GAVI awards - November 2004
Ugandan Vice-President Prof. Gilbert Bukenya receives an immunization award from Dr Tore Godal, Executive Director of GAVI
GAVI awards for top performing countries
Five countries have received special awards from GAVI for outstanding performance in increasing immunization coverage. Immunization Forum looks at some of these success stories.
A country emerging from almost a decade of conflict has received a special award from GAVI for out-performing its own targets for immunization in 2002. Sierra Leone succeeded in reaching 30 000 more children than anticipated – boosting DTP3 coverage from 44% in 2000 to 62% by 2002.
In addition to receiving additional funding from GAVI – a US$20 payment for each additional child immunized – Sierra Leone has received a plaque in recognition of its exceptional performance.
Dr Mercy Ahun, Head of Country Programmes at GAVI, said Sierra Leone’s achievement was outstanding. “To emerge from a period of such instability and increase immunization coverage like this is remarkable,” she said.
Four other countries – Mali, Pakistan, Uganda and Tajikistan – were also awarded plaques for outstanding performance during 2002. The awards were presented in Geneva earlier this year, when government representatives were attending the World Health Assembly.
So how did they do it? And what can other countries supported by GAVI and The Vaccine Fund learn from their experience?
For Sierra Leone, the initial focus (not GAVIfunded) was on restoring health facilities destroyed during the conflict. When the conflict began in 1991 there were 741 Peripheral Health Units throughout the country. By 2002 only 450 of these were still functioning. Today the country has 600 fully functioning Peripheral Health Units.
Funds provided through The Vaccine Fund to help strengthen immunization services were used to provide cold chain equipment and generators, to distribute vaccines and other supplies for immunization, and to cover the cost of vehicle maintenance and the expansion of outreach activities at district level (including the payment of transport costs for the health workers involved).
Efforts to increase immunization coverage included training EPI staff and establishing monthly targets to help motivate them. Each health facility was ranked at district level and districts were ranked at national level – in a bid to encourage health workers to increase coverage. Another key strategy was the use of community mobilization to increase demand for immunization and the use of Village Development Committees to trace immunization drop-outs.
The emphasis on targets and ensuring recognition for high-performing health centres and districts was repeated in the other award-winning countries as well. Mali established a system of performance contracts signed between decentralized districts, the Ministry of Health and community partners. In Uganda (which boosted DTP3 coverage from 53% to 72% in 2000- 2002), best-performing districts were recognized and rewarded (with prizes including bicycles, financial awards, certificates and plaques) in national award ceremonies. At the other end of the spectrum, districts performing badly received extra supervision and focused support.
In both Pakistan and Uganda, the introduction of a new vaccine, hepatitis B, was believed to have been a key factor in increasing demand for immunization. In Uganda the introduction of the pentavalent vaccine (DTP3-HepB-Hib) was given a high-profile launch at the national level by President Yoweri Museveni. Cultural and religious leaders helped promote immunization, while at the grassroots level parish mobilizers registered children for immunization and followed up on those who dropped out. In Pakistan, EPI Programme Manager Dr Rehan Hafiz, said the new vaccine had served as a “promotion tool” to help increase the uptake of existing vaccines. In addition, training in the use of the new vaccine had helped re-motivate the country’s 8000 EPI vaccinators.
Other key elements in these success stories included efforts to expand access – both through increasing fixed delivery points and outreach services and through community mobilization to increase demand for immunization - and an emphasis on training, planning, monitoring and evaluation.
Dr Ahun said all five countries had worked extremely hard to increase coverage to the present level. “The challenge now is to maintain it,” she said.
Immunization Forum November 2004 -