1. Measles mortality reduction in SEAR
Best practices

2. Presentation Outline Regional Snapshot Implementation of Strategies
Desired Outcome
Undesired Outcome
Best Practices
Bangladesh
Myanmar
Nepal
Summary

3. Reported Measles and Rubella Cases1 and MCV1 Coverage2 South East Asia Region, 2000–2011
RCV in RI - 4 countries (Bhutan, Maldives, Sri Lanka, Thailand)
RCV through SIA- 3 countries Bhutan, Maldives, Sri Lanka. Planned- Bangladesh and Nepal in 2012
1 WHO vaccine-preventable diseases: monitoring system 2012 global summary
2 WHO/UNICEF estimates, 2012
Data as of 30 Jul 2012

4. Second Dose of Measles Immunization, SEAR, 2011-12
Through Routine Immunization
Through SIA
Provide MMR vaccine
Measles Vaccine through SIA;
Provide MR Vaccine
MR Vaccine introduction in 2012 (phase wise)
Provide Measles Vaccine
India 17 state Measles & 4 states MMR
India 14 state Measles

5. Implementation of strategies Desired outcome, Bangladesh, 2004-2012 (June)
Accelerated Measles
Surveillance
2 districts
Other districts
National level
Source: Monthly VPD data up to Jun 2012 5

6. Implementation of strategies Desired outcome, Nepal, 2003-2012 (June)
Accelerated Measles
Surveillance
Source: Monthly VPD data up to Jun 2012 6

7. Myanmar, 1990-2012: heading in the right direction
Nation wise Measles SIA ( )
Nation wise Measles SIA (2007) ** **
Data as of 29 February 2012 7

8. MCV1 coverage1 and measles cases2, Country I, 1980-2011
92105 95 % 94 % 93 94 %
106
102 93 % 78 % 97 % 92 % 98 %
SIA
1 WHO/UNICEF estimates, 2012
2 WHO vaccine-preventable diseases: monitoring system 2012 global summary

9. Best practices Ownership Innovation/Analysis/Research
High level political commitment
National Technical Advisory Body
Financing
Innovation/Analysis/Research
2-district pilot in Bangladesh catch-up campaign
Rapid response teams
Use of mobile phones for SMS reporting – Nepal
Case fatality rate studies in Bangladesh and Nepal
Trial of new technology – oral fluids for diagnosis

10. Best practices (contd.)
Good planning, micro-plans, RED and Reaching Every Child (REC) in Nepal, using existing RI infrastructure
Communication and mobilization
Invitation cards
Involvement of local faith and traditional healers
Injection safety and AEFI
Independent monitoring
Partnership – international and national (multi-sector)

11. Best practices Bangladesh
National Immunization Policy- 2010
Comprehensive Multi-Year Plan (cMYP) for immunization with costing- updated covering
National Committee on Immunization Practices (NCIP)
29% of all spending on vaccine is government financed.
37% of all spending on routine immunization is government financed.
Government paid 75% cost of last measles SIA.
All 64 districts have updated micro-plans that include activities to raise immunization coverage
Effective vaccine management (EVM) -- last assessment conducted and cold chain equipment inventory updated in 2011
A national system to monitor adverse events following immunization (AEFI) is available
Source: WHO-UNICEF JRF 2010 11 11

12. High level political commitment
Political commitment from highest level for immunization- Her Excellency The Honorable Prime Minister, Sheikh Hasina inaugurated 19th NIDs

13. High level political commitment (contd.)
Measles Follow-up Campaign 2010
Combined with OPV, Vitamin –A and Albendazole
Inaugurated by Prof. Dr A F M Ruhul Haque, Minister, MOH&FW
Coverage Evaluation Survey
Annual CES conducted since 1991
Findings Disseminated by Minister, MOH&FW

14. Few Examples of activities
Brand for immunization
EPI Logo (Moni Flag) is branded for immunization all over the country
Strong means of communication
Miking
Interpersonal communications
Field worker visits
Vaccines & Logistics distribution
Daily monitoring of stocks at all levels
Effective distribution system by porters 14

15. Measles SIAs monitored by independent observers
Monitoring of SIAs
Measles SIAs monitored by independent observers 15

16. International recognition for Bangladesh
UN Award
Prime Minister Sheikh Hasina receives a UN Wards for Bangladesh’s outstanding achievements in attaining MGDs particularly in reducing child mortality at New York on September 19, 2010
GAVI Honours Bangladesh
For Best Immunization performance
Hanoi, Vietnam, November 2009 16 16

17. Best practices Nepal There is a cMYP 2011-2016 for immunization.
A standing technical advisory group on immunization is available Vaccine provided through static and outreach services.
20% of all spending on vaccine was government financed.
22% of all spending on routine immunizations was government financed.
Routine vaccines: BCG, OPV, Measles, TT and JE are procured from government funds, and Pentavalent (DTP, Hib, HepB) is co-financed by the government.
There is a draft “Immunization Act 2012”.
Source: WHO-UNICEF JRF 2010 17 17

18. High level commitment: Launching of campaign by the minister with secretary, DG, Member of parliament, partners)

19. Female Community Health Volunteers carrying vaccine and distributing invitation cards

20. Getting community support
Female Community Health Volunteer (FCHVs) play a vital role in immunization service delivery, including social mobilization, during SIAs.
FCHVs and volunteers help children out of home to get vaccinated.

21. Using Independent Monitoring (IM) data to improve SIA coverage
Rehearsal for IMs before departing to field.
Local village leaders participate in meetings to improve immunization

22. Independent monitoring
National and International Monitors invited for SIA monitoring. They discuss various issues for improving immunization coverage.
Paramedical students getting orientation on measles and rubella prevention.

23. Monitoring on the Indo-Nepal border
Porous borders with India monitored during national immunization campaigns.
SMOs from India and Nepal meet to discuss cross-border issues.

24. Monitoring coverage
Field supervisors searched small settlement deep in the forest without access to immunization.
EPI supervisor checks kids for immunization status in public places

25. Best practices Myanmar
The country has a cMYP for immunization covering
All townships have updated micro-plans to improve immunization coverage.
There is functional technical advisory group on immunization.
Effective Vaccine Management and cold chain inventory assessment is conducted regularly.

26. Activity planning cMYP for immunization covering 2012-2016 available.
Detailed planning of routine and SIAs are done.
All 330 townships have updated micro-plans to improve immunization coverage.
Cold chain equipment inventory updated regularly.

27. Raising public awareness on immunization
Local street drama with village volunteers, school teachers, children and parents.
People about immunization; good public demand.

28. Coordination and cooperation
Excellent coordination with other ministries, UN agencies, local and International NGOs and partners including WHO, UNICEF, UN Foundation, CDC Atlanta and American Red Cross.
Military helicopters transport vaccines in hilly and many remote areas of Myanmar during measles SIAs.

31. Take home message: Implementation of strategies Desired outcome, Bangladesh, 2004-2012 (June)
Accelerated Measles
Surveillance
2 districts
Other districts
National level
Source: Monthly VPD data up to Jun 2012 31

32. Anne Ray Charitable Trust

33. MCV coverage1 and measles cases2, 1980-2011
92105 95 % 94 % 93 94 %
106
102 93 % 78 % 97 % 92 % 98 %
SIA
1 WHO/UNICEF estimates, For MCV2 Coverage: Country Official Estimates- JRF used
2 WHO vaccine-preventable diseases: monitoring system 2012 global summary