Worldwide, more than 1.5 million children die each year from vaccine-preventable diseases.
Thanks to immunization, every year two to three million children are saved from deadly childhood diseases (measles, pneumonia...) (WHO, 2020), however despite all the progress made, in 2019, 10.6 million children did not receive any vaccine (Gavi 28 October 2020).
In West Africa, some countries have low vaccine coverage or coverage rates below national targets. In Guinea, in 2018, only 40% of children were fully vaccinated. In Niger this rate was 48% in 2017 (Vaccine Coverage Survey).
In response to these low rates and in an effort to accelerate the eradication of wild poliovirus and prevent new outbreaks of vaccine-derived poliovirus in high-risk geographic areas of Africa and Asia, the Bill & Melinda Gates Foundation (BMGF) initiated an innovative approach to strengthening routine immunization systems based on the signing of a memorandum of understanding with the governments of target countries.
This approach differs from traditional supports in that it :
- Federates and pools the support of different donors around a "One Plan" approach, i.e., a single work plan for all partners supporting routine immunization;
- Aims for an increasing contribution from year to year by governments to finance immunization operations with a view to full public funding of the routine immunization program in the long term;
- Emphasizes financial transparency and direct transfer of funds to the end user through government systems;
- Establish routine high-level monitoring by governments through regular assessments supported by quality data dashboards to guide decision-making;
- Continually explore new approaches to measuring progress in each context, with a focus on tracking key process indicators, measuring immunization coverage, and introducing new technologies
In addition to financial support, the Bill & Melinda Gates Foundation provides technical assistance to governments.
This technical assistance in Guinea and Niger is provided by Askaan Santé.
In Guinea, the routine immunization strengthening program targets the Kankan region because :
- It is the most populous (1,972,537 inhabitants in the 2014 RGPH) and the largest (72,145 Km2) of Guinea's eight regions;
- It has the highest fertility rate in the country and is the main driver of population growth of children under 1 year old in Guinea;
- Nearly 6,000 of the region's 91,248 children are at risk of dying from vaccine-preventable diseases before they reach their first birthday (DVDMT 2019) ;
- Kankan is a high-risk region for poliovirus transmission, and has been the focus of all recent poliovirus outbreaks derived from Guinea
In the Republic of Guinea, Askaan Santé supports both the central and regional levels.
At the central level
- Support the UAGCP in developing and updating fund management procedures.
- Support the National EPI Directorate in the implementation and updating of EPI normative documents.
- Support the National EPI Coordination and the UAGCP in advocating with the government, parliament and private companies for the increase and mobilization of resources for the financing of routine immunization activities.
- Support UGACP in strengthening the financial management system and the monitoring and use of funds.
- Support the UAGCP in developing and updating fund management procedures.
- Support the National EPI Directorate in the implementation and updating of EPI normative documents.
- Support the National EPI Coordination and the UAGCP in advocating with the government, parliament and private companies for the increase and mobilization of resources for the financing of routine immunization activities.
- Support UGACP in strengthening the financial management system and the monitoring and use of funds.
At the regional level (Kankan)
- Support the development of annual budgeted work plans and implementation of improvement activities in core program areas including vaccine supply chain, service delivery, data management, formative supervision, and demand generation communication.
- Assist the Regional Health Directorate (DRS) team and the Prefectural Health Directorates (DPS) in the Kankan region to strengthen the coordination of activities at all levels.
- Support the development and implementation of capacity building activities for the immunization program.
- Support the development of annual budgeted work plans and implementation of improvement activities in core program areas including vaccine supply chain, service delivery, data management, formative supervision, and demand generation communication.
- Assist the Regional Health Directorate (DRS) team and the Prefectural Health Directorates (DPS) in the Kankan region to strengthen the coordination of activities at all levels.
- Support the development and implementation of capacity building activities for the immunization program.
To do this, Askaan deploys a set of interventions aimed at :
- Strengthen the coordination of routine EPI activities at all levels, through the establishment and revitalization of various coordination and monitoring bodies and support for the development of costed, effective and integrated annual work plans for all partners supporting immunization;
- "Redesign" financial management processes to ensure direct transfer to the recipient and timely withdrawal of funds for immunization activities;
- Design and support the implementation of interventions targeting all areas of the routine immunization program, including service delivery, vaccine supply chain, data management, supportive supervision and demand generation;
- Ensure the involvement of the communes and all decentralization stakeholders in the planning and implementation of interventions to promote community acceptance and use of immunization services
The Memorandum of Understanding signed on April 15, 2021, by the Bill & Melinda Gates Foundation, the Government of the Republic of Guinea, WHO, UNICEF, and Gavi the Vaccine Alliance, covers a three-year period (2021-2023) and is expected to achieve 90% immunization coverage in the five (5) districts of the region
In Niger, the Aliko Dangote Foundation (ADF), the Bill and Melinda Gates Foundation (BMGF), and Gavi, the Vaccine Alliance, have decided to support the country through the implementation of a program to strengthen routine immunization.
This program targets the regions of Diffa, Maradi and Zinder because these three regions :
- Constitute historical reservoirs of polio transmission;
- Together, they account for nearly 44% of the population of children who have not received all three doses of Penta;
- Have high Penta1-Penta3 dropout rates ( 16%, 11%, and 17% respectively according to the 2017 Vaccine Coverage Survey);
- Are contiguous and concentrate special populations (IDPs, refugees and nomads)
In the Republic of Niger, the main challenge is to improve immunization coverage to reach 90% of the target population, reduce dropouts, and eliminate poliovirus transmission in the regions of Diffa, Maradi, and Zinder by December 2024.
Askaan Health's support targets five (5) key pillars and consists of:
- Establish a funding mechanism for routine immunization operational costs and ensure adequate funding for vaccine procurement by optimizing the vaccine needs assessment system and securing public funds for vaccine procurement through high-level advocacy;
- Identify and vaccinate zero-dose children and high-risk communities such as nomads, refugees, populations living in insecure or desert areas, by deploying innovative strategies and taking advantage of technological innovations;
- To ensure the availability of a functional cold chain at all levels by filling the gaps in maintenance and repair of cold chain equipment and a better control of preventive and curative maintenance of equipment;
- Eliminate dropouts through community engagement, building on traditional chiefdom leadership, for better target identification and tracking;
- Strengthen monitoring and measurement through the deployment of a mobile application providing real-time quality data for informed decision-making and accountability of stakeholders. Regular performance measurement will be institutionalized through annual immunization coverage surveys.
The partnership between the Republic of Niger and the Aliko Dangote Foundation, the Bill & Melinda Gates Foundation and Gavi the Vaccine Alliance was formalized on May 5, 2022 through the signing of a three-year memorandum of understanding (May 5, 2022 to December 31, 2024).
In the first year of implementation the focus will be on:
- Organizing a high-level presidential forum for political commitment to routine immunization
- The implementation of the new financial management mechanism ;
- The creation of a Vaccine Monitoring and Management Committee made up of government officials and partner representatives and in charge of restructuring the process of estimating needs and mobilizing partner and government funding for the purchase of vaccines in time;
- The implementation of monitoring dashboards for immunization activities at the regional and district levels are in place;
- The development of a cold chain maintenance plan;
- The production of a roadmap for traditional leadership engagement on demand generation.
BMGF Funding
