HPV Vaccine One Year On – Part 1 By Chanda Chimba III In a recent presentation to a stakeholders’ meeting, Dr. Sharon Kapambwe and Dr. Penelope Kalesha highlight five main challenges in rolling out the HPV vaccination programme which started in Zambia in May 2013 as data management, planning and co-ordination, social mobilisation, logistics and service delivery. (Read Part 1 of this series here) Kapambwe is Co-Director Cervical Cancer Programme at the Center for Infectious Disease Research in Zambia, CIDRZ, while Kalesha is Deputy Director Child Health at the Ministry of Community Development, Mother and Child Health. Data Management In so much as the challenges in data management are concerned these two experts point out that target group figures from the Ministry of Education were inaccurate and that there were continuing problems with finding all schools in Lusaka to determine the target group. They also note that there was incorrect documentation showing more girls immunized in round two vs round one, something that also happened in round three. The presentation brings out the fact that girls receiving the first dose during the second round were documented as receiving the second dose when they should have infact been documented as having received their first dose. Some girls who missed the second round were infact turned away in the third round. As if this was not bad enough, there were discrepancies between health facility data and district data. Planning and Coordination With regard to planning and co-ordination, Kapambwe and Kalesha bemoan the inadequate financial support for all HPV activities. They say that delayed budget proposal submission by districts resulted in inadequate co-ordination and untimely disbursement of funds by funders for both social mobilisation and service delivery. The lack of strategy to identify 10 year old out of school girls is also identified as a problem. The implementation of both the second and third rounds coincided with the examination period in schools leading to a lot of missed opportunities due to rescheduling of the outreach visits to schools especially in the third round. According to Kapambwe and Kalesha, competing priorities like the Child Health Week, national planning for all districts and HIV activities could not be ignored. Inadequate co-ordination between health centers and schools to plan for visits also meant that health care workers were getting to schools when girls were not there. The opportunity to vaccinate many girls was therefore a missed. Social Mobilisation Kapambwe’s and Kalesha’s presentation to the stakeholders meeting held in February brings out the fact that the late release and cut-backs in social mobilisation funds to districts negatively impacted the successful mobilisation of communities resulting in inadequate and delayed senstisation through the media and interpersonal communications. They add that some parents and girls from religious groups were refusing to be vaccinated. Logistics In as far as logistics are concerned, it has been noted that district level transport was inadequate for distribution and implementation of activities. Also noted is the poor record keeping at district level of the left over vaccine stocks after an exercise posing challenges in planning for the next round. The two experts further note that inadequate cold storage facilities for vaccines in some health facilities resulted in some health workers travelling long distances for the vaccines. Service Delivery Service delivery was perhaps the most problematic with Kapambwe and Kalesha bringing out eleven points altogether. They explain that documentation of registers and tally sheets was not completed in some health facilities. The fact that vaccination cards were kept at schools, homes and health facilities made it difficult to verify whether documentation had been completed. Due to inaccurate data, many girls did not receive all the three required doses of the vaccine. It actually turns out that there was no follow up plan for girls who had not received the first dose in the first round but were immunized and documented in the second or third dose. Other issues noted in service delivery include the fact that there was no strategy to reach out of school girls resulting in a pre-dominantly school based strategy, extremely limited reach of out of school girls and high drop-out rate among the same. It is clear from all the challenges observed by Kapambwe and Kalesha that even though the HPV vaccination roll out which commenced in May 2013 was hailed as a success, huge problems came up along the way due to various reasons. Other players on the ground are infact contending that the launch of the vaccination programme is what may have been a success and not the actual roll out. But do look out for the third and final part which will project the way forward and how to resolve the challenges. zambiareports/2014/06/17/hpv-vaccine-one-year-part-1/
Posted on: Thu, 19 Jun 2014 04:56:18 +0000
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