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Post Introduction Evaluation of New Vaccines

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Timing has been tailored to the country need: ... PIE proved to be a useful excercise in the early stage of NV intro in the region ... – PowerPoint PPT presentation

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Title: Post Introduction Evaluation of New Vaccines


1
Post Introduction Evaluation of New Vaccines
Dr. Tarande Manzila WHO/AFRO
2
Historical perspectives
  • No reliable documentation of new vaccine
    introduction in early introducing countries
    (Botswana, Zimbabwe, Swaziland, South Africa, The
    Gambia)

3
Why PIE in AFRO
  • Lack of regional reference
  • Absence of documentation on experience of
    earlier countries
  • Limited technical assistance to countries
  • during preparation for introduction
  • Result of observation of early assessment

4
Objective
  • The overall objective is to document the
    process of integrating a new vaccine into EPI
    programmes

5
Specific objectives
  • Specific Objectives
  • Document the process of introduction
  • Assess introductions impact on the
  • programme
  • Identify challenges and constrains and define
    ways of overcoming them

6
PIE Audiences
  • The country itself and its partners PIE aims at
    improving the introduction process and to achieve
    the goals set while providing the country with
    written references of what exactly happened
  • Other countries introducing or that may do so in
    future apply lessons learnt from other countries

7
Methodology
  • Terms of reference created
  • District sampling for field visits (attempts made
    to select representative sample of the country
    districts for the evaluation)
  • Evaluation tool (use of standardize questionnaire
    for various levels Central, Province,
    district/health facility).
  • Individual interviews
  • Exit interviews with caretakers
  • Observation of immunization session, the
    environment, cold chain system, vaccine
    management, injection safety, wastage management
    etc.

8
Sequence of events leading to the PIE
  • EPI review
  • National plan for new vaccine introduction
  • Vaccine fund application submitted
  • New vaccine Introduced
  • Early assessment in some cases
  • PIE

9
Timing of the evaluation
  • Timing has been tailored to the country need
  • If too closed, findings may be cluttered with
    short-live operational issues that will not have
    lasting effect on the program
  • If too late, the program may lose the ability to
    detect problems early enough to allow prompt
    corrective action - Lost of memory
  • Recommend time between is 8 to 18 months
    following introduction

10
Similarities with other EPI reviews
  • Address the 5 functions of immunization services
  • Evaluate all levels of the health care system
  • Select representative sample of the health system
  • Opportunity to follow-up on recommendations of
    previous EPI reviews

11
Comparative advantages
  • Small teams
  • Limited time
  • No extensive data analysis
  • Qualitative process description
  • Inexpensive 3000-4000 (local expenses)
  • Possible link with disease surveillance (Hib,
    Yellow Fever)

12
ExampleBenin (9th month)
  • Health facilities using all types of syringes
    and needles (ADs, standard and sterilizables)
  • No national policy on injection safety
  • Very weak/non-functioning ICC
  • HepB introduced with catch-up, up to 2 years of
    age, risk of vaccine shortage
  • Fear of vaccine wastage causing low coverage
  • Lack knowledge of appropriate storage temperature
    for HepB vaccine

13
ExamplesEritrea (10th month)
  • Inability of health workers to forecast vaccine
    and supply needs
  • The absence of monitoring system for drop outs
    and vaccine wastage
  • Inappropriate storage temperatures even at
    regional level

14
ExampleMozambique
  • There were 200,000 doses of DTP still in one
    provincial cold store
  • Has two columns of wastages, but only on the
    monthly reporting forms
  • All vaccines frozen in one district cold store

15
ExampleTanzania
  • The implementation of MVP instituted, with
  • reduction vaccine wastage
  • Defective BCG syringes discovered and
  • supply discontinued
  • Authorities aaproved to consider Hib vaccine
    introduction

16
Conclusion
  • PIE proved to be a useful excercise in the early
    stage of NV intro in the region
  • Process documentation of new vaccine introduction
    now available in most countries
  • PIE is limited,focused and cost effective
  • Provides an opportunity for supportive
    supervision.
  • PIE provides an opportunity to follow up on
    recommendation of previous reviews
  • Tool Has the potential to be expanded or
    integrated with other evaluations
  • Lack of dry storage in most countries

17
Way forward for PIE
  • PIE tool could be expanded to include other EPI
    assessment tools (MNT risk assessment, vehicle,
    etc)
  • It is possible to combine PIE with the rapid EPI
    assessment tool used in southern Africa or with
    formal EPI reviews

18
Thank you!
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