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POST 00602E : SUGGESTIONS FOR THE MEETING AGENDA Follow-up on Posts 00574E, 00584E, 00587E, 00591E, 00595E and 00600E 9 September 2003 ______________________________________________________ This posting contains 4 contributions, and suggestions to the agenda are evolving into a discussion of previous ideas. First John Lloyd (mailto:[log in to unmask]) from PATH continues the dinosaur's thinking, building on Michel Zaffran (mailto:[log in to unmask]) contribution in Post 00595E who then reaffirms his agreement. Patrick Isingoma (mailto:[log in to unmask]) from the BASICS II PROJECT in Uganda and Anthony Battersby (mailto:[log in to unmask]) both comment and discuss from ideas expressed by Modibo Dicko in Post 00600E. ______________________________________________________ I agree Michel, the reasons to have a Technet are still as valid as they were 14 years ago, maybe they are even more valid today in the light of the current speed, scale and centralisation of change management in immunization. But it is good to go through the loop to re-invent our enthusiasm and conviction... I am concerned about a hands-off strategy by immunization for waste management in Primary Health Facilities (PHF) primarily because PHFs will not be prioritized for action unless immunization takes the initiative, and we will then suffer. I do understand the concern re complexity and scope, but I think that immunization can still maintain focus on "sharps" management and syringe destruction if there are other health programmatic partners to represent the broader picture. Specifically, I would hope that immunization would retain an interest in these technologies: - needle removal technology - small scale incineration technology with links to us, Richard and his new staff member - autonomous, non-incineration technologies for syringe destruction/processing in rural health facilities with links to us and.... Urban areas and areas of high density will use collection services to hospitals and centralized processing plants, even to domestic waste collection. These options will be pursued by many other groups I believe and may not need development effort championed by immunization. I also feel, Michel, that increasingly we shall be forced to tackle the broader issues of "multiple-services" delivery and service quality to assure that interventions are economic and sustainable. Perhaps the new organisation of WHO will help that happen? Your third point is spot on too. The work that should characterize Technet is in building and sharing of field evidence of the cost and operational impact of change as fast as possible - so that we have maximum data on which to make policy decisions. The "bottom" for TOP should be operations research in the field. This should be the driver for the Technet meetings, gathering the data available and sharing our interpretation of the results before they are manipulated by the globalists! Who will fund this kind of field work. We will in India, Indonesia and Senegal if our project comes through. I would hope that our engine will generate generic tools which could be used to conduct studies elsewhere. (this is starting to happen, our needle remover protocol is being transformed by Emmanuel for measles campaign use in Erythrea). But the organisation of this work in each country will require parent organisations willing to fund and staff these projects, because they will be quite demanding if they are to be of useful quality. UNICEF and WHO should be willing, at the level of leadership, to seek funding and drive this work in country. Once we have an agenda for operations research related to logistic and tech changes in immunization, we should face up to these and other agencies. If there are no takers, there is little point in Technet in spite of all the good will of the 'workers' who attend the meetings. Sorry to be long winded.... Best regards, John __________________________________ We are fully in agreement on all subjects. Michel __________________________________ There has been a big problem in splitting the two areas. Yet I feel that some areas are left unattended to. In Uganda we have two areas of Operations and the Cold Chain, and many times you find the two failing to clearly taking responsibility. Dividing into the soft and hard logistics I think would solve some problems, though I would not be sure what is hard and what is soft. Another point of focus is the department of Engineering within the MOH and in the local administration (this could give us an area of thought). They are always closed out on cold chain and yet they could be a good resource with extra training. Patrick Isingoma Immunisation Advisor BASICS II Project/Uganda Formally Operations officer UNEPI. ___________________________________________ I think Modibo has raised a critical issue. How come only 2 months was allowed to complete a task that needed much more time? This is a classic example of how the operations side of things gets ignored by the decision-makers. I think Technet needs to include a component where matters of policy are debated. For 15 years we have been advocating that operational aspects be given equal weight when making immunisation plans and still the message does not get heard. This suggest that whatever has been done in the past has failed to educate the decision makers that operational aspects are as important as epidemiological ones. Technet needs to find ways to overcome this. One way might be to have Technet issue strong resolutions aimed at the epidemiological decision makers, indicating the importance of giving full attention to operations and giving individual programmes the right, indeed obligation to refuse to implement a programme until the necessary operational aspects are in place. Anthony ____________________________________________________________________________ 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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