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First Inception Report for Countries Receiving Support from

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First Inception Report for Countries Receiving Support from

    January 2005 (revised)

     Progress Report

    Partnering with The Vaccine Fund to the

    Global Alliance for Vaccines and Immunization (GAVI) and

    The Vaccine Fund

    by the Government of

    COUNTRY: GEORGIA

     Date of submission: 15 .05.2006……………………………

     Reporting period: 2005 ( Information provided in this report MUST refer to

     2005 activities )

     ( Tick only one ) :

     Inception report ?

     First annual progress report ?

     Second annual progress report ?

     Third annual progress report ?

     Fourth annual progress report ?

     Fifth annual progress report ?

    Text boxes supplied in this report are meant only to be used as guides. Please feel free to add text beyond the space provided.

    *Unless otherwise specified, documents may be shared with GAVI partners and collaborators

Progress Report Form: Table of Contents

    1. Report on progress made during 2005

    1.1 Immunization Services Support (ISS)

    1.1.1 Management of ISS Funds

    1.1.2 Use of Immunization Services Support

    1.1.3 Immunization Data Quality Audit

    1.2 GAVI/Vaccine Fund New and Under-used Vaccines

    1.2.1 Receipt of new and under-used vaccines

    1.2.2 Major activities

    1.2.3 Use if GAVI/The Vaccine Fund financial support (US$100,000) for introduction of the new vaccine

    1.3 Injection Safety

    1.3.1 Receipt of injection safety support

    1.3.2 Progress of transition plan for safe injections and safe management of sharps waste

    1.3.3 Statement on use of GAVI/The Vaccine Fund injection safety support (if received in the form of a cash contribution)

2. Financial Sustainability

3. Request for new and under-used vaccine for 2007

    3.1 Up-dated immunization targets

    3.2 Confirmed/revised request for new vaccine (to be shared with UNICEF Supply Division) for year…

    3.3 Confirmed/revised request for injection safety support for the year…

4. Please report on progress since submission of the last Progress Report based on the indicators

     selected by your country in the proposal for GAVI/VF support

5. Checklist

6. Comments

7. Signatures

1. Report on progress made during 2005

To be filled in by the country for each type of support received from GAVI/The Vaccine Fund.

    Having applied to the GAVI/Vaccine Fund Support in October 2001 the Government of Georgia (GoG) has received approval for all three sub-accounts of the application (Ref.: GAVI/01/199/jd dated 10.12.2001), specifically:

    1. 16,604.65 USD has been approved as the 2nd instalment disbursed for the Immunization Service Support (ISS) sub-account in 2003. No additional funds have

    been received in 2005.

    2. Hep B vaccine supply support for 2005 national immunization programme (160,080 doses of HepB, 178,400 AD syringes and 1,400 5 ml safety boxes) was

    received on 21.06.05 & 05.09.05.

     rd3. Financial support for the 3 sub-account - 20,800 USD was issued to the Government of Georgia in March 2003. The funds are planned to be utilised for ensuring

    sustainability of injection safety supplies and improvement of injection and waste management practices within NIP for 2006 and beyond. The country was not

    eligible for additional disbursements or supply assistance within the 3rd sub-account in 2005.

    Implementation of the plans approved by ICC for ISS and New and Under-used Vaccine sub-accounts started in 2003. Details of the fund utilization and performance are

    provided in sections 1.1, 1.2 and 1.3.

     1.1 Immunization Services Support (ISS)

1.1.1 Management of ISS Funds

    Please describe the mechanism for management of ISS funds, including the role of the Inter-Agency Co-ordinating Committee (ICC). Please report on any problems that have been encountered involving the use of those funds, such as delay in availability for programme use.

     ndAs per 2005 annual progress report total funds available for the ISS comprised 51,000 USD (17,000 USD from 2 trench in March 2003 & 34,000 USD received in

    2004) the amount of 17,000 USD) .

    The second trench of of 17,000 USD received in 2003 (deducted to 16,604.65 USD due to exchange rate) was issued as premial funds of the primary health care

    providers engaged in NIP throughout the country. The decision was made by ICC and funds disbursed to 66 district public health care centres countrywide. Overall

    191 public health managers responsible for logistics, monitoring & evaluation & reporting for the national immunization programme have benefited form the premium

    funds. The incentive payment for immunization staff served to improve the motivation of the pubic health staff for maintaining and further improving the NIP

    management. The payments as in 2003 will be accompanied by introductory note from the MLMHSA re: source and purpose of the financial support, thereby

    increasing the awareness of the front-line workers on the assistance Global Alliance is providing to the Government of Georgia

    The 34,000 USD funds received in 2004 has been distributed as follows:

    1. 7,655.49USD for renovation of the national vaccine store & cold-chain department at the National Centre for Disease Control & Medical Statistics.

    2. 5,854.05 USD for procurement of a 4xw vehicle for one of the most vulnerable and hard to reach region (Racha-Lechkhumi PH Regional Centre) affected by severe

    floods emergency in April-May 2005. Due to the floods emergency with subsequent landslides & mobility restrictions, the immunization programme ioperation has

    been disrupted in the region. The ICC has made a decision for the emergency response to immunization programme continuation in the region.

    3. 5364.81 USD - Miscellaneous services covered within the NIP management:

    3.1. Translation of WHO modules “Immunization in Practice‟‟ 1,336.40 USD. 50 courses of “Immunization in Practice‟‟ training co-funded by UNICEF Georgia.

    3.2. Telephone communication for the immunization department, NCDCMS - 193.41 USD

    3.3. Procurement of the IT equipment (2 notebooks, 3 USB) for the immunization department at NCDC - 4835 USD

    Remaining funds for FY 2006: 14,521.00 USD

1.1.2 Use of Immunization Services Support

    In 2005, the following major areas of activities have been funded with the GAVI/Vaccine Fund Immunization Services Support contribution.

    Funds received during 2005 - 0-

     Remaining funds (carry over) from 2004 ____51.000

    Table 1: Use of funds during 2005

    Area of Immunization Total amount in PUBLIC SECTOR PRIVATE

    Services Support US $ SECTOR & Central Region/State/Province District Other

    0 Vaccines

    0 Injection supplies

    16,60465** 4,358.64 (26%) ** 0 12,246.01 (74%)** 0 Personnel

    0 Transportation

    7,655.49 7,655.49 Maintenance and overheads

    0 Training

    0 IEC / social mobilization

    0 Outreach

    0 Supervision

    0 Monitoring and evaluation

    0 Epidemiological surveillance

    5,854.05 5,854.05 Vehicles

    0 Cold chain equipment

     1,336.40 Other … (specify)

    1)1,336.40 1) Translation services 2) 4,835 4835 2) IT equipment 3) 193.41 193.41 3) Tele-communication cost Total: 36,479.00 18,378.94 5,854.05 12,246.01 Remaining funds for next year: 14521.00 *If no information is available because of block grants, please indicate under ‘other’.

    ** Expenditure in 2005 premium funds for the health care workers distributed at central and 66 district levels (public health centres) countrywide.

    Please attach the minutes of the ICC meeting(s) when the allocation of funds was discussed. Attached please find the ICC minutes #3.

    Please report on major activities conducted to strengthen immunization, as well as, problems encountered in relation to your multi-year plan.

    In 2005 the country has witnessed improvements in the national immunization programme performance reflected in increased time-appropriate NIP coverage vs. 2004 data, specifically, antigen-specific age-appropriate (timely) coverage for 2005 has comprised:

     BCG - 95%,

     DPT 3 82%

     OPV3 81.5%

     Measles (MCV1 within MMR) 91.6%

     HepB 3 72%

However as Georgia is still missing out from the global & national tarets of >90% NIP coverage for every vaccines countrywide, the Government is prioritizing to

    address the gaps in timely vaccination coverage through strengthened advocacy and communication. The country is still struggling to overcome the continued delays in start of the age-appropriate vaccination series. Despite the fact that over 90% of children do receive the 9 NIP antigens up to age of 2 years, under-12 month coverage against DPT3 (82%) and OPV3 (81,5%) remains a challenge. The major factor impeding timely completion of the vaccination is the fear of parents 2. As noted HepB-3 timely vaccination has increased from 63.7% in 2004 to 72% in 2005. The achievement is conditioned by the continuous IEC and national staff

    and health care providers stemming from the negative media publicity of suspected AEFI cases from Hep B in 2002, MMR and VPP in 2004. capacity building for changing attitudes to the newly introduced vaccines, though negative publicity from 2002 AEFI was renewed in 2004 due to the media coverage of the court trial of the 2002 suspected AEFI. The Supreme Court of Georgia obliged the Ministry of Labour, Health & Social Affairs to pay life-time Pension fund & a compensation of 60,000 GEL (est. 33,000 USD) to the affected child. The latter has affected coverage of HepB as well as other NIP antigens. In 2005 in order to address the negative publicity & re-gain public trust, ICC intensified efforts for IEC. TV-talk-shows has been arranged for NIP, the First Lady (with

    the newborn child) has been actively involved in immunization communication, UNICEF has supported development of a COMBI plan (communication for behaviour

    impact) focusing on improvement of timely immunization coverage. The COMBI plan implementation will be launched in June 2006.

    3. In 2005 VRF has supported implementation of the “Adolescent Immunization Campaign” among 13-14 years age group. Coverage rate comprised 93,5%.

    4. 50 2-day “Immunization in Practice” trainings for 1200 PHC workers (27 trainings in 2005, and 23 in 2006) has been supported by UNICEF country office, The training is based on up-to-date WHO ICC methodology.

5. 11 training sessions on AEFI has been supported by WHO for 220 PHC managers countrywide.

6. In 2005 UNICEF has supported monitoring and 1-day training sessions for HepB and BCG vaccination among all maternity hospitals (89 total). The performance

    was evaluated for the periods 2004 & Jan-Jun 2005. The monitoring has provided proven evidence & underlying factors for the differences between the vaccination

    coverage of HepB birth dose (75%) and BCG (91%) administered at the maternity hospital levels. The findings have demonstrated persistent resistance & fear of health care providers and parents to HepB vaccination. The ICC has prioritized continuous training & advocacy among the maternity hospital staff and managers.

    1.1.3 Immunization Data Quality Audit (DQA) (If it has been implemented in your country)

Has a plan of action to improve the reporting system based on the recommendations from the DQA been prepared?

    If yes, please attach the plan.

     YES NO ---

     _-

     If yes, please report on the degree of its implementation. ---

     ---

    Please attach the minutes of the ICC meeting where the plan of action for the DQA was discussed and endorsed by the ICC.

     Please report on studies conducted regarding EPI issues during 2005 (for example, coverage surveys).

    UNICEF in 2005 has supported implementation of MICS2 (Multiple Indicator Cluster Survey 2). The survey data is under processing and the final report is expected to be available by September 2006.

1.2 GAVI/Vaccine Fund New & Under-used Vaccines Support

    1.2.1 Receipt of new and under-used vaccines during 2005

    Start of vaccinations with the new and under-used vaccine: MONTH… September YEAR…2002…………….

Please report on receipt of vaccines provided by GAVI/VF, including problems encountered.

    Georgia received the Hepatitis B vaccine and matching quantities of injection supplies in 03.11.2004. The assistance included 160 080 doses of HepB vaccines, 178,400 ndAD syringes and 1,400 safety boxes for the 2 sub-account. General condition of the vaccine and injection safety supplies received by NIP through GAVI/VF assistance

    was good.

    1.2.2 Major activities

    Please outline major activities that have been or will be undertaken, in relation to, introduction, phasing-in, service strengthening, etc. and report on

    problems encountered.

    As noted in the ISS section, the 2002 suspected AEFI case for HepB vaccination & publicity of the Supreme Court trial obliging the Government to cover 60,000

    GEL (33,000 USDD) compensation costs & life-time pension fund to the affected child, has substantially affected the HepB vaccination scale-up.

    Despite the challenge the Government has managed to retain the progressively increasing trend of the HepB vaccination coverage and reaching 73,5% HepB 3

    coverage in 2005 vs. 63.7% in 2004.

    1. Continuous in-service training of NIP workers countrywide 1,200 health care providers trained on immunization-in-practice methodology

    2. Training of 89 maternity hospital staff throughout the country on immunization-in-practice. The training has been complemented by monitoring the BCG &

    HepB 1 coverage & analysis of the key bottlenecks.

    3. Training of 220 PHD workers countrywide on AEFI management supported by WHO;

    4. Media advocacy & communication through supporting special talk-shows on child vaccination & engagement of the First Lady in the communication through

    publicizing the immunization visits of the newly born child.

     For 2006 the following activities have been prioritized by ICC:

    1. Implementation of the COMBI (communication for behaviour impact plan) for immunization focusing on promotion of the age-appropriate immunization

    coverage on basic antigens. The 1-year plan to be launched in June 2006 envisages a wide scope of advocacy, media & inter-personal communication for

    improving the NIP performance.

    2. A series of child health programme will be continued through USAID & UNICEF support in 2006, covering 2 sessions on immunization.

    3. Along with MICS survey, UNICEF and WHO will be supporting a comprehensive evaluation of the national immunization programme to be translated in the

    renewed strategy and multi-year plan of action for the child vaccination programme in Georgia. The evaluation will be commissions in July-Sept 2006 period,

    covering conflict affected zone (Abkhazia) as well.

1.2.3 Use of GAVI/The Vaccine Fund financial support (US$100,000) for the introduction of the new vaccine

    Please report on the proportion of 100,000 US$ used, activities undertaken, and problems encountered such as delay in availability of funds for programme use.

    As per the 2005 annual progress report balance from the supplementary support funds by end 2004 comprised 13,112.85 USD. The funds have not been expended in 2005, due to no identified target priority by ICC. The funds have been left as a contingency support for NIP management needs. One of the options considered by ICC is to ensure co-funding to cold-chain upgrading in 2006 under primary health care reform, with a major investment of >100,000 USD considered by USAID/UNICEF.

    The second alternative is support to outreach immunization team operations, upon finalization of the organization, restructuring and determination of functional links among primary health care providers & public health authorities under review in 2005-2006.

    a. Injection Safety

1.3.1 Receipt of injection safety support

    Please report on receipt of injection safety support provided by GAVI/VF, including problems encountered

The country was not eligible for additional disbursements or supply assistance within the 3rd sub-account in 2005.

    Progress of transition plan for safe injections and safe management of sharps waste

     Please report problems encountered during the implementation of the transitional plan for safe injection and sharp waste

    Indicators Targets Achievements Constraints Updated targets

    1. Injection Safety Assessment FY 2002 Assessment as per WHO/SIGN methodology

    carried out in Oct 2002 by WHO/EURO experts. nd annual report to Final report provided with 2

    GAVI/VF in 2004. Financial support provided

    through UNICEF/USAID.

    2. Waste Management assessment and FY 2002 Waste management assessment and planning Delay in implementation of planning exercise completed in February 2004. Financial injection safety assessment

    support provided through UNICEF/USAID. and political turmoil in the

    country in 2003 3. Elaboration of detailed plan of action for FY 2002 Accomplished as of FY 2004

     injection safety, including safe disposal

    4. Introduction of the injection safety policy FY 2002 Injection safety policy and plan incorporated in and plan at the national and sub-national the revised Ministerial Decree on NIP

    levels management #122/n June 2003. Training of

    EPI staff supported at all levels of programme

    mngt.

    5. Develop training curriculum for FY 2003 Training curriculum developed in 2002 and physicians, nurses, pharmacists and other included in the Ministerial Decree #122/n.

    health professionals on injection safety

    6. Train focal points on management and FY 2003 Accomplished within the scope of training on Continuous training of health care surveillance of injection safety, including implementation of the revised Ministerial Decree providers prioritized within NIP. safe disposal & AEFI #122/n

    7. Inclusion of injection safety in the FY 2003 Pending Major transformation & FY 2006 education curriculum for medical students merging of the State Medical

    University & Medical Academy

    in 2005-2006

    8. Advocacy and communication on injection YY 2002-2006 Advocacy and communication workshop with Continuous advocacy and training safety involvement of 40 PHD and MLHSA rep-s on injection safety prioritised within

     supported by UNICEF in Nov‟02. Training on NIP planning.

    injection safety by BD International in Feb‟02 for

    24 rep-s of NCDC/PHDs. Injection safety training

    included in NIP training in 2003 & 2004 based

    on Ministerial Decree. IIP training, including

    injection safety component supported

    countrywide for 1,200 front-line workers in

    2005-April 2006.

    9. Provision of adequate supplies of safe YY 2002-2006 Non-interrupted provision of injection safety Waste mngt assessment Continue to supply matching injection and disposal equipment (safety equips „‟bundled‟‟ to vaccine supplies ensured completed in Feb‟04. Decision quantities of injection safety boxes and incinerators) at national and sub-throughout reporting period. on waste-management supplies. Provision of incinerators & national levels equipment subject to construction of waste disposal pits

    finalization of primary health FY 2005-06.

    care reform (legal status,

    management systems) 10. Local adaptation/ YY 2003-2005 Waste management assessment and planning implementation of the waste management exercise completed in February 2004.

    plan according to destruction methodologies Implementation of the consultant‟s

chosen. recommendations subject to finalization of

    primary health care reform (legal status,

    management systems)

    11. Transition to AD syringes for all YY 2002-2005 Exclusive use of Ads for immunisation achieved injections by end 2004. Disposal & reconstitution syringes

    used for lyophilised vaccines.

    12. Revise the open vial policy FY 2003 Open vial policy adopted through Ministerial

    Decree #122/n

    13. Establish AEFI monitoring and YY 2003-2004 AEFI surveillance system revised and included Continuous monitoring and surveillance system at all levels of service within the new health information systems for supervision for endorsement of AEFI delivery NIP management (#122/n decree) surveillance system 14. Review potential for local production of FY 2005 Pending Competing priorities within NP End 2006 safety boxes & health care reform process.

    15. Revise and refine the safe immunization YY 2002-2006 Safe immunisation policy continuously discussed policy in compliance with WHO and revised by ICC partners

    recommendations

    16. Evaluate impact of injection safety policy YY 2004-2006 Comprehensive immunization review, including

     injection safety component planned in July-Sept

    2006

    17. Achieve 100% immunization injection FY 2006 Exclusive use of Ads for immunisation achieved Ensure continued monitoring of the safety by end 2004. Disposal & reconstitution syringes procurement and utilization of

    used for lyophilised vaccines. injection supplies for NIP.

1.3.3 Statement on use of GAVI/The Vaccine Fund injection safety support (if received in the form of a cash contribution)

    The following major areas of activities have been funded (specify the amount) with the GAVI/The Vaccine Fund injection safety support in the past year:

     rdThe financial support for the 3 sub-account - 20,800 USD was issued to the Government of Georgia back in March 2003. The funds are planned to be utilised for ensuring sustainability of injection safety supplies and improvement of injection and waste management practices within NIP for 2006 and beyond. Up-to-date the N/A - Government of Georgia has been efficient in meeting the commitment under the Financial Sustainability Plan (2005-2010), thereby no need for complementary funding has been raised. The funds are considered as a contingency planning for the routine NIP as well as the supplemental immunization activities (i.e. MR NIDs planned in late 2007-early 2008).

2. Financial sustainability

    Inception Report: Outline timetable and process for the development of a financial sustainability plan . Describe assistance that may be

    needed for developing a financial sustainability plan.

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