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Seventh GAVI Board Meeting, Stockholm, 11 March 2002

Report by the London School of Hygiene and Tropical Medicine: Summary of Presentation and Discussion

Click here to download presentation [Powerpoint, 47kb]

  • Gill Walt of the London School of Hygiene and Tropical Medicine presented the main findings of the report, "New Products into Old Systems:  Initial Impact of GAVI in Countries". The study caveats included the fact that only four countries were visited and these were not necessarily a representative sample selection of the countries was based on those which the researchers knew, had previous experience in, and were accessible.

  • The main report findings were:

    • Countries welcomed the renewed focus on immunization, the opportunity to introduce hep B vaccine and auto-disable syringes and disposal boxes, and the flexibility of funding for systems support.
    • Immunization systems in the countries studied showed serious weaknesses, including staff shortages and inadequate allowances which compromised their ability to achieve targets; cold chain problems; poor standards of supervision; inadequate waste disposal and inaccurate data reporting.
    • There was some concern that countries received pressure to accept sub-optimal second choice of vaccine formulations, due to vaccine shortages, and whether Hib was appropriate for introduction.
    • The cost of Hib vaccine (at current prices) has a major impact on the cost of the immunization program in Ghana, raising questions over future sustainability.

  • Professor Walt recommended that GAVI needs to take steps to ensure:

    • Introduction of new products does not unduly distort countries' immunization priorities
    • Quantitative performance monitoring is complemented by the addition of other indicators
    • Sufficient systems support is available for implementation of routine EPI, managing information systems, safe disposal
    • Other players are involved in the above, to ensure coordination with existing national processes, to widen the constituency of support
    • Sustainability, by working at a pace which allows change to be consolidated (and costs to be met)

  • The report is an important opportunity to consider the progress and future challenges for  GAVI and the Vaccine Fund. in enhancing collaboration at the country level. Many of the report's findings will be helpful to the GAVI alliance

  • Dr Sam Adjei, Deputy Director-General of Health Services in Ghana expressed some concerns about the design and implementation of the research, having also consulted with the EPI manager in Tanzania - one of the other countries included in the report. While they welcomed the report for raising pertinent and important issues, according to Dr Adjei:

    • The researchers did not adequately convey the process to EPI staff in either country, or brief them on the findings before leaving the country.
    • Some of the descriptions of Ghana's situation were inaccurate. The ICC in Ghana was not under undue time pressure do decide whether to accept pentavalent DTP-hepB+Hib vaccine, nor was the vaccine's epidemiological appropriateness in question. In fact, the country had planned to introduce this vaccine in 2003; its decision was whether it would be able to introduce the vaccine earlier than planned.
    • Many of the issues raised in the report pre-date the emergence of GAVI and the Vaccine Fund, e.g., the challenges of securing sustained financing and staffing of health services. What is important is to integrate sector-wide approaches and global initiatives to produce and sustain better health outcomes.

  • Many of the long-standing issues raised in the report were in fact reasons for establishing GAVI. What is critically important for GAVI is to assess whether its support is succeeding in addressing these weaknesses and making immunisation systems effective.

  • Minister of Health Fatoumata Nafo-Traore from Mali, reporting feedback received from her colleagues in Africa, said that for many countries, the GAVI application and disbursement process has not been too fast, and in some cases it has even been too slow. She also noted that before introducing more expensive new vaccines support should be secured from national decision-makers who control the health budget.

  • It will be important to consider how best to integrate ICC efforts with broader health partnerships in countries. Some partner constituencies such as the bilateral donors and development banks are more involved in these broad partnerships than in immunisation or ICCs; they have a strategic advantage in this regard.

  • It will be important to include the impact of introduction of AD syringes on health care waste management as a part of countries' annual progress report to GAVI and the Vaccine Fund.



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