts not evaluated 5. Strategy's effectiveness should be tested by comparing le Mopti district to a similar

one that does not have performance contracts 6. Key point: Involve all actors Group 5

Setting up a Performance Contract

1. Planning needs to take place at operational level to include particularities, whereas higher levels (regional / delegation / provincial) should coordinate and supervise

- Set up oversight method (inspection with clear definition of entities and roles and responsibilities)

- Include in performance contract social mobilization activities with OCB/ASC/GPF

- To make performance contract sustainable, decentralize district budgets, including a performance contract section with conditions and financed with secure funds, such as PPTF

Group 6 1. Need solid micro planning from start 2. Need to motivate staff, but make incentives specific to context 3. Sustainability will be problematic for vehicles and refrigerators 4. In supporting low-performing districts, use staff from high performing districts as [?]

resource and encourage exchange between - Never discourage high performing districts

5. In the event of a vaccine shortage, find an appropriate solution (social mobilization or lightning campaign)

Group 7 1. Contents of MAP performance plan 2. Advocacy phase 3. Micro planning and data collection phase 4. Performance contract signing, which should contain the following elements:

- Level of expected performance

- Partner commitments, including each member of the community - Incentives and bonus system - System for follow-up and evaluation

- Include drop out rates among criteria 5. Evaluation of performance assessment Group 8 • From the presentation it is not possible to say whether it is advantageous or not • Our concerns:

- It may lead to form reports - There may be under planning for fear of punishments - It is not clear what measures will be taken if the target is not achieved

• No need for signing to improve performance, matter of willingness

Session Topic ___ Integration of EPI_________________________ Your Country ___ Ethiopia___________________________________ Name of Note Taker __Efrem TEPERS___________________________________________________ Objectives (specific to topic and your country)






• Integration of EPI with child survival programme

• Difference in capacity • Capacity building, manpower, budget

• Plans for reproductive health, malaria, EPI / Vit A, nutrition, de-worming policy already exists

• TOT for mid level resource mobilization

Government and community NGOs, WHO, UNICEF

• Involving other sectors : medical schools, agriculture, ministry of education

• Resistance from these sectors ( to accept the programme in integrated manner by teachers and officials)

• Advocacy, meeting to convince population

• IMCI (EPI) Nutrition included in: • Nursing schools • Colleges

• IMCI EPI to be included in medical college curriculum

Ministry of Education, WHO, UNICEF, and bilaterals

• Involve community • Lack of awareness • Lack of access • Harmful traditional

practices

• Create awareness • IEC materials • Involve religious

leaders, influential people

• IEC planned with ICC • Committee developed to

fight harmful traditions • Community promoter

training • HEP (health extension

package) training

• Production of IEC material (community targeted)

• Training of local health providers (with traditional healers)

The government, NGOs, WHO, UNICEF, Women’s Affairs

Community Problem Solving and Strategy Development (CPSSD) Group 1 Good approach to resolving problems on traditional culture vs. medical culture by involving adults as

"good messengers" Importance of the approach in balancing concerns about "health" and "community" Monitoring data should show:

- Extent [ of vaccination coverage ] - Different causes

Need to analyze problem zones where coverage and drop out rates fall Evaluate vaccination coverage rates both before and after implementing approach

Group 2 • The strategy is good. It creates awareness of community health problems • Creates links between health worker and community • Creates ownership of the community on health activity • It should be incorporated into district plan • Scaling up is necessary to include other problems of the community (health problems) Group 3

Improving Planning at Health Facility Level, Including Strong Linkage within the Community • The approach is good • Coverage rises; drop outs decrease • Community and health workers have bridged the gap between them through this approach • Problem of health issues are identified as community problems • Need explained for community based approach in order to solve health and related activities • Need to incorporate community surveillance and monitoring in the approach • Need to put in place the mechanism for sustainability of the approach Group 4 Getting the Message Across: Lessons Learned This approach creates a bond between health care workers and the community to talk about health

problems and solutions (multiple meetings) Acknowledgement of community leaders' experience and knowledge. Approval of traditional culture

at the expense of medical culture for health care workers Regional approach to implement strategy Acknowledge traditional methods of communication Health care workers available to interact with community

Group 5 Getting the Message Across Who are community representatives and how are they chosen? How is community feedback solicited? Dialogue between the health care professional and the community must be rooted in the community's

perceptions (example: talk about morbidity instead of coverage rates) Focal points: are there enough for the entire population? To make the process sustainable, focal point incentives must be considered in advance Weakness of the health care system:

- Health care workers does not have the [?] - Few message aids - Local message efforts are undermined by social mobilization

Need to have quantifiable results for community approach Group 6 Using community committees to improve vaccine coverage rates is a good idea

Community self-diagnostic can be used to resolve some problems, but this approach must be adapted to each community and each problem

Despite EPI country managers' efforts, results are compromised by political instability in the country Group 7 Key to involve communities Foster dialogue between community and health care workers to identify problems, objectives, etc Plan, execute, and follow-up with communities Be flexible in planning and executing activities that fit community's problems

Lessons from presentation: Each time communities were truly involved, results were positive

Group 8 The goal of this approach is to create or strengthen the relationship between the community and health

care workers Group 8 agrees on the 4 factors cited to make this approach succeed There may be drawbacks to health care staff and politicians working together: it would be as if a

health care worker of a certain political persuasion were rejected by a section of the public of another political persuasion

What is the role of community intermediaries in this approach? Issues of decentralization, its effect on decision making, and implementing decisions at the local level


Day 1 Report Chairperson: Dr. Matthieu Kamwa Author: Dr. Michel Othepa 1. Introduction: General Information

a. Opening Remarks

After a brief introduction, the day's moderator ceded the floor to Mr. Brad Barker with USAID / Senegal, to Dr. Celestino Costa with UNICEF, and finally to Dr. Cheikh Fall with the Ministry of Health. The USAID representative read Ms. Mary Harvey's (USAID, Washington) opening remarks to the attendees. On behalf of all attendees, Dr. Costa thanked BASICS for bringing together all the partners for this important meeting. This is an opportunity, he stated, to strengthen our EPI partnership and to share experiences among countries so as to improve the programme's efforts. Dr. Cheik Fall, a representative of the Ministry of Health, also welcomed all the attendees to Senegal. A strong EPI, he stressed, is a prerequisite for our children's survival. Increased consideration should be given to quality vaccinations. Senegal is pleased to have reliable partners for the development of EPI. This meeting's success will depend on the input of each attendee and on the extent that each country shares its experiences. He sincerely thanked USAID, BASICS, WHO, UNICEF and the other partners for their support in this matter. After the opening remarks, Dr. Cheik Fall, on behalf of the Minister of Health, opened the workshop sessions. Dr. Matthieu Kamwa, from the WHO, also thanked the Senegalese authorities for their assistance in organizing the meeting. With regard to the attendees, he emphasized that this meeting is a logical continuation of the activities within the partnership begun at the beginning of the week. It will be about sharing EPI experiences in order to better target efforts in our countries.

b. Presentation of Participants ( Dr. Jules Millogo)

Benin Nepal AMP CDC DRC Nigeria ARIVA CVP / Path Ethiopia Liberia AWARE GAVI Ghana Uganda BASICSII USAID

Guinea Senegal UNICEF World Bank Madagascar Togo WHO Mali Burkina-Faso

c. The meeting's objectives and agenda were presented and discussed. The methodology to follow was explained. The number of presentations per day was set at 4. A sufficiently lengthy period (30 minutes) was given to the speaker to tell not only "what", but "how are the objectives reached". After each presentation, participants were given about 10 minutes to ask questions before joining randomly assigned small group discussions about the presentation's topic. Following these discussions, the small group formulated 4 to 5 consensus points, which were given to the secretariat. Participants then grouped themselves by country and discussed, in light of the topic, their plan, listing objectives, impediments, proposed remedies for the impediments, activities already planned, additional activities needed to reach objectives and potential partners (40 minutes). These country documents were given to the secretariat.

After this general information session, the first presentation got underway.

2. Session 1: Improving Planning and Implementation at District Level

After a brief introduction by the BASICS group leader, Team Madagascar gave its presentation. Implementation of the Reaching Every District Strategy: How to make the package Work Operationally (Madagascar) In this presentation, Madagascar team set the context for EPI in 2002 (poor system quality, poor demand, and social mobility issues). Suffering from little community buy-in and a decrease in demand, on the one hand, but benefiting from BASICS / JSI's [experience / support], on the other, the country developed an EPI re-launch plan using the Reaching Every District (RED) approach with the support of other partners. Health districts were categorized using accessibility and service utilization criteria (DPT1 coverage and drop out rate from DPT1 to DPT3). Districts were targeted, objectives set, and implementation begun (specific steps were taken). At the district level, strategies were developed to improve supply and demand. As a result, there has been a spectacular improvement in district performance. Of 53 're-launched' districts and 21 'priority' districts, 36 of 74 total saw improvement. When comparing performance by district in 2002 and 2003, the difference is clear. Questions:

- Organization of the health care system in Madagascar? What role does politics play?

- What was the community's role in the follow-up and implementation? - What was the ‘feedback like?' - What role did the central team play in implementation? How did you

reorient partners during the implementation? Were you comfortable with district categories?

- Who are the task force members? What were the logistical problems? Financing?

- How did you motivate the community? Were the volunteers trained before beginning work?

Appropriate answers were given to all these questions. Participants were randomly divided into discussion groups prior to meeting with their country groups for planning. District Performance Improvement and Capacity Building (Guinea) The Guinea team began by giving an overview of the process for performance improvement: buy-in of all partners, establish performance markers, describe current performance, compare performance markers and current performance, identify reasons for difference, identify remedies, implement and follow-up. “Performance Improvement” implementation was explained prior to identifying performance deficiencies and setting objectives. The two poorest districts in the country were selected. [ ?] Internal problems. Methodology: Orientation workshop PRIME technical support Drafting of performance targets Identification of performance deficiencies, etc Data analysis Workshop for results collection

Results ― problems linked to: CBC Advanced strategy Motivation of personnel Equipment availability (often rolling stock) Injection safety / reliability (tamper-proof boxes and auto-disable syringes and

staff expertise) The following targeted actions were taken:

Capacity building Increased supervision / management Incentives for vaccination personnel: productivity bonus, promotion, rent /

sell motorcycles, safety equipment Logistics improvement: motorcycles, fuel, refrigerator Improvement of data management

Results:

Improvement of DPT3 coverage Fall in drop out rate from DPT1 to DPT3

Clarification Questions

- How much did all this cost? Cost sharing among partners? Performance-Based Contracts to Stimulate District Performance (Mali) Context: A provincial evaluation of vaccination efforts in the Mopti region (2000) revealed the following:

Low levels of vaccination (DPT3 27%, Measles 32%, etc) Remedies for low level of vaccination Several initiatives at the regional level: SOS, village approach, “cercle”

(health unit), performance-based contract Performance-Based contract = agreement between health care sector and partners, MoH and its partners Defined steps for implementation:

- Awareness phase - Data collection phase - Regional micro planning phase - Contract signing phase - Resource mobilization phase

An incentives contract template was presented and performance benchmarks defined: coverage of children from 0-11 months, vaccine supplies, drop out rate, …. These benchmarks were evaluated and compared to the pre- and post-intervention periods and showed a performance improvement. Difficulties:

- Personnel (under-staffed and under-trained) - Logistics - Vaccines and [consumables] (in stock or out of stock)

- Social mobility - Financing - HIS

Questions:

- Who participates in the micro planning implementation phase? - Is any incentive provided for in the performance contract? - What are the expected accomplishments in the performance contract? What is

the payment scale? - What are the contract's objectives? - Contract expectations and penalties for not reaching objectives? What is the

difference between the contract and the action plan? - Are there compensating factors for with regard to goals? - Are HCC (Health Communication Committee) personnel public sector

employees?

Answers: - Logistician, MC health program, manager of planning (at the regional level) - Yes, incentives provided - High drop out rate ? Mopti, difficult region for vaccination ( surrounded by lake). Contract with community partners to meet challenge - Penalty? No penalty. Comparison of districts - If the contract is drafted, partners are bound by it; if resource mobilization

begins, the contract becomes legally binding - Payment scale does not exist, but a bonus may be given from one district to the next - Objectives set yearly (and evaluated throughout the year). The contract length

is one year. No penalty. The performance contract is an agreement signed by partners. The action plan is not. There are no compensating factors. Pre established selection criteria do not exist. All groups have the same chances. After its annual evaluation, Mopti realized it was behind. They decided to sign contracts with stakeholders. These contracts were analyzed at the national level supported with a regional plan in Mopti to correct the contracts. The objective was for Mopti to have a rate of vaccination close to that of the national level. 3. Session 2: Integration of Routine Immunization With Other Programs

Integrating Routine Immunization with Other Child Survival and Disease Control Initiatives: Opportunities and Challenges (Madagascar)

The team started by listing the principles of integration. Integration means a 'minimum activity pack' (MAP).

Principles of integration: Health of mother and child (IMCI, RH, ENA) Program complementarity Initial training strategy Multidisciplinary buy-in Method of approach

EPI Re-launch EPI re-launched amid several different programs, implemented at various levels. Service offerings were organized by a system with 4 general principles, namely, the logistics system network and cold chain management, capacity building and data management with self monitoring, micro planning and coordination, financing and coordinating community approaches. After this, a rise in demand with a rise in vaccination took place. Comparing rates of vaccination in 2002 and 2003 show improvement in 2003. Questions : Self monitoring (at what level)? Which small feasible steps (who is responsible for this)? Availability of child health training modules? Other available agencies? Collaboration between Ministry of Public Health and Ministry of Higher Education? How does the PEV benefit from this integration? What happened when this training was introduced in the paramedical curriculum? Answers: Video: presents lessons learned with community: Small Doable Actions principles, simple communication, volunteer training at the community level, more use of mass media, how to celebrate success.

- Self evaluation at the district and Sub-district Health Centers levels - Small Doable Actions defined by the teams and national and local partners - Training modules - Financing for services : UN, USAID, international and local NGOs - Motivating volunteers: Give them quality services, show them they have role

to play (uniforms, certificates, badges). Avoid giving money. - EPI has benefited a lot from integration. IMCI, point of entry for all EPI

messages. Integration solicited by other ministers. Each district drafts an action plan and includes the name of partners.

Small working group discussion on integration of initiatives Country working groups on integration of initiatives Wrap-up

Session Topic ________Integration of EPI and Other Programs Your Country ________ Ghana____________________________ Name of Note Taker __Stanley Diamenu (WHO)_____________________________________________________ Objectives (specific to topic and your country)






• To integrate basic services – malaria, EPI, IMCI, IDS – for the effective achievement of the survival of the child

• Different program objectives and plans at national level

• Regular coordination meeting of the program managers to plan and review program of activities

• Develop common

monitoring and supervision systems

• Child health week (May 2004)

• SOS in hard to reach

districts (especially island communities)

• Growth monitoring and

immunizations • CHPS implementation

• Bednet distribution , vitamin A supplementation and bednet retreatment

• GHS / MoH, UNICEF, GAVI

Thème de session _____ Revitalize Vaccine Logistic at All Levels_____________________ Votre Pays ___________ Sénégal______________________________ Nom de preneur de notes _Hassane YARADOU__________________________________________________ Quelles sont les activités déjà planifiées pour faire face à ce thème?




• Amélioration de la gestion des vaccins au niveau intermédiaire et périphérique

• Renforcer la capacité de stockage au niveau intermédiaire et périphérique

• Formation dépositaires

districts de la logistique gestion vaccins et consommables

• Acquisition équipements (congélatuers)

• Élaboration module • Mise en place fiches

techniques • Mise en place outils

(manuels et informatisés) • Gestion vaccins et

consommables

UE (ARIVA) CVP / PATH Luxembourg BAD JICA Banque Mondiale USAID

TITRE DE PRESENTATION: _______Faire Fonctionner l’ACD____________________________________________ VOTRE PAYS: _________________Mali NOM DU PRENEUR DE NOTE: _____Dr. Ndoutabé MODJIROM_______________________


votre pays)





objectifs


• Augmenter la CV en DTCP3 de 80% dans 80% des districts du Mali

• Politique (priorités politiques différentes des priorités techniques)

• Plaidoyer auprès des leaders d’opinion

• Formation des CPM (chefs de postes médicaux) en mai 2004

• Disséminer le plan intégré de communication

• Disséminer le plan de viabilité financière

USAID/ATN, UNICEF, OMS, GAVI

• Renforcer la logistique roulante et de la chaîne de froid

• Absence de plan de maintenance

• Difficulté d’avoir des pièces de rechange de qualité

• Renforcer la maintenance

• Fomer les agents de santé en logistique

• Formation du personnel en maintenance 2004

UE, USAID/ATN, OMS, UNICEF

Making an ICC Functional

Created in 1995 in complex and difficult times, the CCIA, based in DRC, has helped meet the challenge of a collapsing health care system, epidemics, and catastrophes of all manner. Initially made up of UN agencies, diplomatic services, and local and international NGOs, it has evolved over time to become an entity where the State, through the Ministry of Health, plays a pivotal role. Its initial task, carried out through several sub committees ― catastrophe response, AIDS, immunizations, trypanosomiasis, essential drugs, etc ― was to mobilize resources and coordinate its partners' activities. Prodded by the international community's focus on IEP, the vaccination sub committee grew the fastest. The sub committee was active at all levels and operated at the central level to organize JNY and implement the PFA oversight system. Today, with help from GAVI to strengthen routine vaccination efforts, the CCIA has restructured itself and focuses on monthly routine vaccination data monitoring (vaccination coverage rates, drop out rates, vaccine supplies at all levels, vaccine losses, and data quality, etc.). Every 3 months, CCIA Stratégique, which includes agency heads and government authorities, presents recommendations and suggestions. Once a year, government authorities attend the routine vaccination review meeting, give feedback on the macroplan and sign, with the Ministry of Health, a Memorandum of Understanding to finance planned routine vaccination efforts. Nevertheless, additional efforts need be made to make CCIA functional at the local and provincial levels.

Session Topic __Effective Monitoring and Use of Datat at District Level to Increase Immunization Coverage Your Country ___Ethiopia_________________ Name of Note Taker __Efrem ___________________ What activities are already planned to address this topic?




• There is data collection and periodic reporting

• Monitoring and supervision occasional, irregular • Training planned • Planned to give feedback

• Prepare, reorganize the format for analysis and feedback

• Questionnaire development,

setting schedule • Send reports on time and

complete • Analyze the reports sent

• Involve all concerned bodies and partners. Discuss the subject, come up with solution, reach consensus

• Onsite visits and using

reports • TOT will be given • Using feedback, discuss with

the district how to improve the situation

• MoH. NGOs, community • NGO, government • MoH, NGO, community

TITRE DE PRESENTATION: _______Intégration du PEV_______________________________________________ VOTRE PAYS: _________________Guinée_________________ NOM DU PRENEUR DE NOTE: _____Dr. Djenou Somparé_______________________


votre pays)





objectifs


• Assurer la coordination des interventions des partenaires dans les différents programmes à travers le CCIA

• • • élargir les TDR du CCIA à la coordination des interventions

• élaborer les TDR et organiser une réunion de validation

• OMS, UNICEF, USAID, GTZ, BASICS II, PRISM, etc

• • • • •

Session Topic ___ Making RED Work / District Performance Improvement_________________________________ Your Country ___ Ethiopia___________________________________ Name of Note Taker _ Dr. Possy MUGYENYI, Dr. H. MEGERE___________________________________________________ Objectives (specific to topic and your country)






• By the end of 2005, every district to achieve 90% coverage for DPT1

• Inadequate/low community participation

• Inadequate health manpower

• Delays/irregular disbursement of funds

• Advocacy and dialogue between health workers and community leaders

• Train more providers in and vaccinators in EPI

• Develop village health communities

• Community problem solving and strategy development (community dialogue) carried out in 6 districts and planned for 3 more

• Village health teams to be trained and supported

• Scaling up community dialogue

MoH, WHO, UNICEF, UPHOLD/USAID

• By the end of 2005, every district to achieve less than 10% DPT1-DPT3 drop out rate

• Caretakers not aware of immunization schedule/poor IPC

• Lack of reminder system at community level

• Train health providers in interpersonal communication (IPC)

• Develop mechanisms to follow ‘defaulters’

• Train parish volunteers to follow ‘defaulters’ and remind those due

• Piloted in 2 districts • Community reminders

piloted in 2 districts to be scaled up

• Scale up training of health workers in IPC

• Monitor drop outs using charts

• Register children at health facility and community

• Regular feedback to community

MoH, WHO, UNICEF, UPHOLD/USAID

• By the end of 2005, every district to provide quarterly whole site support and supervision to all health units

• Lack of resources, transport (vehicle and fuel) allowances

• Inadequate supervisory skills

• Lack of standards and guidelines

• Plan and mobilize more resources

• Provide vehicles to deserving districts

• Develop and disseminate standards and guidelines

• Health sub-district planned to receive a multi-purpose double cabin

• Districts to be given transport (GAVI budget)

• Provide a motorcycle to every sub county and bicycles for parish

• Increase budget for district team for supervision

• Train district teams in whole site support supervision

MoH, WHO, UNICEF, UPHOLD/USAID, JICA

Revitalizing Vaccine Logistics at All Levels Group 1 Distribution system in place

- Involve the private sector to sustain efforts System to ensure vaccine safety:

- Packaging - Transportation - Constant temperature

Identify bottle necks for resolve distribution problems Free vaccines

Group 2 Recognized importance of projection vaccine needs UNICEF is responsible for ordering and buying vaccines to ensure safety Before engaging the private sector, be sure it can maintain cold chain during transport Important to ensure prompt delivery of aid material for planning supply needs and

distribution Important to plan well for vaccine distribution Not mentioned: procedure for destroying expired product. Normally, the district's

head doctor supervises, evaluates, and chooses method of destruction Group 3 Under the current system, vaccine distribution is problematic. Identify where the

problem lies Identify, inform, and train private sector partners in vaccine transportation techniques Sign a partnership agreement and stick to it Group 4

Growing problem of inappropriate use of funds (example: PPTE funds) Vaccine safety must be a given ( reliable, quality supply; supply management at all

levels; establishment of management culture) External vaccine orders must follow established rules and procedures When using contract transportation, EPI must set safe guards (feasibility studies,

defined norms and procedures) To ensure vaccine safety, countries must implement ANR

Hire high level logistician to oversee supply and distribution chains, and follow up and maintenance

Thème de session _____ Monitorage et utilisation des données _____________________ Votre Pays ___________ Mali____________________________ Nom de preneur de notes GUNIDO__________________________________________________ Quelles sont les activités déjà planifiées pour faire face à ce thème?




• Révision du guide de monitorage

• Extension du monitorage à

d’autres districts

• Atelier de révision du module

• Mise en place des outils

- formation - mise en oeuvre

• UNICEF • UNICEF

Thème de session __________Improving Planning at Health Facility Level_____________ Votre Pays _______________ Bénin_________________________ Nom de preneur de notes ___Abdou CHITOU____________________________________ Quelles sont les activitéd dejà planifiées pour faire face à ce thème?




• Élaboration micro plan faisant suite au monitorage semestriel de la couverture vaccinale avec les membres des comités de gestion des formations sanitaires

• Formation des agents de

santé sur les techniques de communication pour le PEV

• Élaboration micro plans pour chaque formation sanitaire dans les districts prioritaires identifiés pour l’approche “Reach Every District”

• Formation des formateurs

• Atelier de planification au niveau de chaque formation sanitaire

• Atelier d’harmonisation

sur les outils de communication pour le PEV

• UNICEF, OMS • ARIVA, OMS, UNICEF

PLANNING FOR INJECTION PLANNING FOR INJECTION SAFETY BEYOND SAFETY BEYOND

IMMUNIZATION SERVICES IN IMMUNIZATION SERVICES IN

UGANDAUGANDA

Presented at a Participatory Country Exchange on Presented at a Participatory Country Exchange on Strengthening Routine ImmunizationStrengthening Routine Immunization

By Dr. P. By Dr. P. MugyenyiMugyenyiDeputy Program Manager, UNEPIDeputy Program Manager, UNEPI

Dakar, Senegal Dakar, Senegal

April 22April 22--24, 200424, 2004

Background InformationBackground InformationCountry profileCountry profile

Uganda is situated in E. Africa along the equator Uganda is situated in E. Africa along the equator Divided in 56 districts, 214 HSD, 962 subDivided in 56 districts, 214 HSD, 962 sub--counties, counties, 5,168 parishes & 14,174villages5,168 parishes & 14,174villagesDecentralized governments at district and SC levels Decentralized governments at district and SC levels Population (projected for 2004) 26.5mPopulation (projected for 2004) 26.5mTargets for EPI Targets for EPI

Infants Infants 1.25m 1.25m PregPreg. Women . Women 1.4m1.4mNonNon--pregpreg. women . women 4.7m4.7m

Background Information contBackground Information cont’’dd

MoH implementing HSSP (2001MoH implementing HSSP (2001--5) under the 5) under the SWApSWAp & & injection safety is included. Services offered in Hospitals and injection safety is included. Services offered in Hospitals and HCIIHCII--IVIV

It is also a country with a high prevalence of HIV and It is also a country with a high prevalence of HIV and Hepatitis B.Hepatitis B.

Emerging evidence was showing high rates of transmission Emerging evidence was showing high rates of transmission of blood bone pathogens through unsafe injections. SIGN of blood bone pathogens through unsafe injections. SIGN ((HepHep B 23%, HIV 2.5%, B 23%, HIV 2.5%, HepHep C 34%)C 34%)

Situational analysis...(cont)Situational analysis...(cont)

KAP & Safety of injection studies were done in 1999 which KAP & Safety of injection studies were done in 1999 which showed the following:showed the following:

59% of sterilization practices were unsafe59% of sterilization practices were unsafe77% of disposables were unsafe due to the likelihood of being re77% of disposables were unsafe due to the likelihood of being reused used or causing needle stick injuriesor causing needle stick injuries25% and 19% of HW knew families that kept and recycled needles 25% and 19% of HW knew families that kept and recycled needles respectivelyrespectively

As part of the EPI revitalization, As part of the EPI revitalization, ADsADs were introduced in 2000 were introduced in 2000 to address the above gapsto address the above gaps

Uganda had & still has a high frequency of injection use Uganda had & still has a high frequency of injection use especially in curative services due to client preferenceespecially in curative services due to client preference

Situation Analysis(Situation Analysis(……Cont)Cont)

On average, a Ugandan gets 2 injections/yearOn average, a Ugandan gets 2 injections/year

93.5% of injections are curative & 6.5% EPI93.5% of injections are curative & 6.5% EPI

17% of injections are received at home, 22.617% of injections are received at home, 22.6--35.4% 35.4% received from received from Gov.HUGov.HU while the rest are from while the rest are from NGO and private facilitiesNGO and private facilities

Needles reNeedles re--use is about 19%use is about 19%

Situation Analysis(Situation Analysis(……Cont)Cont)

EPI uses ADS which are disposed EPI uses ADS which are disposed off in puncture proof containers off in puncture proof containers while curative uses disposable while curative uses disposable needles& syringes needles& syringes BUTBUT has no has no puncture proof containerspuncture proof containers

Final waste disposal is a big Final waste disposal is a big challenge to the health system challenge to the health system

Prior to current efforts, there was Prior to current efforts, there was no uniform policy or guidelines on no uniform policy or guidelines on Injection safetyInjection safety

Injection Safety Assessment Injection Safety Assessment

Injection safety survey done JuneInjection safety survey done June--July, 2003 with the July, 2003 with the following objectives:following objectives:Estimate magnitude of unsafe injection practicesEstimate magnitude of unsafe injection practices

Determine adequacy of injection equipmentDetermine adequacy of injection equipment

Provide baseline information for formulation of a Provide baseline information for formulation of a policy on injection & waste management policy on injection & waste management

Survey resultsSurvey resultsUsing the WHO/BASICS Tool C,80 HF visited & 96 Using the WHO/BASICS Tool C,80 HF visited & 96

injections observedinjections observed

65% of HF had experienced shortage of disposables 65% of HF had experienced shortage of disposables & ADS& ADS

19% of HF had no puncture proof 19% of HF had no puncture proof containerscontainers

89% of EPI injection areas had safety boxes89% of EPI injection areas had safety boxes

Results contResults cont’’dd

Injections about to be given with nonInjections about to be given with non--sterile sterile equipment was 26% for curative and 7% for equipment was 26% for curative and 7% for EPIEPI

Injections prepared in contaminated areas was Injections prepared in contaminated areas was 14% for curative and 7% for EPI14% for curative and 7% for EPI

11(13.8%) of HF were sterilizing needles 11(13.8%) of HF were sterilizing needles &syringes &syringes

Survey results contSurvey results cont’’dd

45% of providers reported >1 needle stick injury in 45% of providers reported >1 needle stick injury in the previous 12 monthsthe previous 12 months

30.8% of HF disposed of wastes by open burning30.8% of HF disposed of wastes by open burning34.6% used a hole/enclosure34.6% used a hole/enclosure

One health facility had an incineratorOne health facility had an incinerator

38% had sharps wastes discarded on the ground 38% had sharps wastes discarded on the ground

Open burning

Summary of the reviews and Summary of the reviews and assessmentassessment

Prominent factors contributing to unsafe injection Prominent factors contributing to unsafe injection practices:practices:

Overprescription and client demand for injections Overprescription and client demand for injections Unavailability of guidelines for HW on safe injection Unavailability of guidelines for HW on safe injection practicespracticesInadequate supply of injection materialsInadequate supply of injection materialsInadequate facilities for collection and disposal of Inadequate facilities for collection and disposal of injection waste materialsinjection waste materials

Following the assessmentFollowing the assessment

Findings were disseminated to MOH and other Findings were disseminated to MOH and other stakeholders stakeholders Top management concerned about Top management concerned about thefindingsthefindings

Uganda National Injection Safety Task Force Uganda National Injection Safety Task Force (UNISTAF) created with clear TOR(UNISTAF) created with clear TOR

TOR for the taskforceTOR for the taskforce

Review and harmonise the various programme policies Review and harmonise the various programme policies and guidelines on injection safetyand guidelines on injection safety

Build consensus among the key stakeholdersBuild consensus among the key stakeholders

Develop a uniform policy ,standards and guidelines for Develop a uniform policy ,standards and guidelines for injection safety and waste managementinjection safety and waste management

TORTOR……(cont.)(cont.)

Oversee the implementation of the policy and Oversee the implementation of the policy and guidelinesguidelines

Mobilize resources for operationalising the Mobilize resources for operationalising the policy policy

Composition of UNISTAFComposition of UNISTAF

MOH Programs MOH Programs e.ge.g. . HIV/AIDS, quality assurance, HIV/AIDS, quality assurance, reproductive health, infectious disease control, health reproductive health, infectious disease control, health promotion, disability EPI, Clinical services,promotion, disability EPI, Clinical services,infrastructure, NDAinfrastructure, NDA

..UN agencies e.g UNICEF,WHOUN agencies e.g UNICEF,WHO

NGOs like, AIM, UPHOLD, BASICS, NGOs like, AIM, UPHOLD, BASICS, UNACOH UNACOH Line ministries e.g. EnvironmentLine ministries e.g. Environment

Composition.. (cont.)Composition.. (cont.)

Parastatals like NEMAParastatals like NEMA

Medical Bureaus like Uganda ChristianMedical Bureaus like Uganda Christian& Muslim medical bureaus& Muslim medical bureaus

Consumer associations Consumer associations e.t.ce.t.c..

Professional AssociationsProfessional Associations

Representatives of medical training institutionsRepresentatives of medical training institutions

Achievements to dateAchievements to dateRaised the profile of injection safetyRaised the profile of injection safety

High political supportHigh political support

Consensus built, key stakeholders on boardConsensus built, key stakeholders on board

Draft injection safety and waste disposal policy in place Draft injection safety and waste disposal policy in place

Harmonized Standards and guidelines developedHarmonized Standards and guidelines developed

Injection safety project launchedInjection safety project launched

Project core interventionsProject core interventionsDissemination of policy and guidelinesDissemination of policy and guidelines

Improvement of provider skillsImprovement of provider skills

Creation of awareness and communication for behavior changeCreation of awareness and communication for behavior change

Improvement of logistics managementImprovement of logistics management

Promotion of universal precautionsPromotion of universal precautions

Management of health care wasteManagement of health care waste

Project Expected outputsProject Expected outputs

Improved policy environment.Improved policy environment.Rational use of injections.Rational use of injections.Full supply of commodities.Full supply of commodities.Safe waste disposal. Safe waste disposal. Increased practice of universal precautions.Increased practice of universal precautions.Improved knowledge, attitude, and behavior.Improved knowledge, attitude, and behavior.Reduced transmission of blood borne pathogens Reduced transmission of blood borne pathogens by unsafe injection use.by unsafe injection use.

Next Steps Next Steps

First phaseFirst phase-- introduction of the project in 4 introduction of the project in 4 districts for a period of ten (10) monthsdistricts for a period of ten (10) months

Evaluation of the project and scaling up to Evaluation of the project and scaling up to another 4 districtsanother 4 districts

Integration of project interventions into District Integration of project interventions into District and MOH budgets & plans esp. curative and MOH budgets & plans esp. curative servicesservices

End End

Merci beaucoupMerci beaucoup

Thank you Thank you

MwebaleMwebale

nnyonnyo

Session Topic __Effective Monitoring and Use of Data to Increase Immunization Coverage Your Country ___Uganda__________________ Name of Note Taker __H._Megere ___________________ What activities are already planned to address this topic?




• Develop immunization coverage and drop out charts

• Disseminate the charts to the districts and health centers

• Incorporated in the mid level and operational level training manuals

• Provision of feedback to the political leaders at all levels, incorporated in the EPI policy

• Biannual feedback through the EPI news bulletin and administrative circulars to the districts and lower levels

• Strengthen supervision and provide feedback during supervision and afterwards

• To publish district EPI coverage in the national newspapers on a quarterly basis

• To train operational health workers on filling, interpreting and utilising the EPI charts

• Provide information on EPI performance during council meetings at district and sub county levels

• At health sub district level

[training of operational health workers]

• A presentation during council meetings

• Incorporate EPI data in the area team supervision check list

• Minister of health to write circular to district political leaders on EPI coverage

• MoH • UNICEF • WHO • UPHOLD

The Performance Contract in Mali The Malian Experience to Increase Community Participation

in Health Activities

In 2002, the assessment of the Mopti Regional Operations Plan, part of the Socio-Health Development Program (PRODESS), indicated poor performance in the region's health indicators (DTCP3 = 27%, CPN = 32%, assisted birth rate = 17%). In looking for remedies for the poor showing, the idea of fostering team competition through performance contracts to improve coverage rates was born. The performance contract is an agreement between:

- Health teams and local partners to improve coverage rates - The Ministry of Health and its partners to mobilize the resources needed to

achieve stated goals The 'minimum activity pack', a part of the performance contract, features:

- Vaccinations - Prenatal care - Family planning - Anti-malarial efforts - AIDS-related efforts

Phases for implementing the performance contract are:

- Awareness raising and outreach - Data collection - Regional microplanning - Contract signing - Resource mobilization

The system for evaluating and overseeing the contract functions at three levels: community health center, circle, and region Performance criteria include:

- Vaccines: BCG, DTC3 and VAR coverage rates for children aged 0 to 11 months, VAT2 coverage rates for pregnant women, number of days with antigen shortage

- Health information system: agreement between monthly and trimester reports, completed reports, reports turned in on time, reports with feed-back, SIS manager's participation in planning meetings organized by the Community Health Association

- CPN, PR, malaria, and AIDS criteria in the Socio-Health Development Program materials used for oversight

Types of Problems Encountered: - Personnel - Logistics - Vaccines and consumables

- Financing - Health information system

Lessons Learned:

- Cooperation among health care teams, administrative authorities, and elected officials in view of boosting routine vaccinations

- Ready access to necessary resources for vaccination program - Community commitment to pay health care personnel's wages and to oversee

cold chain - Health information system: periodic workshops to coordinate data

collection at different levels Conclusions:

- Performance contract allows more input from decision makers and local partners and helps achieve stated goals

- Results are considerable, with steep decline in DTCP1-DTCP3 drop out rate - Equipment set-up and access to resources ― with help of the State, GAVI,

UNICEF, WHO, regional and local authorities ― are pivotal for meeting performance contract objectives

The following recommendations were made: - Training and professional development for health care staff - Good stock management and regular logistics oversight - Ensure regular supply of antigens and consumables - Develop an integrated communications plan - Provide access to funds at the operational level - Plan periodic monitoring and microplanning workshops so as to correct errors

and resolve problems

Session Topic Community Linkage / Monitoring to Improve Coverage______ Your Country _________ Ghana Name of Note Taker ___ Stanley Draimem ___________________ What activities are already planned to address this topic?




• Community based health planning and services (CHPS)

• Social mobilisation for SIAs

and NIDs • Revision of supervisory

checklist • Training of districts health

staff using field guide • Regional / District peer

monitoring training programme

• Monthly feedback • Quarterly bulletin

• Collaboration with religious groups; sensitization meetings

• Training of health workers on community entry techniques

• Printing of field guide • Develop guidelines for

orientation

• 1 day consensus meeting with religious leaders

• Meetings with identified

groups • 2 day district / sub-district

training for health staff on PRA technique

• Meeting with regional and

district teams • District level training • Orientation workshop of

national level to be followed by field visits

• Monthly review of district

reports and provide feedback

• Danida, DFID, MoH • WHO, UNICEF, MoH, GAVI • WHO, UNICEF, GHS/MoH,

GAVI

Implementation of the Reaching Every District Strategy: How to Make the Work Packet Operational?

Group 1 1. Implementation of components of the RED approach (Madagascar) 2. Use of Performance Improvement Approach to strength routine vaccinations (Guinea)

Importance of categorizing target districts with problems Importance of demographic changes on the drop out rate

- Promote community activities et increase supervision How to maintain district performance in Category I

- Make the case to partners. Bolster demand through social mobilization Make EPI efforts a priority when facing private sector competition: donate

motorcycle to health center after 3 years' operation

Thème de session _____ Monitorage et utilisation des données _____________________ Votre Pays ___________ Madagascar___________________________ Nom de preneur de notes Aimé_RANDRIAMANACINA______________________________________________ Quelles sont les activités déjà planifiées pour faire face à ce thème?




• Suivi mensuel systématique des données (niveau district vers niveau provincial et vers niveau central)

• Généralisation et/ou

renforcement sur l’approche du résolution des problèmes (retro-information avec les 3 piliers)

• Supervision formative vers districts avec problèmes sur l’envoi de rapports

• Formation initiale pour les

nouveaux districts et redynamisation pour les anciens districts

• Élaborer un tableau de bord

• Analyse situationnelle • Détermination des

activités prioritaires • Retroinformation

mensuelle pour les 3 piliers

• OMS, USAID, UNICEF, GAVI

• USAID, OMS, UNICEF,

GAVI

Thème de session ____Sécurité des Injections & Gestion des Déchets____ Votre Pays _________ DR Congo ________________________________ Nom de preneur de notes ______Vlio YOLANDE_____________________________________________ Quelles sont les activitéd dejà planifiées pour faire face à ce thème?




• Évaluation de la sécurité des injections dans le pays

• L’acquisition des SAB et

boîtes de sûreté

• Mettre en place une task force avec TdR bien définis

• Réviser la politique

nationale • Élaborer les guides et

directives • Diffuser la politique et les

directives • Superviser les aspects

spécifiques • Doter les ZS en

incinérateurs conformément aux normes adoptées

• Plaidoyer • réunions régulières • Atelier de la task force • Atelier • Formation • Sensibilisation

• Supervision intégréee • Achat • construction

• UNICEF, OMS, USAID, Rotary, Basics, SAMRU, CRS, MEMISA, MSFIB&F, PMURR, GTZ, PNLS, PNMLS, Transfusion sanguine, Autres

TITRE DE PRESENTATION: _______Faire Fonctionner l’ACD____________________________________________ VOTRE PAYS: _________________Bénin___________________ NOM DU PRENEUR DE NOTE: _____Chitou ABDOU_______________________


votre pays)





objectifs


• Dans chacun des districts prioritaires, rendre fonctionnel et régulier

• Les stratégies avancées d’ici fin 2004 dans 80% des formations sanitaires

• Insuffisance de motos et de carburant

• Chevauchement des activités

• Recherche financement additionnels

• Identification des villages

• Supervision • Analyse

situationnelle

• Refaire un autre regroupement des villages pour les stratégies avancées

OMS, UNICEF, USAID

• Déterminer les causes des contre performances par aire de santé (revue rapide)

• Financement insuffisant

• Plaidoyer au CCIA- PEV • Revue rapide en cours dans 23 des 30 districts prioritaires

• Poursuivre les revues dans les 7 districts prioritaires nouvellement identifiés

• Exploitation des données de la revue

OMS, UNICEF

• Élaborer les microplans de relance du PEV dans 100% des districts prioritaires

• Mise en oeuvre basée sur les ressources du financement communautaire

• Revue rapide en cours

• Sousmission des données au CCIA-PEV

OMS, UNICEF, USAID

Integrating Child Survival and Disease Control Programs

Basic Principles of Activities Integration (Minimum Activities Pack or MAP): Principle 1: Health of child and mother

Integrated responsibility for child health Palu/PEV Reproductive health Essential steps in nutrition Health/Environment Integrated community activity

Principle 2: Program complementarity Principle 3: Initial training strategy

Multidisciplinary in scope - 85% of university-level disciplines have adapted their

curricula in response to integration

Principle 4: Synergy among Ministries (Ministry of Higher Education and the Ministry of Health and Family Planning) Practical application of techniques from time of graduation to

promote healthy development and reinforce training Cost and efficiency, geographic coverage Program sustainability

Principle 5: Method of Approach

PEV relaunched amid varying programs implemented at all levels

Service offerings were organized by a system with 4 general principles, namely: - Logistics system network and cold chain management - Capacity building and data management with self

monitoring, micro planning, coordination and financing - Coordinating community approaches

Project expanded from 2 to 20 health districts, each made up of 20 boroughs on average. Managed by health committees at the borough-level (COSAN/COGES), about 3895 volunteers ensure grass-roots outreach

Interactive preventive efforts, intensive mass media support, child-to-child activities, and model communities bolster community mobilization and encourage behavioral change in teachers, technicians, and the community. Promoting the rise in demand for all PMA activities is essential.

Each activity is based on a small doable action (SDA) — an approach that can be easily adopted by the organization: identify the variable, whether enabler or impediment, that influences results. This is an opportunity to apply the simplicity rule. Outcome: Availability of training module on integrated responsibility for child health Inclusion of PCISE agencies and partners Collaboration between the Ministries of Health and Family Planning and the Ministry

of Higher Education Inclusion of training in medical and paramedical curricula Data comparison on vaccination coverage in 2002 and 2003 showed an improvement

in 2003

REVITALISING VACCINE LOGISTICS REVITALISING VACCINE LOGISTICS AT ALL LEVELSAT ALL LEVELS

IN NIGERIAIN NIGERIA

A PRESENTATION BY DR. EMMANUEL ODU

AT THE ‘PARTICIPATORY COUNTRY EXCHANGE FOR STRENGTHENING ROUTINE IMMUNIZATION’

WORKSHOP IN

DAKAR, SENEGAL (APRIL 22-24, 2004)

Nigeria ProfileLocation Nigeria is located between the Central & Western

African Block

Area 923,678 square kilometersProjected Population 122 million (projected from 1991 census)Target Population

(0-59 months)(0-11 months)

41,492,000 children (projected from 1991 census)5,054,373 children

Major Languages > 250 tribes~ cultural diversity. The main ethnic groups are Yoruba, Hausa and Igbo

Systems of Government •Federal: Abuja•6 geo-political zones: North West; North East, North Central; South West; South East; South South.•36 States + FCT Abuja•774 LGAs and 5,514 Health district

VACCINE SECURITY LOGISTICS VACCINE SECURITY LOGISTICS ISSUES ISSUES -- 11

• Forecasting • Procurement• Storage & distribution• Cold chain rehabilitation• Private Sector Vaccine Distribution

VACCINE FORECASTING VACCINE FORECASTING

• Done by extrapolation from 1991 census at a yearly population growth rate of 2.83%.

• Micro planning based on catchments areas covered at the HF level was conducted.

• Data collated at HF and transmitted in succession to the district, LGAs, states, zones and National levels.

VACCINE FORECASTING

• .

NATIONAL

ZONAL

STATE

LGA

DISTRICT

HEALTH FACILITY

DISTRICT MICROPLAN

VACCINE PROCUREMENTVACCINE PROCUREMENT

• Procurement of all routine vaccines is exclusively funded by the Federal Government of Nigeria

• To enhance vaccine security UNICEF currently assists in procurement of all Routine Vaccines for Nigeria, on a quarterly basis.

• All vaccines are received at the strategic store in Abuja and distributed to the zonal stores.

• National Agency for Food &Drug Administration and Control( NAFDAC) is responsible for quality control of all vaccines.

VACCINE STORAGE AND VACCINE STORAGE AND DISTRIBUTION IN NIGERIA DISTRIBUTION IN NIGERIA

• The National strategic store in Abuja has 8 cold rooms with total capacity of 160 m3

• 6 zonal cold stores each has 4 cold rooms with a capacity of 80 m3.

• Each of the zonal stores has a complement of trained staff.• Vaccines are delivered to the zonal stores quarterly. Zonal stores

deliver to state stores. LGA collect vaccines and support materials from the state cold stores.

• LGA cold stores supply Vaccine to HFs and outreach sites through a push and pull system.

• Functional Refrigerated Trucks: 1 per zone, 2 at National Cold Store.

VACCINE STORAGE AND VACCINE STORAGE AND DISTRIBUTION IN NIGERIADISTRIBUTION IN NIGERIA-- ((contdcontd))

• The state cold stores are the responsibility of the state government .

• The LGAs stores are the responsibility of the Local government authority.

• The HF are to be equipped with solar refrigerator, gas/electric fridges and cold boxes where necessary.

VACCINE DISTRIBUTION SHOWING THE PUSH & PULL SYSTEM

• .NATIONAL

ZONAL

STATE

LGA

DISTRICT

HEALTH FACILITY

PUSH

PULL

AGENCY SUPPORT IN VACCINE LOGISTICS

• UNICEF, WHO & EU provide further technical and admin. Support;

– UNICEF recruited and positioned Cold Chain Officers in all States

– WHO; Zonal Logistic/Cold Chain Officers.– EU provides support in 6 pilot States.

PRIVATE SECTOR VACCINEPRIVATE SECTOR VACCINE

DISTRIBUTION (DISTRIBUTION (PSVDPSVD))

.

PSVD CONCEPTPSVD CONCEPT

•• Private Sector Vaccine Distribution Private Sector Vaccine Distribution (PSVD) is a scheme whereby private (PSVD) is a scheme whereby private firms/companies are contracted for, and firms/companies are contracted for, and undertake, the distribution of vaccines and undertake, the distribution of vaccines and support materials from the Zonal Cold support materials from the Zonal Cold Stores to the States , Stores to the States , LGAsLGAs and health and health facilities in a timely manner while ensuring facilities in a timely manner while ensuring that vaccine potency is maintained.that vaccine potency is maintained.

OBJECTIVE OF PSVDOBJECTIVE OF PSVD

• To ensure the availability of potent vaccines at the health facilities on a sustained basis.

• To strengthen RI & Contribute to improved coverage by eliminating the factor of lack of geographical access as a barrier.

THE NEED/PROMPT/RATIONALETHE NEED/PROMPT/RATIONALE

• The pre-existing distribution system (push & pull) required NPI to deliver vaccines to the zonal (+/- State) cold stores and the States and LGAs to collect their vaccines.

» System was ineffective.

» Lack of vaccines at service delivery points despite sufficient quantities at Zonal or State Cold Sores.

IMPLEMENTATION OF PSVD IMPLEMENTATION OF PSVD PROJECTPROJECT

• CRITICAL AREAS:

– MANAGEMENT & COORDINATION LEVELS

– CONTRACT EXECUTION APPROACH

– EVALUATION/FINDINGS

– SCALING-UP.

MANAGEMENT & COORDINATION MANAGEMENT & COORDINATION LEVELS LEVELS -- 11

•• PSVD NATIONAL SECRETARIAT CONSITUTEDPSVD NATIONAL SECRETARIAT CONSITUTED

–– CONSIST OFCONSIST OF 7 MEMBERS, DRAWN FROM ALL DEPTS. OF NPI.7 MEMBERS, DRAWN FROM ALL DEPTS. OF NPI.–– ROLES INCLUDE ROLES INCLUDE MONITORING AND SUPERVISION, PSVD DATA MONITORING AND SUPERVISION, PSVD DATA

MANAGEMENT, PERFORMANCE ASSESSMENT.MANAGEMENT, PERFORMANCE ASSESSMENT.

•• STATE PSVD COORDINATING COMMITTEESTATE PSVD COORDINATING COMMITTEE–– MADE UP OF 4 OFFICERS: STATE NPI MANAGER, COLD CHAIN MADE UP OF 4 OFFICERS: STATE NPI MANAGER, COLD CHAIN

OFFICER, NPI DESK OFFICER, REPRESENTATIVE OF THE FIRM.OFFICER, NPI DESK OFFICER, REPRESENTATIVE OF THE FIRM.

–– ROLES : ENSURE VACCINE AVAILABILITY, PROPER ROLES : ENSURE VACCINE AVAILABILITY, PROPER HANDLING/PACKAGING, ENSURE THE INTEGRITY OF CCS. HANDLING/PACKAGING, ENSURE THE INTEGRITY OF CCS. MONTHLY REVIEW MEETING. MONTHLY REPORTING TO ZONAL MONTHLY REVIEW MEETING. MONTHLY REPORTING TO ZONAL AND NATIONAL LEVELS.AND NATIONAL LEVELS.

MANAGEMENT & COORDINATION MANAGEMENT & COORDINATION LEVELS LEVELS -- 22

•• LGA PSVD COORDINATING COMMITTEELGA PSVD COORDINATING COMMITTEE–– 3 MEMBER COMMITTEE: NPI MGR, CCO, HEALTH 3 MEMBER COMMITTEE: NPI MGR, CCO, HEALTH

EDUCATION OFFICER.EDUCATION OFFICER.

–– WORK WITH DISTRICTS TO IDENTIFY ROUTINE WORK WITH DISTRICTS TO IDENTIFY ROUTINE IMMUNIZATION DAYS, INCLUDING OUTREACH AND IMMUNIZATION DAYS, INCLUDING OUTREACH AND MOBILE SERVICE DELIVERY CENTRES.MOBILE SERVICE DELIVERY CENTRES.

–– MONITOR PERFOMANCE OF FIRMS AND IMMUNIZATION MONITOR PERFOMANCE OF FIRMS AND IMMUNIZATION ACTIVITIES AT THE HEALTHE HEALTH FACILITIESACTIVITIES AT THE HEALTHE HEALTH FACILITIES

–– OTHER ROLES = IDENTICAL WITH THOSE OF STATE OTHER ROLES = IDENTICAL WITH THOSE OF STATE COMMITTEE.COMMITTEE.

CONTRACT EXECUTION APPROACH CONTRACT EXECUTION APPROACH -- 11•• VACCINE COLLECTION AND DISTRIBUTIONVACCINE COLLECTION AND DISTRIBUTION

– PSVD distribution system involves the collection and distribution of vaccines

• Bi-monthly; from the zonal stores to States Stores.• Weekly; from State Stores to LGA Cold Stores.• LGA Stores to health Facilities based as based on

distribution plan or vaccination visit schedule

- Collection at the vaccine issuing store and delivery to the next lower level is accomplished within 24 hours

CONTRACT EXECUTION APPROACH CONTRACT EXECUTION APPROACH -- 22

• DOCUMENTATION & UTILIZATION RETURNS– STORE ISSUE VOUCHERS (SIV) & STORE

RECEIPT VOUCHERS (SRV) ARE DULY COMPLETED AND SERVED AS APPROPRIATE.

– ORIGINAL COPIES OF SIV & SRV ARE SUBMITTED TO NATIONAL SECRETARIAT USING THE SAME DISTRIBUTION CHANNEL, IN A REVERSE ORDER. COPIES RESERVED AT CORRESPONDING LEVELS.

EVALUATION/FINDINGS

• COS-EFFECTIVE• IMPROVED COVERAGE IN PILOT AREAS• IMPROVED DATA MANAGEMENT• GOVERNMENTS IN OTHER STATES

EXPRESSED INTEREST AND REQUES FOR IMPLEMENTATION IN THEIR STATES

NEXT STEPS ON PSVD

• Scaling up: PSVD Project to be extended to other States in view of the success of the pilot phase.

• Screening of reputable firms, selected by various States, is in progress.

ANNEX: SUPPLY OF SELECTED COLD CHAIN EQUIPMENT

S/NO ITEM TOTAL

1 MOTORCYCLE 3, 708

2 BICYCLES 12, 841

3 FREEZERS 190

4 FRIDGES (E/K/G) 407

5 COLD BOXES 178,771

6 VACCINE CARRIERS (OTHER) 30, 596

7 MEGA PHONE (COMMUNICATION EQUIPT.) 7, 533

8 BOAT ENGINES (25HP) 109




12 GEN.SET 2

13 FRIDGES (SOLAR) 746

14 THERMOMETERS 9,865

15 GAS CYLINDERS 1,714

16 ICE PACK 15, 104

17 SAFETY BOX 71, 650

18 SCISSORS 35, 818

19 LIFE JACKET 10

20 STABILIZERS 69

21 FREEZER ELECTROLUX 28

22 TOYOTA HILUX (4WHEL-DRIVE) VEHICLE 42

With the ongoing national efforts and with the support of our agency partners and other stakeholders, we believe that Routine Immunization will attain a high overall national coverage in Nigeria. Experiences shared in this workshop is likely to contribute to this.

THANK YOUTHANK YOU

(MERCI)(MERCI)

THE END

Session Topic ________Making RED Work and District Performance Improvement Your Country ________ Ghana____________________________ Name of Note Taker __Stanley Diamenu (WHO)_____________________________________________________ Objectives (specific to topic and your country)






• To achieve 80% coverage of all antigens in all districts

• To reduce

incidence of mortality of VPD

• To interrupt the

transmission of world polio virus by 2004

• Physical features – water bodies

• Limited resources

and funds, human resources and equipment

• Conflicts • Social – in urban

communities • Ignorance

• Increase outreach services with SOS package

• Promote integrated

services and collaboration with other agencies

• Negotiations with

various parties • Agree on service time

with community • Social mobilization

and education • Weak supervision at

all levels

• Microplanning and implementation in 10 low performing districts

• Collaboration with

private midwives • EPI service delivery in

markets • Development

/distribution of education material to general public

• Mobilization of

identifiable groups

• Re-orientation of district / sub district personnel involved in EPI activities

• Training of community-

based volunteers for EPI

• Training of district and

regional officers with peer monitors

• Supportive supervision • Training needs

assessment for pre- and in-service institutions

• GHS / MoH,

UNICEF, GAVI

LISTE DES PARTICIPANTS REUNION ANNUELLE DES DIRECTEURS DU PEV ECHANGE INTER-PAYS POUR LE RENFOREMENT DE LA VACCINATION DE ROUTINE

NGOR DIARAMA, DAKAR 22 – 24 AVRIL 2004

PAYS / COUNTRY

NOMS / NAME

INSTITUTION / ORGANIZATION

TITRE / TITLE

E-MAIL

TELEPHONE

Adovohekpe, Paul UNICEF Project Officer [email protected] / [email protected]

229.30.02.66 / 97.05.97

Bamouni, Blaise WHO Point Focal PEV [email protected] / [email protected]

31.63.37

Jaillard, Phillippe AMP Conseiller Regional/Logistic

[email protected] 229.31.86.72

Benin

Moudjibi, Chitou Abdou

Ministry of Health EPI Manager [email protected] [email protected]

229.31.61.54/90 33 05

Nacoulma, Daniel UNICEF Project Officer [email protected] 226.30.0235 226.26.12.02

Burkina Faso

Ndikumana, Cassien ARIVA/CATR-Ouagadougou

Coordonnateur Adjoint de Ariva/Catr

[email protected] / [email protected]

226.31.69.16

Avokey, Fenella WHO/AFRO/ICP Yellow Fever Control Officer

[email protected] 225.22.51.72.63

Fall, Amadou WHO Conseiller Regional ICP

Falla@oms-ci 225.22.51.72.64

Kamwa, Mattieu WHO Team Leader ICP/EPI West Africa

[email protected] / [email protected]

225.22.51.72.15

Koné Souleymane WHO Logisticien ICP/PEV [email protected] 225 22 51 62 18

Cote d’Ivoire

Sawadogo, Adama WHO Logistics Officer [email protected] 225.22517219 Kaseya, Jean SANRU Point Focal PEV [email protected] /

[email protected] 243.982.28460

DR Congo Othepa, Michel BASICS II Country Team Leader [email protected] 243.982.64450

1







Masembe, Yolande Vuo

BASICS II EPI Advisor [email protected] 243.991.5405

Mbuya Mbayo, Jean Marie

Ministry of Health Directeur PEV [email protected] 08.18.10.11.58

Sakasaka, Antoine BASICS II IEC Advisor [email protected] 243.997.0587 Hailu, Kassa Ministry of Health Health Program Team

Leader Oromia, Balezone


Kebede, Alemu Ministry of Health Head Health Prog./Department Regional/HB Amhara

251.08.20.09.91

Ethiopia

Teferi, Efrem Ministry of Health EPI/IMCI Coordinator 251.6.20.59.50 Antwi Agyei, K. O. Ministry of Health EPI Manager [email protected]

m.gh 233.21.678078

Diamenu, Stanley WHO National Professional Officer (NPO) EPI

[email protected] 233.21.76.39.18/9

Ghana

Kone, Adama AWARE-RH/USAID/WARP

Child Survival Specialist

[email protected] 233.21.786.15.2/3

Bah, Mariama Cire USAID Reproductive Health Specialist


Diallo, Mamadou Adama

BASICS II Consiller PEV [email protected] 224.40.80.74

Malick, Sylla Papa WHO Epidemilogiste PEV/OMS


Sherif, Abdourahmane Ministere de la Sante Publique

Coordinateur National PEV/SSP/ME


Guinea

Sompare, Djenou Ministere de la Sante Publique

Directeur National de PEV

224.46.35.20

Dieng, Boubacar UNICEF EPI Officer [email protected] 377.47.528.740 Liberia Sankoh, Mohamed EPI Ministry of Health

Social Welfare National EPI Programme Manager

[email protected]

065.288.82

2


Andriamitantsoa, Benjamin

USAID Child Survival and Family Planning Manager

[email protected]

261.20.22.539.20

Ralaivao, Josoa Samson BASICS II Child Survival Technical Advisor


Randriamanalina, Aime

BASICS II Conseiller Technique en Mobilisation Sociale PEV

[email protected] 261.20.22.644.74 261.20.22.417.32 261.20.320.75.55.66

Madagascar

Randriamanalina, Bakolalao

Ministere de la Sante et du Planning Familial

Chef de Service Vaccination


Guindo, Boubacar Projet Sante USAID/ATN

Responsible du Volet PEV

[email protected]

223.224.17.52

Konate, Youssouf Ministere de la Sante Directeur National Sante


Kone, Nouhoum Ministere de la Sante Chef de Section Immunisation


Modjirom, Ndoutabe WHO Point Focal PEV/OMS [email protected] 223.222.37.14 / 223.675.55.00

Mali

Nichols, Lisa Programme Sante USAID/ATN

Directrice Adjointe [email protected] 223.224.17.52

Nepal Shah, Hari Krishna Nepal Family Health Program (NFHP)

EPI Consultant [email protected] 977.1.552.4313

Agle, Andrew N. BASICS II Country Team Leader [email protected] / [email protected]

234.26710363

Nwulu, Gloria U. UNICEF APO, EPI/PEV [email protected] 234.1.461.5644/5

Nigeria

Odu, Emmanuel FMOH/NPI Doctor [email protected] 234.080.23.10.45.71

3




Yakubu, Abdurahmane Ministry of Health, Kano

EPI Manager [email protected] 234.64.63.42.33 / 234.8036790388

Camara, Matar USAID Child Survival Specialist


Costa, Celestino UNICEF/WCARO Regional Advisor Health Immunization


Diack, Aissatou World Bank Health and Nutrition Specialist


Diallo, Ndiouga CVP/PATH Conseiller [email protected] 221.639.73.95 Diawara, Fatoumata UNICEF Project Officer [email protected] 221.889.03.28 /

548.01.30 Diop, Mohamed Boss WHO Routine EPI Focal

Point [email protected] 221.823.02.70 /

221.823.02.96 Fall,Cheikh Ministere de la Sante

Prevention Directeur de la Prevention


Koffi, David WHO Point Focal PEV [email protected] 221.823.02.96 Mbaye Seye, Serigne PATH BCC Advisor [email protected] 221.869.11.51 Mbow, Amadou Elhadji

CVP/PATH Conseiller Sante Publiaue


Mor Diaw MOH/DAHRA Medecin Chef de District

[email protected] 968 61 43

Mutombo Wa Mutombo, Boniface

CVP/PATH Child Survival Advisor mutombo@path .org 221 869 11 51

Ndiaye, Safietou Toure BASICS II Conseiller IEC/CCC [email protected] 221.865.12.75 Sene, Ibra Ministere de la Sante,

Mbour Medecine Chef District 957.37.40

Sow Sall, Djariétou Ministry of Health Médecin Chef de District

[email protected] 951 12 80

Thiam, Aboubacry BASICS II Chef d’Equipe [email protected] 221 865 12 75

Senegal

Yaradou, Hassane BASICS II EPI Advisor [email protected] 221.865.12.75

4

Bentsi-Enchill, Adwoa WHO Medical Officer [email protected] 41 22 791 1154 Switzerland Mayers, Gill WHO Technical Officer [email protected] 41.22.791.46.74 Amenyo-Bebou, Afi Ntifa

UNICEF Project Officer/EPI [email protected] 228.223.15.23

Gbedonou, Placide WHO Point Focal OMS [email protected]

228.221 3360

Pekpeli, Mairesiwa Minisere de la Sante Division de L’Epidemiologie

Chef de Service d’Immunisation


Togo

Tiekoura, Coulibaly WHO Point Focal OMS [email protected] 228.90.251.05 Megere, Humphrey Uganda Program for

Human and Holistic Development

Child and Adolescent Health Specialist

[email protected]

077.77.55.723 Uganda

Mugyenyi, Possy UNEPI – Ministry of Health

Deputy Program Manager - EPI

[email protected] 256.41.321.427 256 77 630 639

Hossain, Iqbal BASICS II Immunization Technical Officer


Millogo, Jules JSI [email protected] Shimp, Lora BASICS II Technical Officer [email protected] 703.312.6569 Steinglass, Robert BASICS II Immunization TFA

Leader [email protected] 703.312.6800

U.S.A

Wilkins, Karen CDC Strengthening Childhood Immunization


Zimbabwe Dicko, Modibo WHO Coordonnateur ISS [email protected] 67.241.38200 263.11.412488

Kezaala, Robert WHO Measles Officer [email protected] 263.11421308 Nshimirimana, Deo WHO VPD Regional Advisor [email protected]

rg

Salla, Mbaye WHO Polio Officer [email protected]

5





TITRE DE PRESENTATION: _______Intégration de PEV avec des autres programmes_______________________________________________ VOTRE PAYS: _________________Mali___________________ NOM DU PRENEUR DE NOTE: _____Dr. Ndoutabe MODJIROM_______________________


votre pays)





objectifs


• Élaborer un module de formation integrée pour les relais communautaire

• Chaque activité a son module de formation

• La mise en commun des ressources des partenaires pour les activités planifiées

• Plaidoyer auprès des partenaires

• Sensibilisation des chefs de programmes

• Documentation • Atelier d’élaboration • Atelier de restitution

et validation juillet-août 2004

USAID/ATN. OMS, UNOCEF

• Former 100 relais pour 2004 au nouveau module intégré

• Critères des choix de relais

• Hivernage [?]

• Élaborer les critères de choix de relais

• Former en dehors de l’hivernage

• Formation de relais juin-juillet 2004

USAID, Keneya

UTILISATION DES DONNEES POUR AMELIORER LES PERFORMANCES

DU PEV

Dr CHEIKH HANNE

LE CAS DU DISTRICT DE PODOR

DISTRICT DE PODORRégions de St. Louis et de Matam

• Pop: 292.565• Pop cible: 10.536• Superficie: 12.947Km²• PS: 45• Unités de vaccination:46

Réunions de coordination

- Rythme mensuel

- Chaque ICP présente ses données selon canevas standard

- Discussion&recommandations pour l’amélioration

Bulletin de rétro-information

- 5 indicateurs- Complétude des rapports- Promptitude- Couverture DPT3 et rougeole- Taux d’abandon DPT1-DPT3- Taux de perte (BCG, DPT, Measles)

Etat des lieux des 5 indicateurs:- situation du district- situation de chaque poste

Induit la compétition

BULLETIN DE RETRO-NFORMATION

Cible pour la distribution- équipe du poste de santé- comité de santé- autorités politico-administratives locales- équipe cadre du district- partenaires opérant dans le district- région médicale et niveau central

SYNTHESE DU DISTRICT

Graphique completude et promptitude

Maladies cibles déclarées

Graphique sur les taux de couverture

Distribution des aires de santé selon couverture DTC3

< 50% 50-80% et > 80%

Distribution des aires selon taux d’abandon DTC1-DTC3 < 10% et > 10%

Distribution des aires selon taux de perte en vaccin (BCG, DTC, VAR)

< 25% et > 25%

COMPLETUDE ET PROMTITUDE DES RAPPORTS DE JANVIER A DECEMBRE 2003, DISTRICT DE PODOR

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

COMPLETUDE PROMPTITUDE

COUVERTURE VACCINALE CUMULEE, DE JANVIER A DECEMBRE 2003, DISTRICT DE PODOR,

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

110%

120%

BCG DTC1 DTC3 VAR VAA VAT2+

DISTRIBUTION DES AIRES DE SANTE SELON LA COUVERTURE DTC3 DE JANVIER A DECEMBRE 2003, DISTRICT DE PODOR

0

2

4

6

8

10

12

14

16

18

20

22

24

< 50% 50% - 80 % > 80 %

DISTRIBUTION DES AIRES DE SANTE SELON LES TAUX D'ABANDON DTC1-DTC3

DE JANVIER A DECEMBRE 2003, DISTRICT DE PODOR

0

4

8

12

16

20

24

28

32

36

< 10% > 10 %

DISTRIBUTION DES AIRES DE SANTE SELON LES TAUX DE PERTE EN VAR,

DE JANVIER A DECEMBRE 2003, DISTRICT DE PODOR

0

4

8

12

16

20

24

28

32

36

< 25 % > 25 %

COMPLETUDE ET PROMPTITUDE DES RAPPORT PAR POSTE DE SANTE DE JANVIER A DECEMBRE 2003, DISTRICT DE PODOR

0

1

2

3

4

5

6

7

8

9

10

11

12

AERELAO

WASSETAKE-BAROBE

BOGUELBOKE-D

IALLOUBE

CASCASDARAHALAYBE

DONAYE

DEMETTE

DIABA

DIAMAL

DIONGUI

COMP PROMT

COUVERTURE VACCINALE CUMULEE DTC 3 ET VAR PAR AIRE DE SANTE DE JANVIER A NOVEMBRE 2003, DISTRICT DE PODOR

0%

20%

40%

60%

80%

100%

120%

140%

160%

AERELAO

WASSETAKE-BAROBE

BOGUEL

BOKE-DIA

LLOUBECASCAS

DARAHALAYBEDONAYEDEMETTE

DIABA

DIAMAL

DIONGUI

DIOUDE-D

IABE

DODELDOUNGUEL

FANAYEGALO

YAGOLERE

GUEDEVILLAGE

GUEDECHANTIERLOUGUEMADIN

A

DTC3 VAR

TAUX D' ABANDON CUMULE DTC1-DTC3 PAR AIRE DE SANTE DE JANVIER A DECEMBRE 2003, DISTRICT DE PODOR

-20%

-10%

0%

10%

20%

30%

40%

50%

60%

70%

AERELAO

WASSETAKE-BAROBE

BOGUEL

BOKE-DIA

LLOUBECASCAS

DARAHALAYBEDONAYEDEMETTE

DIABA

DIAMAL

DIONGUI

DIOUDE-D

IABE

DODELDOUNGUEL

FANAYEGALO

YAGOLERE

GUEDEVILLAGE

GUEDECHANTIERLOUGUEMADIN

A

38%41%

22%

16%

36%

48%

7%

41%

52%

0%

10%

20%

30%

40%

50%

60%

< 50% 50-80% > 80%

MAI AOUT DECEMBRE

EVOLUTION DANS LE TEMPS DE LA DISTRIBUTION DES AIRES DE SANTE SELON LE NIVEAU DE COUVERTURE DTC3, DISTRICT DE PODOR, ANNEE 2003

CONCLUSION

REUNION COORDINATION ET BULLETIN DE RETRO-INFO

- outils pour l’amélioration des performances

- monitore progres vers les objectifs

- génère competition

- identifie solutions aux problèmes

PERSPECTIVES

- ajouter d’autres indicateurs lorsque satisfait

- choix en accord avec la région et le niveau central

Session Topic ________Integration of EPI and Other Programs Your Country ________ Uganda Name of Note Taker __Drs. P. MUAYENYI and MEGERE_____________________________________________________ Objectives (specific to topic and your country)






• To establish a desk at every out patient department to screen children and women for immunisations and vitamin A

• Lack of awareness on benefits of integrating immunization with outpatient clinics

• Lack of guidelines for integrating services

• High vaccine wastage

• Train health workers • Develop and

disseminate guidelines for integration of services

• None yet

• UNICEF, WHO, MoH, UPHOLD/USAID

• • • • • •

• • • • •

Session Topic __Improving Planning at Facility Level, including Stronger Links and Communities Your Country ___Uganda__________________ Name of Note Taker __H._Megere ___________________ What activities are already planned to address this topic?




• Incorporated the CSSPD in the national EPI plan

• Strategy introduced in six districts so far

• Scaling up to 3 more districts • Developed and printed

facilitation manuals

• Training of district health teams in the new districts

• To scale up beyond the BASICS-supported district to cover the whole country

• Hold consultation meetings with the operational level health workers in the 3 new districts

• Mobilise resources for continuation of the strategy in the initial districts and for scaling up

• DHTs of the 3 districts to be trained together in a central place

• Advocacy to all the key stakeholders (meeting)

• DHT supported to train operational level health workers

• Make a budget and solicit for the resources

• MoH • UPHOLD • UNICEF • WHO • Uganda Red Cross

MAKING AN ICC FUNCTIONAL Experience from DR Congo

Échange participatif entre pays

Dakar 22-24 avril 2004

OUTLINEBACKGROUNDORGANISATION DU COMITESOUS COMITE VACCINATIONORIENTATIONSSTRUCTURE DU SOUS COMITEFONCTIONNEMENT:

Organisation JNVSurveillance PFARenforcement PEV de routine:

CCIA techniqueCCIA politique ou Stratégique

RésultatsPROBLEMES A RESOUDRECONCLUSION

BACKGROUNDEN 1995, CREATION DU CCIA, EN RDC, DANS UN CONTEXTE D’URGENCE COMPLEXE ET MULTIFORME POUR FAIRE FACE:

A LA DEGRADATION CONTINUE DU SYSTEME DE SANTEAUX EPIDEMIES: EBOLA, ROUGEOLE, POLIO, CHOLERA, ...AUX CATASTROPHES DE TOUT GENRE

BACKGROUND (cont’d)LE COMITE INTER-AGENCES AINSI CREE AVAIT POUR ROLE:

MOBILISATION DES RESSOURCESCOORDINATION DES PARTENAIRES ET DES INTERVENTIONSSUIVI, SURVEILLANCE CONTINUE, EVALUATION DES RESSOURCES ET DES INTERVENTIONS AVEC L’APPUI DES PARTENAIRES TECHNIQUES LOCAUX

ORGANISATION DU COMITECE COMITE INTER AGENCES D’ACTION, DE MOBILISATION ET DE COORDINATION DES RESSOURCES POUR LA SANTE AVAIT, DANS SON SEIN:

AGENCES DES NATIONS UNIESMISSIONS DIPLOMATIQUESONGs INTERNATIONALESTOUT AUTRE ORGANISME OU INSTITUTION IMPLIQUEE DANS LA RESOLUTION DES PROBLEMES DE SANTE EN RDC

ORGANISATION DU CCIA

Comité Inter Agences

Sous Comité SIDA

Sous Comité Urgences et gestion des catastrophes

Sous ComitéVaccination

Sous ComitéTrypanosomiase

Sous ComitéMédicaments

essentiels

Sous ComitéEnvironnement

Sous Comité Surveillance épidémiologique

SOUS COMITE VACCINATIONDEVANT LA DEGRADATION CONTINUE DU PEV, L’INTERET DES AGENCES POUR LES ACTIVITES DE VACCINATION ET LES RECOMMANDATIONS EN RAPPORT AVEC IEP, LE SOUS COMITE VACCINATION S’EST DEVELOPPE PLUS VITE QUE LES AUTRESAUJOURD’HUI, LE SOUS COMITE VACCINATION S’APPELLE CARREMENT LE CCIA.

ORIENTATIONSAVEC L’INTERET DE LA COMMUNAUTE INTERNATIONALE D’ÉRADIQUER LA POLIO, LES EFFORTS DU CCIA ETAIENT ORIENTES INITIALEMENT VERS:

L’ORGANISATION DES JNV DE QUALITELA MISE EN PLACE D’UN SYSTEME DE SURVEILLANCE DE PFA

STRUCTURE DU Sous Comité Vaccination

CCIA

C/Technique C/Logistique C/Moso C/Mob Ress.

CNC, CPC,CLC

Niveau centralNiveau provincialNiveau local

Chefs d’agencesEt Gouvernement

Ministre de la santé= Coordonnateur National

Commissions multi sectorielles

STRUCTURE DU Sous Comité Vaccination

Évolution de la structure du Sous Comité …

C/Technique etLogistique

C/Moso et Mob Ressources

CCIA

FONCTIONNEMENT 1. Organisation des JNV

LES DIFFERENTES COMMISSIONS SE REUNISSAIENT SEPAREMENT POUR EXAMINER:

LES PROBLEMES TECHNIQUES ET LOGISTIQUES EN RAPPORT AVEC L’ORGANISATION DES JNV ET LA SURVEILLANCE DES PFALES PROBLEMES DE MOSO ET DES RESSOURCES EN RAPPORT AVEC L’ORGANISATION DES JNV ET DE LA SURVEILLANCE PFA

TENUE DES REUNIONS DE TOUTES LES COMMISSIONS EN PRESENCE DU COORDONNATEUR A TOUS LES NIVEAUX

Résultats JNVQUALITE DES JNVs S’EST AMELIOREE PROGRESSIVEMENT DE 1999 – 2002

INDICATEURS DE QUALITE DES JNV ONT ETE DOCUMENTES ET PRESENTES

COMME CONSEQUENCE, DEPUIS 2001: AUCUN POLIO VIRUS SAUVAGE N’EST ISOLE DANS LE PAYSTOUS LES INDICATEURS PFA AU-DELA DU STANDARD ACCEPTABLEACQUIS DES JNV POUR LE PEV DE ROUTINE

Nombre d’enfants vaccinés, par phase et par an, RDC,

1998-2002

0

2000000

4000000

6000000

8000000

10000000

12000000

14000000

1998 1999 2000 2001 2002

Années

Nbr

e d'

enfa

nts

vacc

inés

1ère phase2e phase3èphase

2. Surveillance PFA Indicateurs de performance, RDC, 1999-2003

AnnééCas

noti-fiés

Taux de PFA

non polio

Investi- gués

dans les 48h

2 échantillons dans les 14 j

1 échantillon dans 28 jrs

Polio- virus

sauvage isolés

Zones de santé ayant notifié

1/100000 n % n % n % n %

1999 84 0,2 57 68 36 43 59 70 2 38 12

2000 1085 1,8 864 80 461 42 1051 97 28 212 69

2001 2157 5,6 1835 85 1491 69 1836 85 0 278 91

2002 1239 3,6 1082 87 1036 84 1170 94 0 281 88

2003 974 2,9 858 88 881 90 961 99 0 262 81

3. Renforcement du PEV de routine

DEPUIS 2003, RDC BENEFICIE DE L’ASSISTANCE GAVI POUR RENFORCER LES ACTIVITES DU PEV DE ROUTINEGAVI EXIGE AUX PAYS ASSISTES:

D’AUGMENTER LA CV DTC3 DANS LES ZONES DE SANTEDE REDUIRE LE TX D’ABANDON DTC1-3 A < 10%DE REDUIRE LES PERTES EN VACCINSD’AMELIORER LA QUALITE DES DONNEES

GAVI PREVOIT UN AUDIT DE QUALITE DES DONNEES POUR CONFIRMER QUE LES PERFORMANCES OBSERVEES SONT REELLES

Renforcement du PEV de routine (cont’d)

POUR FAIRE FACE AUX EXIGENCES GAVI:LE CCIA TECHNIQUE A ETE MIS EN PLACE POUR FAIRE FACE AUX PROBLEMES TECHNIQUES, LOGISTIQUES, DE MOBILISATION SOCIALE ET FINANCIERE LIES AUX PERFORMANCES DU PEVLE CCIA POLITIQUE EGALEMENT AVEC LES CHEFS D’AGENCES ET LES REPRESENTANTS DU GOUVERNEMENT POUR SUIVRE ET APPROUVER LES DECISIONS DU CCIA TECHNIQUE

CCIA TECHNIQUELE CCIA TECHNIQUE SE REUNIT CHAQUE MOIS POUR:

ANALYSER LES DONNEES DE VACCINATION PAR ZONE DE SANTEANALYSER LA GESTION DES VACCINS A TOUS LES NIVEAUXIDENTIFIER LES PROBLEMES OPERATIONNELS QUI SE POSENT ET LEURS CAUSESPROPOSER DES SOLUTIONS POUR AMELIORER LES PERFORMANCESFAIRE LE SUIVI DES RECOMMANDATIONS GAVI (DQA, PVF, RAPPORTS, …)

CCIA POLITIQUEUNE FOIS TOUS LES TROIS MOIS, LE CCIA POLITIQUE SE REUNIT POUR:

ECOUTER LES DECISIONS ET LES RECOMMANDATIONS / SUGGESTIONS PROVENANT DU CCIA TECHNIQUE POUR APPROBATIONSUIVRE L’ÉVOLUTION DE LA SITUATION DU PEV DANS LES ZONES DE SANTE ET APPRECIER LE NIVEAU DE PERFORMANCEDECIDER DES ACTIONS A PRENDRE POUR AMELIORER LE PROGRAMME

CCIA POLITIQUE (cont’d)UNE FOIS PAR AN, LE CCIA TECHNIQUE ORGANISE UNE REVUE ANNUELLE DU PEV, PROPOSE UN MACRO PLAN, OBTIENT UNE RETRO-INFORMATIONUN MEMO D’ENTENTE EST SIGNE ENTRE LES CHEFS D’AGENCES ET LE MINISTRE DE LA SANTE POUR LA MISE EN ŒUVRE DES ACTIVITE DE VACCINATION LES 12 PROCHAINS MOISCE MEMO DEFINIT LES DOMAINES D’INTERVENTION ET LES RESPONSABILITES DES PARTENAIRES POUR LE DEVELOPPEMENT DES ACTIVITES DE VACCINATION

RESULTATSLe nombre d’enfants vaccinés augmente chaque année (DTC3)Proportion de zones de santé avec DTC3 > 50% augmente chaque annéeRéunion régulière de CCIA technique au niveau central avec rapport

Évolution d’enfants vaccinés en DTC 3, RDC, 1999 - 2003

0

200000

400000

600000

800000

1000000

1200000

Nbr

e d'

enfa

nts

vacc

inés

1999 2000 2001 2002 2003Années

DTC 3

ELEMENTS CLES ET LECONS APPRISESMINISTRE DE LA SANTE TRES DYNAMIQUE

COORDINATION DES PARTENAIRESCOORDINATION DES INTERVENTIONSMOBILISATION DES RESSOURCES

PRESENCE D’UNE DIRECTION DU PEV TRES COMPETENTE

SUIVI DES RECOMMANDATIONSCOORDINATION DES ACTIVITES TECHNIQUES

ENGAGEMENT DES PARTENAIRES (AGENCES)COLLABORATION SINCERE ENTRE PARTENAIRES

LA PLANIFICATION LA MISE EN ŒUVRE, LE SUIVI ET L’EVALUATION

PROBLEMES A RESOUDRE …FONCTONNEMENT DU CCIA AU NIVEAU PROVINCIAL N’EST PAS ENCORE OPTIMALLE CCIA AU NIVEAU DE DISTRICT /ZONE DE

SANTE NON ENCORE FONCTIONNELCOMMUNICATION ENTRE LES DIFFERENTS NIVEAUX N’EST PAS ENCORE AUTOMATIQUE

CONCLUSIONEN RDC, LE CCIA A ETE RENDU FONCTIONNEL AU NIVEAU CENTRAL GRACE A:

DYNAMISME DU MINISTRE DE LA SANTELA RESTRUCTURATION DU COMITEL’IMPLICATION DE LA DIRECTION DU PEVL’ENGAGEMENT ET LA COLLABORATION DES PARTENAIRES

LES EFFORTS RESTENT CEPENDANT A FAIRE AUX NIVEAUX PROVINCIAL ET LOCAL

Implementation of the Reaching Every District Strategy: How to Make the Package Work Operationally

Context: 2002

- Poor System Quality: logistics management system (vaccines and oil), incoherent data at all levels, low system utilization; hence, low vaccination coverage rates

- Weak Demand: High drop out rates, little community involvement Achievements: Implementation of decentralization in 1994, practical application of partners' experiences (BASICS/JSI/USAID in Madagascar), creation of PEV relaunch plan, and introduction of community participation phase in all its forms (the challenge being enlisting community support, which is central to increasing demand…), and the development of different standards tools, such as the National Health Policy as well as documents covering norms and standards. Steps Taken:

- 2 national managers trained on RED in Dakar (May 2003) - Districts targeted and categorized at central level according to

accessibility and utilization criteria. - Task force and technical group established, which are composed of

national and international PEV partners whose job it is to: - Make the PEV relaunch plan operational - Coordinate and reorient efforts ― including community-based

health efforts - Support the implementation of the integrated epidemiological

surveillance system - Supervise the overall implementation of the RED approach

and establish microplans at the district level with CSB heads (soliciting commitments, buy-in to the RED approach, defining strategy and efforts, and budget issues)

- Draft microplan at the target district level Recommended Strategy: Targeting districts and assessing obstacles Improve supply and increase demand Districts have been categorized according to their levels of accessibility (DTC1 rate) and utilization (drop out rate) Results: At the national level, financing for 74 districts secured

- 53 relaunched districts: April 2003 - 21 priority districts: October 2003

- Performance improvement in 36 of 74 districts

2002 2003 Category Number % Number %

Néant 1 1% 0 0%cat.1 6 5% 47 42%cat. 2 25 23% 42 38%cat. 3 16 14% 8 7%cat. 4 63 57% 14 13% 111 111

At the provincial level, BASICS/JSI/USAUD efforts :

NATIONAL ANTANANARIVO FIANARANTSOA NO CHANGE 23 21% 3 16% 6 26% IMPROVED 79 71% 15 79% 17 74% WORSENED 9 8% 1 5% 0 0% 111 19 23

Lessons Learned:

- Supervisor pool and RED task force - Plan for sharing and remittance - Coordination of efforts - Buy-in of community and political leadership - Context-appropriate work materials

Community Problem Solving and Strategy Development Uganda Presentation

The government of Uganda has been carrying out immunization services for the country since it was revitalized in 1996. However, there has been gradual decline in immunisation coverage over the last 10 years. For a number of reasons, two of these reasons were identified as poor social mobilisation and low participation by the community in the planning and implementation of immunisation activities; according to a KAP study that was carried out in 1998. Immunization is one of the priority interventions identified by the Ministry of Health in the Ugandan Minimum Health Care Package described in the Health Sector in the Health Secotr Strategic Plan (HSSP) for the period 2000-2005. Arising from this prioritization by the MoH, our EPI Policy and Strategic framework for revitalisation of Immunisation was sen. VP that called for improving involvement in Immunisation and the development of stronger linkages between the health workers and the community. Similarily, the reach every district (RED) strategy for improving Immunisation coverage developed by GAVI, UNICEF and WHO puts emphasis on developing linkages between health workers and the communities that they serve as well as regularly monitoring the immunisation performance by both the health unit staff and the community in partnership. BASICS, therefore, came in to support the MoH through UNEPI to operationalize this approach starting in two districts in the first year and adding on another four districts in the second year where health workers were taken through a process of understanding how to work with community members in partnership and to monitor their performance on a regular basis, including providing feedbacks. Tools for monitoring immunisation coverage and drop out were developed and disseminated to the health units in the six districts for use by the health workers to monitor their performance and for providing feedback to the community. Other guidelines, e.g. EPI Standards and job aides like the immunisation schedule were produced to support the health workers in their work. Political, civic and religious leaders met periodically and immunisation discussed. This led to support from these leaders and advocacy by them whenever they were in contact with the community. As a result of all these activities, the relationships between the health workers and the community improved, the relationship between the health workers and the leaders became easier and better. Immunisation coverage has now improved in these districts and drop out rate reduced significantly. The attitude of the health workers that was reported to be positive initially, has now improved and the communities plan with the health workers on the outreach services and negotiate on the appropriate time and date when the outreaches can function. Political support on the district, subcounty and parish levels has led to planning and budgeting for immunisation in their budgets amd actually finding immunisation activities at these levels in addition to the finding that comes through the central government grants.

Thème de session _____ Revitalisation de la Logistique Vaccinale_ Votre Pays ___________ Guinée____________________________ Nom de preneur de notes Dr. Djénou SOMPARE_________________________________________________ Quelles sont les activités déjà planifiées pour faire face à ce thème?




• Signature de l’accord de coopération entre gouvernment et UNICEF pour approvisionnement en vaccins

• Amélioration de la capacité de stockage des vaccins aux niveaux national et régional

• Formation en gestion

informatisée des vaccins aux niveaux national et régional

• Commande de camions

pour l’approvisionnement en vaccins des régions

• Dotation en équipement

informatique des niveaux central et régional pour la gestion des vaccins

• Accord de coopération avec l’UNICEF, suivre le document auprès des partenaires jusqu’à la signature

• Installer la chambre de

40m3 au niveau central et celle de 17m3 dans la région de FARANAH

• Formation planifiée en

gestion des vaccins en juin 2004

• Acquisition d’équipement

informatique prévue juillet 2004

• OMS, UNICEF, ARIVA, BASICS II, GTZ, USAID, Prism


Day 3 Report Chairperson: Dr. Jules Millogo Author: Dr. Souleymane Kone Dr. Jules Millogo moderated day 3's sessions. The day's agenda was essentially dedicated to session 5 of the overall workshop agenda concerning logistics and injection safety. Sessions were organized around 2 presentations, namely: planning injection safety beyond vaccination services and revitalizing vaccine logistics at all levels. 1. Planning for Injection Safety Beyond Immunization Services (Uganda)

1.1 Presentation Uganda's experience, presented by Dr. Mugyenyi, can serve as a reference, stimulate questions, and open debate. The presentation exposed the country's current situation, one marked by a high prevalence of HIV and Hepatitis B and C infections. Results of an analysis of different studies and surveys completed between 1999 and 2003 on injection safety were shown. In 1999, the CAP survey showed high rates of reuse and accidental needle sticks. Auto-disable equipment was introduced for vaccine injections, which represent almost 6 % of total injections. In 2003, these results were confirmed by an evaluation, using “Tool C”, of injection safety assessment instruments. In addition to the multi-faceted problems with injection safety, there is also the problem of:

Over-prescription of injections Inadequate stock / supply Absence of policy Insufficient means of destroying needle waste

Faced with these problems, a sector-wide task force on injection safety has set up for:

Policy coordination Development and policy approval Resource mobilization

Members of this group are drawn from a broad cross-section, including environmental Ministries, UN agencies, NGOs, professional and consumer groups, and health care training centers.

Advances have resulted in the creation of standards and in the launch of the US President's injection safety project. The project's efforts center around improvements of:

[ Awareness / training / scholarship ] logistics management waste disposal

The first phase of the project will last 10 months and is restricted to 4 districts in the country. The outcome of this phase will determine whether the project will be extended countrywide. 1.2 Questions and Answers

The Q & A session enriched the discussions and provided answers to the participants’ questions. There were about 10 comments and questions, such as:

Selection criteria for the districts used in project Management of waste disposal Task Force's operating procedures Timeline used for establishing Task Force Impediments to setting up Task Force Management criteria for 'common fund' Private sector's role in improvement of waste management Role and attitude of health care workers during increase in demand for

injections

1.1 Work Group Discussions

Discussions continued in work groups, where a more complete examination of specific country experiences and the adaptability of those experiences to other countries took place.

2.0 Revitalizing vaccine logistics at all levels (Nigeria)

2.1 Presentation

The presentation dealt with Nigeria's experience with out-sourcing EPI vaccine distribution. Dr. Emmanuel Odu made the presentation. After the general country presentation, he then turned to the failures that led to privatizing distribution. Nigeria guarantees its ability to pay for vaccine stocks. An agreement was concluded with UNICEF, which assists in buying vaccines. The distribution system includes:

A national warehouse with 8 refrigerated cold rooms with a total capacity of 160m3

4 regional warehouses with capacity of 80 m3 State level warehouses and LGA

The presentation indicated that the vaccine distribution chain in the country includes two supply features, based on level:

Delivery from the national level to the regional and state levels Pick up at state level warehouses by the LGA and from LGA by outlying

health units. This system empowers lower levels to pick up their own vaccine supply at the higher level if in need

The presentation underlined the problems with this vaccine distribution plan, which results in frequent shortages, often due to lack of transportation. Privatization was proposed to remedy the problem. By contract, the private sector entity is responsible for stocking intermediary and outlying warehouses. Responsibility for warehouse stock lies with the program.

2.2 Questions and Answers The Q & A session that followed the presentation answered participants' concerns about managing a private sector, outsourced distribution system. The major questions covered:

Storage temperature of vaccines during transport Contract and payment terms for private company Signing authority for contract (federal, state, LGA) Selection criteria for private company Evaluation standards and procedures to enforce contract terms

Other comments focused on the decision to use a private sector entity. Funds spent on vaccine delivery should be better spent finding a public sector solution.

3. General synthesis

Dr. Millogo, the day's moderator, made a general synthesis of the meeting. He made note of the day's most controversial topics and remarked on the participatory method that resulted in lively exchanges between participants.

4. Closing session

Three remarks were made during the closing session:

On behalf of all the attendees, Dr. Sherif (Guinea) expressed how pleased he was with the conference. The participatory method and the discussions were both praiseworthy.

On behalf of the partners, Dr. Kamwa (ICP/EPI, WHO) reminded the participants of the lessons learned

Dr. PC Faye, the representative of the Senegalese Ministry Public Health, made closing remarks. On behalf of the Ministry of Public Health, he encouraged regular analysis and evaluation for the continuation of the shared experiences

Session Topic Injection Safety / Waste Management______ Your Country _________ Ghana Name of Note Taker ___ Stanley Draimem ___________________ What activities are already planned to address this topic?




• Construction of de Monfort incinerators

• Modification of existing incinerators to improve on performance

• Estate Department of GHS to modify the existing incinerator

• Estate Department to

construct new incinerators in selected health centers

• WHO, GAVI, GHS, UNICEF

New Vaccine Introduction and Financial Sustainability The Ghana Experience

Ghana successfully introducted the new vaccine, DPTHepBHib (also called the pentavalent or five-in-one-vaccine) in 2002. This was made possible with the support of the Global Alliance for Vaccines and Immunizations (GAVI). The support entailed payment for the supply of DPTHepBHib and yellow fever for five years. However, the country decided to phase out the GAVI-VF contribution over a period of 10 years with government contributions increasing whilst that of GAVI-VF decreased. It is worth noting that the cost of routine services increased by more than 100% (from $3.5m to $7.2m per annum) The country is putting measures in place to ensure continuity with the new vaccine after GAVI support phases out, hoping for a reduction in the cost of vaccine.

Intégration des programmes de la survie de l’enfant et la

surveillance des maladies cibles

REPUBLIQUE DE MADAGASCARMinistère de la santé

et du Planning Familial

Présenté par l’ équipe de Madagascar, Session 2: 15h50 – 16h 20Mr Andriamitantsoa Benjamin / Dr Josoa Ralaivao

Principes de base de l’intégration des activités (Paquets Minimum d’Activités ou PMA)

SantSantéé de la

de la

Reproduction (SR)

Reproduction (SR)

Principe 1: Santé des enfants/Santé de la mère

Actions Essentielles

Actions Essentielles

en Nutrition (AEN)

en Nutrition (AEN) SantSantéé/Enviro

nnement

/Environnem

ent

Prise en Charge

Prise en Charge

IntIntéégrgréée des Sant

e des Santéé

des Enfants (PCISE)/Palu/PEV

des Enfants (PCISE)/Palu/PEV

ActivitActivitéé

Communautaire Communautaire IntIntéégrgrééee

Principe 2: Complémentarité du programme

Enfant sain et suivi Enfant sain et suivi de croissance:de croissance: suivi de croissance, évaluation et counselling alimentaires, sel iodé, vérification de l’état vaccinal/vitamine A/ déparasitage.

Postnatal et Postnatal et planification planification familiale :familiale : AME, alimentation, fer/acide folique, PF, prévention des IST, vaccinations de l’enfant

Vaccination:Vaccination: vaccinations, vitamine A, déparasitage, évaluation et prise en charge de l’anémie chez l’enfant, PF, et référence pour IST

Accouchement Accouchement Accouchement sans risque, AME, Vitamine A, fer/acide folique, alimentation, PF, BCG, VPO0, prévention des IST/SIDA

Grossesse:Grossesse: VAT,consultation prénatale, fer/acide folique, déparasitage, MII, anti- paludéen, alimentation, AME, signes de danger, PF, prévention des IST/SIDA, accouchement sans risque, sel iodé

PCISE:PCISE: suivi de croissance, évaluation et prise en charge selon la PCISE, counselling alimentaire, évaluation et prise en charge de l’anémie, palu, vérification de l’état de la vitamine A, vaccination, déparasitage.

Implication CommunautaireImplication Communautaire

Implication pluridisciplinaire

Disciplines de la Santé PubliqueÉpidémiologie et Statistique, Utilisation des Données pour une Prise de Décision Efficace, Institut National de santé Publique et Communautaire, et Institut de Formation des Para-médicaux

Principe 3: Stratégie de la formation Initiale:

Principe 4: Implication pluridisciplinaire

2 IFP privéesCentre de

documentation

Synergie entre Ministères (Min.Sup et Min San.PF)

INSPCInstitut National de Santé Publique et Communautaire

Min San.PFMin San.PF

66Instituts de Formation des Para-médicaux

Instituts de Formation des Para-médicaux

Ministère de l’enseignement

Supérieur

Ministère de l’enseignement

Supérieur

FacultésFacultés2

Principe 5: Modèle d’approche

2 DPS/PF2 DPS/PF

•• Relance du Programme PEVRelance du Programme PEV•• IntIntéégrationgration àà la Formation initialela Formation initiale

Pérennisation sur terrain et du système:: •• IntIntéégrationgration / / renforcement de la renforcement de la

mobilisation socialemobilisation sociale : mass: mass--mméédias, dias, communautcommunautéés championnes, enfant s championnes, enfant

àà enfant, santenfant, santéé et environnementet environnement

20 districts20 districts Intégration

FdF en CCC des resp IEC (PCISE_C)

RELANCE DU PEV

Contexte :Appropriation de l’ensemble des différents programmes à tous les niveaux (EMAD ou Équipe de Management de Districts)

Analyse de la situation par l’équipe de l’EMAD

Pourra évaluer :Suivi du systèmeMaîtrise des l’utilisation des données pour la prise de décision (ex: dénominateur dans le calcul du taux de couverture vaccinale)Capacité d’analyse au niveau périphériqueSystème de formation en cascade et de remise à niveau

L’EMAD ayant acquis plus de responsabilité et une autonomie suffisante au niveau du District:

Objectifs spécifiques:

1. EMAD doit avoir un système gestion performant, et

2. Obtenir l’engagement des acteurs-clés (consensus par rapport aux stratégies adoptés)

Proposition d’approche

1. Collaboration étroite entre les structures existantes: communautaires, ONG, autorités locales et administratives

2. Etablir des stratégies de PAF (Petite Action Faisable) à tous les niveaux fixant les termes de références des secteurs-clés

Mise en place d’un système avec 4 principes généraux :1. Réseaux en système logistique, et en chaîne de froid en

quantité et qualité des produits 2. Développement des capacités (Qualifications) des

prestataires avec formation des EMAD / superviseurs3. Gestion des données du PEV (avec l’auto-monitorage,

micro-planification, et coordination )4. Capitalisation et harmonisation de l’approche

communautaire pour l’appropriation par la communauté par l’animation au niveau des centres de vaccination avec les différents stratégies

• Fixes• Avancées (déterminées avec la communautés)• Mobiles avec la collaboration des équipes sanitaires mobiles

Organisation de l’Offre de service :

Maintien de la demande :Renforcement des capacités du personnel d’appui et des agents communautaires membres du ComitéVillageois de Santé par des Equipes issues de l’EMAD en communication (responsables des différents programmes)

Implication des tous les secteurs-clés

Adaptation et cohérence des outils de travail à tous les niveaux jusqu’au niveau des CSB

RéalisationsOffre de service1. Logistique:

Informatisation de la:• Gestion de la chaîne de froid: Finalisation de l’outil• Gestion de stocks des produits: disponibilité du

Manuel d’utilisation, • Gestion des données intégrées sur le système de

suivi et évaluation (auto-monitorage, réorientation stratégique, coordination et suivi des activités)

• Installation informatique au niveau central et des 2 DPS USAID et les 4 autres DPS, 22/42 SSD

RéalisationsOffre de service2. Développement des capacités du personnel:

3

Gestion du programme PEV à tous les niveaux (SSD, DPS et SdV),

• Disponibilité, et application des TdR des responsables PEV• Formation des responsables

– Initiation, et utilisation de l'outil de gestion informatisé des 2 DPS, et 22 SSD (responsable PEV, et responsable SIGS).

– et 2 responsables/DPS (12), et 4 personnels au niveau central en Epiinfo 2002, EpiMap et Health Mapper 0.3

3

Initiation en Approche ACD (Atteindre Chaque District) , et en Middle Level Management des 23/23 SSD de la DPS Fianarantsoa

3

Supervision formative: 1 mois après la formation

Réalisations: demandeMI & Adjoint Technique

Responsable IEC/CCC

Responsable PEV

Médecin-Chef CSB

Responsable SIGS

Surveillance Epidémiologique Autres

Atelier Semestriel du Programme PEV 23 SSD Fianarantsoa 23 22 1 1 8 55

DPS Fianarantsoa 23 23 1 47

DPS Antananarivo 19 19 38DPS Fianarantsoa 2 5 7 1 3 18DPS Antananarivo 2 5 5 1 2 15DPS Toamasina 2 2 2 1 2 9DPS Toliara 1 1 2DPS Antsiranana 1 1 2DPS Mahajanga 2 2 2 1 2 9

Monitorage PEV & Initiation à la communication inter-personnelle Antananarivo Ville 16 16

Remise à niveau des superviseurs centraux

Responsables centraux 16 16

Participation à la remise à niveau en Surveillance Epidémiologique Intégrée

Points focaux régionaux des 6 DPS

6 6

Supervision de l'application des outils de gestion et recueil des données (UDDE) 22 SSD des 2 DPS 22

FDF en approche communautaire 23 SSD Fianarantsoa 27 27

Remise à niveau des agents de santé & Initiation de l'approche ACD SSD Antsirabe II 2 1 2 38 1 1 8 53

Tsiroanomandidy 32 32Ambalavao 25 25Manandriana 13 13

AGENTS DE SANTE FORMES:

Appui à la microplianification de l'approche ACD

Revue trimestrielle PEV, Initiation MLM et Echange d'experiences

TOTAL

Initiation de l'outil de travail informatisé et en Epiinfo 2002,

EpiMap et Heath Mapper 0,3

Responsable des districts

Districts SanitairesObjet : Responsables Régionaux

Réalisations

DPS CommunePersonnel de santé Leaders

Leaders religieux

COSAN & COGE Animateurs CASC SBC GF Enseignants Matrones NAC Autres

Total formés

ANTANANARIVO 36 113 186 1 59 1065 55 74 69 7 1 17 116 1763

FIANARANTSOA 44 71 311 19 32 1344 129 19 82 32 15 11 67 2132

TOTAL 80 184 497 20 91 2409 184 93 151 39 16 28 183 3895

Agents Communautaires Leaders CommunautairesAugmentation de la demande:

Redynamisation

1. Utilisation des supports IEC standardisés

2. Renforcement du système de Surveillance Épidémiologie Intégrée

3. Intégration des activités dans le Paquet Minimum d’Activités (Promotion de : Allaitement Maternel Exclusive, Planning Familial, Maternité sans risque, Palu/PEV/PCISE communautaire, Examen prénatal, ……….)

Réalisations

Ciblés Présents

1 Ambatolampy 232 36 36 4

2 Ambohidratrimo 200 46 39 4

3 Anjozorobe 169 57 48 4

4 Antananarivo Atsimo 186 58 55 4

5 Antananarivo Avaratra 191 44 44 4

6 Antananarivo Renivohitra 169 56 56 4

7 Antsirabe I 184 60 60 4

8 Antsirabe II 218 43 42 4

9 Manjakandriana 214 69 67 4

10 Ambalavao 196 25 24 4

11 Ambohimahasoa 186 59 59 4

12 Ambositra 180 69 68 4

13 Fandriana 205 123 123 4

14 Farafangana 194 41 33 4

15 Fianarantsoa I 207 50 50 4

16 Fianarantsoa II 178 34 34 4

17 Ifanadiana 183 74 72 4

18 Manakara 194 43 42 4

19 Mananjary 182 45 45 4

20 Vohipeno 227 44 44 4

3 895 1 076 1 041 80

RECAPIT ULAT ION DU NOMBRE DES PART ICIPANT S FORMES EN APPROCHE COMMUNAUT AIRES

TOTAL

N° Animateurs Formés

Fokontany Communes SSD

77,8

60,8

85,8

0

20

40

60

80

100

POURC

ENTAGE

2001 2002 2003

DONNEES PEV DE ROUTINE SUR LE TAUX DE COUVERTURE VACCINALE

(Source SDV/SSEGIS )

BCG DTC3 P3 ATR

RELANCE DU PEV PAR APPROCHE DISTRICT

S itu a tio n 2 0 0 2 - 2 0 0 3

Nombre % Nombre %Néant 1 1% 0 0%cat.1 6 5% 47 42%cat. 2 25 23% 42 38%cat. 3 16 14% 8 7%cat. 4 63 57% 14 13%

SSD 111 111

Catégorie20032002

RELANCE DU PEV PAR APPROCHE DISTRICT

Situation 2002 - 20032002

Thème de session _____ Revitalisation de la Logistique Vaccinale à Tous les Niveaux_____________ Votre Pays ___________ Madagascar___________________________ Nom de preneur de notes Aimé_RANDRIAMANACINA______________________________________________ Quelles sont les activités déjà planifiées pour faire face à ce thème?




• Approvisionnement des vaccins des centres de stockage régionaux et des districts

• Plan de distribution en urgence des vaccins

• « Partenariat privé-

public » (campagne rougeole) (chambre froide)

• Élaborer un tableau de bord

• Plaidoyer

• GAVI • Membres CCIA Senior