RFP-4: Papua New Guinea

Better Use of Public Health Campaigns for Child Survival: The Impact and Operations of Papua New Guinea’s Supplementary Immunization Activity (SIA) 2003 – 2005

The Papua New Guinea Institute of Medical Research was awarded RFP-4 by OCHRC in April 2006 to evaluate the impact and operation of Papua New Guinea’s Supplementary Immunization Activity (SIA) 2003 - 2005. The implementing organizations were Papua New Guinea National Institute for Medical Research (PNG IMR), Macfarlane Burnet Institute for Medical Research and Public Health (Burnet) and the Centre for International Child Health, University of Melbourne.

Despite two rounds of National Immunization Days (NIDs) in 1997 and 1998, Papua New Guinea continued to experience measles epidemic throughout the country. Since 1998 there have been more than 30,000 cases and several thousand deaths, many in young infant and some in young adults. In 2003, the National Department of Health (NDOH) introduced Supplementary Immunization Activity (SIA) which aimed to deliver measles vaccines to all children aged six months to ten years, along with oral polio vaccine and vitamin A. It was conducted using flexible timing where each province worked district by district and determined its own timing, following the general national schedule. The national SIA was completed within two years between 2003 to early 2005. The reported coverage of measles Supplementary Immunization Activity (SIA) which included interventions beyond vaccination was high, suggesting a public health success that is unusual in recent history of Papua New Guinea and worth further study for this reason. Closer evaluation of the impact, operations and costs of the campaign are also of value to health planners in PNG to identify the best way to control measles in that country.

Therefore, this study was designed to evaluate the impact of both coverage and efficacy with attention to unreached populations, potential use of the PNG SIA model for other child health interventions, operational effectiveness, social mobilization, inter-sectoral collaboration and impact on other routine child health services.

The study findings encompassed the impact of SIA, potential use of SIA for other child public health intervention SIA operations, SIA’s impact on routine services, social mobilization and community engagement, and operational costs.

1. Impact of SIA: There had been a marked decline in measles cases and death, which can be partially attributed to SIA. Flexible timing and resources allowed good coverage and included previously unreached groups.
2. Potential use of SIA for other child health intervention: Many districts and health centres included DTP and tuberculosis vaccines especially for remote outreach. Interventions outside the routine MCH services such as insecticide-treated bed nets were not included. Despite the added workload of the staff it did not have any adverse effect on SIA activity.
3. Impact on routine services: Including additional interventions helped to better integrate the SIA more closely with routine services. In fact, there was some strengthening of routine services through SIA. The health providers reported that they benefited from a new understanding of respective catchment populations and gained skills for planning outreach.
4. Social mobilization and community engagement: There was significant but varied support from political institutions, businesses and the police in terms of raising awareness; less commonly, there was provision of transport or gifts-in-kind. The social mobilization part of SIA did not have a high level of central coordination and very little participation from other sectors in planning.
5. SIA operations: The SIA operation was implemented using a flexible schedule agreed upon by the districts rather than the central government. The flexible timing allowed each district an independent start date which helped in providing good coverage and logistic support, e.g. sharing of staff and vehicles. The SIA enabled coverage in communities that were not normally served by routine services. Transport was seen as the most major resource and logistical issue. The major constraints included insufficient number of staff members and the absence of roads in many areas where foot patrols were required to reach. There was also a need for ‘mop-up’ activities but due to insufficient allowance made during planning phase, only one out of four provinces was able to do it.
6. Operational cost: The cost of SIA was not more than NIDs but resulted in increased coverage and benefits.