SPECIAL REPORT: WHO seeks global partnership for curbing preventable diseases

Monday April 27 2015

An under-five child gets vaccination in one of

An under-five child gets vaccination in one of the health centres in Tanzania. PHOTOS|FILE 

By Syriacus Buguzi,The Citizen Reporter

Dar es Salaam. As Tanzania joins the rest of the world in marking the World Immunisation Week that reaches its climax this Thursday, the World Health Organisation (Who) is calling for renewed global collaboration in dealing with diseases.

The world health agency warns that countries around the world are off-track in their efforts to attain the global targets of averting 1.5 million deaths each year caused by preventable diseases.

Under the theme: Closing the Gaps -- the Who is highlighting the need to save 1 in 5 children who are still missing out on routine life-saving immunisations by strengthening health systems so that vaccines continue to be given even in times of crisis.

The call comes at a time when Tanzania is being regarded as one of Africa’s success stories in its immunisation strategies as stated in this year’s Good Governance Africa Report.

However, with over 90 per cent coverage, the country still has gaps, according to the Who representative to Tanzania, Dr Rufaro Chatora.

In this exclusive interview Dr Chatora explains how the World Health Organisation has been working with Tanzania on how to tame immunisable diseases. Excerpts: 

QUESTION: Going by the theme of this year’s Immunisation Week which is ‘Closing the Immunisation Gaps, the Who aims at promoting the use of vaccines to protect people of all ages against diseases. What gap(s) does the agency see in Tanzania’s immunisation coverage?

ANSWER: I think the first thing here is to acknowledge that the immunisation coverage in Tanzania is very high at the coverage of above 90 per cent, according to our Indicator Surveys that we use to monitor coverage. In spite of that, we know that there are areas where the country has gaps.

The 90 percent coverage I said is the national figure but when you break it down into regions, you find that some of them are slightly higher and others lower. When you break it down into districts, it now becomes very interesting because some districts are not performing well. Some would be performing at 75 per cent and others higher than that.

So, it’s these low performing districts that we need to address in bridging the gaps. But even in those districts that are performing well, there are some health centres in the sub districts where children’s access to vaccines is much lower.

Other gaps that we have to talk about are those children who start early immunisation schedules but drop out in due course. So, such children are not fully protected.

But we also know that there are resource gaps not only in terms of money, but also in terms of human resource. Shortage of skilled staff cuts across the health services and therefore immunisation services are also affected by this.  

What role does the agency intend to play in bridging the gaps, or rather, what role has the agency been playing in promoting immunisation programmes in Tanzania and what are the future plans?

As you know, the Who offers technical support and advice to Tanzania in many programmes, including immunisation. So, we advise on the appropriate approaches that they should be using to reach out to the people.

We also help in introducing new vaccines. The country recently introduced the new Rotavirus Vaccine and the Pneumococcal Vaccine.

We also helped the country to introduce the Rubella vaccine and we recently helped the country to introduce the second dose of the measles vaccine which is like a booster dose. We are also now working with the government to introduce the Human Papilloma Virus Vaccine for young girls around nine years plus. 

We have helped the country in training health workers including accompanying them in obtaining data as well as evaluating programmes in the areas of interest.

We also provide logistics support such as buying vehicles for distribution of the vaccines and supervision of the immunisation programmes at the regional level and sometimes at the district level.

We also buy refrigerators for preserving the vaccines both for districts and regions. We are now working on buying new refrigerators for health facilities which have old equipment. This shows the range of our involvement in bridging the gaps.

This year’s report by Good Governance Africa regards Tanzania as one of Africa’s success stories in protecting children against measles, with over a 90 per cent vaccination coverage. The GGA sources some data from the Who. What do you make of this information as an agency?

It’s correct. The data is good and encouraging. What the Who does is to put together data that comes from every country in the world so that we use it to monitor global trends. It’s that same data that we use to tell how one country is performing relative to the other. And through that analysis you will realise that Tanzania was performing very well; going above 90 per cent which is beyond the recommended level.

However, as I mentioned, the above coverage is not uniform.  There are discrepancies among districts and communities. For 2014, the districts which achieved 90 percent and above were 118 (72 percent) out of total of 163 local district authorities.

Our concerns and efforts are directed to assist those areas that are not achieving the high coverage while helping areas which have done well to maintain their pace.

However, in addition to coverage, also we need to use actual findings of unvaccinated children due to problems with denominators amongst districts and facilities. Therefore, we do coverage surveys and data quality assessment frequently to verify the administrative data.

What else, as a world health agency, do you think has been Tanzania’s major success in immunisation programmes?

I think the major success is being able to tame polio since 1996. Measles, which used to happen every year with major outbreaks every three years or so is not happening in Tanzania. If you go to hospitals today and you ask them: when did you last see a measles case? They will be surprised.  Hospital wards where they used to keep children affected by measles are no longer there.

Then, we talked earlier about the introduction of new vaccines like the second dose of the measles vaccine. You will count a few countries, may be two or three in Africa that have introduced those vaccines. Countries that have eliminated neonatal tetanus in Africa are 23 out of 46, Tanzania being one of them.  That shows that the country is on the right track.

Last month, the World Health Organisation issued its first-ever guidance/guidelines for the treatment of chronic hepatitis B and warned that some 240 million people have chronic hepatitis B virus with the highest rates of infection in Africa and Asia. To what extent is Tanzania affected by Hepatitis B?

The information available shows that Hepatitis B is present in about two to seven per cent of the population. This implies with a population of 47 million the number of people affected is between 1.4 and 3.3 million.

Some areas may be more affected than others. Yes, it’s a concern and the ministry of Health knows about that and I think they are considering how best to handle it. That’s why they introduced the Hepatitis B vaccine in the country.

I want to know your role, as an agency, in helping Tanzania implement these guidelines.

The role of the agency is to provide technical support to the government to ensure it implements the guidelines in a correct and effective way.  The assistance entails capacity building and training on the guidelines, supervision and monitoring. 

How does the government respond to your recommendations in such cases?

The response is good. These guidelines have just come out, so we have not yet started talking about incorporating them, but I recently had a discussion with the permanent secretary on how best to deal with the problem.

Babies who are born now are protected. But those who are older still have the risk of getting the virus. Some perhaps are already infected now. So, this is what the permanent secretary was asking and this is what the new guidelines are aiming at; issues around treatment and diagnosis of the disease.

Whether or not these guidelines will be implemented, my answer is positive. If not implemented, then it goes back to the gaps that I have been saying which also depends on the availability of finance, human resources and materials including the vaccines themselves.

Tanzania often suffers budget shortfalls when it comes to financing its healthcare programmes. Donor reliance has been adversely affecting the plans to implement some projects, especially when the donors walk out. As a world health agency, do you think immunisation programmes in African countries like Tanzania are affected by such financial hurdles? Why?

The immunisation programme partly benefits from donor support. I am emphasising partly.  Because the government’s contribution is quite significant and perhaps even higher than the donor support. Tanzania buys some of the vaccines.

Fortunately with immunisation, some of the issues involve agreements that Tanzanian enters with Gavi Alliance which supplies vaccines for developing countries. Gavi helps the countries to introduce the vaccine and they give them start up money and the first few vaccines. 

But after few like 3 to 4 years, Gavi starts reducing the assistance. And then the country begins to pick up the cost. So, right from the beginning there is a donor component and the government component. When the government can support itself, Gavi walks out, and then the government picks up.

But there are vaccines where the government totally depends on its own but the newly introduced vaccines are still totally dependent on donors but with anticipation that the donor component will be reduced.

But also, there is some communications going on between governments and Gavi that when a country attains a middle income status, that support will be reduced. We are discussing with the ministry on how to go about that when such an issue comes up.

However, Tanzania is depending on donor support in terms of procurement of most of the vaccines and logistics.  Despite the increasing allocation of country budgets on health, still most of the activities and logistics are met by donor support.  Therefore African countries immunization services will be affected when such support stops as the country may not be able to afford some of these logistics and supplies at the optimum level.