WHAT'S NEW THIS SUNDAY: ADVANCES IN CHILD IMMUNIZATION IN SOUTH AFRICA

Friday, 23rd of November 2012

ADVANCES IN CHILDHOOD IMMUNISATION IN SOUTH AFRICA: WHERE TO NOW? PROGRAMME MANAGERS’ VIEWS AND EVIDENCE FROM SYSTEMATIC REVIEWS

Charles S Wiysonge1,2*, Nthombenhle J Ngcobo3, Prakash M Jeena4, Shabir A Madhi5, Barry D Schoub5, Anthony Hawkridge1, Muki S Shey6 and Gregory D Hussey1,2

* Corresponding author: Charles S Wiysonge charles.wiysonge@uct.ac.za

BMC Public Health 2012, 12:578 doi:10.1186/1471-2458-12-578

The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2458/12/578

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The Expanded Programme on Immunisation (EPI) is one of the most powerful and cost-effective public health programmes to improve child survival. We assessed challenges and enablers for the programme in South Africa, as we approach the 2015 deadline for the Millennium Development Goals.

Methods

Between September 2009 and September 2010 we requested national and provincial EPI managers in South Africa to identify key challenges facing EPI, and to propose appropriate solutions. We collated their responses and searched for systematic reviews on the effectiveness of the proposed solutions; in the Health Systems Evidence, Cochrane Library, and PubMed electronic databases. We screened the search outputs, selected systematic reviews, extracted data, and assessed the quality of included reviews (using AMSTAR) and the quality of the evidence (using GRADE) in duplicate; resolving disagreements by discussion and consensus.

Results

Challenges identified by EPI managers were linked to healthcare workers (insufficient knowledge of vaccines and immunisation), the public (anti-immunisation rumours and reluctance from parents), and health system (insufficient financial and human resources). Strategies proposed by managers to overcome the challenges include training, supervision, and audit and feedback; strengthening advocacy and social mobilisation; and sustainable EPI funding schemes, respectively. The findings from reliable systematic reviews indicate that interactive educational meetings, audit and feedback, and supportive supervision improve healthcare worker performance. Structured and interactive communication tools probably increase parents’ understanding of immunisation; and reminders and recall, use of community health workers, conditional cash transfers, and mass media interventions probably increase immunisation coverage. Finally, a national social health insurance scheme is a potential EPI financing mechanism; however, given the absence of high-quality evidence of effects, its implementation should be pilot-tested and the impacts and costs rigorously monitored.

Conclusion

In line with the Millennium Development Goals, we have to ensure that our children’s right to health, development and survival is respected, protected and promoted. EPI is central to this vision. We found numerous promising strategies for improving EPI performance in South Africa. However, their implementation would need to be tailored to local circumstances and accompanied by high-quality monitoring and evaluation. The strength of our approach comes from having a strong framework for interventions before looking for systematic reviews. Without a framework, we would have been driven by what reviews have been done and what is easily researchable; rather than the values and preferences of key immunisation stakeholders.

Health Specialist (Cold Chain and Logistics), P3

Duty Station: Abuja, Nigeria Contract Type: Long Term Staff (FT)

Application Deadline: 29 November 2012

UNICEF is a global leader in vaccine supply, reaching 40 percent of the world’s children. Immunization is a central part of our commitment to protecting the world’s most vulnerable children, and we are looking for experienced Cold Chain and Logistics professionals. Key Responsibilities

Under the direct supervision of the Immunization Manager, incumbent will work with the government, NGO and other bi-lateral partners to ensure adequate logistics on vaccine security as well as the planning and implementation of Effective Vaccine Management activities as part of UNICEF Nigeria Country Programme.

Key responsibilities include:

1. Prepares, implements, monitors and evaluates immunization logistics, vaccine security including effective vaccine management, vaccine forecasts and Logistic Management Systems; analyses and evaluates data to ensure achievement of objectives and takes corrective action when necessary to meet project objectives. Contributes to the development and/or introduction of new approaches, methods and practices in project implementation and evaluation.

2. Collects and analyses data for situation analysis regarding cold chain equipment, other aspects of vaccine security and conditions for supplemental immunization activities in the country, to be used in interventions to vaccine preventable diseases and polio eradication; prepares relevant tables, graphs and other statistical data, reports outcome of analysis and proposes corrective action.

3. Undertakes visits to national, zonal and state vaccine cold stores assess local conditions and resources. Supports the Vaccine and Security Consultants in implementation of their work plans. Communicates with local counterpart authorities and the Community on project feasibility and effectiveness including monitoring the flow of supply, technical and financial inputs.

4. Assists government authorities in implementing the Effective Vaccine Management Plans and Logistics Management Systems. Identifies training needs and objectives for the purpose of capacity building, programme sustainability, as well as promotion and advocacy.

5. Participates in Intersectorial collaboration with other programme colleagues. Assists in development of appropriate communication and information strategy to support and/or advocate programme development.

6. Networks with national and international agencies on immunization, with particular emphasis on immunization logistics, vaccine security and the planning and implementation of supplemental immunization activities; participates in meetings with the National Primary Healthcare Development Agency and state ministries responsible for programme/project review, and follows up on implementation of recommendations and agreements.

7. Supports networking and information sharing between core partners and the National Primary Healthcare Development Agency, for improved leveraging and resource mobilization for immunization.

8. Coordinates with the Operations/Supply staff on supply and non-supply assistance activities ensuring proper and timely UNICEF and government accountability. Certifies disbursements of funds, monitors and submits financial status reports to the Sr. Programme Officer or Representative, as required.

9. Drafts sections on immunization as inputs to Health Section reports as required (donor, management, annual reports, etc).

10. Ensures the accurate and timely input of project information in the computerized programme system, and issues status reports for monitoring and evaluation purposes.

Qualifications

Advanced university degree in Public Health, Health Sciences, Logistics Management or other relevant disciplines. A first university degree with a relevant combination of academic qualifications and experience may be accepted in lieu of the advanced university degree. Minimum five years of relevant work experience at the national and international levels in planning, programming, implementation monitoring and evaluation of health/Immunization programmes. Professional work experience in a technical expert position related to logistics management particularly with child survival & health care. Developing country work experience. Background/familiarity with Emergency. Fluency in English and another UN language. To Apply

Please visit us at www.unicef.org/about/employ to register in our e-Recruitment system, and search using keyword “cold chain” for additional details/to apply before deadline.