Information meeting for health authorities of the ECOWAS member states

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1 Strengthening the decision-making process in immunization in West Africa Support to the creation of National Immunization Technical Advisory Groups (NITAGs) in ECOWAS member states Information meeting for health authorities of the ECOWAS member states April 14th and 15th, 2011 Ouagadougou, Burkina Faso FINAL REPORT Rapporteurs: Sybil Nana Ama OSSEI-AGYEMAN YEBOAH (WAHO), Ali SANI (WAHO), Pape Coumba FAYE (AMP), Lara GAUTIER (AMP)

2 Contents 1. INTRODUCTION OBJECTIVES OF THE WORKSHOP General objective Specific objectives METHODOLOGY PARTICIPANTS MEETING MINUTES Day Introductory session Plenary session 1: Introduction Plenary session 2: Evidence-based decision-making for national immunization policies/strategies: situation in Africa and the rest of the world Day Plenary session 3: Support to the establishment of NITAGs in ECOWAS member states Synthesis FINAL RECOMMENDATIONS ANNEX... 8

3 1. Introduction Pursuing the fight against infectious diseases potentially fatal or disabling, immunization is one of the most cost-effective public health interventions. In May 2010, the 61st World Health Assembly noted that even if vaccines can save two to three million people every year, they remain underused, especially in low and middle-income countries. Thus, in 2007, 24 million children (nearly 20% of children born each year) have not received all the required vaccines during the first year of life. Moreover, apart from infants, children, adolescents and adults are not as well protected as they could be through immunization against diseases from which they are exposed. Facing this situation and so as to achieve a significant reduction in the burden of mortality and morbidity due to vaccine-preventable diseases, policy options and appropriate strategies in immunization, based on consistent local knowledge will have to be operated by national health authorities. Thus, the World Health Organization recommends the establishment of National Immunization Technical Advisory Groups (NITAGs) (GIVS WHA (2008), WHO / SAGE Nov. 2008, TFI / WHO-AFRO December 2008). These are groups of national experts in charge of making recommendations to national authorities in areas related to immunization such as the revision of current programs, the introduction of new vaccines, etc. The SIVAC Initiative 1 aims at promoting the use of evidence-based decision-making processes for developing immunization policies and programs in low and middle-income countries by supporting the establishment or strengthening of NITAGs. This initiative is led by Agence de Medecine Preventive (AMP) and implemented in partnership with the International Vaccine Institute (IVI) based in Seoul (Republic of Korea) and in close collaboration with the World Health Organization (WHO) through its headquarters and regional & country offices. In West Africa, in order to enable a larger number of countries to rapidly benefit advices from NITAGs, the idea of establishing an Inter-State ITAG for the West-African region emerged from AMP and the West-African Health Organization (WAHO). In the perspective of assessing the relevance and feasibility for the establishment of an Inter-State ITAG in West Africa, WAHO and the SIVAC Initiative decided to conduct a study by questionnaire targeting the 15 countries of the Economic Community of West-African States (ECOWAS) and key partners in the field of immunization (WHO, UNICEF, USAID, UEMOA). The raw results of this study revealed a positive assessment of the adequacy of the proposed creation of an IS-ITAG for ECOWAS member states but also the wish expressed by most countries to develop national ITAGs. Under the coordination of WAHO, partners who participated in the study have also insisted on the interest of strengthening the decision-making process at national level rather than through a regional body. Therefore was held on 04th and 5th of February, 2011 in Bobo Dioulasso, a workshop of technical partners (coordinated by WAHO and also including the AMP, EVIPNet and WHO) to define and adopt a methodology and work plan adapted for generalizing the creation of NITAGs within ECOWAS member states. At the end of the workshop, participants suggested expanding and strengthening this cooperation framework for technical partners to support the establishment in 2011 of NITAGs in two or three countries of ECOWAS and generalize between 2012 and 2015 the creation of these NITAGs in all countries of the sub-region. They will receive technical support from the Working Group of partners for drafting their project description and to the effective implementation of their NITAG. Following the workshop, it was decided to organize an information/orientation meeting on NITAGs targeting senior officials of the Ministries of Health of ECOWAS member states, so as to disseminate information and to give all countries the same opportunities to benefit from support for the establishment of NITAGs. 1

4 2. Objectives of the workshop 2.1 General objective Under the coordination of WAHO and in partnership with AMP and WHO, to inform and increase health officials of ECOWAS member states awareness on the importance of establishing NITAGs for strengthening decision-making process in immunization policies and strategies. 2.2 Specific objectives To share ongoing experiences in the strengthening of national decision-making in the field of immunization; To present missions and roles of NITAGs and discuss their value in improving decisionmaking in the context of national policies and strategies of immunization; To present the methodology for supporting the establishment and functioning of national NITAGs in West Africa; To present work plans for 2011 and to support the establishment of NITAGs in ECOWAS member countries; To share the procedures for selecting and supporting the countries wishing to establish a pilot NITAG in 2011 with the support of the Working Group of partners. 3. Methodology Plenary session: presentation, discussion, and summary 4. Participants Country participants (10): o General Director of Pubic Health from Benin; o Head of Logistics Department, Supply and Maintenance, EPI from Burkina Faso; o Representative of the Director of Health Services from the Gambia; o EPI Deputy Manager from Ghana; o Executive Secretary of Health Ministers from Guinea; o Director of Prevention and Health Promotion from Guinea Bissau; o Executive Secretary of Health Ministers from Mali; o Representative of the Executive Secretary of Health Ministers from Niger; o Director of Health Prevention from Senegal; General Director of Health from Togo. Members of the Working Group of technical partners (13): o WAHO (4) o AMP (5) o WHO/EVIPNET (1) o WHO-IST/WA (1) o UEMOA (1) o Mozambique NITAG (COPI) (1)

5 5. Meeting minutes 5.1 Day Introductory session The meeting was opened by Professor Adama TRAORE, Executive Secretary of the Ministry of Health of Burkina Faso. Dr Johanna AUSTIN-BENJAMIN, Director of the Primary Health Care and Disease Control Department at the West African Health Organisation made the introductory speech welcoming all the participants, and presenting the main steps of the process leading to holding meeting in Ouagadougou. In his opening speech, the Executive Secretary of the MoH in Burkina also welcomed the participants and was delighted that this important meeting was held in his country. Afer reminding that immunization was an efficient tool but still underutilized in West Africa, he stressed the importance for West African countries to develop efficient vaccination policies so as to face all the challenges (high number of unvaccinated children, resurgent epidemics...). Finally, Dr. Traore thanked partners for their support and wished that the work could lead to concrete recommendations for policymakers. After this speech, participants introduced themselves and Dr B. KIEMA (Head of Logistics Department, Supply and Maintenance, EPI from Burkina Faso) was appointed president of the meeting. The objectives and expected results were presented, followed by the agenda which was modified, before being adopted Plenary session 1: Introduction The first session of the meeting was punctuated by four (4) presentations and exchanges regarding the topics that were addressed. Dr Nehemie MBAKULIYEMO from WHO IVD/IST/West Africa made a general presentation on the current situation and perspectives of immunization in West Africa. Discussions tackled unimmunized children and how to reach them, the issue of the denominator used to calculate rates of vaccination coverage, introduction of new vaccines through the support of the GAVI Alliance, relevance of using a coverage by zones instead of countries for the MenAfriVac campaigns, use of WHO/UNICEF estimated data, quality of official data, etc. Ali SANI, from WAHO/Department of Planning & Technical Assistance presented the institutional organization, missions and activities of WAHO; he was then followed by Alfred DA SILVA, the Executive Director of Agence de Médecine Préventive (AMP) who made a presentation of his own organization. Then, the audience listened to a description of the WHO/EVIPNet Initiative: methodology for developing policy briefs made by Isabelle WACHSMUTH from WHO. Participants expressed concerns on the risk of duplication of activities between WAHO and other organizations, WAHO representatives highlighted the importance of consultation/collaboration so as to avoid these potential problems. Participants also asked clarifications on WAHO s role for harmonizing policies and pooling resources. English-speaking participants deplored the relative concentration of AMP projects in Frenchspeaking countries. They suggested developing new AMP projects in partnership with WAHO for extending its interventions in all ECOWAS member states. Participants also asked several questions on the criteria and procedures for implementing EVIPNet teams in the countries, the selection process etc. Mrs. WACHSMUTH added that the will should come from the Ministries of Health of the countries.

6 5.1.3 Plenary session 2: Evidence-based decision-making for national immunization policies/strategies: situation in Africa and the rest of the world The session started by a presentation made by Dr Pape Coumba FAYE describing the roles and functioning of NITAGs, followed by Dr Kamel SENOUCI s presentation on the SIVAC Initiative aiming at the establishment and strengthening of NITAGs at global level During discussions, participants noted that some countries already had to put up on ad hoc basis the bodies responsible for national health authorities to give guidance on specific issues (e.g. introduction of new vaccines). However, the process of creating these bodies and their mandate, their composition or their functioning does not allow them to be considered NITAGs as defined in the WHO guidelines. Exchanges between participants also highlighted differences between NITAGs and Inter-Agency Coordinating Committees (ICC) and other existing committees in the field of immunization. On this issue, the intervention of Professor Martins, also a member of the Task Force for Immunization (TFI) of WHO AFRO enable the participants to understand the similarities between the country level and regional level where the TFI works in perfect harmony with the African Regional Inter-Agency Coordination Committee (ARICC). Participants also stressed the important role that WAHO should play in the process of supporting the establishment and operation of NITAGs in ECOWAS member states. In the second part of the plenary session 2, Miss Lara GAUTIER presented the results of the feasibility study for the establishment of an Inter-State ITAG for ECOWAS member states before Dr FAYE and Prof MARTINS shared with participants the experience of Côte d'ivoire and Mozambique in the establishment and functioning of a NITAG. While recognizing the appropriateness of WAHO and partners initiative to provide support to ECOWAS in the implementation of national ITAGs, representatives of countries asked to pursue the reflection on the establishment of IS-ITAG because of the relevance of this approach which may allow, inter alia, the definition of policies and strategies for solving border issues of common concern in the fight against vaccine-preventable diseases. Participants also discussed the importance of NITAGs as an effective tool for adaptation to national context of policy and strategy defined at global or regional and other issues related to independence of expertise, conflicts interest, human resources and financial resources required for the establishment and proper functioning of a GTCV, the sustainability of NITAGs etc. 5.2 Day Plenary session 3: Support to the establishment of NITAGs in ECOWAS member states Day 2 started at 9:00am with the review and adoption of the first day report. Two main presentations were presented under on the Support to the establishment of NITAGs in ECOWAS member states. Mrs. Sybil Nana Ama OSSEI-AGYEMAN-YEBOAH, Professional Officer for Medicines and Vaccines/WAHO/ DPHC-DC elaborated on the Methodology for supporting the creation and functioning of NITAGs in ECOWAS member states. She stressed that in the establishment of the NITAG, support provided by the technical partners working group (AMP, WHO) was under WAHO s leadership, and that NITAGs creation follows a country driven-process, which countries should own, ensure sustainability and share experiences and information. The criteria for benefiting from WAHO support to establish a NITAG are: expression of interest from National Authorities, strong willingness and availability of national expertise. The positive conclusions from the evaluation mission in the country regarding institutional willingness and technical feasibility for a NITAG will identify countries to be supported. All these stages include: Transmission of an official letter of interest from Ministry of Health to WAHO ; Review of the requests from countries by the working group of partners (WAHO, AMP, WHO/IST, WHO/EVIPNet) ;

7 Response to preselected countries and planning of an evaluation mission in the country on institutional willingness and technical feasibility for creating a NITAG; Evaluation mission in the countries (meeting with national authorities, national experts and local partners) Transmission of the report of the evaluation mission and final decision of inclusion from WAHO to the Ministry of Health. Development of a concept paper for implementing the NITAG and signature of a convention of support for the functioning of the newly-established NITAG. Then, Dr Pape Coumba FAYE, AMP presented the work plans for the establishment of NITAGs for 2011 and He outlined the various meeting and activities planned for 2011 and 2012 in the scope of the activities of the working group of partners. After this meeting, partners and countries should embark on the following activities for 2011: May 2011: Information note on NITAGs presented during the Assembly of Health Ministers. June 2011: Expression of interest by countries to WAHO by and Consultation WAHO/Partners. July 2011: Screening of countries and assessment in pre-selected countries missions. Then there should be a response to expression letter of interest to WAHO and designation of national focal points by countries. August 2011: Visits to selected countries for presentation of NITAG and implementation methodology should be carried out. September to October 2011: Preparation of the concept paper by a working group supported by a national consultant. November 2011: Validation of the concept paper by the national authorities November-December 2011: official creation of the NITAG The presenter stressed that over the period, there must be regular dissemination of lessons learned with the countries already have functional committees. In 2012 WAHO/partners intend to support two or even three countries per year for the establishment of NITAG. From 2013, activities of advocacy and mobilization of resources, establishment of a mechanism for evaluation of the process at the level of countries (WAHO, partners) should be carried out. Lastly, from 2014 there should be integration of the standardized establishment of NITAGs in all member states within the WAHO strategic plan. Countries acknowledged the importance of setting up NITAGs and stressed on advocacy towards health ministers on this topic. Several countries asked to accelerate the process of NITAGs creation after However, due to limited resources, the working group of partners suggested to keep the proposed timeline for Other countries apprehended not to be selected for establishing a NITAG due to unfavorable evaluation of their local capacities (lack of expertise, etc.). Members of the working group of partners reassured them. Professor MARTINS notably insisted on his own experience: at the beginning of the process he also feared lack of expertise, but in the end he was able to find all the required skilled national experts. Other participants also expressed concerns about the sustainability of the newly-established committees after the end of WAHO support. Presenters insisted on the importance of establishing NITAGs step by step and not too fast. They also ensured that routine activities of a NITAG are not costly and that partners will keep on supporting their activities technically after the end of financial support. One country mentioned the specific case of Nigeria, which is a giant in West Africa in terms of population and territory: it would be difficult for a sole NITAG to operate. Dr Senouci gave the example of successful regional sub-committees existing in federal states such as Canada Synthesis

8 The expected outcomes of the meeting have been met: experiences and initiatives in the strengthening of national decision-making in the field of immunization were shared with the participants; and the SIVAC/WAHO/WHO methodology and work plan for supporting the creation of NITAGs in West Africa were successfully presented to the countries. Countries acknowledged the importance of creating such advisory bodies in the context of growing complexity of the vaccines world, financial limitations. NITAGs would therefore help the health authorities of ECOWAS member states to implement immunization strategies and programs tailored to their needs, whether it is for the revision of current programs, the introduction of new vaccines, or the improvement of coverage rates. 6. Final recommendations Participants expressed their interest in establishing NITAGs with the support of the Working Group of partners and made several recommendations to the attention of WAHO: 1. To carry out strong advocacy for the establishment of NITAGs in the ECOWAS member states towards health authorities and partners 2. To support the establishment of NITAGs in all ECOWAS member states 3. To pursue the reflection for establishing an Inter-State ITAG 4. To promote the sharing of experiences with countries that have operating NITAGs 5. To accelerate the creation of NITAGs in coordinating the work plan of partners with the strategic plan of WAHO 6. To pursue resources mobilization in order to support the countries in the establishment and functioning of NITAGs The meeting was closed at 12pm by the president. He thanked the participants and encouraged the development of the initiative in West Africa. 6 Annex Participants list Agenda

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