A Comprehensive Policy framework for the National Immunization

							A Comprehensive Policy framework for
the National Immunization Programme




 Dr Nihal Abeysinghe,
 [M.B.,B.S., MSc, M.D.]
 Chief Epidemiologist,
 Ministry of Health
Immunization Programme
Sri Lanka : Vaccines used at present

   BCG for Tuberculosis
   Oral polio for Poliomyelitis
   DPT / DT for Diphtheria, Pertusis
    [Whooping Cough] & Tetanus
   Measles
   Rubella
   Tetanus
   Hepatitis B
   Japanese Encephalitis
Present status of the Immunization
Programme, Sri Lanka
   Dramatic reduction in illness, disability & death from

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

        Childhood tuberculosis
        Japanese Encephalitis
        Rubella

   Very high vaccine coverage > 95%
  Decision Making Process
 Evidence based decision making
          Epidemiology Unit recognizes the needs
          Makes addition to the surveillance system
          Carries out burden & cost studies
          Proposes to the Advisory Committee on Communicable Diseases

   Reviewed & approved by the Advisory Committee on
    Communicable Diseases [ACCD]
   Discussion with a wider group of stakeholders;
    [“Immunization Summit-held on 5th January 2007”]
   Negotiate for funding & convince the Finance Ministry
   Acquire logistics, other facilities & prepare the field staff
   Develop a communication strategy
   Develop plans for Continuous follow up, Monitoring & Evaluation
                            Strength of the Sri Lankan EPI : Number of Years
                            Taken to Reach Over 90% Coverage Following
                            Introduction of a New Vaccine


              100
              90
              80
              70
Coverage(%)




              60
              50
              40
              30
              20
              10
               0
                    74 75   77   79   81   83     85     87      89     91   93     95    97     99   01   03   05

                                                                 Year

                                           DPT3        Measles        MR     OPV3        HepB3
Present Challenges
   Sustaining high coverage
   Achieving eradication & elimination targets
   Ensuring vaccines of assured quality
   Introducing new vaccines
   Strengthening the capacity for surveillance of
    Vaccine-preventable diseases & Adverse Events
    following immunizations
   Ensuring financial sustainability for the
    immunization programme
   Strengthening Primary Health care system
Cost Considerations in the National EPI

      Introduction of a new                          $12.0




                                           Millions
       vaccine is always considered
                                                      $10.0
       within the framework of the
       National EPI, not separately                    $8.0

      Total cost
                                                       $6.0
           Vaccine

           Injection supplies                         $4.0
           Other routine recurrent cost
                                                       $2.0
                 Cold chain equipment

                 Transportation
                                                          $-
                                                               2007          2008      2009          2010          2011
                                                      Traditional Vaccines            New and underused vaccines
                                                      Injection supplies              Personnel
                                                      Other routine recurrent costs   Cold chain equipment
                                                      Other capital equipment
Policies that would help us to
achieve the desired status
   Equity and equality
   Ownership, partnership and responsibility
       Government
       Other stakeholders
       International organizations
   Accountability
       publicly accountable for the policies, goals,
        strategies and actions
   Assured quality, safe products and services
       Internationally recognized standards of quality,
        safety, and services are delivered according to best
        practices.
Policies that would help us to
achieve the desired status
   Adaptability to local needs and circumstances

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

   Sustainability through technical and financial capacity building

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

   Policies and strategies based on evidence and best practices
       The choice of policies, strategies and practices should be based on
        evidence from surveillance, monitoring and evaluation, operational
        research, diseases burden and impact assessments, and economic
        analyses
Key Strategies
   Implementing the comprehensive Multi Year Plan
    & annual plans
   Reaching children in “difficult to reach areas”
   Ensuring quality vaccine supply & accessories
   Improving quality services by enhancing the
    service facilities, vaccine storage capacity &
    surveillance of Adverse Events Following
    Immunization
   Creating a Community demand
   Introducing new vaccines to combat „emerging‟
    new VPD with financial sustainability plans
   Regular reviewing of the programme
       “What works & What not”
Key Strategies
   Ensuring financial sustainability
   Improving National regulatory authority activities by
    regular discussions
   Promoting operational research : Disease Burden
    studies
   Improving management of human resources
   Strengthening laboratory capacity
   Strengthening capacity for data management
   Planning for immunization in complex emergencies
   Develop & implement a comprehensive communication
    strategy
   Include immunization in epidemic preparedness plans
   Define & delegate responsibilities to stakeholders
Thank you


Epidemiology Unit
Ministry of Health