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CAR 3rd Annual Progress Report

By Randy Graham,2014-05-15 13:15
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CAR 3rd Annual Progress Report

    January 2006

     Progress Report

    Partnering with The Vaccine to the Fund

    Global Alliance for Vaccines and Immunization (GAVI)

     and

    The Vaccine Fund

    by the Government of

    COUNTRY: CENTRAL AFRICAN REPUBLIC

     Date of submission: 12 May 2006……………………………

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

     2004 activities )

     ( Tick only one ):

    Inception report ?

    First annual progress report ?

    Second annual progress report ?

    Third annual progress report X

    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

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    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 (USD100,000) 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 2007

    3.3 Confirmed/revised request for injection safety support for the year 2007 (N/A)

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

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1. Report on progress made during 2004

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

    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.

    ? The mechanism for management of funds is documented in the GAVI guidelines concerning usage of funds ANNEX I ? ICC principal functions and responsibilities: (Ministerial decree no.0044 MSPP/CAB/SG/DGSPP/SPEV 7 February 2002) ANNEX II

    1. To co-ordinate the activities of the partners;

    2. To contribute to the examination and approval of routine EPI plans, National/Local Vaccination Days and integrated epidemiological monitoring

    of diseases;

    3. To mobilise the internal and external resources needed to implement activities;

    4. To oversee transparent and responsible management of resources while making, with the EPI team, regular audits of the use of programme

    resources;

    5. To encourage and sustain the exchange of information at the national operational level with the exterior;

    6. To oversee proper programme execution;

    7. To find ways and means to resolve the constraints likely to hinder the programme’s proper working.

    The ICC, through decree no. 113MSPP/CAB/SG/DGSPP/DMPM/SPEV 11 March 2003, set up its Technical under-committee which is a multi-sectoral and multi-disciplinary structure (ANNEX III) called the EPI Technical Support Committee (EPITSA), who’s job is to:

    1. Examine and approve the EPI operational action plans;

    2. Approve the budgets for implementation of these plans;

    3. Monitor execution of action plan activities

    4. Prepare technical dossiers for audits

    5. Produce periodic reports on the status of programme implementation;

    6. Propose to the ICC any action that might enhance programme performance

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Problems encountered in the use of GAVI funds in 2005 are the following:

    ? Delay in receiving ISS funds: these funds were received at end of the fourth quarter of 2005, which had a negative impact on the

    implementation of routine vaccination activities foreseen for the year;

    ? VAT charged at 19% on local purchases

Proposed solutions:

    ? the programme recommends that the second tranche of funds for 2005 should be released immediately with the aim of implementing planned

    activities

    ? the Minister for Public Health and Population is negotiating with his counterpart in Finance and Budget with the aim of exempting local

    purchases made with GAVI funds from tax;

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    1.1.2 Use of Immunization Services Support

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

Funds received during year considered 111 400.00 USD

    Remaining funds (carry over) from previous year 11 721.65 USD

Table 1: Use of funds during 2005

    Area of Immunization Total amount in PUBLIC SECTOR PRIVATE

    Services Support USD SECTOR & Central Region/State/Province District Other Vaccines Injection supplies Personnel Transportation 916.2 916.2 Maintenance and overheads 5 916.21 667.00 5 249.21 Training IEC / social mobilization Outreach Supervision 808.60 808.60 Monitoring and evaluation 4 074.85 3 361.11 713.75 Epidemiological surveillance Vehicles Cold chain paraffin Paraffin packaging (barrels)

     11 715.87 4 028.11 7 687.76 Total:

     111 405.78 Remaining funds for next

    year:

    *If no information is available because of block grants, please indicate under „other‟.

    Details of expenditure per level are annexed to this report

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Please attach the minutes of the ICC meeting(s) when the allocation of funds was discussed.

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

1. Activities already undertaken in 2005

    ? Vaccine storage and conservation capacity at the central level were reinforced by the installation of four new cold chamber units meeting

    international standards: two positive units and two negative units

    ? Health district vaccination centres have been given more cold chain equipment (91 refrigerators; 148 freezers; 1750 giostyle vaccine carriers,

    1000 ordinary vaccine carriers, 277 ice boxes, thermometers and refrigeration cards and 37000 litres of paraffin.) GAVI funds were used in the

    transport of equipment by hiring vehicle for the transport of this equipment.

    ? The country’s health district vaccination centres have had an intermittent supply of vaccines and injection safety equipment, thanks to GAVI

    support allowing vehicles to be serviced and fuel provided subject to fund availability;

    ? The supply of vaccines for routine vaccination, including injection equipment (auto-destruct syringes, dilution syringes and safety boxes) and

    other consumables;

    ? The technical capacity of 2 078 health workers and volunteers has been improved in the fields of injection safety, waste management, data

    collection and processing and proper handling of cases of PVARs during the two phases of the anti-measles vaccination campaign; ? Trained health workers were supervised during both the national anti-measles vaccination campaign and the polio SVAs. ? Informed families and communities participated actively in the mass anti-measles campaign and polio SVAs with a financial contribution

    from GAVI towards the funding of advocacy, social mobilisation and communication activities.

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2. Main activities planned for 2006

GAVI funds will contribute to the implementation of the following activities planned for this year:

    ? Elaboration of district micro-plans following the “Reach Every District” approach;

    ? Regular and uninterrupted supplies to health districts of cold chain equipment, vaccines and other consumables;

    ? Improved geographical accessibility through the opening of new stationary centres and the allocation of motorcycle and bicycle vaccination units

    for outreach strategy implementation;

    ? Organisation of half-yearly and annual reviews of EPI activities bringing together district and regional foundation teams, and central level EPI

    managers;

    ? Continuing training of intermediate and district managers in the planning, management, monitoring and evaluation of EPI activities;

    ? Continuing training of vaccination agents in daily EPI management including vaccination safety

    ? Continuing dissemination of injection safety policies to all vaccination centres

    ? Development of a mechanism to ensure long-term programme funding

    ? Introduction of new vaccines to the EPI

    ? Elaboration of a communication and social mobilisation plan;

    ? Support for supplementary vaccination activities: MNT campaign and polio NIDs

3. These main activities are contained in the following documents:

- Routine EPI strategic plan 2003 2007 (ANNEX IV)

    - Routine EPI action plan 2006 (ANNEX V)

    - Action plan to boost anti-yellow fever vaccination (ANNEX VI)

    - National injection safety policy (ANNEX VII)

    - National strategic plan for vaccination injection safety 2003-2007 (ANNEX VIII)

    - National strategic plan for the elimination of maternal and neonatal tetanus (MNT) in the Central African Republic (ANNEX IX) - Reduction of vaccine wastage plan CAR 2003-2007 (ANNEX X)

4. Problems encountered

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In summary, these are:

     4.1 Programme funding

     th? The implementation of activities suffered due to the late arrival of GAVI funds for vaccination service support (end of 4 quarter 2005) ? The limited number of development partners to support the routine EPI

    ? The Government’s limited financial capacity after several politico-military crises does not allow for efficient EPI support despite its willingness to

    budget for the programme within its own spending. This limited State capacity also means insufficient funding is actually released for the EPI, even

    though these figure appear in its own spending.

4.2 Insufficiency of routine vaccination services rendered

    ? The quantity and quality of health workers are inadequate , which has a negative impact on the vaccination services rendered;

    ? Instability of health staff

    ? Staff are demotivated (irregular payments of salary)

    ? An obsolete vehicle fleet at all levels, resulting in multiple breakdowns and frequent repairs;

    ? Insufficient geographical coverage of vaccination units, despite the rehabilitation of vaccination centres and the replacement of obsolete cold chain

    equipment;

    ? The concentration of efforts on the organisation of five days of polio NIDs (vaccinating 700 000 children from 0 to 59 months per round) and two

    phases of a national anti-measles campaign covering 1 699 546 children aged 6 months to 14 years) did not allow the implementation of important

    routine vaccination activities according to the “Reach Every District” approach.

4.2 Constraints limiting better routine vaccination services

    ? Geographical inaccessibility of certain areas during the rainy season (Vakaga)

    ? Limited financial capabilities of communities to buy paraffin for cold chain operation through the medical establishment Management Committees ? Lack of security due to banditry in certain parts of the country, particularly in districts that account for almost half of the country’s vaccination

    centres.

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    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 X

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

    Not Applicable (N/A)

    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 the past year (for example, coverage surveys).

    1. An assessment of the cold chain was made in 2005. The results of the assessment made it possible to draft a cold chain rehabilitation plan and organise a mass anti-measles campaign.

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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…FEBRUARY........ YEAR…1979*.......

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

    In 2005, 92 700 doses of GAVI-supplied Anti-Amaril vaccine were received on 8 September 2005: lot Y5675-1, expiry date May 2007

*The year anti-yellow fever vaccination was introduced into the EPI in Central African Republic

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.

Activity type Activities already implemented Activities to be implemented

    ? Introduction of ? Regular and uninterrupted restocking of ? Introduction of new vaccines, particularly those aiming to prevent

    new vaccines and AAV vaccination services haemophilus influenza and Hepatitis B from 2008

    under-utilised ? Continue to supply vaccination services with AAV vaccines

    vaccines

    ? Vaccination ? Dissemination of vaccination safety ? Drafting, implementation and monitoring of the execution of district

    services support policy micro-plans according to the “Reach Every District” approach;

    ? Cold chain assessment in the context of ? Improvement of geographical accessibility to EPI services through the

    implementing anti-measles vaccination creation of new centres and an increase in the number of outreach

    campaign activities; strategy teams;

    ? Supply of paraffin to vaccination ? Re-training/training of intermediate and district managers in MLM;

    centres; ? Re-training /training of vaccination workers in vaccination safety;

    ? Contribution to the organisation of ? Equipping health districts with vehicles for the supply, supervision,

    polio and measles SVAs 2005 monitoring and assessment of activities ? Injection safety ? Dissemination of injection safety policy; ? Continue to disseminate injection safety policy

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