Guidelines

1
Global Action Plan for the Prevention and Control
of Pneumonia (GAPP)
Thomas Cherian Coordinator, EPI On behalf of the
GAPP Team
2
Background

• About 156 million cases of pneumonia and close to
  1.8 million deaths occur in under five children
  every year
• Effective interventions exist for prevention and
  management of pneumonia
• A determined and cohesive effort to make
  effective use of these interventions has been
  lacking
• Call for action on childhood pneumonia ISPPD-5,
  Alice Springs, 2006

35 associated with malnutrition
Sources Rudan et al. Bull WHO 2008 86408-16
WHO Global Burden of Disease 2004
3
Patterns of pneumonia risk

• Patterns of pneumonia mortality risk may vary in
  different settings
• Economic poverty - wealth quintiles
• Distance from a health facility - geography
• Other factors
• Ethnicity
• Gender (in some settings)
• Ability to deliver immunization through outreach
  community case management near the home is the
  central argument for their primary role in
  pneumonia control

Pneumonia mortality in highland PNG by distance
from a health facility
Source Mulholland et al. Bull WHO 2008
4
Hib Pneumococcus account for a majority of
pneumonia deaths
Pneumonia due to these organisms are specifically
targeted by immunization and case management
Only non-HIV related
WHO estimates for 2000
5
Need to establish multi-pronged approach

• No single approach will fully address the problem
  of pneumonia it requires
• Prevention vaccination (Pertussis, Measles, Hib
  and PCV)
• Case management (community and facility)
• Risk factor modification environmental
  pollution, breastfeeding nutrition etc.
• Implementation at scale of a package of
  interventions including Hib and PCV, case
  management and nutritional interventions could
  reduce overall child mortality by up to 20 and
  be highly cost-effective (Niessen L et al -
  unpublished)

6
Global Action Plan for the Prevention and control
of Pneumonia (GAPP)

• OBJECTIVES
• To accelerate pneumonia control through scaling
  up the delivery of interventions of proven
  benefit in the context of newborn and child
  survival strategies in countries
• To identify and implement a set of priority
  activities within each area of work in reducing
  pneumonia mortality
• To develop an approach towards monitoring,
  documenting and evaluating the impact of the
  action plan

7
The process

• Consultative meeting held in March 2007
• Technical consensus on the key interventions for
  prevention control of pneumonia
• Publication of reviews on epidemiology and on
  potential interventions for control
• Documentation of the evidence base
• Stakeholder's meeting in 2008
• Broader consensus on priority interventions and
  strategies
• Draft strategic plan (under development)

8
Priority interventions for pneumonia control

• Main interventions
• Case management (particularly community case
  management) and promotion of care-seeking
• Immunization (increase coverage with measles and
  pertussis and introduce Hib and pneumo)
• Additional interventions
• Zn supplementation, initially through treatment
  of diarrhoea
• Promotion of exclusive breast feeding
• Interventions to reduce low birth weight
• MTCT prevention and co-trimoxazole prophylaxis
  (in HIV endemic popn.)
• Measures to reduce indoor air pollution (e.g.
  special stoves)

9
Joint implementation of the interventions
creating a win-win situation

• Scale up delivery of selected interventions
  through existing programmes
• EPI, IMCI, Safe Motherhood, Child Nutrition, HIV
  prevention, Environmental Health
• Create synergies between the different programmes
  to maximize the benefit and create efficiencies
• Joint planning, review and revisions of policies
  and strategies
• Joint advocacy and social mobilization
• Harmonize processes for procurement stock
  management of supplies and for logistics
• Develop synergies in processes for monitoring
  evaluation

10
Proposed programme management cycle at the
country level (draft)
11
Current initiatives for pneumonia control at
global level

• Accelerated vaccine introduction project
• Partnership between WHO, UNICEF, the Technical
  Advisory Consortium (consortium of PATH, Johns
  Hopkins, CDC) and the GAVI secretariat
• Support the accelerated introduction of Hib and
  Pneumococcal Vaccines in the 72 poorest countries
• Community case management (CCM) Implementation
  Task Force
• Members UNICEF (Chair), WHO, Save the Children,
  BASICS, IRC etc.
• Policy work to promote advocate for CCM in
  priority countries
• CCM Operational Research Group
• UNICEF, WHO (Co-chair), Save the Children,
  Karolinska institute, Sweden (Co-chair) and BU
  etc.
• Undertake situation analysis address OR issues
• Zinc task force re-activated

12
Risks opportunities

• RISKS
• Uncoordinated action resulting in development of
  parallel structures and processes
• Duplication of efforts
• Conflicting messages to countries communities
• Suboptimal results

• OPPORTUNITIES
• Use the current investment and interest in
  introduction of new vaccines to leverage support
  for scaling up other pneumonia interventions
• Use the current focus on primary health care to
  create synergies between different programmes

13
Next Steps

• Global level
• Finalise strategy document
• Establish a GAPP International Task Force,
• Develop implement an advocacy and resource
  mobilization plan
• Identify and work with priority countries for
  rapid action
• Essential in-country activities
• High level advocacy policy support
• Situation analysis
• Support the development of costed country
  implementation plans

14
Now is the time to act

• No longer unacceptable that large number of
  children die from pneumonia when effective
  interventions exist
• Pneumonia control is essential for achieving
  MDG-4
• The investments for introduction of PCV and Hib
  vaccines and the renewed interest in creating
  synergies between programmes as part of
  strengthening primary health care provides new
  opportunities for pneumonia control.
• Success depends on broad support GAPP and
  resources (human financial) to jump start
  activities