Making the commitment for effective vaccine management

for children and mothers in Afghanistan

Dr Sanjay Bhardwaj
UNICEF Afghanistan/2019/Dejongh
13 February 2020

Where are we today?

Afghanistan has made tremendous progress towards reducing the under-five mortality rate, from 192 to 77 deaths per 1000 live births between 2001 and 2015. Most of the deaths in the first five years of life are preventable and provision of quality vaccines to all eligible children is one of the most cost-effective means for averting this preventable mortality. More than 50% of children aged 12-23 are not fully immunized and there are wide disparities across geographical regions.

Ministry of Public Health in Afghanistan is catering to more than 1.4 million children under the age of one year and 3.5 million women of child bearing age, with Expanded Programme on Immunization (EPI) vaccines, and almost 10 million children under the age of five with polio vaccine. These mothers and children are spread out in all 34 provinces across the country, in many cases challenged by protracted conflict, difficult geographic terrain, extreme weather conditions and poverty. UNICEF, with financial support of Gavi, the Vaccine Alliance and Government of Japan, is the sole provider of vaccines and cold chain equipment in Afghanistan.

Afghanistan is one of the only two polio endemic countries in the world. Although the country continues to report cases of polio, the programme has made progress towards interrupting wild polio virus transmission. Transmission is more geographically restricted than ever before. Currently polio is mainly limited to the Southern region (Kandahar Helmand and Urozgan provinces) and Eastern region (Kunar province) of the country, that form part of the northern and southern epidemiological block with neighbouring provinces of Pakistan.  Recent cases are geographically clustered in areas where insecurity and access continue to present challenges to reaching all children during campaigns.

UNICEF Afghanistan/2020
Effective Vaccine Management (EVM) Assessment was rolled out in collaboration with UNICEF, WHO and Ministry of Public Health Afghanistan on 2 February, 2020, Kabul, Afghanistan.

Why efficient vaccine management?

Only half of the eligible children under the age of one year are fully immunized in Afghanistan, yet the country has the best vaccine arrival procedure in the South Asian region.  It is therefore extremely important to ensure that good quality vaccines are available for all mothers and children across the country. Investment in a sustained, agile and efficient supply chain roadmap is crucial.

What is being done to guarantee that we reach every child and every mother?

To ensure the provision of quality vaccines to all eligible mothers and children in Afghanistan, Effective Vaccine Management (EVM) Assessment was rolled out in collaboration with WHO and Ministry of Public Health Afghanistan on 2 February.

EVM assessment is a WHO and UNICEF approved tool to systematically assess Immunization Supply Chain (ISC) at all levels. It covers all ISC elements including human resources and infrastructure, temperature and stock management and recording & reporting. The EVM assessment will cover national vaccine store, 33 regional and provincial stores and more than 30 health facilities.

A total of 45 participants from across Afghanistan were trained for five days and these trained assessors are visiting the assigned cold chain points to review the status of ISC at different levels. This provides a great opportunity to share the bottlenecks faced in the field, and collectively identify best possible solutions. The assessment was launched by high level delegation from Ministry of Public Health, WHO Afghanistan, UNICEF Afghanistan, Kathmandu and New York.

UNICEF Afghanistan/2019/Fazel

Making the commitment

Any immunization program can only be successful if right vaccine is delivered to right target population in right quantity and quality at right time and right place. The objective of EVM assessment is to identify best practices, issues and bottlenecks in cold chain and vaccine logistic management at national, regional, provincial and health facility level. Thereafter, a five-year comprehensive Improvement Plan (cIP) will be prepared for Afghanistan that will address the key issues pertaining to system design, human resources, cold chain equipment management, temperature management, distribution of vaccines and logistics and data management. The results will also be included in the five-year proposal for strengthening of immunization feed into the comprehensive Multi-Year Plan (cMYP) for Afghanistan (2020-24).