Category: Medical & Health

Brazzaville – In 2020, the World Health Organization (WHO) Regional Office for Africa pioneered mobile money transfer system under the Polio Eradication Initiative programme essentially to pay vaccination campaign workers. So far eight African countries have adopted the payment system, with others working to deploy mobile-based cash transfers in health programmes beyond polio. Dorcas Karimi, Digital Finance Officer with the WHO Regional Office for Africa, explains the progress achieved so far.

So, why has mobile cash transfer been adopted in health programmes?

Mobile cash transfer is a prominent payment system in sub-Saharan Africa, which boasts 469 million active accounts—nearly half the world’s total—and US$ 1.3 billion in daily transactions, according to the 2019 State of the Industry Report on Mobile Money by GSMA, a global mobile operators body. WHO in Africa, with the support from the Bill and Melinda Gates Foundation, has committed to introducing digital payments as a specific area of operational support to the 47 countries in the region in line with the Global Strategy on Digital Health.

A key consideration in adopting mobile cash transfer is because cash payments pose operational problems such as the risk of diversion and fraud, delays in paying field workers, security risks associated with the physical transportation of large sums and high administrative costs, in particular the costs of transporting funds to the field, as well as the processes of justifying expenses.

Crucially, with the advent of COVID-19, every measure to prevent infection is lifesaving. The use of contact-free digital payments plays an important role in ensuring the safety of health and workers who risk their lives to provide lifesaving vaccines and treatments.

What barriers have had to be overcome?

First, change is never easy. WHO country offices have advocated strongly with health ministries to include mobile money transfers in their existing payment systems and processes. They have amplified the benefits of cash transfer systems in health programmes such as efficiency, timely payments that have a positive impact on workers’ motivation, as well as transparency and accountability issues.

Efforts are also being made to set up accurate and complete health worker databases in countries. WHO has partnered with a United States-based software company to develop an application to set up databases and is working closely with ministries of health to establish accurate health worker information.

Despite the widespread use of mobile money transfer in Africa, low mobile network coverage in some regions, weak systems in ensuring proper identification, verification and knowledge of cash transfers recipients continue to pose challenges. Efforts are underway to overcome these barriers such as by negotiating with mobile phone providers to issue free SIM cards to the community health workers involved in polio vaccination drives.

What progress has been made?

The pilot test phase of mobile money transfers in polio vaccination campaigns in the eight countries has shown positive results. In Liberia, for instance, payment timelines have been significantly reduced, with more workers preferring mobile payments over cash, according to a recent survey.

Secondly, health worker database and financial transparency have improved. In the pilot countries, databases now exist for all vaccination campaign workers with vital information such as name, gender, worker designation in the campaign, health district, mobile number and the amount paid. Once a payment is processed, a report can be extracted from the payments portal and shared with all partners.

Finally, mobile payments are cost-saving. A United Nations report after the 2014—2016 Ebola outbreaking West Africa found that mobile money transfers were significantly cost-effective in Sierra Leone in terms of money, time and lives saved. For WHO in Africa, cost-savings are already being realized under the mobile cash payment programmes. For example, programme assistants now do not need to travel to remote districts to deliver cash for health worker payments, saving travel and per diem expenses.

Source: World Health Organization. Africa

Having survived the ongoing cholera outbreak in Jigawa State, Mallam Saleh Magaji Baranda, a father of 11 and a farmer from Baranda village in Dutse Local Government Area (LGA or District), has been vaccinated with the Oral Cholera Vaccine (OCV) at the recently concluded cholera vaccination campaign in the state.

After his near-death experience, Mallam Baranda had no doubts about receiving the vaccine during recent launch of the vaccination campaign. He now advocates for people in his community to get vaccinated against the disease.

“I have been talking to the people in my community to receive the vaccine. I call on my brothers and sisters, farmers, fishermen, traders and everyone to turn out and be vaccinated against cholera so that we are all protected from this deadly disease”, he said.

Narrating his experience, Mallam Baranda said, the night before he fell ill, he had five to six bouts of watery stool and had also refused to heed to his wife’s advice to seek medical treatment because he did not want to miss the first day of the farming season. Going to the farm at the break of dawn, he could barely achieve anything, as he was too weak and tired. Hardly had he began ploughing the land when he fainted and was taken to the Infectious Disease Hospital in Duste, where he was admitted and treated for cholera in the State’s Cholera Isolation ward.

Intervention

As of the second week of October, over 90,908 suspected cases, as well as, over 3,000 deaths have been reported across 32 states of the Federation since the beginning of the year. In Jigawa, reports for the same period indicates over 10,000 suspected cholera cases and almost 500 deaths reported so far. Twenty-two of the 27 LGAs are currently battling with cases of cholera. The state capital, Duste, then Birnin Kudu and Hadejia, are the worst hit by the current outbreak.

In response to the outbreak, the Jigawa State Government, in partnership with World Health Organization (WHO), is conducting a five-day vaccination campaign, targeting almost a million people, aged above 1 year with the OCV. And as of the end of day 4 of the campaign, 702,885 persons had already been vaccinated.

In collaboration with the state agencies and the National Primary Health Care Development Agency (NPHCDA), WHO supported the collation and submission of a request to the Inter-Agency Coordination Group (ICG) for cholera vaccinations. Details of the request include approval and release of over 3.5 million doses of OCV as well as operational cost for two rounds of reactive vaccination exercise across six LGAs in three states, of which three are in Jigawa State.

Through the support from the ICG and the Global Task Force on Cholera Control (GTFCC), the reactive vaccination campaign was flagged-off in one of the worst affected settlements or community (Baranda village) in Duste, on 22 October 2021 by the Emir of Duste, His Royal Highness Dr Nuhu Muhammadu Sanusi.

The first round conducted 21 – 26 October 2021, targeted over 900,000 people, while the second round of the vaccination is slated for 20 – 24 November, 2021. This is so, because two doses of the vaccine offered at least two weeks apart confirms full protection for 2 – 3 years.

Speaking at the flag-off ceremony, the WHO National Surveillance Officer/Vaccine-Preventable Disease (VPD) focal point, Dr. Terna Nomhwange, emphasized the importance of the vaccine and its safety. He pledged WHO continuous support to the states in ensuring health security and response to vaccine-preventable diseases.

Meanwhile, the Executive Secretary of the Primary Health Care Agency in the state, Dr Kabir Ibrahim, assured residents that the government is responding to the outbreak through multiple approaches, including cases management, risk communication, etc.

Commending WHO and other partners for the support, he said, “we received doses (of vaccine) from the Federal Government through WHO and everyone from above the age of one to adulthood is qualified to take the vaccine”.

Similarly, the Emir, in his welcome address said, “it is saddening that Nigeria is still combatting the disease”.

He recalled that the disease was first reported in his locality in 1968 after the yearly religious pilgrimage.

“We still have a lot to do regarding personal and environmental hygiene and desist from open defecation. On behalf of the emirate and state, I am grateful to WHO and other partners for supporting the state during crucial times of need. You have always been supportive of us in emergencies and will forever be grateful to you for the timely support as always” he said.

A similar vaccination response has been completed in Bauchi LGA of Bauchi State, with over 700,000 persons vaccinated in July and almost 800,000 persons vaccinated in August 2021, with the first and second doses of the vaccine. WHO has continued to support all states in its response to the outbreak through an Incident Management System (IMS), with funding provided for implementation of an Incident Action Plan (IAP) and deployment of technical assistance across all affected states.

As part of the control process, a hot spot mapping has also been completed with plans for pre-emptive vaccinations against cholera across selected LGAs in the coming months. This preemptive vaccination will be supported by the GTFCC.

Cholera is an acute diarrhoeal disease that can kill within hours if left untreated. Cholera outbreaks have become a yearly occurrence in Nigeria and remains a threat to public health. It affects both children and adults and has led to many avoidable deaths over the years.

Source: World Health Organization. Africa

Brazzaville – In November 2020, the novel Oral Polio Vaccine type 2 (nOPV2) became the first vaccine to be authorized under the WHO Emergency Use Listing. The vaccine has since been rolled out for limited initial use in countries to tackle vaccine-derived poliovirus. Dr Richelot Ayangma, Medical Officer and nOPV2 Focal Point at the WHO Regional Office for Africa explains the vital role of the vaccine in ending all forms of polio and what countries must do to ensure effective vaccination campaigns.

What advancements is nOPV2 bringing to the fight against polio?

The nOPV2 is an additional innovative tool to tackle polio outbreaks in the African region. It is a modified version of the mOPV2 vaccine that provides comparable protection against poliovirus type 2 but with an increased stability. This means it has less risk of mutations and reverting to virulence, and hence reduces the risk of paralysing children in areas outside of the targeted mass immunization campaigns where there is low immunization coverage. Ultimately, nOPV2 poses less risk of seeding new polio outbreaks in our region.

The vaccine is being deployed under an Emergency Use Listing (EUL) that requires countries to meet a set of readiness requirements prior to use of the vaccine. We have seen that working to meeting these requirements has benefited countries as it has enabled them to more accurately review, plan and implement activities and thus strengthened the overall program performance in surveillance and routine immunization. All in all, these nOPV2 readiness activities have enabled countries to more rapidly detect, notify, and investigate new polioviruses while ensuring necessary steps for implementing high quality response rounds in the event of an outbreak.

As the first vaccine to receive an EUL recommendation from WHO globally, nOPV2 paved way for other vaccines such as COVID-19 to be rolled out when there is urgent need to respond to outbreaks.

What is the uptake of nOPV2 vaccine in Africa?

To date, more that 50 million children in six countries: Benin, Congo, Liberia, Niger, Nigeria and Sierra Leone have been vaccinated using nOPV2 with no major safety concerns. By the end of 2021, Ethiopia, Mauritania, Nigeria, The Gambia, Senegal and Uganda will be implementing their mass immunization campaigns using nOPV2, targeting a total of approximately 30 million children.

In terms of nOPV2 readiness, 23 countries in our region (Benin, Burkina Faso, Central African Republic, Chad, Congo Republic, Cote d’Ivoire, Democratic Republic of Congo, Ethiopia, Guinea, Kenya, Liberia, Niger, Nigeria, Mali, Mauritania, Senegal, Sierra Leone, South Sudan, The Gambia, Togo and Uganda) have met the criteria for nOPV2 under the Emergency Use Listing, making our region the leader in nOPV2 preparedness. An additional 9 countries have already started work to meet these requirements.

How can countries improve vaccination campaigns to be more effective?

The two critical elements to conduct immunization campaigns that will effectively stop polio outbreaks are timely response and implementation of high-quality campaigns.

To effectively stop polio outbreaks, mass immunization campaigns need to ensure that no child is missed, and they must be implemented in a timely manner, that is within two months of notification.

In addition, we’ve seen that the work done by countries to meet the nOPV2 readiness criteria, coupled with the existing polio outbreak response guidelines, can help in improving campaign effectiveness as countries are required to conduct and validate their micro-planning. This takes into account the correct estimate of the target population, identifying the real needs for the implementation of the campaign, including special populations that are difficult to access.

Countries also must address vaccine refusals due to misinformation by integrating targeted communication and social mobilization activities into campaigns, allowing population and parents access to the correct information on the current vaccination rollouts. This is crucial given the concurrent rollout of nOPV2 and COVID-19 vaccines. An increase in refusals has become one of the leading causes for non-vaccination.

And finally, countries are required to use current innovations such as Geographic Information System technologies and update existing tools for real time monitoring of pre-, intra- and post-campaign implementation to ensure that every child is reached. For instance, monitoring dashboards have made it possible to assess the level of preparation for the campaigns and ascertain that campaigns are being implemented at the appropriate level of readiness.

What are major challenges in the efforts to eradicate polio?

Among the major obstacles that countries experience in their efforts to eradicate polio are overwhelming public health challenges. Diseases such as the COVID-19, cholera, measles, yellow fever and others deprioritize the polio outbreak response. This means that more children are at risk of being paralysed.

The weakened routine immunization in Africa has led to well-documented low vaccination coverage rates which are due to poor service delivery and few vaccination centres delivering inadequate vaccination strategies. Too many children are being chronically missed in mobile populations and hard-to-reach areas.

Other factors include delayed response due to the difficulty in accessing certain areas during vaccination campaigns due to insecurity and conflicts, and the inability to sustain the gains made in the polio programme. These can only be achieved by having countries integrate the polio functions into their broader public health system. Timely and effective coordination across country borders for large-scale synchronized mass immunization campaigns is critical so that no child is missed.

Finally, insufficient resources for countries, including vaccines and funds to conduct these outbreak response activities also hamper progress in eradicating polio.

Source: World Health Organization. Africa

With strong political commitment, the State of Eritrea has made enormous strides to improve the health and wellbeing of women and children since independence.

As part of the ongoing efforts to consolidate progress line with, the Ministry of Health with WHO support, conducted a review of the RMNCAH and Ageing programs in the months of September and October 2021. A comprehensive RMNCAH & HAA Strategic plan 2022 -2026 was thus developed with support from WHO, UNICEF and UNFPA. This strategic plan will guide the implementation of Sexual and Reproductive Health, maternal and newborn health, child health, adolescent health and healthy ageing including during the COVID pandemic. It delineates the strategic objectives together with national targets and milestones to be attained during the implementation period as a way of achieving UHC in the country.

The plan has been designed to facilitate the annual planning and reporting process. It focuses on high impact, cost effective RMNCAH & HA interventions, which if implemented will significantly accelerate the progress in the attainment of health-related SDGs.

Key highlights and strategic objectives of the 2022-2026 RMNCAH & HAA strategic plan are to build a resilient health system to support delivery of quality (RMNCAAH) services. The strategic plan also seeks to entrench universal coverage of comprehensive (RMNCAAH) health services and interventions along the continuum of care. It will also institutionalize a Multisectoral response for Healthy Ageing.

The key achieved results of this WHO intervention that will lead towards attainment of SDG and GPW 13 related goals in the country was the development of the draft RMNCAH Strategic Plan 2022-2026. The plan will be costed before the end of December 2021 and disseminated to key partners towards attainment of SDG and GPW 13 related goals in the country.

Source: World Health Organization. Africa

The Government of Hungary in cooperation with the World Health Organization (WHO) has provided a mobile, rapidly deployable container structure, fully equipped with the appropriate medical equipment to support rapid and effective clinical management of severe and critically ill patients with highly infectious diseases in Uganda.

Within the framework of a development project worth over 140 000 euros, Hungary provided a rapidly deployable mobile unit, which contains electrocardiogram (ECG) machines, spirometers, blood glucose meters, air filters, thermometers, hospital beds, an office desk, chairs, storage cabinets, air conditioners, six “Contimed” (CN20) foldable containers and blood pressure machines. The current deployment aims to provide emergency care for critical patients with COVID-19 and other potentially infectious diseases in the country.

“Uganda, like other countries around the world, is facing an unprecedented crisis that has taken a toll on people’s health and livelihood. This equipment that we have received today will boost our efforts to provide timely and effective care to patients who are in critical condition,”- Honourable Dr. Jane Ruth Aceng, Minister of Health of Uganda.

The Hungarian ambassador accredited to Uganda, His Excellency Mr. Zsolt Mészáros affirmed the Government of Hungary’s commitment to supporting Uganda in the fight against infectious diseases.

“The use of mobile rapid deployment units has proven to be a very practical solution when public health events that require the urgent deployment of resources occur.” He further said that after installation, experts will train local staff in the use of the mobile unit.

The WHO representative in Uganda, Dr. Yonas Tegegn Woldemariam, said, “these mobile rapid deployment units will provide space for immediate critical care of patients with highly infectious diseases such as Cholera, Ebola and COVID-19 under strict control measures and can be deployed to any part of the country at short notice when required.”

Dr. Yonas explained that because of the portability of the containers, the mobile units can be deployed away from the main health facilities, so as not to interfere with the provision of existing essential services. The units can also provide additional space when existing bed space is over-saturated, serve as field laboratories or temperature-controlled storage units for essential medicines and vaccines.

Between May and July 2021, the country experienced a sharp increase in the number of cases, reaching the peak of the second wave of the COVID-19 pandemic. Soroti region continues to experience an increase in the number of COVID-19 cases and doubles as a hotspot for the transmission of the disease.

Therefore, Soroti Regional Referral Hospital will be the first beneficiaries of this highly effective infrastructure. When the targets in Soroti are reached, the facility will either be moved to another hotspot or stored for future use.

“We must always be on guard and take effective measures to avoid the resurgence of COVID-19 cases,” concluded Dr. Yonas.

Source: World Health Organization. Africa