Current Status of Immunization Service Delivery in Africa Mary Harvey AFR/SD/HRD SOTA/PHN Meeting June 13, 2002

Nearly one million vaccine preventable deaths occurring annually in the Region Measles Hib Hepatitis B related diseases 150,000 Pertussis MNT110,000 Yellow Fever20,000-30,000 Meningococcal diseases30,000-50,000

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

Measles coverage, Selected Countries,

DPT3 Coverage, Selected Countries,

Take Home Message USAID Support is important/Essential Support includes Technical Assistance for Routine EPI Advocacy and TA for Cost-Effective Interventions Management of Health Sector Reforms Strengthened Partnerships/ICCs

Changing Environment of EPI

Disease Control Initiatives Polio Eradication Measles Control/Elimination Neo-Natal Tetanus Elimination

Polio Funding Trends by Region Sources: USAID Bureau of Global Health and Polio Eradication Initiative Total Funding Amount = $164,398,302

Polio Eradication : progress made # of polio endemic countries AFP cases Reported Wild polio viruses confirmed

Progress and Plan to Eradicate Polio Source: World Health Organization, April 24, 2001 Surveillance acceleration begins Revised target: Poliovirus transmission interrupted by Dec Earliest estimated date for global certification: 2005 Earliest estimated date for stopping immunization: 2010

Wild Poliovirus Cases, , WHO/Africa Region Jan-Dec 2000 AFRO/ Data up to 30 November, 2001 Jan-Dec 1999 Jan-Dec 2001

Proposed Revisions – May 20 USAID PEI Results Framework Stabilize World Population and Protect Human Health in a Sustainable Fashion Stabilize World Population and Protect Human Health in a Sustainable Fashion Agency Goal USAID-PEI Strategic Objective: Global Polio Eradication USAID-PEI Strategic Objective: Global Polio Eradication Critical Assumptions: — USAID supports the World Health Assembly resolution on global polio eradication — Successful global eradication depends upon continued support from all partners — Polio immunization can one day be stopped — Transmission of poliovirus can be interrupted — Polio-related activities will continue until 2010 Selected immunization support systems, at the national and sub-national levels in the public and private sectors, strengthened to achieve and maintain polio eradication Improved quality, detailed and timely planning and implementation for supplemental polio immunization (including NIDs, SNIDs, mopping up) and, when appropriate, other interventions or vaccines Improved Acute Flaccid Paralysis (AFP) surveillance and response system that is integrated with surveillance for other infectious diseases Timely documentation and use of information to continuously improve the quality of polio eradication immunization and VPD-control activities Build Effective Partnerships Strengthen Selected Systems Support Supplemental Immunization Improve Surveillance Improve Information Collection and Use First-level Results Support the global eradication of polio and related actions to maintain immunity by the year 2007, in selected countries and regions, in ways that contribute to the development of sustainable immunization and disease control programs Effective partnerships to support the implementation of polio eradication, immunization, and vaccine preventable disease-(VPD) control programs established and operational Note: Italics represent proposed revised language.

Take Home Messages Maintain Heads of States and Health Ministers involvment-We are close to achieving the goal but the work is not yet done anywhere in Africa! NIDS will need to continue every two to three years after 2005 and polio eradication has been certified, IF ROUTINE COVERAGE for polio 3 is less than 90% Document experiences of implementation of district performance contracts and potentials for other health interventions Strengthen sub-regional EPI coordinating structures (bi- laterals, rotating chairmanship) Use infrastructure built for polio eradication to expand support to other disease control activities

Measles Mortality Reduction WHO/UNICEF Goals Reduce the number of measles deaths by half by 2005 Achieve and maintain interruption of indigenous measles transmission in large geographical areas with established elimination goals Review progress in 2005 with other partners

Recommended Strategies Providing the first dose of measles vaccine to successive cohorts of infants ensuring that all children have a second opportunity for measles vaccination enhancing measles surveillance with integration of epidemiological and laboratory information improving the management of every measles case including vitamin A supplementation.

Take Home Messages USAID recognizes that measles causes significant morbidity and mortality Based on the data, USAID strongly supports intensified efforts to reduce measles transmission and disease burden USAID supports a balanced and comprehensive approach to effective measles control, which is consistent with and contributes to delivery of primary health care services.

MNT Elimination: Attaining a true rate of NT <1/1000 live birth/year/district Strategies for attaining elimination TT Supplemental immunization activities in high risk areas with  80% coverage in CBAW Clean delivery practices of  70% Active surveillance for NT

Countries’ MNT Elimination Status in the African Region Countries’ MNT Elimination Status in the African Region Potentialité Eliminated NT near Elimination With POAs No POAs

Other Initiatives GAVI

The Global Alliance for Vaccines and Immunization Mission: “ To save children’s lives and protect people’s health through the widespread use of vaccines”

Status of GAVI/VF Support, African Region (Sept 01)

GAVI at the National Level Concepts –Coordination among all partners supporting immunization (ICC or other)- ICC has additional role to play –Focus support on consolidated national 5 year plan and annual workplans –Monitoring and evaluation through shared instruments –Support and intra-country coordination available through Regional Working Groups

GAVI At The National Level Upcoming areas of attention –Completion of application for available support –Support for implementation of national annual plans (participation in ICC and provision of TA) –Data Quality audits - improved district level reporting –Enhanced financial planning & completion of Financial Sustainability Plans

CountriesActivities fundedObservations MALI ($429,000 in Jan 01) Microplanning workshop Funds for EPI operations for 13 districts District microplans approved by ICC Performance contract signed with districts GHANA ($265,400 in Dec 00) Procurement of motor bikes, copiers Training / microplanning /data management VF for infrastructure and not recurrent costs Checks through Audit GAVI/VF have already reached the districts : a critical factor for success

CHALLENGES Maintain all partner commitments to EPI in the Region HIGH on their Agenda. Keep Countries commitment to EPI and maintain a significant funding for EPI from national Budget It is difficult to get all partners working together, but there is no better way way to succeed Take Home Messages

CHALLENGES USAID should nurture the development of Competent and Functional ICCs to Support EPI and its MYIP: Participate in the ICC, Support, Monitoring and Evaluation activities. Respond to increasing demand for Technical Assistance in Countries Encourage support for improving safety of injections and encourage timely introduction of HepB, Hib and Yellow Fever Vaccination Take Home Messages