Training activities

2007

• Vaccination for the next decade in the Arab world
  Amman, Jordan, 9 – 11 December 2007
• Inter-country mid-level management course for Lusophone countries
  Maputo, Mozambique, 20 – 31 August 2007
• Reqional consensus workshop on integrated packages on EPI and child health
  Ouidah, Benin, 6 – 10 August 2007
• Workshop on nursing immunisation curriculum review and update
  Vanderbijlpark, South Africa, 1 – 4 April 2007
• Inter-country workshop on capacity building for multi-year plans
  Damascus, Syria, 18 February - 1 March 2007
• Workshop on capacity building in vaccine stock management
  Lahore, Pakistan, 9 – 10 January 2007

Vaccination for the next decade in the Arab world
Amman, Jordan, 9 - 11 December 2007

The vaccinology workshop was organised by the Jordan University under the Patronage of Her Majesty Queen Rania Al Abdullah, with support from NESI and in close collaboration with WHO/EMRO.

Participants of the following countries attended the meeting: Bahrain (2), Egypt (2), Iraq (1), Lebanon (2), Libya (2), Morocco (2), Palestine (2), Sudan (2), Syria (2), Tunisia (2), United Arab Emirates (1), Jordan (19), Jordan Universities (13). Several international organisations participated and supported the workshop: WHO/EMRO, GAVI, UNICEF/MENARO, the Arab League and NESI. Lecturers were from Jordan University, WHO/EMRO, NESI, CDC, Vanderbilt University, Jordan MoH, American University of Beirut – Medical Centre, John Hopkins University, School of Public Health.

The goal of the workshop was to establish a common understanding of the scientific and public health aspects of vaccination among academics, programme managers and other partners involved in immunisation programmes, vaccine research and training in the Arab Region with the aim of fostering further cooperation in research and implementation on immunisation among the Arab countries.

The specific objectives included: to advocate for the value of vaccination to improve the health of the Arab child; to understand current status, opportunities and challenges of vaccination in the Arab Region; to provide comprehensive information on new vaccines and the vaccine introduction process with the aim of fostering regional cooperation in this endeavour; and to reach a consensus among civil society partners, academics, programme directors and international organisations to help in the planning process for vaccination in the Arab Region for the coming decade.

The Arab World has made significant progress in strengthening routine immunisation and in introduction of new vaccines. However, some countries are still lagging behind. Recently, many new life-saving vaccines have become available, but major obstacles such as lack of awareness among decision makers and lack of financial resources continue to delay their introduction. Only six countries within the Arab World are eligible for GAVI support, the rest of the countries are middle and high income countries that do not qualify for GAVI support.

Her Majesty reinforced the issue of raising awareness through campaigns addressing the public as well as the medical community. She stressed the importance of immunisation as a top priority for health planners in the Arab Region and the need for private and public sectors to work together to achieve the goal particularly in introduction of new vaccines. She reiterated the need for human and financial resources mobilisation.

The following conclusions were reached and recommendations made:

1. There is a need for increased advocacy within the Arab world for introduction of new vaccines.
   
   
2. Long term planning for Arab countries
   1. Maintenance of established programs and safeguarding the achievements made in vaccine introduction and sustaining high coverage.
   2. Prioritisation of vaccines – introduction of new vaccines into the existing EPI schedules is a priority.
   3. Formulation of costed multi-year plans for all Arab countries, taking into account the epidemiology of vaccine preventable diseases in the Arab World.
      
      
3. Financial planning
   1. Improve utilisation of existing mechanisms for vaccine purchasing (e.g. expand on the Gulf Cooperation Council Group Purchasing Program).
   2. Develop innovative financing mechanisms to ensure group financing and procurement, e.g. the revolving fund.
   3. Identify venues for Arab countries to discuss vaccine financing as a group, such as during the Arab League Ministers of Health meetings.
      
      
4. Role of Academia.
   1. Academia in the Arab Region should be mobilised to help support the national immunisation programs and agenda.
   2. Academia should help the National Advisory Committees/Inter-Agency Coordinating Committees on matters of policies concerning new vaccine introduction based on burden of disease, cost benefit, cost efficacy and availability of the vaccines.
   3. To support collaborative research studies.
   4. To provide laboratory and other technical support.

Inter-country Mid-Level Management course for Lusophone countries
Maputo, Mozambique, 20 – 31 August 2007

The Lusophone MLM course was organised by WHO/AFRO in collaboration with the Ministry of Health of Mozambique, UNICEF and NESI.

The mid-level management course aims at providing a clear framework for public health managers, especially those in the immunisation programmes: this will help them to better conduct their day-to-day managerial activities and resolve problems that arise in the achievement of their national and district EPI plans. The main objectives of the course were: (1) to describe the Global Immunisation Vision and Strategy (GIVS); (2) to explain the 2006-2009Strategic EPI Plan for the AFRO Region; (3) to explain the Reach Every District (RED) approach; and (4) to apply the problem solving approach to immunisation service management.

A total of 34 participants of the following countries attended the course: Angola (12), Mozambique (11), Cabo Verde (4), Sao Tome e Principe (4), and Guinée Bissau (3). Facilitators included staff from the EPI programme of the Ministry of Health of Mozambique, WHO/AFRO, UNICEF and NESI.

For the meeting, MLM modules had been translated into Portuguese. Presentations were translated on a daily basis, and translation was provided by one the local facilitators when needed. All key modules of the MLM course were addressed during the course by means of presentations, discussions and group work.

Regional consensus workshop on integrated training package on EPI and child health
Ouidah, Benin, 6 – 10 August 2007

The Lusophone MLM course was organised by WHO/AFRO in collaboration with the Ministry of Health of Mozambique, UNICEF and NESI.

The mid-level management course aims at providing a clear framework for public health managers, especially those in the immunisation programmes: this will help them to better conduct their day-to-day managerial activities and resolve problems that arise in the achievement of their national and district EPI plans. The main objectives of the course were: (1) to describe the Global Immunisation Vision and Strategy (GIVS); (2) to explain the 2006-2009Strategic EPI Plan for the AFRO Region; (3) to explain the Reach Every District (RED) approach; and (4) to apply the problem solving approach to immunisation service management.

A total of 34 participants of the following countries attended the course: Angola (12), Mozambique (11), Cabo Verde (4), Sao Tome e Principe (4), and Guinée Bissau (3). Facilitators included staff from the EPI programme of the Ministry of Health of Mozambique, WHO/AFRO, UNICEF and NESI.

For the meeting, MLM modules had been translated into Portuguese. Presentations were translated on a daily basis, and translation was provided by one the local facilitators when needed. All key modules of the MLM course were addressed during the course by means of presentations, discussions and group work.

Workshop on nursing immunisation curriculum review and update
Vanderbijlpark, South Africa, 1 – 4 April 2007

The objectives of the meeting were to evaluate and update the nursing curriculum for immunisation in teaching institutions in South Africa: this included updating participants on the immunisation policies and strategies, including GIVS; get a consensus on the EPI curriculum prototype; and make recommendations for the implementation of the EPI curriculum revision process within the pre-service training institutions.

Vaccination is a very cost effective public health measure for control and elimination of infectious diseases. It is with this premise that teaching on immunisation needs to be comprehensive and up to date in medical and nursing institutions, ultimately to improve service delivery and research outcomes. Against this background and in line with the plan of action and recommendations of the 2006 Douala workshop, the University of Limpopo (Medunsa campus, which includes SAVIC, the South African Vaccines and Immunisation Centre) in collaboration with the University of Antwerpen and WHO, organised a 3-day workshop on EPI curriculum review and development for nursing educators.

The workshop was attended by a total of 50 participants: WHO/AFRO, South African National Department of Health (NDOH), University of Limpopo, University of Witwatersrand, University of Johannesburg, University of Cape Town, South African Nursing Council (SANC), South African district EPI teams, Nursing Colleges from Gauteng, Mpumalanga, Limpopo and North West Provinces, and NESI.

The methods of the workshop included didactic lectures in information sessions, presentations and demonstrations, and group discussions. Group work focused on identifying gaps on the content curriculum for EPI related teaching and developing a plan of action for filling the identified gaps and implementing the recommendations. For the group work, participants were divided into 3 groups each looking at the content issues using the prototype curriculum. The groups went through the content to identify gaps and any major differences in the prototype curriculum and their institutional curricula.

All institutions are expected to debrief and share the materials with their respective supervisors and heads of departments. Follow-up meetings need to be done by the University of Limpopo with the South African Nursing Council, other universities and other provinces. Training on immunisation and vaccinology for the health workers and nursing educators is also being pursued. In addition an integrated approach to teaching immunisation will be adopted along the global trends of designing and implementing an integrated package on child survival.

Inter-country workshop on capacity building for multi-year plans
Damascus, Syria, 18 February - 1 March 2007

Multi-year planning is a key management tool for national immunisation programmes. Developing a comprehensive multi-year plan (cMYP) presents an opportunity to consolidate existing plans into a single document that addresses global, national and sub-national immunisation objectives and strategies, and that also evaluates the costs and financing of that plan.

Traditionally the largest proportion of the cost in countries that are only using traditional vaccines is related to staff, transport cost, cold chain and campaigns. With the introduction of under-used and new vaccines, vaccine cost increases from about 5% to 20% of the total cost. Moreover, transportation and cold-chain cost increases significantly. In low-income countries these costs are mainly covered by international donors. This is not the case for most countries in the WHO/EMRO region. The countries present at the meeting (Syria, Egypt, Morocco, Jordan and Tunisia) are low and middle income countries.

All five countries present at the meeting intend to introduce under-utilised and new vaccines in line with the WHO/EMRO recommendations.  It is therefore important that the Ministries of Health as well as the Ministries of Finance have a clear understanding of the budget implications of the further strengthening and expansion of vaccination programmes. For this purpose, WHO/EMRO had invited national vaccination programme managers, directors of planning of health ministries and representatives of the Ministries of Finance of each of the countries.

Facilitators explained the cMYP planning framework and introduced the participants to the principles of cost analysis and the use of the costing tool. This is an Excel-based comprehensive planning tool, with data entry sheets and linked sheets calculating cost projections and producing graphs.

The cMYP workshop used Syria as an example for the planning process. Vaccination data from Syria were critically reviewed, shared, analysed and compared with GIVS and EMRO EPI objectives. Working groups looked into specific planning aspects of the Syria’s Multi-year plan.

Workshops on cMYP also provide a useful platform for NESI to discuss the importance of developing a training plan within the cMYP. Within the planning process, training activities are often mentioned in almost all components (eradication of polio and measles, surveillance, routine immunisation, introduction of new vaccines, etc.).  However, these activities are rarely based on a training needs assessment and a comprehensive training plan. Within the budgeting process, training is only a minor component as compared to salaries, vaccine supplies, transport, etc. For budgeting purposes, it may therefore be appropriate to add a fixed proportion of the total budget for training.

The goal of preparing a first draft of the cMYP for Syria was achieved and the other participating countries developed skills to prepare their own cMYP later this year. Bringing together EPI staff, directors of health planning and staff from Ministries of Finance is challenging as EPI staff is used to specific terms, objectives and indicators that are not familiar to other staff. This was addressed during presentations and group discussions. In addition, presentations on the economic aspects of vaccination were very helpful to strengthen the common understanding of issues by EPI and financial planning experts. The joint participation will therefore be very helpful for stimulating further collaboration at country level.

The immunisation cost projections for Syria, produced by the costing tool showed a considerable increase in cost in the coming years which is mainly attributable to the projected introduction of new vaccines. The Syrian Government seems to be very committed to the immunisation programme and the workshop and further technical assistance by WHO will enable the Government to plan for the sustainable increased investment in immunisation. Disease surveillance should be strengthened to document the effectiveness of the introduction of new vaccines. Additional resources should be raised for the poorer countries in the region. This is not only of interest for the poorer countries themselves, but also for the higher-income countries considering the high population movement within the region.

Workshop on capacity building in vaccine stock management
Lahore, Pakistan, 9 – 10 January 2007

The objectives of the meeting were to review countries progress in developing and improving vaccine stock management; to learn from the global advances in developing software for vaccine stock management; to demonstrate and discuss in detail the first edition of the software developed by WHO/EMRO and to develop a plan for installation and training of the staff in National Vaccine Stores in selected countries of the region.

There is a broad variation among the countries in the EMRO region regarding the target population, transport and communication infrastructure, complexity of vaccine management, the quantity of vaccines managed, the capacity of national programmes, the capacity to run reliable paper-based vaccine management systems, the resources to manage vaccination programmes and the information technology environment. Most countries have identified a need to use information technology to facilitate their vaccine management activities.
During this meeting a remarkable variety of locally developed solutions to address the needs of national EPI programmes were demonstrated and discussed. Each of these responded to specific needs in particular contexts. It therefore seems an illusion at this stage to work towards one type of “vaccine management programme” that will be flexible as well as powerful enough to fit all needs. Also within one country different systems may be used by different type of services. For example, district clinics and health centres may use a paper-based system, district hospitals/stores may use a spreadsheet-based system, while regional and central stores may use a more complex database.

At this stage, it therefore seems crucial to continue developing and supporting the ongoing efforts and to ensure that the programmes developed have the following characteristics: (1) standard definitions for vaccines and related supplies. The use of standard field names and field definitions facilitates the export of data into a standard format. This makes it easy to compile and analyse data from different programmes and systems, and to transfer collected data from one system to another. This standard list is used as a catalogue by software experts. This catalogue is not visible on the screens used by staff that will usually see a simplified list in local languages, agreed with the local software expert; (2) it is important for the EMRO region that useful software developed in one country can be adapted by local software experts for use in another country; and (3) it is important for EMRO to agree about standard reports that are important for vaccine and programme management at national level as well as periodic reports from countries to WHO/EMRO. This will facilitate the tasks for software experts as well as national programme managers.