Post 00646e : Improving Coverage

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 : http://www.technet21.org/Drop_out_in_civ.ppt 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... Gasss _________________________________ 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. Alejo ---------------------------------------------------------------------------------------- Visit the TECHNET21 Website at http://www.technet21.org You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. ______________________________________________________________________________ To UNSUBSCRIBE, send a message to : mailto:[log in to unmask] Leave the subject area BLANK In the message body, write unsubscribe TECHNET21E ______________________________________________________________________________ The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. It is moderated by Claude Letarte and is hosted in cooperation with the Centre de internationale , Canada (http://www.ccisd.org) ______________________________________________________________________________ ##text##