EpiVacPlus: Improving the performance of Immunisation Programmes through On-the-job Training and Technical Support

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    – SILVER WINNER OF THE 2016 EXCELLENCE IN PRACTICE AWARDS –

    World Health Organisation (WHO) sponsored programmes have succeeded in raising immunisation coverage in developing countries from 5% in the 1970s to more than 80% in the 1990s. But in Africa, immunisation coverage has lagged dramatically behind.

    Agence de Médecine Préventive (AMP), a NGO founded in 1972 and dedicated to improving health, has for more than 40 years worked actively on immunisation and vaccination in many countries, including Africa.

    In the 1990s it realised that the biggest problem facing Africa in successful immunisation and vaccination was not only access to vaccines but the weaknesses of the delivery system. One major reason why African countries lagged in terms of vaccination coverage was the limited effectiveness of the various national public health organisations. Without finding the appropriate enablers, Africa would fall short of the WHO target of 80% of countries achieving and sustaining 90% national coverage and 80% in every district with all vaccines in national programmes.

    As a result, in 2002 AMP designed the EpiVacPlus Program.

    EpiVacPlus aims to address the human resources issue in the health crisis by developing and implementing innovative and high-quality training programmes combining classroom and distance learning, professional supervision and research support.

    These programmes are implemented through professional and academic partnerships.

    The programme has four main characteristics:

    • It targets the key medical actor for vaccination in Africa: the District Medical Officer (DMO)
    • It has a central location in Ouidah (Benin) for the DMOs’ initial four weeks of training
    • There is a one-year training programme that combines distance learning and on-site supervision
    • It is a multi-country and multi-stakeholder initiative

    The DMO is a public health worker and he or she is usually responsible for a team including a treasurer, an accountant, medics and nurses. There are sometimes doctors working under his/her authority and she or he usually works in a health centre. When there is a district hospital in his/her zone, there are several doctors working in the hospital under his/her supervision.

    A DMO thus manages the Public Health of the district. In the health field, a DMO is simultaneously a doctor and a manager.

    Why target the DMO?

    Experience provided over 40 years of intervention and support, particularly in Africa, has forged AMP’s philosophy: action and assistance need to be conducted and implemented with direct contact to populations and with and for field medical actors. The design of EpiVacPlus favoured initial group training in one central West African location for just four weeks where trainees would take the initial courses followed by practical and on-site learning and tutoring. This design favours cost reduction and provides efficiency without removing the DMOs from their primary activity.

    Ouidah (Benin) was chosen for its central location. The courses were taught at the Regional Institute of Public Health, a campus the WHO manages. Most of the training of DMOs in the programme takes place on this site.

    In the EpiVacPlus programme design, supervision is key for the trainee, mixing peer and expert review. This approach results from a supervisors’ team – usually three people composed of different profiles: typically, one alumni from the programme (a District Medical Officer) and two experts, usually one AMP member and one academic. Three times a year, this multi-profile team of supervisors will spend three days on-site with the trainee, assess and review his/her managerial skills and epidemiologic processes. The main areas for supervision are: human resources management, data and information management, financial management and supply chain management.

    This multi-country design of EpiVacPlus was obviously necessary: in vaccinology, human contamination has never been stopped by national frontiers. The number of countries participating in the EpiVacPlus Programme has steadily increased since 2002.

    The EpiVacPlus Program has been co-designed by various partners, including AMP and University Paris-Dauphine (UPD).

    AMP and UPD built on their respective strengths to leverage the programme. Their areas of expertise were obviously complementary: applied epidemiology and vaccinology expertise, field know-how, contacts with the national public health authorities, contacts with international partners and funders for AMP, and competencies in management and public health economics for UPD.

    The continuous funding of the EpiVacPlus Programme by AMP since 2002 has been key to its success.

    It has relied since its foundation on the funding and support of various partners, including WHO, UNICEF, the EU and the vaccine industry. The active support of the different national public health services of Western Africa countries has also been key, particularly in proposing DMO as participants in the programme.

    EpiVacPlus results rely a great deal on the joint efforts of its various stakeholders and partners, particularly through the partnerships developed by AMP with West African universities in epidemiology and vaccination techniques that directly contribute to the District Medical Officer’s efficiency and to EpiVacPlus results.

    Worthy of particular mention is the contribution of the University of Cocody (Abidjan, Ivory Coast) that is responsible for the MIVA Master 2 in Applied Vaccinology, part of the EpiVacPlus Programme.

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