Measles mortality reduction in SEAR Best practices A

Measles mortality reduction in SEAR Best practices A global partnership to stop measles & rubella

Presentation Outline § Regional Snapshot § Implementation of Strategies – Desired Outcome – Undesired Outcome § Best Practices – Bangladesh – Myanmar – Nepal § Summary A global partnership to stop measles & rubella

Reported Measles and Rubella Cases 1 and MCV 1 Coverage 2 South 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 A global partnership to stop measles & rubella 1 2 WHO vaccine-preventable diseases: monitoring system 2012 global summary WHO/UNICEF estimates, 2012 Data as of 30 Jul 2012

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

Accelerated Measles Surveillance Implementation of strategies Desired outcome, Bangladesh, 2004 -2012 (June) 2 districts Other districts National level A Jun partnership to stop measles & rubella Source: Monthly VPD data up to global 2012

Accelerated Measles Surveillance Implementation of strategies Desired outcome, Nepal, 2003 -2012 (June) Source: Monthly VPD data up to Jun 2012 A global partnership to stop measles & rubella

Myanmar, 1990 -2012: heading in the right direction Nation wise Measles SIA (2002 -2004) Nation wise Measles SIA (2007) ** ** A global partnership to stop measles & rubella Data as of 29 February 2012

MCV 1 coverage 1 and measles cases 2, Country I, 1980 -2011 92105 95 % 94 % 93 94 % 106 102 93 % 78 % 97 % 92 % 98 % SIA 1 2 WHO/UNICEF estimates, 2012 WHO vaccine-preventable diseases: monitoring system 2012 global summary A global partnership to stop measles & rubella

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 A global partnership to stop measles & rubella

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 (multisector) A global partnership to stop measles & rubella

Best practices Bangladesh § National Immunization Policy- 2010 § Comprehensive Multi-Year Plan (c. MYP) 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 A global partnership to stop measles & rubella Source: WHO-UNICEF JRF 2010

High level political commitment • Political commitment from highest level for immunization- Her Excellency The Honorable Prime Minister, Sheikh Hasina inaugurated 19 th NIDs A global partnership to stop measles & rubella

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 A global partnership to stop measles & rubella

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 A global partnership to stop measles & rubella

Monitoring of SIAs § Measles SIAs monitored by independent observers A global partnership to stop measles & rubella

International recognition fo 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 A global partnership to stop measles & rubella

Best practices Nepal § There is a c. MYP 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, Hep. B) is co-financed by the government. § There is a draft “Immunization Act 2012”. A global partnership to stop measles & rubella Source: WHO-UNICEF JRF 2010

High level commitment: Launching of campaign by the minister with secretary, DG, Member of parliament, partners) A global partnership to stop measles & rubella

Female Community Health Volunteers carrying vaccine and distributing invitation cards A global partnership to stop measles & rubella

Getting community support § 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. A global partnership to stop measles & rubella

Using Independent Monitoring (IM) data to improve SIA coverage Rehearsal for IMs before departing to field. Local village leaders participate in meetings to improve immunization A global partnership to stop measles & rubella

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. A global partnership to stop measles & rubella

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. A global partnership to stop measles & rubella

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. A global partnership to stop measles & rubella

Best practices Myanmar § The country has a c. MYP for immunization covering 20122016. § 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. A global partnership to stop measles & rubella

Activity planning § c. MYP 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. A global partnership to stop measles & rubella

Raising public awareness on immunization § Local street drama with village volunteers, school teachers, children and parents. § People about immunization; good public demand. A global partnership to stop measles & rubella

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. A global partnership to stop measles & rubella

A global partnership to stop measles & rubella

Accelerated Measles Surveillance Take home message: Implementation of strategies Desired outcome, Bangladesh, 2004 -2012 (June) 2 districts Other districts National level A Jun partnership to stop measles & rubella Source: Monthly VPD data up to global 2012

Anne Ray Charitable Trust A global partnership to stop measles & rubella 32

MCV coverage 1 and measles cases 2, 1980 -2011 92105 95 % 94 % 93 94 % 106 102 93 % 78 % 97 % 92 % 98 % SIA WHO/UNICEF estimates, 2012. For MCV 2 Coverage: Country Official Estimates- JRF used 2 WHO vaccine-preventable diseases: monitoring system 2012 global summary A global partnership to stop measles & rubella 1