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WHO/UNICEF Framework for Collaboration to ensure sustainable measles mortality reduction

To achieve sustainable reduction of measles it is important to set out a framework for good practice. Based on experience gained in a number of countries, at a Measles Informal Consultation held in Geneva in January 2002, WHO and its partners identified and agreed upon criteria that should be used to assess national plans of actions, so that the sustainability objective is achieved. These criteria are outline below.

The following criteria should be satisfied before embarking on accelerated measles control efforts or there should at least be a commitment by the country and its partners to fulfil them in timely manner.

1. There must be a multi-year immunization plan including measles activities, with a detailed 1-year work-plan, both endorsed by the national inter-agency coordinating committee (ICC) and with a clearly defined role for all key stakeholders.



2. The plan should include a defined strategy, financing plan and adequate human resources (technical support) to sustain the impact for at least 5 years. This involves identifying and addressing the reasons for low coverage to ensure that at least 90% of children receive a first opportunity for measles immunization, and providing a second opportunity for measles immunization through either routine immunization or measles supplementary immunization activities, as appropriate.



3. If measles supplementary immunization activities are implemented, they should be in accordance with broader country and regional immunization and health goals, and include funding for a comprehensive evaluation plan. When conducting measles supplementary immunization activities, the priority is to protect children at highest risk from dying from measles (in general children 5 years), as well as those in older age groups as they are often important sources of measles virus infection for young children.



4. Measles surveillance activities should be in place, or in the process of being established, to obtain and analyse basic data for monitoring and evaluating impact. These activities should be built on existing infrastructure (e.g. AFP surveillance) and facilitate development of integrated surveillance systems.



5. Countries with large populations or those experiencing complex emergencies represent an opportunity for partners to work in close collaboration in reducing measles deaths. Sufficient planning time is essential to ensure high-quality and sustainable impact of measles mortality reduction activities. Careful assessment of feasibility and operational issues (e.g. considering progressive implementation by geographic area and/or age group) is needed, particularly in polio-endemic countries, to ensure that measles mortality reduction and polio-eradication activities are synergistic.

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