Title: Integrating ITN delivery and mass vaccination
1Integrating ITN delivery and mass vaccination
RBM Board Meeting, Geneva, 1 April 2005 Mark
Grabowsky, MD, MPH CDC Technical Advisor,
American Red Cross
2Recommendations
- This approach represents a potential breakthrough
to achieve Abuja targets - Need RBM leadership to refine strategy and
develop country guidance - Empower RBM staff for operational coordination
- Harmonize EPI and RBM assessment methods
3MM Partners
- Measles Partnership
- American Red Cross
- United Nations Foundation
- Centers for Diseae COntrol
- UNICEF
- World Health Organization
- Ministries of Health
- Ghana
- Zambia
- Togo
- Red Cross Societies
- Ghana
- Zambia
- Togo
- Canadian
- Danish
- New Zealand
- Norwegian
- Swiss
- RBM
- IFRC/IFRC Foundation
- World Bank
- ExxonMobil
- Vestergaard-Frandsjen
- Rotarians Against Malaria
- Plan Togo
- FUCEC
- CIDA
- NORAD
- PSI
- NetMark
- DHL
- Peace Corps
- Satellife, Inc
- Freedom from Hunger
- Liverpool School of Tropical Med.
- London School of Tropical Med.
- University of Geneva
4MM Evaluation Plan
5Togo Campaign Acknowledgements
- Togo Ministry of Health
- Vincent Takpa, EPI Coordinator
- Kodjo Morgah, Malaria Control Coordinator
- Red Cross
- Jean Roy, IFRC-Geneva
- Nick Farrell, IFRC-Geneva
- Marcy Erskine, Canadian Red Cross
- Norbert Paniah, Togo Red Cross
- Vestergard-Frandsen
- Mikkel Vestergaard
- CDC
- Bill Hawley, Malaria Branch
- Adam Wolkon
- Jamie Eliades
- Jodi Vanden Eng
- Allen Hightower
- Mac Otten, NIP/GMB
- WHO
- Placide Gbedonou, EPI Focal Person
6Potential areas for collaboration during SIAs
Delivery of free treated nets, or vouchers, to
children under 5 years
7"Free mass distribution of malaria bed-nets . . .
for all children in regions of malaria
transmission by the end of 2007. "
8Reaching 100 million children in two
yearsAnnual number of children attending
measles campaigns, WHO/UNICEF Priority Countries,
1999-2004
9 Polio vaccination
Mebendazole tablets
Insecticide treated nets
Measles vaccination
3
10Campaign Overview
- Target Population
- 870,000 children ages 9-59 months
- 735,000 households
- Delivery strategy
- One-week campaign
- 1,340 fixed, outreach, mobile posts
- 20,000 health workers volunteers
- 840,000 ITNs
- Financial Resources - 5.9 million
- Govt contribution CFA 10m (20,500)
- Cold chain 500,000 (Rotary, GAVI, UNICEF)
- ITNs 4.4m (CIDA, IFRC, Rotary, Norwegian RC)
- Measles Initiative 639,000
11Social Mobilization
More than 7,400 Red Cross volunteers trained,
monitored, and engaged
5,000 TRC volunteers received ITNs 2 weeks before
the campaign, demonstrated use
12Organization of Posts
- Registration card
- Polio vaccination
- Mebendazole
- Measles vaccination
- Bednet distribution
13Focus of this Presentation
Procurement
Delivery
14Evaluations
- Anemia surveys pre- and post-campaign
- Pre-campaign survey, September 2004
- Post-campaign survey, September 2005
- Coverage surveys 1 and 6 months post-campaign
- 1 month survey completed February 2005
- 6 month survey planned for June 2005
- Facility-based mortality study ongoing
- Cost effectiveness evaluation ongoing
15Study Methods
- All 6 regions included
- 2 Districts/Region
- 12 Enumeration Areas/District
- Simple random sample of Enumeration Areas
- GPS mapping (all houses in EA)
- PDA selection (16 Households per EA)
- PDA-based survey
16Coverage, Post-Campaign
Denominator Children under 5 years of age
Measles vaccination
Polio vaccination
Mebendazole tablets
Coverage 98.4 94.3 92.7
17ITN Coverage and Equity, Pre- and
Post-Campaign
HHs with lt5 child All HHs
Coverage, pre 10.0 8.0 Coverage,
post 87.0 62.5 Equity
ratio, pre .25 .25 Equity
ratio, post 1.02 1.02
18(No Transcript)
19ITN Coverage Children lt 5 (n2599)
Among eligible children, 90.8 received a
campaign net and 44 slept under the net.
20(No Transcript)
21Eligible Children and Households Receiving ITNs,
by Region
22ITN Retention
Retention, among those receiving an ITN, one
month post-campaign
23Cost Overview, per child, US
Summary Total cost 5.9 million Total children
870,000 6.75 per child for all 4
interventions 0.78 per child vaccinated for
measles
24Summary
- Campaign was completed on schedule and on budget
- ITN coverage was high (90) and equitable
- ITN logistics costs were low (about 0.50/net
delivered) - ITN use was modest (40), consistent with known
seasonal patterns - Data on efficacy and cost-effectiveness available
2/2006.
25Procurement
Delivery
26Delivery
Procurement
27Procurement
Delivery
28Global/Regional Activities
Assessment/Assurance
Research
Policy
Financing
In-country activities
Procurement
Delivery
Monitoring
Proper Use
29- there is a huge gap between the current
understanding at the global (partners') level and
the likelihood of countries to immediately embark
on the process. - from recent RBM/AFRO MM mission report
30Not constraining currently
- Funding
- Partners
- Political will
31Constraints on Integration
- Ambiguous ownership of integration, Measles or
RBM? - Lack of consensus on strategy (One ITN per child?
per HH? per Bed?) - Mismatch of EPI and RBM staff number, mission,
support - Lack of in-country coordination for both MoH and
UN agencies - Differences in EPI/RBM indicators, assessment
methods, and use of data
32Recommendations
- This approach represents a potential breakthrough
to achieve Abuja targets - Need RBM leadership to refine strategy and
develop country guidance - Empower RBM staff for operational coordination
- Harmonize EPI and RBM assessment methods
33(No Transcript)
34(No Transcript)
35What is science?
- A predictive discipline based on falsifiable
facts. - Non-predictive
- Each social marketing effort has a unique country
context which precludes extrapolation of results
to other countries. - Non-scientific
- Social marketing is more sustainable than mass
distribution. (Non-falsifiable)
36Post-Campaign Survey Denominators
- 2254 households
- 2599 children (all lt5s)
- 2469 total nets
- 2194 ITNs
- 1611 households with at least one ITN
37ITN Use
Children lt5 sleeping under net
Pregnant Women
38Household ITN Coverage (n2254)
Among eligible households, 87 retained a
campaign net.
39Coordination spreadsheet, AFRO/RBM
40Campaign Attendance
- 97 of eligible children attended the campaign