Modern Vaccination Program mes in Rural & Remote Areas Essay

Modern Vaccination Program mes in Rural & Remote Areas Essay

The recent Ebola outbreak puts into focus the prevalence of infectious diseases in Africa.

In sub-Saharan Africa, infectious diseases such as malaria and HIV/AIDS cause 69% of deaths. Though we can deliver short-term aid and try to develop innovative vaccines or treatments for these diseases, the real issue is the danger of a weak healthcare system. To address this, we must focus on building better healthcare infrastructure in Africa. For example, Africa bears one-quarter of the global disease burden, yet has only 2% of the world’s doctors. This is unacceptable, and we need to take steps to address inadequate healthcare infrastructure now.Modern Vaccination Program mes in Rural & Remote Areas Essay

We’ve learned a few important lessons on how to deal with infrastructure challenges in Africa, and have identified where sustainable investments can make a long-term difference. We need to focus on three areas: leveraging digital technologies, improving knowledge, skills and resources, and creating collaboration and consensus among key stakeholders.

1. Digital technologies

We’ve seen that mobile phones have been particularly beneficial where infrastructure is limited in Africa. As mobile devices become increasingly common, they become an unexpected force in delivering better healthcare. For example, previously, patients would travel to far-off health clinics only to find that the medicines they needed were no longer in stock. Today, around 27,000 government health workers in Uganda use a mobile health system called m TRAC to report on medicine stocks across the country. Novartis is also working on an m Health pilot in Nairobi and Mombasa to better understand the supply chain cycle and build capabilities to ensure our medicines reach those patients in need. Through this initiative, pharmacists register their patients for surveys via SMS. The survey results then help us map out where patients are located in order to redistribute medicines to areas where they are most needed.Modern Vaccination Program mes in Rural & Remote Areas Essay

2. Getting the right knowledge, skills and resources where they’re needed

Secondly, we must focus on making sure all those who need them have the right knowledge, skills and resources, for example by training the next generation of scientific leaders. During a recent trip to Africa, I visited the Kombewa Clinical Research Center and the CDC-KEMRI Center in Kenya. It’s clear from these sites that sub-Saharan Africa is making strides in building up its own R&D capabilities. While Kombewa is remote, it is impressive that Phase II and III research is being conducted at the Kombewa Clinical Research Center on various drugs, vaccines and diagnostic tests.

We’ve seen increased commitment to training local scientists and encouraging research through program mes such as Human Health and Heredity in Africa (H3Africa), which was recently established by the NIH and Well come Trust. This initiative funds African scientists and local institutions to conduct basic research on the genomic and environmental bases of health issues prevalent on the continent. Additionally, Novartis is supporting scientific exchange through a partnership with H3-D, the first drug discovery and development center in Africa. The goal of H3-D is to train local scientists from Ghana, Kenya, South Africa, Sudan and Zimbabwe to develop treatments that address widespread conditions in Africa, such as tuberculosis, malaria and cardiovascular disease.Modern Vaccination Program mes in Rural & Remote Areas Essay

3. Public-private partnerships for health

Public-private partnerships can really make a difference. For example, USAID and Orange, the global telecommunications operator, just announced a new collaboration to find innovative ways to use mobile phones to accelerate access to health information and services in Africa. At Novartis, one way we’re reaching across sectors is through building our Foundation for Chronic Disease Management (FCDM), in collaboration with IBM and Vodacom in South Africa. The FCDM links public sector community health workers and private physicians to bring high-quality, cost-effective care to people’s homes with mobile technologies. This grass-roots approach can make a big difference, as the cost of a patient spending one day in a hospital could fund two health workers for a month.

It’s clear that in sub-Saharan Africa, interventions are having an impact. I met a one-year-old boy suffering from malaria at the Ahero Sub-District Hospital in Kenya, and though he was extremely ill, his condition was improving thanks to his being able to gain access to a life-saving treatment. This drove home to me that as healthcare stakeholders, it’s our responsibility to develop new medicines to treat disease, but these medicines are useless if they can’t get to the patients who need them most. We need to commit ourselves to working together with all other healthcare players to move away from simply donating aid, to building sustainable infrastructure that can ensure needed therapies are available in even the most remote areas. Everyone should have access to good health, no matter where they live.Modern Vaccination Program mes in Rural & Remote Areas Essay

From the perspective of public health investment, immunization program mes are considered the most successful and cost-effective for saving future generations. Globally, around 6 million children died in 2015 and out of that 30 percent resided in South Asia. Eight million out of 23 million under-immunized children resided particularly in Pakistan, India and Afghanistan.

Pakistan is considered to be fastest growing country in South Asia with a growth rate of 2.4 percent. However, infant and maternal mortality rates are very high. Almost half of population face issues related to malnutrition, particularly children under the age of five. The lower rate of immunization and higher prevalence of deaths have also contributed significantly in number of deaths in Pakistan.  With lower immunization rates, 53.8 percent in 2012-13, the future generations of Pakistan are at a risk. While it is easy to target the blame on the government, various reasons at the provincial level affect the demand and supply aspects.

Pakistan ranks 29th in the World Infant Mortality Rate (IMR) and 8th in Asia, i.e. 52.10 per 1,000 births. The higher rate of child mortality can be expected from lower rates of immunization. As per Pakistan Demographic Household Survey (2012-13), national coverage rate of child vaccination is 53.8 percent (GoP, 2017). Stunting is common in as high as 44 per cent of children and 31.5 per cent of children are underweight. In terms of rural–urban division, stunting among children and underweight issues are higher in rural areas as compared to urban areas. Almost, 35,000 children die of diarrhea yearly before age of five. Last year, threats from chickenpox were still looming as 16 children died from it.

The lower rates of immunization are a significant issue in Sindh and Baluchistan. Provincially, Punjab is leading Khyber Pakthunkuwa (KP), Sindh and Baluchistan. Immunization coverage in Punjab and KP has significantly improved because of active role of local governments in the past decade. Immunization coverage stands at 65.6 percent in Punjab and 52.7 percent in KP. The accountability factor of government functionaries at supply side and awareness among families regarding the benefits of immunization are possible factors behind these such good rates. However, immunization rate in Sindh is 29 per cent and Baluchistan is 16.4 per cent .Modern Vaccination Program mes in Rural & Remote Areas Essay

The government of Pakistan is providing free vaccines to save children from preventable diseases under Expanded Program me on Immunization (EPI), launched in 1978 for improving immunization against preventable diseases. It targets to immunize 6 million children of age group between 0 to 11 months. This immunization process is based on vaccinations for coping nine diseases: childhood tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus, hepatitis B, hemophiliacs influenza type b, pneumonia, and measles. Apart from vaccinations for children, vaccinations are also provided to pregnant women against tetanus. The devolution of ministries has increased role of provincial government in implementation of program mes. The differences in immunization coverage rate provincially validate differences of service delivery of this program me.

Major barriers

There are various factors which came on forefront during a project conducted by Sustainable Development Policy Institute (SDPI) and Global Alliance for Vaccination and Immunization (GAVI). This project focused on less immunized provinces, namely, Sindh and Balochistan. This included involvement of key stakeholders such as civil society organizations, media, local government representatives and parliamentarians during advocacy sessions.

In Sindh province, major barriers in routine immunization are lack of awareness about immunization and its outcomes, lack of access to vaccination centers, inadequate financial resources, poor performance of local governments, and inefficient service especially in urban slums as well as rural and remote areas. Besides, low income, low levels of literacy and less understanding of social mobilizers about the issue also contributes to lower immunization. Additionally, lack of coordination among federal, provincial and local governments and weaker role of social and electronic media are also potential barriers. Few stakeholders identified negative perception about vaccination hinder immunization.Modern Vaccination Program mes in Rural & Remote Areas Essay

In Baluchistan, major barriers to immunization are lack of awareness about vaccination process, lack of health services, lack of planning and commitment of staff, shortage and negligence of field workers. Instead of security issues, cultural and religious barriers also negatively affect immunization coverage. Door-to-door vaccination is not possible because of scattered and complex geographic structure of the province. Lack of interest of print and electronic media in creating awareness about routine immunization and lack of accountability and governance in addressing health program mes, and inefficient role of EPI staff led to minimum immunization coverage. Furthermore, lack of legislation on routine immunization a major barrier in tackling the issue in Balochistan.

The EPI representatives from Sindh and Baluchistan described lack of funds was a major barrier in achieving possible outcomes. The budget allocation by PSDP for EPI is about Rs 2792.693 million and assistance by GAVI was Rs 477 million. The EPI staff has increased its outreach and improved services provisions in all provinces. They are hopeful to have achieved 80 percent of immunization coverage nationally.Modern Vaccination Program mes in Rural & Remote Areas Essay

These problems highlight need for coordination among institutes for reducing demand and supply gaps in enhancing immunization coverage nationally. The major suggestions for improving immunization given by stakeholders are to conduct baseline studies for identifying vulnerable areas in each district.  The awareness campaigns are needed by engaging clerics, print, electronic and social media, and government organizations especially in remote areas. The formulation of act or bill to make immunization mandatory is a key to improve immunization both provinces.