Vaccine and its delivery in Nepal
•Download as PPTX, PDF•
1 like•378 views
In remote and high altitude areas, we need to walk for hours and hours to reach from one village to another. There is no other option. This is going to be your daily routine, if you decide to live there or serve these people. Sometime, we have to risk our lives. Many health professionals have lost their life while in duty. Therefore, most of the time, vaccine transportation is through human vehicle, walk for many hours to days even up to 10 days in some places. It is definitely heavy and painful, while paid less and walk for days to reach these children and vaccinate them. We have to acknowledge, the office helpers, who are indispensable in carrying out vaccination program in these remote high altitude areas. Sometime it is not easy to carry so they have devised a local method – carry it on your, shoulder, back or head.
Recommended
More Related Content
Viewers also liked
Viewers also liked (18)
Similar to Vaccine and its delivery in Nepal
Similar to Vaccine and its delivery in Nepal (20)
Recently uploaded
Recently uploaded (20)
Vaccine and its delivery in Nepal
- 1. 1 Glimpse of Vaccine Delivery in “High Altitude & Remote” parts of Nepal 11 Sept, 2014 Anuj Bhattachan http://anujinhimalayas.blogspot.kr/ Skype: anuj.bhattachan Tweeter: Yeti4mNepal
- 2. Disclaimer: All pictures are sourced and used for educational purpose only Photo source: www.google.com/picture 2
- 3. Me and Female Community Health Volunteers (FCHV) Photo source: Anuj Bhattachan Foot soldiers for VACCINATION !! 3
- 4. Agenda 1. Introduction of Nepal 2. Existing Needs and Problems in Immunization 3. Solution to the needs or problems 4. Future conditions where we can “act” Focus Challenges during “Vaccine Delivery” in Remote High Altitude Areas 4
- 6. Health Structure below District level in Nepal District Health Office Primary Health Center FCHVs PHC/ORC clinic EPI Out reach Clinic Health Post Sub health Post 6
- 7. District Health Office Photo source: Anuj Bhattachan Energy Source (S) in remote districts of Nepal Firewood Kerosene Solar Hydro Wind 7
- 8. Temperature Monitoring Thermometer Temperature log Photo source: Anuj Bhattachan 8
- 9. Delivery – Safe and Effective vaccine Photo source: Anuj Bhattachan 9
- 10. But, ?? Photo source: Anuj Bhattachan 10
- 11. What could be the reason? Old!! Old and leaky!! Photo source: Anuj Bhattachan 11
- 12. Drop Out – Complete vs. Incomplete dose(s) Photo source: Anuj Bhattachan 12
- 13. Missed children – New Born Babies Photo source: Anuj Bhattachan 13
- 14. Photo source: Anuj Bhattachan Want to vaccinate - not aware “where & when to vaccinate?” Will walk for hours to vaccinate their children Children living in wild – “Zero dose” Want to vaccinate but busy with their “family works” 14
- 15. Untouchables Not vaccinated – “Zero Dose” “Not Completely” vaccinated Photo source: Anuj Bhattachan 15
- 16. Questions - How to REACH and VACCINATE these children? Vaccinator Children at High Risk of diseases A child diagnosed as “Paralytic poliomyelitis” Photo source: Anuj Bhattachan 16
- 17. Geography – 3Ds Photo source: Anuj Bhattachan Difficult Days Dangerous 17
- 18. Walk & Carry Vaccine(s) Photo source: Anuj Bhattachan 18
- 19. Challenges vs. Solution Photo source: Anuj Bhattachan Challenge District Health Officer Challenges Solution Macro level Geographical challenges At local and state level Resource Management At local and state level Socio – political landscape At local and state level Micro level Sustainable Energy Supply for district cold room Solar / Wind /Hydro electricity Vaccine Carrier SMART vaccine carrier Vaccine Stock management Information technology + local knowledge and wisdom Continuous Temperature Monitoring Vaccine Transportation management Micro planning of EPI at district / village level (Monitoring, Evaluation and Information management/vaccine supply & quality) 19
- 20. Future conditions where we can “act” “The best way to escape from a problem is to solve it” Photo source: Anuj Bhattachan 20
Editor's Notes
- In today’s “Design for Manufacturing” class, my intention is not to inspire or lecture or convince you of what needs to be done. Instead, I am going to show you ↑ what I have personally observed and experienced the challenges while delivering vaccines in remote high altitude areas. However, if one of you get inspired from this talk, then it is fine with me. ↑ As a disclaimer - All pictures are sourced and used for educational purpose only ↑
- First thing first, let me dedicate this talk to these wonderful ladies, ↑ who are the foot soldiers for immunization in low income settings ↑ like Ethiopia and Nepal. They are known as Female Community Health Volunteers (In short - FCHV). ↑ They are directly involved in vaccinating the children in rural communities. Without them, immunization program would fail!! ↑
- In next 25 minutes, I am going to walk you through this talk in 4 parts. ↑ ↑ ↑ ↑ ↑ The focus here would be on the ↑challenges that we face during delivery of vaccines in remote high altitude areas. ↑
- First, let me ask you how many of you have travelled to South Asian countries – Nepal, India, Bhutan, Pakistan, Bangladesh, Sri Lanka? So, before jumping into vaccine delivery , let me give you an overview of Nepal. Nepal is a land locked country in South Asia. The estimated population is around 27 million. It is surrounded by 2 giants – China in the North and India in the East, West and South. It is divided administratively into ↑ 5 regions and 75 districts. ↑ ↑ It comprises 3 ecological zones – Southern Terai plain, Middle Hilly and High altitude Mountainous regions in the north. Altitude increases from south to north: the 16-districts in mountain region are the focus of my talk. Among these districts, my particular focus would be a district ↑ named ↑ “Mugu” – this is one district which has the lowest human developmental index in Nepal.
- It is also my duty to give you a picture of how public health system functions in Nepal. Let me take Mugu as an example. There is ↑ district health office (DHO) at district head quarter, whose responsibilities lies in the provision of both curative as well as public health services. Depending upon the electoral constituencies, ↑ there may be one or two primary health centre (PHC) in the district. In Mugu, there is only one PHC below district level. ↑ ↑ ↑ ↑And there are either health post or sub health post in every village development committee (VDC). The VDC is the lowest government administrative unit. Under each health post or sub health post, there will be FCHVs, ORC clinics and EPI ORC that function to provide public health services in the community. ↑
- As I have already stressed, ↑ DHO is the command centre for all public health activities. Many aspects of vaccination like vaccination policies, disease surveillance, injection safety, new vaccines & technologies, has already been covered in previous presentation so I will not touch upon it. Here, I will primarily talk of vaccine delivery and focus on vaccine cold chain ↑ ↑. In remote districts like Mugu, the sustainability of energy requirement and transportation of health commodities are of the highest priority to the district management. Once we have commodities like vaccine, it cannot remain in district headquarter. These have to reach people and if it is especially vaccine, then it has to reach the children at the earliest. For vaccines have to be kept potent through cold chain maintenance, energy is scarce in this part of the world. ↑ The basic source of energy here is firewood. This does not help them in cold chain maintenance. Next nearest energy source is kerosene, which is very expensive and it is difficult to sustain for the whole district cold chain system. So the next reliable source would be either solar or wind or hydro energy. Here in Mugu DHO, the source of energy is solar energy. There is no wind & relibale water based electricity source as of now. ↑
- We have to remember and be aware of by now, the ↑ cold chain maintenance of vaccine is very important. ↑ If we fail maintain it due to various reasons – human or technical error, we are committing crime to humanity. You may ask, why is that? It is because vaccinating a child with vaccine that has lost potency is as good as giving child a poison. Therefore, the ↑ continuous monitoring of temperature and ↑ documenting those numbers is very important. However, our experience tells that this is not always done. More than technical error, we have observed that it is in majority of cases due to human errors and partly technical error. This is one area many research organizations are utilizing their innovative ideas that can address and solve both human and technical limitation. ↑
- As we know, the primary goal of Expanded Program on Immunization (EPI) is to ↑ deliver safe and effective vaccine to the children of every country, every province, every district, every village and each child from every family. Apart from it, we also need to realize that: Getting vaccinated is the birth right of every child and we all have a moral responsibility to achieve this mission. Above all, we also need to deliver complete dose of vaccine and fully immunize the children thereby reducing drop out. ↑
- But a very practical question comes to us, “Are we able to achieve these objectives?” I have to say, “Sorry, no!!” ↑ Why is that? Look at this picture – this is a oral polio vaccine (OPV) given to protect child from paralyzing poliomyelitis. Unfortunately, we found this vaccine ↑ which is not potent as ↑ Vaccine Vial Monitor (VVM) shows stage 4, which means this vaccine is not cold chain maintained. So you may ask, “Why does it happen?” It has various reasons, as a result of human or technological limitation(s). ↑
- One of the main reason, many of times, we find ↑ vaccine carriers – either ↑ old or ↑ ↑ in old and leaky conditions. ↑
- Another challenges is DROP OUT that leads to ↑ incomplete dose of vaccination. In this aspect, role of mothers, health workers, community leaders, engineers, volunteers, teachers & students are vital. ↑
- Another important challenge for vaccination is ↑ all new borne babies. The new born babies are highly prone to infectious diseases. Many of times, they tend to be missed from getting early vaccination. It is because “thousands” of babies are still given birth in home in low income settings. Therefore, we need to serve the community living in the hardest to reach areas of any community and country. This is one important challenge that every government in low income setting is trying to solve to serve the most impoverished population. ↑
- To understand the real scenario from family & community perspective is important, so a question is why many parents fail to vaccinate their children? ↑ There parents who will walk for hours and hours to get ↑ their children vaccinated ↑ There are mothers who wants to vaccinate their children but ↑ they are not aware “where and when” to vaccinate ↑ There are also mother who will vaccinate their children but ↑ are busy with family works because they have other things to worry, how to feed their child & their family. ↑ There are children like these, who are in the wild playing happily. When I took this picture, ↑ they have not received a single dose of vaccination. These are the children and family whom we need to focus & get them completely vaccinated. They are the most vulnerable of all vulnerable children. ↑
- Does anybody know what it means by “untouchables”? In South Asian society, there still exist ↑ millions of people considered “untouchables”. These people are perennially pushed at the lowest of low of socio – economic ladder. ↑ The children from these communities are usually those who are either ↑ “Zero Dose” or ↑ “incompletely vaccinated”. And it is in this community, where most of the disease outbreak occurs. ↑
- So as a ↑ vaccinator, ↑ she has to face a practical question – ↑ how do we reach ↑ these children and vaccinate these children? She has to think – how to reach there? On foot or on horse or how many night halts or per diem or insured? Many of times, she has her own social responsibilities as mother, wife and daughter in law? These are real public health “dilemma” many field level health workers have to go through and affects the vaccination program. If ↑ she does not do her duty well, ↑ then somewhere an “unfortunate” child may ↑ get diseased or even die untimely !! ↑
- In most of ↑ the high altitude areas, we need to ↑ walk for hours and hours to reach from one village to another!! There is no other easy option. This is going to be your daily routine, if your decide to live there or serve these people. Sometime, we have ↑ to risk our lives. Many health professionals have lost their life while in duty.
- Most of the time, transportation of vaccine here is ↑ through human vehicle, walk for many hours to days, even up to 10 days in some district. Sometime ↑ heavy and painful, while paid less and walk for days to reach these children and vaccinate them. ↑ Office helpers are indispensable in carrying out vaccination program in these remote high altitude areas. Sometime it is not easy to carry so they ↑ have devise a local method – carry it on your head. ↑
- It is said, it takes a whole community to educate a child”. In our case, it takes a ↑ whole district to vaccinate every child. However, there are ↑ challenges which we have negotiate through ↑, so we reach each child and vaccinate them. ↑ Macro vs. Micro level challenges and its possible solution. ↑
- Finally, let me leave you all here with this thought– “The best way to escape from a problem is to solve it” This is what I have learnt here in Korea the best way & in true sense. Thank you for listening and Khamsa Hamnida !!