PPT - Audiences

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					Post Introduction Evaluation of
         New Vaccines

                   Dr. Tarande Manzila
                       WHO/AFRO
                                   1
 Historical perspectives

No reliable documentation of new
vaccine introduction in early introducing
countries (Botswana, Zimbabwe,
Swaziland, South Africa, The Gambia)




                                        2
      Why PIE in AFRO
 Lack of regional reference
 Absence of documentation on experience of
earlier countries
Limited technical assistance to countries
during preparation for introduction
 Result of observation of early assessment


                                       3
          Objective

The overall objective is to document
the process of integrating a new
vaccine into EPI programmes




                                       4
        Specific objectives
Specific Objectives
   Document the process of introduction
   Assess introduction’s impact on the
   programme
   Identify challenges and constrains and
  define ways of overcoming them


                                            5
        PIE Audiences
The country itself and its partners: PIE aims
at improving the introduction process and to
achieve the goals set while providing the
country with written references of what
exactly happened

Other countries introducing or that may do so
in future: apply lessons learnt from other
countries
                                                6
         Methodology
Terms of reference created
District sampling for field visits (attempts
made to select representative sample of the
country districts for the evaluation)
Evaluation tool (use of standardize
questionnaire for various levels: Central,
Province, district/health facility).
  Individual interviews
  Exit interviews with caretakers
  Observation of immunization session, the
  environment, cold chain system, vaccine
  management, injection safety, wastage
  management etc.                              7
Sequence of events leading to the PIE

EPI review
National plan for new vaccine introduction
Vaccine fund application submitted
New vaccine Introduced
Early assessment in some cases
PIE

                                        8
     Timing of the evaluation
Timing has been tailored to the country need:

  If too closed, findings may be cluttered with
  short-live operational issues that will not have
  lasting effect on the program
  If too late, the program may lose the ability to
  detect problems early enough to allow prompt
  corrective action - Lost of memory
  Recommend time between is 8 to 18 months
  following introduction
                                                 9
Similarities with other EPI reviews
 Address the 5 functions of immunization
services
 Evaluate all levels of the health care
system
Select representative sample of the health
system
Opportunity to follow-up on
recommendations of previous EPI reviews

                                        10
    Comparative advantages
Small teams
Limited time
  No extensive data analysis
  Qualitative process description
Inexpensive $3000-$4000 (local expenses)
Possible link with disease surveillance
(Hib, Yellow Fever)


                                     11
Example:Benin (9th month)
 Health facilities using all types of syringes and
needles (ADs, standard and sterilizables)
 No national policy on injection safety
 Very weak/non-functioning ICC
 HepB introduced with catch-up, up to 2 years of
age, risk of vaccine shortage
Fear of vaccine wastage causing low coverage
Lack knowledge of appropriate storage
temperature for HepB vaccine

                                               12
Examples:Eritrea (10th month)

 Inability of health workers to forecast
 vaccine and supply needs
 The absence of monitoring system for
 drop outs and vaccine wastage
 Inappropriate storage temperatures
 even at regional level


                                           13
    Example:Mozambique
 There were 200,000 doses of DTP still in
one provincial cold store
Has two columns of wastages, but only on
the monthly reporting forms
All vaccines frozen in one district cold store



                                            14
      Example:Tanzania
 The implementation of MVP instituted, with
  reduction vaccine wastage
 Defective BCG syringes discovered and
 supply discontinued
 Authorities aaproved to consider Hib
vaccine introduction


                                        15
             Conclusion
PIE proved to be a useful excercise in the early
stage of NV intro in the region
Process documentation of new vaccine
introduction now available in most countries
PIE is limited,focused and cost effective
Provides an opportunity for supportive supervision.
PIE provides an opportunity to follow up on
recommendation of previous reviews
Tool Has the potential to be expanded or
integrated with other evaluations
Lack of dry storage in most countries            16
    Way forward for PIE
PIE tool could be expanded to include
other EPI assessment tools (MNT risk
assessment, vehicle, etc)

It is possible to combine PIE with the rapid
EPI assessment tool used in southern
Africa or with formal EPI reviews

                                          17
Thank you!

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