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A Comprehensive Policy framework for the National Immunization Programme
Dr Nihal Abeysinghe,[M.B.,B.S., MSc, M.D.]Chief Epidemiologist,Ministry of Health
Immunization Programme Sri Lanka : Vaccines used at present
BCG for Tuberculosis Oral polio for Poliomyelitis DPT / DT for Diphtheria, Pertusis
[Whooping Cough] & Tetanus Measles Rubella Tetanus Hepatitis B Japanese Encephalitis
Present status of the Immunization Programme, Sri Lanka
Dramatic reduction in illness, disability & death from
Poliomyelitis (0) since 1994Diptheria (0) in 2005Tetanus (25) / Neonatal Tetanus (0)Whooping Cough (32)Measles (24)
Childhood tuberculosisJapanese EncephalitisRubella
Very high vaccine coverage > 95%
Decision Making Process Evidence based decision making
Epidemiology Unit recognizes the needs Makes addition to the surveillance system Carries out burden & cost studies Proposes to the Advisory Committee on Communicable Diseases
Reviewed & approved by the Advisory Committee on Communicable Diseases [ACCD]
Discussion with a wider group of stakeholders; [“Immunization Summit-held on 5th January 2007”]
Negotiate for funding & convince the Finance Ministry Acquire logistics, other facilities & prepare the field staff Develop a communication strategy Develop plans for Continuous follow up, Monitoring & Evaluation
0
10
20
30
40
50
60
70
80
90
100
74 75 77 79 81 83 85 87 89 91 93 95 97 99 01 03 05
Year
Cove
rage
(%)
DPT3 Measles MR OPV3 HepB3
Strength of the Sri Lankan EPI : Number of Years Taken to Reach Over 90% Coverage Following Introduction of a New Vaccine
Present Challenges
Sustaining high coverage Achieving eradication & elimination targets Ensuring vaccines of assured quality Introducing new vaccines Strengthening the capacity for surveillance of
Vaccine-preventable diseases & Adverse Events following immunizations
Ensuring financial sustainability for the immunization programme
Strengthening Primary Health care system
Cost Considerations in the National EPI
Introduction of a new
vaccine is always
considered within the
framework of the National
EPI, not separately
Total cost
Vaccine
Injection supplies
Other routine recurrent
cost
Cold chain equipment
Transportation
$-
$2.0
$4.0
$6.0
$8.0
$10.0
$12.0
2007 2008 2009 2010 2011
Mill
ions
Traditional Vaccines New and underused vaccines
Injection supplies Personnel
Other routine recurrent costs Cold chain equipment
Other capital equipment
Policies that would help us to achieve the desired status
Equity and equality Ownership, partnership and responsibility
Government Other stakeholders International organizations
Accountability publicly accountable for the policies, goals,
strategies and actions Assured quality, safe products and services
Internationally recognized standards of quality, safety, and services are delivered according to best practices.
Policies that would help us to achieve the desired status
Adaptability to local needs and circumstances
commitment of all responsible stakeholders to appropriately adapt to the local needs and circumstances.
Sustainability through technical and financial capacity building
All stakeholders including the government should work collectively, to ensure financial and technical self reliance with continuing, incremental infrastructure building.
Policies and strategies based on evidence and best practices The choice of policies, strategies and practices should be based on
evidence from surveillance, monitoring and evaluation, operational research, diseases burden and impact assessments, and economic analyses
Key Strategies
Implementing the comprehensive Multi Year Plan & annual plans
Reaching children in “difficult to reach areas” Ensuring quality vaccine supply & accessories Improving quality services by enhancing the
service facilities, vaccine storage capacity & surveillance of Adverse Events Following Immunization
Creating a Community demand Introducing new vaccines to combat ‘emerging’
new VPD with financial sustainability plans Regular reviewing of the programme
“What works & What not”
Key Strategies
Ensuring financial sustainability Improving National regulatory authority activities by
regular discussions Promoting operational research : Disease Burden
studies Improving management of human resources Strengthening laboratory capacity Strengthening capacity for data management Planning for immunization in complex emergencies Develop & implement a comprehensive communication
strategy Include immunization in epidemic preparedness plans Define & delegate responsibilities to stakeholders
Thank you
Epidemiology UnitMinistry of Health