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A Comprehensive Policy framework for the National Immunization Programme. Dr Nihal Abeysinghe, [M.B.,B.S., MSc, M.D.] Chief Epidemiologist, Ministry of Health. Immunization Programme Sri Lanka : Vaccines used at present. BCG for Tuberculosis Oral polio for Poliomyelitis
A Comprehensive Policy framework for the National Immunization Programme Dr Nihal Abeysinghe, [M.B.,B.S., MSc, M.D.] Chief Epidemiologist, Ministry of Health
Immunization Programme Sri Lanka : Vaccines used at present • BCG for Tuberculosis • Oral polio for Poliomyelitis • DPT / DT for Diphtheria, Pertusis [Whooping Cough] & Tetanus • Measles • Rubella • Tetanus • Hepatitis B • Japanese Encephalitis
Present status of the Immunization Programme, Sri Lanka • Dramatic reduction in illness, disability & death from Poliomyelitis (0) since 1994 Diptheria (0) in 2005 Tetanus (25) / Neonatal Tetanus (0) Whooping Cough (32) Measles (24) Childhood tuberculosis Japanese Encephalitis Rubella • Very high vaccine coverage > 95%
DecisionMaking Process • Evidence based decision making • Epidemiology Unit recognizes the needs • Makes addition to the surveillance system • Carries out burden & cost studies • Proposes to the Advisory Committee on Communicable Diseases • Reviewed & approved by the Advisory Committee on Communicable Diseases [ACCD] • Discussion with a wider group of stakeholders; [“Immunization Summit-held on 5th January 2007”] • Negotiate for funding & convince the Finance Ministry • Acquire logistics, other facilities & prepare the field staff • Develop a communication strategy • Develop plans for Continuous follow up, Monitoring & Evaluation
Strength of the Sri Lankan EPI : Number of Years Taken to Reach Over 90% Coverage Following Introduction of a New Vaccine
Present Challenges • Sustaining high coverage • Achieving eradication & elimination targets • Ensuring vaccines of assured quality • Introducing new vaccines • Strengthening the capacity for surveillance of Vaccine-preventable diseases & Adverse Events following immunizations • Ensuring financial sustainability for the immunization programme • Strengthening Primary Health care system
Cost Considerations in the National EPI • Introduction of a new vaccine is always considered within the framework of the National EPI, not separately • Total cost • Vaccine • Injection supplies • Other routine recurrent cost • Cold chain equipment • Transportation
Policies that would help us to achieve the desired status • Equity and equality • Ownership, partnership and responsibility • Government • Other stakeholders • International organizations • Accountability • publicly accountable for the policies, goals, strategies and actions • Assured quality, safe products and services • Internationally recognized standards of quality, safety, and services are delivered according to best practices.
Policies that would help us to achieve the desired status • Adaptability to local needs and circumstances • commitment of all responsible stakeholders to appropriately adapt to the local needs and circumstances. • Sustainability through technical and financial capacity building • All stakeholders including the government should work collectively, to ensure financial and technical self reliance with continuing, incremental infrastructure building. • Policies and strategies based on evidence and best practices • The choice of policies, strategies and practices should be based on evidence from surveillance, monitoring and evaluation, operational research, diseases burden and impact assessments, and economic analyses
Key Strategies • Implementing the comprehensive Multi Year Plan & annual plans • Reaching children in “difficult to reach areas” • Ensuring quality vaccine supply & accessories • Improving quality services by enhancing the service facilities, vaccine storage capacity & surveillance of Adverse Events Following Immunization • Creating a Community demand • Introducing new vaccines to combat ‘emerging’ new VPD with financial sustainability plans • Regular reviewing of the programme • “What works & What not”
Key Strategies • Ensuring financial sustainability • Improving National regulatory authority activities by regular discussions • Promoting operational research : Disease Burden studies • Improving management of human resources • Strengthening laboratory capacity • Strengthening capacity for data management • Planning for immunization in complex emergencies • Develop & implement a comprehensive communication strategy • Include immunization in epidemic preparedness plans • Define & delegate responsibilities to stakeholders
Thank you Epidemiology Unit Ministry of Health