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Measles mortality reduction in SEAR

This presentation outlines the regional snapshot, implementation of strategies, desired outcomes, and best practices for reducing measles mortality in the South East Asia Region. It covers success stories from Bangladesh, Myanmar, and Nepal, along with reported measles and rubella cases and MCV1 coverage data from 2000 to 2011. The text discusses the introduction of MR vaccine, implementation of strategies, and key practices like ownership, political commitment, financing, and innovation. It highlights successful initiatives such as the 2-district pilot in Bangladesh, rapid response teams, and the use of mobile phones for reporting in Nepal. The presentation also emphasizes areas like good planning, communication, injection safety, and partnerships. The importance of national immunization policy, comprehensive multi-year plans, and effective vaccine management is underscored, along with specific achievements and recognition for countries like Bangladesh.

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Measles mortality reduction in SEAR

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  1. Measles mortality reduction in SEAR Best practices

  2. Presentation Outline • Regional Snapshot • Implementation of Strategies • Desired Outcome • Undesired Outcome • Best Practices • Bangladesh • Myanmar • Nepal • Summary

  3. Reported Measles and Rubella Cases1 and MCV1 Coverage2South East Asia Region, 2000–2011 • RCV in RI - 4 countries (Bhutan, Maldives, Sri Lanka, Thailand) • RCV through SIA- 3 countries Bhutan, Maldives, Sri Lanka. Planned- Bangladesh and Nepal in 2012 1WHO vaccine-preventable diseases: monitoring system 2012 global summary 2 WHO/UNICEF estimates, 2012 Data as of 30 Jul 2012

  4. Second Dose of Measles Immunization, SEAR, 2011-12 Through Routine Immunization Through SIA Provide MMR vaccine Measles Vaccine through SIA; Provide MR Vaccine MR Vaccine introduction in 2012 (phase wise) Provide Measles Vaccine India 17 state Measles & 4 states MMR India 14 state Measles

  5. Implementation of strategiesDesired outcome, Bangladesh, 2004-2012 (June) Accelerated Measles Surveillance 2 districts Other districts National level Source: Monthly VPD data up to Jun 2012

  6. Implementation of strategiesDesired outcome, Nepal, 2003-2012 (June) Accelerated Measles Surveillance Source: Monthly VPD data up to Jun 2012

  7. Myanmar, 1990-2012: heading in the right direction Nation wise Measles SIA (2002-2004) Nation wise Measles SIA (2007) ** ** Data as of 29 February 2012

  8. MCV1 coverage1 and measles cases2, Country I, 1980-2011 92105 78 % 97 % 95 % 92 % 98 % 106 102 93 % 94 % 93 94 % SIA 1 WHO/UNICEF estimates, 2012 2WHO vaccine-preventable diseases: monitoring system 2012 global summary

  9. Best practices • Ownership • High level political commitment • National Technical Advisory Body • Financing • Innovation/Analysis/Research • 2-district pilot in Bangladesh catch-up campaign • Rapid response teams • Use of mobile phones for SMS reporting – Nepal • Case fatality rate studies in Bangladesh and Nepal • Trial of new technology – oral fluids for diagnosis

  10. Best practices (contd.) • Good planning, micro-plans, RED and Reaching Every Child (REC) in Nepal, using existing RI infrastructure • Communication and mobilization • Invitation cards • Involvement of local faith and traditional healers • Injection safety and AEFI • Independent monitoring • Partnership – international and national (multi-sector)

  11. National Immunization Policy- 2010 Comprehensive Multi-Year Plan (cMYP) for immunization with costing- updated covering 2011-2016 National Committee on Immunization Practices (NCIP) 29% of all spending on vaccine is government financed. 37% of all spending on routine immunization is government financed. Government paid 75% cost of last measles SIA. All 64 districts have updated micro-plans that include activities to raise immunization coverage Effective vaccine management (EVM) -- last assessment conducted and cold chain equipment inventory updated in 2011 A national system to monitor adverse events following immunization (AEFI) is available Best practices Bangladesh Source: WHO-UNICEF JRF 2010

  12. High level political commitment • Political commitment from highest level for immunization- Her Excellency The Honorable Prime Minister, Sheikh Hasina inaugurated 19th NIDs

  13. High level political commitment (contd.) • Measles Follow-up Campaign 2010 • Combined with OPV, Vitamin –A and Albendazole • Inaugurated by Prof. Dr A F M Ruhul Haque, Minister, MOH&FW • Coverage Evaluation Survey • Annual CES conducted since 1991 • Findings Disseminated by Minister, MOH&FW

  14. Few Examples of activities Brand for immunization EPI Logo (Moni Flag) is branded for immunization all over the country • Strong means of communication • Miking • Interpersonal communications • Field worker visits • Vaccines & Logistics distribution • Daily monitoring of stocks at all levels • Effective distribution system by porters

  15. Monitoring of SIAs Measles SIAs monitored by independent observers

  16. International recognition for Bangladesh UN Award Prime Minister Sheikh Hasina receives a UN Wards for Bangladesh’s outstanding achievements in attaining MGDs particularly in reducing child mortality at New York on September 19, 2010 GAVI Honours Bangladesh For Best Immunization performance Hanoi, Vietnam, November 2009

  17. There is a cMYP 2011-2016 for immunization. A standing technical advisory group on immunization is available Vaccine provided through static and outreach services. 20% of all spending on vaccine was government financed. 22% of all spending on routine immunizations was government financed. Routine vaccines: BCG, OPV, Measles, TT and JE are procured from government funds, and Pentavalent (DTP, Hib, HepB) is co-financed by the government. There is a draft “Immunization Act 2012”. Best practices Nepal Source: WHO-UNICEF JRF 2010

  18. High level commitment: Launching of campaign by the minister with secretary, DG, Member of parliament, partners)

  19. Female Community Health Volunteers carrying vaccine and distributing invitation cards

  20. Female Community Health Volunteer (FCHVs) play a vital role in immunization service delivery, including social mobilization, during SIAs. FCHVs and volunteers help children out of home to get vaccinated. Getting community support

  21. Rehearsal for IMs before departing to field. Using Independent Monitoring (IM) data to improve SIA coverage Local village leaders participate in meetings to improve immunization

  22. Independent monitoring National and International Monitors invited for SIA monitoring. They discuss various issues for improving immunization coverage. Paramedical students getting orientation on measles and rubella prevention.

  23. Monitoring on the Indo-Nepal border Porous borders with India monitored during national immunization campaigns. SMOs from India and Nepal meet to discuss cross-border issues.

  24. Monitoring coverage EPI supervisor checks kids for immunization status in public places Field supervisors searched small settlement deep in the forest without access to immunization.

  25. Best practices Myanmar The country has a cMYP for immunization covering 2012-2016. All townships have updated micro-plans to improve immunization coverage. There is functional technical advisory group on immunization. Effective Vaccine Management and cold chain inventory assessment is conducted regularly.

  26. Activity planning cMYP for immunization covering 2012-2016 available. Detailed planning of routine and SIAs are done. All 330 townships have updated micro-plans to improve immunization coverage. Cold chain equipment inventory updated regularly.

  27. Raising public awareness on immunization Local street drama with village volunteers, school teachers, children and parents. People about immunization; good public demand.

  28. Coordination and cooperation Excellent coordination with other ministries, UN agencies, local and International NGOs and partners including WHO, UNICEF, UN Foundation, CDC Atlanta and American Red Cross. Military helicopters transport vaccines in hilly and many remote areas of Myanmar during measles SIAs.

  29. Take home message: Implementation of strategiesDesired outcome, Bangladesh, 2004-2012 (June) Accelerated Measles Surveillance 2 districts Other districts National level Source: Monthly VPD data up to Jun 2012

  30. Anne Ray Charitable Trust

  31. MCV coverage1 and measles cases2, 1980-2011 92105 97 % 92 % 98 % 106 102 93 % 94 % 78 % 93 94 % 95 % SIA 1 WHO/UNICEF estimates, 2012. For MCV2 Coverage: Country Official Estimates- JRF used 2WHO vaccine-preventable diseases: monitoring system 2012 global summary

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