New Vaccine Introduction, Mozambique

1
New Vaccine Introduction, Mozambique

• 16 - 27 de September, 2002
• Manuel Novela

2
Introduction

• Mozambique total area 7,874,090 km2.
• Localization Southern Africa.
• Total population 18,082,523.
• Administrative units 11 provinces divided into
  144 districts.
• EPI first established in 1979 for diphtheria,
  measles,
• pertussis, poliomyelitis, tetanus and
  tuberculosis.
• In July 2001, introduced combined DPT-HepB

3
New Vaccine Introduction, Mozambique

• Summary of Evaluation
• MISAU, OMS, UNICEF e CDC
• 16 - 27 de September, 2002

4
TERMS OF REFERENCE

• Document the process of the introduction and
  launching of the new Vaccine DPT-HepB
• Evaluate the impact on the routine immunization
  programme
• Identify the constraints, challenges and learned
  lessons
• Propose recommendations based on the main
  findings

5
METHODOLOGY

• Standardized questionnaire
• Key informants at all levels (Central,
  provincial, District e Health Facility)
• Observation of the vaccination sessions
• Vaccine depots and supply
• Three teams involving international experts and
  central and provincial level MOH officials
• Visits
• Central level
• Provincial level (two or three districts each)
• Maputo City
• Cabo Delgado
• Zambézia

6
Findings Vaccine Introduction

• Nationwide on 1st July 2001
• Went smoothly and was successful
• There were no opposition or resistance
• Helped to improve immunization services

7
FINDINGSTRAINING

• The training took place lately, mainly at the
  provincial level
• Some people performing EPI activities without any
  basic training in this area
• The ancient EPI manual still in use without
  DPT-HepB information

8
Findings Injection Safety

• Mozambique made a successful transition to the
  use of the auto-disable (AD) syringes for all
  vaccines of the program
• Safety boxes were available at all levels
• No functioning incinerators even in the big
  health facilities
• Sharp disposal is done basically by burning and
  burial after burning.

9
Findings Adverse Events Following Immunization
(EAAI/AEFI)

• Are not tracked systematically (EAAI/AEFI) There
  are neither reporting nor investigation forms for
  AEFI.

10
Findings Institutional Support Funding (ISS/GAVI)

• Health workers did not know about GAVIs support
  funding from the provincial to the health
  facility
• No funds were received at the health facility
  level

11
Findings Monitoring and Reporting

• New data monitoring forms have been introduced
  into the programme
• Monitoring charts were not commonly or displayed
  in the system
• There were no indications that reports were used
  for decision making

12
Cold Chain Vaccine management

• The vaccine management is usually adequate (only
  one case of frozen vaccine was seen).
• In one facility, the EPI refrigerators contained
  other medications, blood bags and lab reagents
• Stock records are not regularly updated, even at
  national and some provincial levels
• Over 90 percent of health workers interviewed did
  not know the correct storage the temperature for
  the DPT-HepB vaccine (2 -8). They stated 0 8
  deg. C.
• Freeze watches are not used at all levels

13
Findings Vaccine Wastage

• There is confusion about vaccine wastage and it
  is not reported regularly
• Partial wastage rate data suggests that the
  DPT-HepB wastage rate is bellow 20
• There were 200,000 doses of DPT in the central
  depot without any plan of using the
• Some health facilities still had stocks of DPT in
  their depots

14
Findings Supervision

• Only 50 of planned supervisory visits are
  carried out
• Only 7 of districts visited had the guide for
  supervision
• The introduction of the new vaccine did not
  improve supervision

15
Advocacy, Communication and Social Mobilization

• High level advocacy for new vaccine.
• In general communication and social mobilization
  was at the level of mothers attending
  immunization services.
• Community mobilization through the involvement of
  community leaders media campaigns on Hep. B and
  other efforts.

16
Advocacy, Communication and Social Mobilization
(cont.)

• No guide lines on communication for new vaccines
  were available.
• Mothers had no idea that new vaccine was being
  introduced into the programme.
• Training for new vaccine did not prepare health
  workers for conducting social mobilization and
  interpersonal communication.

17
RECOMENDATIONS

• A minimum central stock level for tetravalent
  should be established
• Usage of Freeze watches at all levels
• The EPI revised manual should be finalised and
  disseminated

18
RECOMENDAÇÕES, CONT.

• Wastage Monitoring
• The vaccine wastage should be redefined and
  harmonized so that all levels of the system
  understand what vaccine wastage is and monitor
  and report wastage regularly using the same
  indicators.

19
RECOMENDAÇÕES, CONT.

• In facilities there is a need for posters
  displaying important immunisation messages as
  well as technical information on the new
  vaccines
• Supervision activities need to be intensified at
  district and health facility levels
• Supervisors should be encouraged to use
  standardised tools and leave supervisory records
  with specific instructions or activities to be
  done
• MOH with the assistance from partners needs to
  develop a social mobilisation strategy to reach
  the community

20
RECOMENDAÇÕES, CONT.

• Mozambique should study the burden of
  Haemophilus influenzae do type b, (Hib).
• Pentavalent
• Taking into account the worldwide availability of
  vaccines, it is suggested that Mozambique
  submitted its interest for the pentavalent
  vaccine to GAVI in the next three months

21
Thanks for your attention!
Khanimambo!