POST 00646E : IMPROVING COVERAGE
Follow-up on Post 00642E
5 March 2004
This posting contains two contributions. The first is from Gasse
(mailto:[log in to unmask]) from UNICEF Headquarters. It is likely to
generate much discussion. The PowerPoint presentation to which GASSE
refers is indeed available, I admit, and it was sent to me after Robert
Davis' request. When studying it, I then thought that it didn't share
enough details without a full presentation or a supporting document to be
practical for programme managers. I was told that such a detailed document
exists but despite a number of requests, I never saw it. Time went by and
the presentation was never published on TechNet.
It hasn't lost any relevance over time and I will let members judge by
themselves this time. As it is a rather heavy document (almost 1Meg), it
can be accessed directly from our website at :
Actually, a new page has been added to our site for country programme
documents. Programme Managers, if you feel that you have documents from
your National Programme that would interest other members, please do not
hesitate at sharing them with us.
The second contribution is from Alejo Bejemino
(mailto:[log in to unmask]) from UNICEF/Afghanistan. The IPO (input,
process, output) approach that he uses in his example is indeed helpful. It
is one among a number of analysis frameworks that various management
schools have developed to help with programming and problem-solving. The
body of his contribution is in tabular form thus incompatible with "plain
text" messaging. So you will find it attached and it is very light in Ks.
* Cote d'Ivoire experience in reducing drop-out rate is a classic which
was shared with Robert Davis. It is in a Power point presentation format
and still available.
* Tanzania has achieved major successes in reducing drop-out rate and
improving coverage, using effectively ISS funds in low-performing districts
with an approach that could be used by many countries as well. Documenting
the lessons learn in Tanzania could be useful to many countries.
* PDRLao a country where 60% of the population can only be reached by foot
has also an experience to share using the RED concept in a few districts.
* Cambodia and Togo have also made progress using the RED approach
What is missing is proper documentation of theses efforts to be shared as
widely as possible.
However in many countries with low coverage only out-of-the-box thinking
and innovative strategies will bring a substantial difference in
coverage...One such strategy should be "routine campaigns" for areas beyond
reach of current immunization services, as well-planned and well-funded as
Measles and MNTE are, with manpower exclusively from the Health System.
Mobile teams providing 4 times a year preventive and curative services
(limited package of life saving interventions) to identified populations
will make that coverage difference we looking for. Every developing country
has from 5% to 80% of populations that can only be reached that way due to
system barriers..and will require extra funding to do so. It is time in
those areas to offer more than just one antigen , or only immunization and
reduce inequities in health.
Of course some ideologues are against a campaign delivery mode and think
such an approach destroys the health system. Do we have on the short and
mid-term any alternative strategies to reach the never-reached in many
countries? Do we have an alternative strategy to reach the MDGs? Nobody
can overturn the low pace of development.
Such strategies have to be an integral part of a well-thought Health
System. Countries need to reach their entire population and develop
strategies that can overcome sytem barriers and reach, for equity reasons,
the never-reached populations. Some will say, these are unsustainable
strategies...Polio delivery strategies (NIDs) have been sustained yearly
for the past 14 years because of international and national consensus, and
commitment to Polio eradication with sustained funding as most of these
countries cannot afford the price of NIDs in their national budget.
A 5 to 10-year plan with funding for 4 yearly campaign-style delivery mode
operations for well-identified special populations is a sustainable
approach. But we need global consensus.and commitment of all partners and
document the impact of such strategies in few countries to prove the case.
However delivering only one antigen or only immunization services is not
acceptable today in such a delivery mode. Adding few life-saving
interventions would be the only way to reduce substantially IMR or
underfive mortality in those areas. Every country will have to define their
own essential minimum package of services based upon local epidemiology and
effectiveness of interventions.
Would love reactions...
Just would like to share my experience with immunization campaigns (NIDs,
Measles) and Routine EPI activities. I'm looking at these activities as the
linkages of the IPO (input, process, output). To generate a desired output,
the input should be of certain proportions and be cautiously processed.
Allow me to present these in tabular form.
Thanks and regards.
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