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Post00283 ######################### 21 August 2000 CONTENTS Date: Wed, 09 Aug 2000 08:04:06 -0400 From: "Robert Steinglass" To: [email=A.Bass@uq.edu.au]A.Bass@uq.edu.au[/email] Cc: [email=slandry@usaid.gov]slandry@usaid.gov[/email], [email=olivej@who.ch]olivej@who.ch[/email], [email=wengerj@who.ch]wengerj@who.ch[/email], [email=ZaffranM@who.ch]ZaffranM@who.ch[/email] Subject: Re: making use of TECHNET Forum related to the Task Force on Have you gotten any responses yet on topics which could be addressed to TECHNET? Here is a quick and too-long (10) list of topics which relate to the expertise represented in TECHNET and which through a structured discussion might help the GAVI efforts. - how can TECHNET contribute to GAVI - how to build capacity for immunization programs - how to improve outreach - how to conduct an effective EPI review as part of GAVI: what has been learnt in the past - how to reduce drop-out and what actions are needed and what actions are needed by diffferent levels - how to reduce wastage and what actions are needed by different levels - is there a need for a smaller (e.g. 5-dose) vial size of new more expensive vaccines? - how to avoid accidental freezing - how to keep vials dry so labels can be read and don't come off - how to improve labelling of vials for better understanding - how to improve participation on TECHNET Forum by nationals Robert -- >>> Allan Bass 08/03 7:28 PM >>> Dear Jay and all, Thanks for copying me on this interesting discussion. * Are there any objections to posting this to Technet Forum? I'm currently working on a series of GAVI postings - which started with the Guidelines earlier this week. The update on GAVI/CVF submissions should be posted today. This may also dovetail with the Technet Strategic Framework postings which should start in the next week or so. regards and best wishes, allan --- From: [email=wengerj@who.ch]wengerj@who.ch[/email] X-Mailer: ccMail Link to SMTP R8.31.00.5 Date: Wed, 02 Aug 2000 16:42:42 +0200 To: , , , Cc: , , , , , , Subject: Re: making use of TECHNET Forum related to the Task Force on Robert> Thanks for the note. I would like to comment on 1 aspect of Technet involvement which we HAVE discussed - use of technet persons for consultancies to countries wishing to put together and/or organize various components of EPI programs - ie, general 5 year plans, reviews, and ICC's. We realize the Technet membership is probably the biggest gathering of general imm prog experts around. Although a number of members can be contacted through contacts with other organizations (ie, BASICS, CDC, WHO, UNICEF), a large number of the members who might be more available are not directly associated with any specific large organization, and it has been a bit hit and miss about how to get in contact with them. Several of these persons have already been lined up with GAVI related projects, some through personal contacts, others through advertising on the technet forum pages. However, this is not really systematized yet and we probably need to figure out how to best access this expertise. We are open for ideas on this. I am trying to form an ad-hoc sub group on country coordination to work on ideas for the TFCC meeting in late Sept. The volunteers for this sub group, which is to come up with ideas for plan of action in this area, include only WHO, CDC, and UNICEF, to my knowledge. Can we have a nomination or two representing the technet membership for this group (which will interact a few times by email and conf call between now and late sept?). As far as technet input on GAVI issues in general, I will leave that to others to address. Jay ---------------------- Reply Separator ---------------------- Subject: Re: making use of TECHNET Forum related to the Task Force on Author: "Robert Steinglass" Date: 8/2/00 8:23 AM The GAVI assessments, 5-year work planning and the results of the country proposal reviews has revealed a disturbing problem: there is a serious shortage of expert EPI consultants with operational and programmatic field experience in developing countries. This strikes to the heart of the issue of capacity building which the Task Force on CC and TS will need to address. Related to this, I have been meaning for some time to suggest to the new Task Force about systematically making use of the TECHNET Forum on selected issues which face GAVI, particularly those within the mandate of the Task Force on CC and TS. TECHNET is a repository of expertise on operational and programmatic aspects of immunization programs in developing countries. The Forum could add its perspectives on such operational issues as wastage, drop-out, vial size, etc. and bring a dimension of field issues into the global-level discussions This would have to be done in a carefully structured way. Some may worry that involvement of the Forum might slow down GAVI or introduce bothersome details. I believe it is worth these risks, because their field perspective will help strengthen this major initiative at all levels - the conceptual and the field. Has this been discussed at all? Robert Robert Steinglass Immunization Team Leader BASICS 1600 Wilson Blvd., Suite 300 Arlington, VA. 22209 USA voice: 1-703-312-6800 fax: 1-703-312-6900 e-mail: [email=rsteingl@basics.org]rsteingl@basics.org[/email] At 04:42 pm 2/08/00 +0200, [email=wengerj@who.ch]wengerj@who.ch[/email] wrote: > Robert> Thanks for the note. I would like to comment on 1 aspect of >Technet involvement which we HAVE discussed - use of technet persons >for consultancies to countries wishing to put together and/or organize >various components of EPI programs - ie, general 5 year plans, reviews, >and ICC's. > >We realize the Technet membership is probably the biggest gathering of >general imm prog experts around. Although a number of members can be >contacted through contacts with other organizations (ie, BASICS, CDC, >WHO, UNICEF), a large number of the members who might be more available >are not directly associated with any specific large organization, and >it has been a bit hit and miss about how to get in contact with them. >Several of these persons have already been lined up with GAVI related >projects, some through personal contacts, others through advertising on >the technet forum pages. However, this is not really systematized yet >and we probably need to figure out how to best access this expertise. > >We are open for ideas on this. I am trying to form an ad-hoc sub group >on country coordination to work on ideas for the TFCC meeting in late >Sept. The volunteers for this sub group, which is to come up with >ideas for plan of action in this area, include only WHO, CDC, and >UNICEF, to my knowledge. Can we have a nomination or two representing >the technet membership for this group (which will interact a few times >by email and conf call between now and late sept?). > >As far as technet input on GAVI issues in general, I will leave that to >others to address. > >Jay >---------------------- Reply Separator ---------------------- >Subject: Re: making use of TECHNET Forum related to the Task Force on >Author: "Robert Steinglass" >Date: 8/2/00 8:23 AM > >The GAVI assessments, 5-year work planning and the results of the >country >proposal reviews has revealed a disturbing problem: there is a serious >shortage >of expert EPI consultants with operational and programmatic field >experience in >developing countries. This strikes to the heart of the issue of >capacity >building which the Task Force on CC and TS will need to address. > >Related to this, I have been meaning for some time to suggest to the >new Task >Force about systematically making use of the TECHNET Forum on selected >issues >which face GAVI, particularly those within the mandate of the Task >Force on CC >and TS. TECHNET is a repository of expertise on operational and >programmatic >aspects of immunization programs in developing countries. > >The Forum could add its perspectives on such operational issues as >wastage, >drop-out, vial size, etc. and bring a dimension of field issues into the >global-level discussions This would have to be done in a carefully >structured >way. Some may worry that involvement of the Forum might slow down >GAVI or >introduce bothersome details. I believe it is worth these risks, >because their >field perspective will help strengthen this major initiative at all >levels - the >conceptual and the field. > >Has this been discussed at all? > >Robert > > >Robert Steinglass >Immunization Team Leader >BASICS >1600 Wilson Blvd., Suite 300 >Arlington, VA. 22209 >USA > >voice: 1-703-312-6800 >fax: 1-703-312-6900 >e-mail: [email=rsteingl@basics.org]rsteingl@basics.org[/email] --- X-Mailer: Novell GroupWise 5.2 Date: Wed, 09 Aug 2000 14:43:01 -0400 From: "Rebecca Fields" To: [email=MWEEKS@basics.org]MWEEKS@basics.org[/email], [email=rsteinglass@basics.org]rsteinglass@basics.org[/email] Cc: [email=A.Bass@uq.edu.au]A.Bass@uq.edu.au[/email] Subject: Fwd: Re: making use of TECHNET Forum related to the Task ForceonCCand TS Yes, my idea for an issue that Technet could address vis a vis GAVI is that of the cluster involving vaccine wastage, vial size, impact on cold chain capacity at each level of introducing smaller size vials, and potential impact on session frequency. It would have to be framed more carefully as a set of issues. In the move to reduce vaccine vial size, one issue that arises is how to reconcile the discrepancy between vials of different sizes, e.g., 20 dose for BCG vs. 10 dose for DPT, OPV or measles, and 5 dose (or lower) for the "new" vaccines. Has anyone thought this through? What will be the instructions to the peripheral health worker about when to open a vial of vaccine when she/he is faced with different-sized vials? Will the BCG vial act as the rate-limiting step for opening vials or holding vaccination sessions? PAHO is just ordering 10-dose BCG vials this year--why isn't this happening elsewhere? In our current circumstances where you countries are putting a moratorium on training (recent countries include Zambia, Madagascar, and now Senegal), or where training is being cut to a minimum as part of integration (in Uganda, EPI's shrunk from two weeks to two hours in an integrated PHC course), how can such nebulous issues as the one above be communicated to health workers AND THEIR SUPERVISORS clearly? It took at least four years for the comprehension of VVM's to be developed at peripheral levels. No doubt GAVI doesn't have that timeframe in mind for new vaccine introduction. Rebecca Date: Fri, 04 Aug 2000 08:22:07 -0400 From: "Robert Steinglass" To: [email=mweeks@basics.org]mweeks@basics.org[/email], [email=rfields@basics.org]rfields@basics.org[/email] Subject: Fwd: Re: making use of TECHNET Forum related to the Task ForceonCCand TS Mime-Version: 1.0 Content-Type: multipart/mixed; boundary="=_227A8744.24452C24" fyi any ideas? Date: Fri, 04 Aug 2000 11:00:01 +1000 To: "Robert Steinglass" , [email=FBA@compuserve.com]FBA@compuserve.com[/email], [email=awylie@hamwylie.demon.co.uk]awylie@hamwylie.demon.co.uk[/email] From: Allan Bass Subject: Re: making use of TECHNET Forum related to the Task ForceonCC and TS In-Reply-To: Mime-Version: 1.0 Content-Type: text/plain; charset=US-ASCII Content-Disposition: inline Dear Robert, Anthony, and Alasdair, Yes - this really has been going on since - at least - the Technet'99 meeting. Jay has asked for the nomination of 2 Technet "representatives" - and I'm hoping to post his request to Technet Forum in the next week. I'm hoping to post an edited form of all the discussions in this thread soon - I have a lot of bits and will have to get agreements on posting. The main issue seems to me to be: That of establishing a useful mechanism for providing a reality (meaning - program implementation) based significant influence on the GAVI partners decision making and implementation processes. It is probably most important that the individuals who do the day to day management and administration of GAVI partners are influenced and informed on the choices, problems, costs, and implications including the unintended impact of decisions and methods. In this WHO has the natural lead role. Anthony's point about the disconnect between the WHO/GAVI policy/decision makers and the field is a good one. It represents both the changes that have taken place in WHO, post reorganization & $ constraints of recent years, and the generational gap that is self evident. Us old Technet folks - are seen as troublemakers - (I've heard complaints about all - as you no doubt have as well), disturbing the smooth planning process with field reality issues. Technet does not exist in isolation - from the organizations that participate in the Technet process to the Technet members that have a GAVI hat - and many are also Technet Forum subscribers. That is not to say that the are all logisticians or particularly well informed in logistics, but more and more do know that logistics management is critical to success. To make use of the forum, those of us interested in GAVI operations will need to post well articulated pieces to enhance the discussion. The mis-communications of ideas or perceived attacks will not be useful, as currently there seems to be good will from the policy level GAVI players. Sooner, rather than later, a formal mechanism for Technet participation in the GAVI process. Technet has done well on the issue of safe injections - that is part of the GAVI agenda. VVMs on other vaccines are just coming in.We have not done as well in other areas. The temperature zones, Low Temperature Protection, and PIS are still not at the equipment availability stage - just when more money is likely to go into rehabilitating the cold chain in many countries. What else are we lagging behind on. * What are the other issues that Technet must ensure is properly included in GAVI supported immunization service delivery? Everything from the supply system & cold chain to program management are Technet concerns. Perhaps we should try to draw up a list of specific issues to be addressed! * In parallel with GAVI development and field implementation, Technet urgently needs to complete the Technet Strategic Framework. John Lloyd left WHO and did not get a chance to work on it and I volunteered to help out - but in the event had less time to work on it than I would have liked - and my RTW trip added to the delay of posting the pieces necessary to work on it. In the next week or so all technet recommendations from Technet 1999 and 1998 will be posted. We will also try to post all of the older recommendations soon after. I propose that we use the Technet Strategic Framework process to strengthen both Technet and GAVI. Contributions and thoughts please! regards and best wishes, allan At 08:35 am 3/08/00 -0400, Robert Steinglass wrote: >Yes, I and (I assume others) have been raising this issue for quite some >time about the non-representation of field experienced persons in the >decion-making going on. I don't know if you saw the original e-mail from >me to Jay, Jean-Marc and Michel which I think touched this off. It is >frustrating, I agree. > >I understand that WHO may reach out to tap some of that field wisdom >represented by TECHNET, for example in the planning for a meeting in >September of a new GAVI Task Force on Country Coordination (and technical >support). I am a member of that Task Force. I don't yet know who else is. > >We are not participating in the management resource thing you referred to, >although we are aware of it. > >I hope that TECHNET Forum will be more engaged in GAVI for two reasons: >a) to inform GAVI, and >b) for TECHNET Forum itself to be revitalized and to remain relevant in a >changing world. > >I think it would be extremely useful for some regular participants to >TECNET Forum to think among themselves (not necessarily publicly on the >Forum) about how this could best be done. I know for a fact that WHO >(Wnger, Zaffran) is listening. > >I am going to share this with Allan Bass. > >Robert > > >>> Anthony Battersby 08/03 3:31 AM >>> >Robert, Alasdair, > >I agree with Alasdair, and It seems that there is a whole new cast of >characters in Geneva who know little or indeed nothing about TECHNET and >precious little about EPI. > >I suggest that two or three people from TECHNET should form part of the >GAVI decision making process. Afterall it is TECHNET members who actually >have the experience of making things work. Not one of the "big decision >makers" as far as I can make out has any field experience. The urgency is >entirely self made. What is the point of rushing if the result is half >baked plans that will not work? For example who has dreamed up this >management resource manual? Why is it thought necessary? We did all this >general stuff nearly 20 years ago. If there is a need now then it is for >country specific material in a great deal more detail than is being >offered. What is being proposed just looks amateur. > >Anthony --- Received: from BARRB0204.usaid.gov ([165.13.93.4]) by smtp.basics.org; Wed, 02 Aug 2000 08:39:56 -0400 Received: by BARRB0204.usaid.gov with VINES-ISMTP; Wed, 2 Aug 2000 8:41:44 EDT Date: Wed, 2 Aug 2000 8:38:25 EDT Message-ID: X-Priority: 3 (Normal) To: From: "Steve Landry" Reply-To: Errors-to: Subject: fwd: making use of TECHNET Forum X-Incognito-SN: 1125 X-Incognito-Version: 5.1.0.78 Mime-Version: 1.0 Content-Type: text/plain; charset=US-ASCII Content-Disposition: inline Robert, I fully support the use of Technet to solicit input on GAVI related issues. Steve --- To: "Robert Steinglass" , [email=FBA@compuserve.com]FBA@compuserve.com[/email], [email=awylie@hamwylie.demon.co.uk]awylie@hamwylie.demon.co.uk[/email] Subject: Re: making use of TECHNET Forum related to the Task ForceonCC and TS Cc: [email=Lloydj107@aol.com]Lloydj107@aol.com[/email], [email=a.bass@uq.oz.au]a.bass@uq.oz.au[/email] Dear Robert, Anthony, and Alasdair, Yes - this really has been going on since - at least - the Technet'99 meeting. Jay has asked for the nomination of 2 Technet "representatives" - and I'm hoping to post his request to Technet Forum in the next week. I'm hoping to post an edited form of all the discussions in this thread soon - I have a lot of bits and will have to get agreements on posting. The main issue seems to me to be: That of establishing a useful mechanism for providing a reality (meaning - program implementation) based significant influence on the GAVI partners decision making and implementation processes. It is probably most important that the individuals who do the day to day management and administration of GAVI partners are influenced and informed on the choices, problems, costs, and implications including the unintended impact of decisions and methods. In this WHO has the natural lead role. Anthony's point about the disconnect between the WHO/GAVI policy/decision makers and the field is a good one. It represents both the changes that have taken place in WHO, post reorganization & $ constraints of recent years, and the generational gap that is self evident. Us old Technet folks - are seen as troublemakers - (I've heard complaints about all - as you no doubt have as well), disturbing the smooth planning process with field reality issues. Technet does not exist in isolation - from the organizations that participate in the Technet process to the Technet members that have a GAVI hat - and many are also Technet Forum subscribers. That is not to say that the are all logisticians or particularly well informed in logistics, but more and more do know that logistics management is critical to success. To make use of the forum, those of us interested in GAVI operations will need to post well articulated pieces to enhance the discussion. The mis- communications of ideas or perceived attacks will not be useful, as currently there seems to be good will from the policy level GAVI players. Sooner, rather than later, a formal mechanism for Technet participation in the GAVI process. Technet has done well on the issue of safe injections - that is part of the GAVI agenda. VVMs on other vaccines are just coming in.We have not done as well in other areas. The temperature zones, Low Temperature Protection, and PIS are still not at the equipment availability stage - just when more money is likely to go into rehabilitating the cold chain in many countries. What else are we lagging behind on. * What are the other issues that Technet must ensure is properly included in GAVI supported immunization service delivery? Everything from the supply system & cold chain to program management are Technet concerns. Perhaps we should try to draw up a list of specific issues to be addressed! * In parallel with GAVI development and field implementation, Technet urgently needs to complete the Technet Strategic Framework. John Lloyd left WHO and did not get a chance to work on it and I volunteered to help out - but in the event had less time to work on it than I would have liked - and my RTW trip added to the delay of posting the pieces necessary to work on it. In the next week or so all technet recommendations from Technet 1999 and 1998 will be posted. We will also try to post all of the older recommendations soon after. I propose that we use the Technet Strategic Framework process to strengthen both Technet and GAVI. regards and best wishes, allan At 08:35 am 3/08/00 -0400, Robert Steinglass wrote: Yes, I and (I assume others) have been raising this issue for quite some time about the non-representation of field experienced persons in the decion-making going on. I don't know if you saw the original e-mail from me to Jay, Jean-Marc and Michel which I think touched this off. It is frustrating, I agree. I understand that WHO may reach out to tap some of that field wisdom represented by TECHNET, for example in the planning for a meeting in September of a new GAVI Task Force on Country Coordination (and technical support). I am a member of that Task Force. I don't yet know who else is. We are not participating in the management resource thing you referred to, although we are aware of it. I hope that TECHNET Forum will be more engaged in GAVI for two reasons: a) to inform GAVI, and b) for TECHNET Forum itself to be revitalized and to remain relevant in a changing world. I think it would be extremely useful for some regular participants to TECNET Forum to think among themselves (not necessarily publicly on the Forum) about how this could best be done. I know for a fact that WHO (Wnger, Zaffran) is listening. I am going to share this with Allan Bass. Robert >>> Anthony Battersby 08/03 3:31 AM >>> Robert, Alasdair, I agree with Alasdair, and It seems that there is a whole new cast of characters in Geneva who know little or indeed nothing about TECHNET and precious little about EPI. I suggest that two or three people from TECHNET should form part of the GAVI decision making process. Afterall it is TECHNET members who actually have the experience of making things work. Not one of the "big decision makers" as far as I can make out has any field experience. The urgency is entirely self made. What is the point of rushing if the result is half baked plans that will not work? For example who has dreamed up this management resource manual? Why is it thought necessary? We did all this general stuff nearly 20 years ago. If there is a need now then it is for country specific material in a great deal more detail than is being offered. What is being proposed just looks amateur. Anthony --- Date: Thu, 03 Aug 2000 08:35:10 -0400 From: "Robert Steinglass" To: [email=FBA@compuserve.com]FBA@compuserve.com[/email], [email=awylie@hamwylie.demon.co.uk]awylie@hamwylie.demon.co.uk[/email] Cc: [email=a.bass@mailbox.uq.oz.au]a.bass@mailbox.uq.oz.au[/email] Subject: Re: making use of TECHNET Forum related to the Task ForceonCC and TS Yes, I and (I assume others) have been raising this issue for quite some time about the non-representation of field experienced persons in the decion-making going on. I don't know if you saw the original e-mail from me to Jay, Jean-Marc and Michel which I think touched this off. It is frustrating, I agree. I understand that WHO may reach out to tap some of that field wisdom represented by TECHNET, for example in the planning for a meeting in September of a new GAVI Task Force on Country Coordination (and technical support). I am a member of that Task Force. I don't yet know who else is. We are not participating in the management resource thing you referred to, although we are aware of it. I hope that TECHNET Forum will be more engaged in GAVI for two reasons: a) to inform GAVI, and b) for TECHNET Forum itself to be revitalized and to remain relevant in a changing world. I think it would be extremely useful for some regular participants to TECNET Forum to think among themselves (not necessarily publicly on the Forum) about how this could best be done. I know for a fact that WHO (Wnger, Zaffran) is listening. I am going to share this with Allan Bass. --- X-Mailer: Novell GroupWise 5.2 Date: Wed, 02 Aug 2000 07:59:48 -0400 From: "Robert Steinglass" To: [email=A.Bass@uq.edu.au]A.Bass@uq.edu.au[/email], [email=birminghamm@who.ch]birminghamm@who.ch[/email] Subject: Re: Fwd: Re:shouldn't WHO be asking for DTP 1 data? I would have no objection. Let's hear from Maureen. >>> Allan Bass 08/01 7:28 PM >>> Dear Maureen and Robert, Any objections to posting an edited version of this discussion and the bits that went ahead of it? regards and thanks, alan >Date: Tue, 01 Aug 2000 11:38:23 +0200 >From: >To: , >Cc: , >Subject: Re:shouldn't WHO be asking for DTP 1 data? >Mime-Version: 1.0 >Content-Type: text/plain; charset=US-ASCII >Content-Disposition: inline > >yep. we will probably slip it into next year's joint form. > >____________________Reply Separator____________________ >Subject: shouldn't WHO be asking for DTP 1 data? >Author: "Robert Steinglass" >Date: 27-Jul-2000 11:29 > >Dear Maureen, > >I think I should share with you something which I prepared for another purpose >related to the GAVI review process. Michel and John Lloyd already have a copy >of this. > >I think that WHO/Geneva should consider revising the EPI Information System to >include reporting of DPT1 data. Countries already collect these data but they >are not passed to regional and global levels. Drop-out is becoming an >increasingly important indicator of programme performance and quality, as it >combines elements of supply, systems, demand and client satisfaction. >Furthermore, now that more expensive vaccines are being introduced, the >value of >being able to track and monitor drop-out has increased in importance. > From a >strictly economical point of view, we need to focus attention on drop-out >rates >as this contributes greatly to the high inefficiency and wastefulness of >programs. > >What do you think? > >Robert > >Robert Steinglass >Immunization Team Leader >BASICS >1600 Wilson Blvd., Suite 300 >Arlington, VA. 22209 >USA > >voice: 1-703-312-6800 >fax: 1-703-312-6900 >e-mail: [email=rsteingl@basics.org]rsteingl@basics.org[/email] Selected news items reprinted under the fair use doctrine of international copyright law: http://www4.law.cornell.edu/uscode/17/107.html


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