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POST 00600E : SUGGESTIONS FOR THE MEETING AGENDA Follow-up on Posts 00574E, 00584E, 00587E, 00591E and 00595E 1 September 2003 ______________________________________________________ Some more suggestions for the meeting agenda. First from Modibo Dicko (mailto:[log in to unmask]) from AFRO followed by Michel Zaffran (mailto:[log in to unmask]) from WHO/HQ. Then Khadija Msambichaka (mailto:[log in to unmask]) also from WHO/AFRO comes in support of Pham Ngoc Len (Post 00591E). The fourth contribution is from Youssou N'Dao (mailto:[log in to unmask]) from EPI/Sénégal. ______________________________________________________ After reading all these technicalities, which I fully agree with, I would like however to add some more wrinkles on our dinosaurs' foreheads. We all know that a health technology consists of 3 equally important elements: (i) the device, (ii) the utilization procedures and (iii) the user. Our big problem in Africa is that we tend to focus on the device and overlook the 2 other elements, which ultimately are key to the success of any technology. I would like to give one dinosaurly example and another one, which is more recent to illustrate what I am saying: In 1982 (or 83, or 84: I can dig out the exact date if you wish), we received at the Solar Energy Lab in Bamako 4 solar fridges from NASA for testing; we installed 3 in Government-owned health centres and one in a church-managed health centre; before 2 years the first 3 were completely down and abandoned; regarding the 4th one, the last time I heard about it was in 1997: it was still working! All hinges were broken, to open it users would take the lid completely aside, but the fridge was still working; and remember it had the first generation of regulators in which a red light would come on when batteries are low and the user had to stop the fridge himself and wait until the green light is back on, then he will switch on the fridge. That is an example showing how a "poor" technology was properly working because of good utilization procedures and good user! Recently, we embarked on building De Montfort incinerators using measles money; the necessity to have them ready for the campaigns in less 2-3 month time ahead made us focus on the device and overlook the utilization procedures and the users; you all know what happened: someone called it the "De Montfort Gloom" ... Although Adama Sawadogo argues "le DEMON est TRES FORT", I am sure it will become really "très fort" when we finalize good construction and operation guidelines and train builders and users in their correct implementation! I am sure John is implicitly thinking about procedures and users in his proposed operations research projects because he is talking about protocols and staffing in addition to funding. But after introduction of a device in national programs, the sticks we can use to extend our arms in order to reach and train all users are the national logistics managers. But the majority of them have very low qualification level (nurses, technicians, sometime even just handymen) although some of them are very competent and know what they are doing! During years and years, we insisted that qualification level of national logisticians be raised. We succeeded in 3 countries (Cameroon, Mali and Niger): they designated some medical doctors already working in EPI as national logisticians just because it was difficult for them to obtain and retain engineers. I would like therefore to suggest we split EPI logistics into 2: the "soft" logistics and the "hard" one. "Soft" logistics would deal with vaccine management and logistics of injection safety. "Hard" logistics would deal with equipment planning, installation, monitoring and maintenance: cold chain, transport, disposal, etc. For soft logistics we would promote medical doctors in every immunization program; if accepted it will certainly raise the profile of logistics within EPI, and EPI Managers will accept to discuss logistics with their colleagues. For "hard" logistics, we would turn our eyes toward the departments within MoHs, which deal with infrastructure, equipment and maintenance. These departments have engineers and high-level technicians, but presently they deal mainly with hospital equipment and maintenance. We would discuss with MoHs to extend their role to cover PHFs as well. Private enterprises would also be involved in "hard" logistics. These are some droplets of thought from my dinosaur wrinkles ... Modibo _________________________ Modibo, Agreed! Let us get to work on these excellent ideas before the dinosaurs are extinct. What can concretely be the role of HQ, RO and partners in supporting the views that you have expressed? Michel __________________________ I would like to support the suggestion from Len to discuss issues of coordination between EPI and any other Unit/institution in the country that is involved with Vitamin A supplementation. These should be strategy for routine supplementation, logistics and monitoring and availability of data. We are all aware that a lot is happening outside campaigns but little is reported. Dr. Khadija Msambichaka __________________________ I think it would be interesting to include in the agenda a topic on the introduction of new vaccines, especially when you consider that the production of certain vaccines is very limited while demand is very high (DPT-Hep-Hib/ex). Very kind regards Dr Youssou Ndao EPI National Logistician (Sénégal) -------------------------------------------------------------------------------------- Visit the TECHNET21 Website at You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. ______________________________________________________________________________ To UNSUBSCRIBE, send a message to : mailto:[log in to unmask] Leave the subject area BLANK In the message body, write unsubscribe TECHNET21E ______________________________________________________________________________ The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. It is moderated by Claude Letarte and is hosted in cooperation with the Centre de coopération internationale en santé et développement, Québec, Canada ( ______________________________________________________________________________

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