The article provided good news and both EMRO and Project Optimize should be congratulated for selecting Tunisia for this important activity. Having worked in Tunisia, knowing the situation and their seriousness, I am certain that the result will be significant and the finding will be replicable and useful for other countries.
I am also pleased to understand that the role of private sector in supply chain has been considered. However, in my opinion, the increasing role of the private sector in providing immunization services should also be included into the project. Tunisia has a strong pediatric association and undoubtedly they provide a big chunk of immunization particularly in large urban areas. The recent experience in Syria showed the importance of this sector in regard to vaccination programs. Tunisia is not an exception. Private sectors providing immunization services are increasing in Iran, Egypt, and the Gulf Countries and to a smaller extent in Pakistan too.
In Syria, it is estimated that from 10 to 15% of total immunization is provided by private physicians particularly by pediatricians. My feeling is that Tunisian private sector must be more active in regard to provison of vaccination services. In Syria, private physicians purchase vaccines from pharmacies belong to Ministry of Health. The price of vaccines purchased from MOH pharmacies is high, on average as high as US $ 10 per dose. Unverified information indicates that the private physicians charge up to US $ 30 for each immunization when the bulk of immunization provided by the MOH is free of charge.
The unanswered question in Syria was whether private physicians were aware of the VVM function or not. I hope the project includes the role of private sector in Tunisia, provides answers to these questions and addresses the efficiency and effectiveness of the private sector’s network of vaccination.
I also would like to bring to your attention that EPI Tunisia was aware of the
Vaccination Supplies Stock Management (VSSM) computer tool originally designed by Eastern Mediterranean Regional Office and in some stage were interested to use it as their standard tool for the national and provincial stores. Version 4.5 of VSSM is now ready for use and it is translated into French and Arabic.
VSSM provides possibility of management of all supplies (injection equipment, cold chain equipment, all types of pharmaceuticals) and supports bundling of all supplies with vaccines. Since one of the objectives of the project is to modernize the information system in Tunisia, I suggest considering the use of VSSM in Tunisia and to further prove its utility and suitability and to probe its further expansion and development through the activities of this project.
Mojtaba Haghgou