Michel and others,
Thanks for suggesting two different discussion tracks.
Pioneers in EPI logistics such as yourself, James Cheyne, Modibo Dicko, John Lloyd have done and continue to do a formidable job of improving storage conditions, creating VVMs, creating transportation systems to reach geographically hard to reach areas, managing injection waste, etc. In terms of “logistics”, we are not at the perfect place yet: the “dream vaccines” will not need any cold chain or any injection.
However, weak vaccination coverage should not be blamed on logistics, logisticians and the very universal excuse of “lack of resources”.
- Some populations live across the street of health centers and are not vaccinated.
- Some people are afraid of vaccinations for various reasons (rational or irrational)
- Some districts or countries still report more than 100% of coverage
- Costly disease surveillance systems still fail to detect outbreaks until it is too late to contain them, etc.
I am not advocating for weakening the logistics systems and the very important role of logisticians, but I suggest that we also emphasize on some basic principles (and put them in practice!)
1. Supervision
There are enough tools and generalizing their use could improve the program in many countries
- Health posts should receive a supervision visit- or should report to health centers at least twice monthly
- Health centers should receive a supervision visit of some sort once a month
- District should have some form of communication, or organize a supervision visit to their health centers every three or four months
- National level should be able to gather information, supervise, have a review of all districts at least every semester
2. Communication
- Stop treating communication and behavior change staff as a 5thwheel that are called only for campaign slogans and poster production
- Allocate more resources to this part of the program to allow them to organize surveys, planning and implementation
- Associate this category of staff to all stages of the program--even before introducing a new vaccine
- Use non-traditional partners such as health care workers associations and community groups (see model of Barack Obama presidential campaign)
I don’t mean to list all the program issues and solutions, but my point is that we should help our logistician colleagues help the program
Thanks
Jules
Jules Millogo, MD, MSc
Senior Advisor
Public Health Policy and Planning
9760 Hatmark Ct
Vienna, VA 22181
USA
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