Monday, 03 November 2008
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POST 01345E: DURING GLOBAL RECESSION USE SCARCE RESOURCES RESPONSIBLY (POLIO ERADICATION) FOLLOW-UP ON POSTS 01339E, 01341E, 013342E, 01343E & 01344E 3 NOVEMBER 2008 ****************************************** FOCUS NEEDS TO SHIFT TO OVERALL WELL-BEING OF CHILDREN Before the eradication programme began, most rich countries were polio free; though there were exceptions such as Holland and Canada, where for religious reasons certain groups rejected immunization. Why were they polio free? Because they had high routine coverage. When the eradication programme was launched high routine coverage was seen as a prerequisite, sadly high routine coverage has not been reached and maintained. To answer Mogens’s question, in countries such as Nigeria the eradication efforts have certainly damaged routine services. To answer another of Mogens's questions, to date over $5 billion of aid money had been spent on polio, on top of this is all the money spent by countries themselves. To suggest as Hans does that we have to continue with eradication because it is not possible to maintain high coverage is strange. If you believe this then all susceptible diseases should be targeted for eradication and there should be no routine services, because as soon as a service becomes successful and the cases become minimal routine services will fail. There are now plenty of countries where routine services are doing a good job, at a sustainable cost. To suggest that we would go back to the status quo ante is disingenuous and assumes there has been no development in routine services since 1988. This is manifestly not the case. The original target for polio eradication was 2000; we are now 8 years late and seem to be chasing an ever-receding target. The earliest eradication could be certified now would be about 2015. Each year we are told polio will be eradicated in the next 18 to 24 months provided $X million are made available. For 2008-09 the figure at the moment is $355,000,000. To put this sum in perspective it is 10 times to total aid budget spent eradicating smallpox. I am sorry, but eradication is just not happening and meanwhile this year will probably see more cases of measles than there were polio cases back in 1988. For the rich countries, eradication is very convenient; they use an expensive IPV and would certainly save money if there was no polio. For poor countries, their contribution to the eradication programme is made up in part of money but more importantly in human effort. Nurses carrying out SIA and NID are not available for providing routine care. In Nigeria where there are numerous campaigns each year, there is practically no time left to provide routine care. The IPD certainly does not provide routine care. For how many years do we go on claiming that success is just around the corner? There are only four countries left where polio is endemic but those four countries have been struggling for years to succeed without final success and include two of the biggest countries in the world. Why when polio has been circulating freely in DRC and Angola for at least three years does WHO claim these countries are not endemic. How can we be certain that a country that is as lawless as Somalia really has no cases and how many cases lurk unreported, in the Tribal Territories along the Pakistan–Afghan border. To make ethical claims as Hans does I am afraid does not wash. What is ethical about saving a child from polio only to see it die from Cholera, meningitis, measles, malaria or diarrhoea? To claim that routine immunization benefits from the equipment supplied for polio is not true. For example, in 2003, I found 500,000 doses of HepB vaccine frozen in the State store in Kano because the only available equipment there were multiple freezers supplied for polio eradication. The storekeeper was forced to put the hepB in the freezer and then turn it off when it was getting too cold, sadly this technique failed and half a million doses of an expensive vaccine were lost. The subversion of the health service was neatly summed up by the Governor of Sokoto in 2005 when he said, ‘Why would we want to eradicate polio people make far too much money from it.’ This year polio cases are up 9% on the total cases for last year and there have been cases in 15 countries compared to 11 in 2007. With a global recession making money much more scarce and with the MDGs way off target, I am afraid we do have to ask, could the health benefits to children be better served by spending resources in a different way? Polio eradication has achieved much, e.g. encouraging effective mapping of districts, which is invaluable for all elements of a health service. The fact is that polio eradication will have practically no impact on the MDGs and their deadline is only 6 years away we cannot afford to continue to chase the chimera of polio eradication. The Americas eliminated polio thanks to strong routine services. Let us take those parts of polio eradication that are helpful to the routine health services and use them to focus on the overall well being of children. That way there may be chance that the MDGs will be met. All good managers have plan A and plan B when they embark on a task. When plan A is no longer attainable, you move to plan B using the lessons from plan A to make sure that plan B works. Plan B is the OVERALL WELLBEING of children as set out in the MDGs. Now is the time to implement plan B. It is not a question of success or failure it is a question of focus and the focus needs to shift to OVERALL WELLBEING of children. Anthony ([[email protected]][email protected][/email]) Anthony Battersby FBA Health Systems Analysts -------- HIGH QUALITY SHORTER SUPPLEMETARY ROUNDS WITH ROUTINE IMMNIZATION SESSIONS Dear All, I share my own experience of leading the program of Polio eradication (Supplementary Immunization rounds) in Delhi state alongside my role as State EPI officer between 2000 and 2004. *The positives include*: Political & Bureaucratic commitments through better understanding of disease profiles; the health benefits likely to accrue with support of all kinds flowing easily; team working spirit in health providers; planning & microplanning for the most vulnerable, who would be missed otherwise even for RI; a confident & better informed health structure; a more informed community & service seekers for RI; improved cold chain arrangements even at the sub-district levels (for HTH activity & for RI); improved supervision & all round understanding (& application) of its importance even for RI; development of structures for monitoring both polio eradication & RI; collaborative partnership building with all stakeholders, including the Development Partners for building the RI technical capacities through trainings; etc. The gains have resulted in RI evaluated coverages (FI) coming up from around 58% in 1998 to around 81% (Unicef CES 2006). Polio cases have been only in single digit all through, that too due to high in-migration. Sustained motivation of health workforce, with responsive programme officers with clear understanding of synergy between polio eradication & high RI coverages, at the helm, are important requisites for achieving success on both fronts. However, manpower crunch (because the same health workforce undertakes other RCH activities) & practically a monthly supplementary round in the recent years, in selected states, may be a concern. Technical & strategic considerations (of short 2 -3 days activity instead of 7-10 days that happens now), & doing only house-to-house high quality supplementary rounds every 3-4 months intervals, with adequate planning (including social mobilization through scientific sharing), including RI sessions at all the Fixed Health Facilities during those 2-3 days of supplementary polio activity are worth serious consideration of experts. In states with sporadic polio case & whenever a "Hot" case gets reported there, doing an immediate outbreak response (ring immunization) needs also to be considered . Dr D K Dewan ([[email protected]][email protected][/email]) State MCH /EPI officer, Delhi Govt. Post generated using Mail2Forum (http://www.mail2forum.com)
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