BACK TO SEVENTH GAVI BOARD MEETING
Seventh GAVI Board Meeting, Stockholm, 11 March 2002
Report by the London School
School of Hygiene and Tropical Medicine: Summary of Presentation
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
- 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,
- 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
- 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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