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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

     Progress Report

    to the

    Partnering with The Vaccine Fund Global Alliance for Vaccines and Immunization (GAVI)

     and

    The Vaccine Fund

    by the Government of

    COUNTRY: Republic of Armenia

     Date of submission: …01.07.05

     Reporting period: 2004 ( 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 ?

     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 2004

    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 2006

    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

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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 GAVI funds are on the extra- budget account of the Ministry of Health of the Republic of Armenia. The annual budget is being defined and approved

    during the ICC meeting. The budget approved by ICC is submitted to the Ministry of Finance of the Republic of Armenia for their verification. The annual budget includes:

    - list of expenditures and budget allocations;

    - timetable for expenditures.

    In order to receive funds for different budget allocations the request has to be submitted to State Procurement Agency (SPA). EPI Manager specifies all

    the technical specification to be taken into consideration by SPA. On a basis of submitted request SPA announces a tender among suppliers. The SPA also acts as decision maker on selection of supplier of requested goods or services. When decision on supplier is made EPI Manager signs a supply agreement with Supplier. Based on the terms of the Agreement, Supplier is obliged to provide the purchased goods or services within agreed deadlines (usually one month). EPI Manager is obliged to report on progress development as well as on the way of utilization of purchased goods or services on every consequent ICC meeting.

One of the major problems to be addressed is necessity to pass the stage of SPA approval. The problem is that it takes around four months from the first

    day of submission the request to SPA until the stage of decision on supplier is made.

    The other question to be addressed is because the ISS Fund has been removed from International Agreement and placed as extra-budget account, during the implementation of mission activities the VAT in amount of 20% has to be paid. All the International Funds are free of VAT payments.

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    1.1.2 Use of Immunization Services Support

    In 2004, the following major areas of activities have been funded with the GAVI/Vaccine Fund Immunization Services Support contribution.

Funds received during 2004 ______20000USD _________

    Remaining funds (carry over) from 2003 134300 USD ________

Table 1: Use of funds during 2004

    Area of Immunization Total amount in PUBLIC SECTOR PRIVATE

    Services Support US $ SECTOR & Central Region/State/Province District Other Vaccines 0 Injection supplies 0 Personnel 0 0 0 0 0 Transportation 4600 600 1700 2300 0 Maintenance and overheads 0 0 0 0 0 Training 0 0 0 0 0 IEC / social mobilization 400 100 150 150 0 Outreach 0 0 0 0 0 Supervision 0 0 0 0 0 Monitoring and evaluation 0 0 0 0 0 Epidemiological surveillance 1000 700 300 0 0 Vehicles 0 0 0 0 0 Cold chain equipment 18200 560 2800 14840 0 Other …………. (specify) 0 0 0 0 0

    24200 1960 4950 17290 0 Total:

    129800 Remaining funds for next

    year:

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

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Note: As the funds are placed on the same account, it is impossible to separate the ex pansies

    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.

    - Development of the Immunization Program as a separate field of health care (in the process); - Accurate compliance to FSP requirements;

    - Inclusion of updated Measles Elimination Program into the National Immunization Program; - Maintaining 95% coverage of all vaccination on a district level throughout the country; - Introduction of a new pilot system of AEFI.

    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

    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 2004 (for example, coverage surveys).

    No studies/surveys were eon ducted during reporting period

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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 2004

    Start of vaccinations with the new and under-used vaccine: MONTH…January….. YEAR…2004….

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

With support of GAVI Armenia Hepatitis B vaccines were received. Vaccines were supplied in time and in requested quantities. A distribution of this

    vaccine is made in accordance with vaccination schedule and was delivered to Maternity Hospitals and policlinics. The major problems encountered were related to timely delivery from regional to local levels (Health centers, policlinics, ambulatories).

    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.

Activities

    - In order to strengthen services, new software was developed that enables monitoring of the whole program of immunization: supply of vaccines,

    stock of vaccines on all levels, vaccination coverage, wastage, storage, etc;

    - Training of doctors and nurses;

    - Monitoring of AEFI;

    - Social mobilization;

    - Ensuring Cold chain-refrigerators in rural ambulatories.

Problems encountered.

    - Lack of qualified staff;

    - Not adapted system of optimisation of Health Care (rejecting the old system without proper operation of the new one);

    - Not optimal system of budget allocation for immunization, for example: budget allocations for purchase of vaccines is made on quarterly basis

    during the year, meanwhile the optimal solutions would of been allocation of the entire budget at the beginning of the year.

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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.

    - 18 200$ were used for procurement of 65 refrigerators and distributed on district levels (especially in rural areas) - 4 600$ were used for the timely transportation from airport to national level and from national level to marzes (district) level - 1000$ were used for the Immunization Program monitoring and epidemiological surveillance

    - 400 were used for the social mobilization

TOTAL 24 600 US$

1.3 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

In reporting period the country is not receiving injection safety support from GAVI.

1.3.2 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

    The law of sanitary-epidemiological safety of people is being updated and comprises of the law on immunization. It will involve the injections safety, sharps waste and management. The major problem encounters is absence of efficient incinerators for used syringes and sharp waste, which will be

    ecologically harmless.

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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.

    First Annual Progress Report: Submit completed financial sustainability plan by given deadline. Describe major strategies for improving financial

    sustainability.

    After attending the training course in Moscow the working group for the FSP preparation was organized involving representatives from the Ministry of Health and Ministry of Finances. An expert from GAVI was invited to assist the working group.

    A questionnaire (of all immunization details) was developed and sent to all medical facilities having immunization services all over the country. The draft of FSP was developed based on the data of completed questionnaires received from all the medical institutions and information from the Ministry of Finance. After some amendments done in the draft version, the final version of FSP was prepared and approved by the Minister of

    Health and Minister of Finance.

    GAVI, WHO and UNICEF largely contributed to development of FSP.

    Subsequent Progress Reports: According to current GAVI rules, support for new and under-used vaccines is covering the total quantity required to

    meet country targets (assumed to be equal to DTP3 targets) over a five year period (100% x 5 years = 500%). If the

    requested amount of new vaccines does not target the full country in a given year (for example, a phasing in of 25%),

    the country is allowed to request the remaining (in that same example: 75%) in a later year. In an attempt to help

    countries find sources of funding in order to attain financial sustainability by slowly phasing out GAVI/VF support,

    they are encouraged to begin contributing a portion of the vaccine quantity required. Therefore, GAVI/VF support can

    be spread out over a maximum of ten years after the initial approval, but will not exceed the 500% limit (see figure 4 in

    the GAVI Handbook for further clarification). In table 2.1, specify the annual proportion of five year GAVI/VF

    support for new vaccines that is planned to be spread-out over a maximum of ten years and co-funded with other

    sources. Please add the three rows (Proportion funded by GAVI/VF (%), Proportion funded by the Government

    and other sources (%), Total funding for Hepatitis B. (new vaccine)) for each new vaccine.

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    Table 2.1: Sources (planned) of financing of new vaccine Hepatitis B (specify)

    Annual proportion of vaccines

    Proportion of vaccines supported by *

    2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

    A: Proportion funded by GAVI/VF (%)*** 100% 100% 100% 100% 100% 50% 0 0 0 0

     B: Proportion funded by the Government and other sources 0 0 0 0 0 50% 100% 100% 100% 100% (%)

     C: Total funding for Hepatitis B (new vaccine) US$ 61047 57827.3 59573 60426.4 61750 62702 63968.8 65568.2 67529.7

    * Percentage of DTP3 coverage (or measles coverage in case of Yellow Fever) that is target for vaccination with a new and under-used vaccine.

** The first year should be the year of GAVI/VF new vaccine introduction

    *** Row A should total 500% at the end of GAVI/VF support

In table 2.2 below, describe progress made against major financial sustainability strategies and corresponding indicators.

Table 2.2: Progress against major financial sustainability strategies and corresponding indicators

    Financial Specific Actions Taken Progress Achieved Problems Baseline Value of Current Value of Proposed Changes To Sustainability Strategy Towards Achieving Encountered Progress Indicator Progress Indicator Financial Sustainability

    Strategy Strategy 1. Increase of the The definite issue The first Problems in Concordance with Augmentation of The changes were done share funded by the development in the investment (16 timeliness of the FSP the budget for according to proposals Government to Governmental Budget 000$) was the budget vaccines receipt for got from the GAVI attain financial decided to submit submitted for means the coming year secretary sustainability fund for vaccines the OPV submitting

    annually vaccines receipt

    The investment

    for 2005

    (66000$) will

    submit for OPV,

    BCG, DTP and

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    safety injection.

    2. Elimination of Endorsement of the Updating of the Elimination of The updated The epidemiological measles Measles Elimination Measles measles by 2010 Program is in the situation was

    Plan at the Elimination Plan evaluation and considered and the

    Governmental level endorsement phases of Program

    process currently implementation were

    revised 3. Management of Stage by stage held The training of Not persistent Increase in The most required No changes 100% training of training courses in all nurses is use of the got skilfulness and marzes

    doctors and nurses the marzes completed and knowledge in knowledge level of involvement into

    the training of practice; the personnel the training

    doctors is started updating of procedure

    the modules

    4. The Management of the Determination The Immunization The required Having the acting Immunization Program development of the Program acting materials Program as a base the Program approval for the following ideological and independently preparation for the optimisation program by the Government approval at the the juridical Immunization issues were considered in general Governmental level base for the Program

    Program

3. Request for new and under-used vaccines for year 2006

    Section 3 is related to the request for new and under used vaccines and injection safety for 2006.

    3.1. Up-dated immunization targets

     Confirm/update basic data approved with country application: figures are expected to be consistent with those reported in the WHO/UNICEF Joint

     Reporting Forms. Any changes and/or discrepancies MUST be justified in the space provided (page 12). Targets for future years MUST be provided.

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