POST 00220 : OPINION PART II

Post0220 OPINION PART II 24 January 2000 CONTENTS 1. RESPONSE: Post0191 NEW FEATURE: OPINION EPI & POLIO ERADICATION 2. OPINION: EPI AND POLIO 1. RESPONSE: Post0191 NEW FEATURE: OPINION EPI & POLIO ERADICATION In TECHNET Post0191, Robert Steinglass, BASICS, in an opinion piece, discussed the relationship between the accelerated polio eradication effort and the routine expanded program on immunization (EPI). Anthony Battersby, FBA Analysts, responds. The moderator apologizes for the delay in posting Anthony's comments. For the convenience of readers, Robert's original posting follows as Item 2. Robert originally presented his views at the Global Consultation on Progress towards the Eradication of Poliomyelitis, WHO/Geneva, 2-3June 1999. * We understand that WHO/V&B considers the points raised to be serious and is looking at ways to address these concerns. Direct feedback, comments, and field experiences to the TECHNET Forum would be appreciated. Action, comments and additions please: [[email protected]][email protected][/email] or use your reply button _____________________________________________________________ Date: Wed, 24 Nov 1999 12:22:55 -0500 From: Anthony Battersby Subject: Post0191 NEW FEATURE: OPINION To: Technet Moderator Dear Allan, Robert has raised a very important issue. One point that does not come across is the fact that we deal with a finite "energy bank". Health workers and those in the Agencies, have a finite amount of energy they are prepared to invest in their job. If they use that energy for a single activity such as polio eradication then they have little or nothing left for other aspects of their work. A quote from a UNICEF colleague "Polio is driving us crazy and everything else is neglected." Polio is a unique vaccine in EPI, it does not need a needle and syringe, to suggests that the management and application of this unique vaccine can be a "platform" (whatever that means) for the rest of EPI is deceptive. The malaise for EPI seems to start at WHO HQ where the systematic dismemberment of the service appears to continue. Why is this being done? Those of us who have been working in EPI since its early days know that the prospect of the routine service being sustained long term is problematic. Unless unambiguous and vigorous support is received from the top it will wither. Sorry for the delay in responding I have been in inaccessible parts. Anthony ____________________________________*________________________ 2. OPINION: EPI AND POLIO Re-posted from: TECHNET Post0191, NEW FEATURE: OPINION, 8 October 1999 Action, comments and additions please: [[email protected]][email protected][/email] or use your reply button _____________________________________________________________ The TECHNET Forum is inaugurating a new feature called "OPINION" to generate discussion, argument and the debate of ideas. The opinions expressed in this column do not represent the views of the TECHNET or any of the sponsoring or collaborating organizations. In his opinion piece, originally presented at the Global Consultation on Progress towards the Eradication of Poliomyelitis, WHO/Geneva, 2-3 June 1999, Robert Steinglass, BASICS, discusses the relationship between polio eradication and the routine expanded program on immunization (EPI). We had expected that the effort to eradicate polio would strengthen the routine national immunization programs that we have been building since the late 1970s. Robert's premise is that the push on polio, along with other global health policy and management trends have contributed to the recent decay of routine immunization programs. Your comments, arguments, and contributions to this discussion are appreciated. REPLY TO: [[email protected]][email protected][/email] _____________________________________________________________ Comments by Robert Steinglass at the Global Consultation on Progress towards the Eradication of Poliomyelitis, WHO/Geneva, 2-3 June __________________________________*__________________________ Polio achievements have been impressive. Demonstrates what can be accomplished when we apply sufficient human and financial resources behind a common purpose. But to some extent Rome is burning. We've built an immunization system over 2 decades which is decaying. Systems need constant attention, maintenance and repair. But funding is fragmented, unstable and insufficient. We should expect polio eradication - TO THE EXTENT THAT IT CAN - to help strengthen the routine system. But the routine system also needs DIRECT investment of its own. Polio funding cannot realistically be used for many of the practical things which are needed, e.g.: - updating stagnant EPI policies - introducing bottom-up monitoring for improved decision-making - improving injection safety - teaching some countries how to procure vaccines - introducing new vaccines - engaging the health sector reformers to ensure that immunization does not suffer in the process of reform. POLIO FUNDING CANNOT BE USED FOR THESE THINGS. THERE ARE SERIOUS THREATS. The routine program is being abandoned for a variety of reasons: - health sector reform - donor fatigue - donor belief that the job is done - donor over-possessiveness in some countries, leading to the exclusion of potential partners and to a lack of national ownership - lack of donor coordination at national level - and, yes, even polio eradication has been a threat by displacing, for some partners, funding which would otherwise be available for EPI. It used to be said that polio nests within EPI. Now we're told that polio has become the platform upon which the routine program must rest, the vehicle which will propel EPI forward. But how good a vehicle or platform is polio? No doubt there can be some positive spin-offs, although they are not automatic. We have to re-commit to deliberately enhance the positive spin-offs and reduce the negative. And I think that we have to honestly acknowledge that there are continuing needs for DIRECT INVESTMENT in the routine system, that indirect investment through polio eradication alone will not and cannot be expected to meet those needs. SO TWO CONCRETE THINGS THAT WE CAN DO: a) mobilize resources for strengthening immunization and not only for eradicating polio, and b) the UN community and countries need indicators that are tracked, along with numbers of stools, to increase the likelihood that routine systems and services are being sustainably strengthened. ____________________________________*________________________