POST 00765E : MEASLES CAMPAIGN AND ITN DISTRIBUTION

POST 00765E : MEASLES CAMPAIGN AND ITN DISTRIBUTION Follow-up on Post 00763E 20 March 2005 _____________________________________ NOTE : It has to be reminded, especially for newer members, that TechNet21 operates in two languages simultaneously. Consequently, all contributions are sent for translation, revised upon return before being published. Obviously, this has the effect of slowing down discussion but it is an unavoidable constraint. Thus one must exerts patience; at least ten days are needed between reception of a contribution and its publication in general by chronological order. However TechNet has the advantage of reaching more than 1000 members around the world, possibly generating many original contributions. This present discussion started on TechNet on March 16, had already many contributions in waiting. It has since exploded. It is then possible, given the pace of publishing and the posting size, that the interval lengthens considerably. besides, the discussion is threading in all directions making follow-up difficult. You are thus requested to exert also discipline. All those who wish to participate in this public discussion on the forum are requested to send their contribution directly to the moderator (mailto:[email protected]). Thank you, The Moderator --------------------------------------------------------- It is advised to read the joint WHO-UNICEF statement on the topic at : http://www.rbm.who.int/docs/RBM-EPI-EN.pdf This posting contains two contributions. First that of Mark Grabowsky (mailto:[email protected]) from the American Red Cross. We draw your attention that Mark has published, with ten other colleagues an article on the topic, "Distributing insecticide-treated bednets during measles vaccination: a low-cost means of achieving high and equitable coverage". The abstract can be found at : http://www.who.int/bulletin/volumes/83/3/grabowsky0305abstract/en/ and the full text in the Bulletin of WHO (March 2005), at : http://www.who.int/bulletin/volumes/83/3/en/195.pdf The second contribution comes from Robert Steinglass (mailto:[email protected]) of the Immunization Basics project of the United States, reacting to the first. _____________________________________ 1. The debate on "campaigns versus routine" will end up for ITNs where it ended up for vaccinations - both have a role to play based on program goals and epidemiologic setting. The debate on "free versus paid" echoes those of the Bamako initiative which argued that sustainability required "user fees." In the end, if a service was a public health good - like immunization - then society was better off it was free to consumers (leading to simpler management, higher coverage and greater equity). The sustainability issue then came down to how much was paid for by government versus donors. Even if government found donors willing to pay for 100%, it was deemed sustainable. Some of the vaccines that are routinely given for free cost more than ITNs (e.g., Pentavalent DPT-Hib-HepB or Pnmeumococcal). 2. Mass, free distribution, compared to social marketing, achieves higher, quicker, and more equitable coverage at lower cost to both consumers and providers. In each measles/ITN campaigns (Ghana/Zambia/Togo), coverage has risen from 80% with equal coverage among all wealth groups. The marginal cost per ITN delivered was about $0.50. That is a fraction of the cost required to run a social marketing program. Giving nets away is cheaper for both the consumer and the provider. 3. The title of the email is provocative, "What do malaria experts have to say . . . ." Here is what some published experts say: "Rather than subsidizing marketing systems, we urge that new funding would be better targeted at organized provision of ITNs and their retreatment so that cost to those suffering from malaria is not a limiting factor in attaining high coverage rates." (Christopher Curtis, Caroline Maxwell, Martha Lemnge, Richard W Steketee, William A Hawley, Yves Bergevin, Carlos C Campbell, Jeffrey Sachs, et al Lancet Infectious Diseases 2003;3:304-7.) 4. What does the UN Millennium Project have to say about this approach and achieving the MDGS: "Developed and developing countries should jointly launch, in 2005, a group of Quick Win actions to save and improve millions of lives and to promote economic growth. The Quick Wins include but are not limited to: Free mass distribution of malaria bed-nets and effective antimalaria medicines for all children in regions of malaria transmission by the end of 2007." (http://unmp.forumone.com/eng_html_07.html) 5. The fundamental reason to support mass, free distribution is that the evidence suggests that it is the best way to deliver services to the poor. In most countries of sub-Saharan Africa, about 75% of the population lives in poverty (See, for example: http://poverty.worldbank.org/library/view/8717/). Are we against giving free nets to the poorest 76% so that we can preserve the rights of the wealthier 24% to buy subsidized nets? There will always be a place for those who want to provide efficient market-based mechanisms to serve the relatively wealthy but should we use public or donor funds to support this in preference to more efficient systems for delivering services to the poor? Mark Grabowsky, MD, MPH CDC Technical Advisor American Red Cross ---------------------------------------- Mark, Plenty of stuff to chew on. I am glad you took the bait. I hope that more people will join in the debate, especially malaria staff with a long-term developmental view. It would be good to hear their views. Campaigns certainly have a roll to play but their harmful effects must be minimized: Advocates should cease exaggerating what campaigns are going to contribute to strengthening the routine services! The fact that simple measures of accountability (vis a vis the routine program) are not accepted by campaigners, even as they claim that support for campaigns will indeed strengthen the routine program (thereby placating potential donors who have some concerns), is telling. At every TFI meeting and measles partnership meeting where it has been proposed, there has been resistance to accept adoption of, tracking and reporting on indicators -- e.g., including DTP3 coverage - - of routine immunization performance AS AN INTEGRAL PART OF ACCELERATED DISEASE CONTROL INITIATIVES. Given that the vast amount of resources that are mobilized these days are spent on accelerated disease control, and that these initiatives persist in claiming that routine immunization is the all-important foundation that the campaigns are indeed helping to strengthen, then indicators are an obvious necessity. Do you agree or not that as part of accelerated disease control initiatives, indicators for routine immunization performance - e.g., including DTP3 coverage - - should be formally adopted, tracked and reported? Robert ______________________________________________________________________________ ____________________ Visit the TECHNET21 Website at http://www.technet21.org 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:[email protected] 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. 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