25 – Building resilience in fragile states

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This panel featured exceptional health and immunisation leaders from Afghanistan, Chad and Sierra Leone, as well as representatives from WHO, Medecins Sans Frontieres (MSF), Organization for Economic Cooperation and Development (OECD) and the GAVI Alliance Secretariat

Afghanistan_UNICEF_2007_Shehzad Noorani copyF

Copyright UNICEF/2007/Shehzad Nooran

Access to basic health services – including immunisation - can be at risk in countries that find themselves in protracted fragility situations. Whatever might be at the origin of the crisis, it is often the children and the most vulnerable segments of the population that suffer most. This raises not only equity concerns, but may also jeopardise achievement of the MDGs.

Moderated by Mukesh Kapila, this panel featured exceptional health and immunisation leaders from Afghanistan, Chad and Sierra Leone, as well as representatives from WHO, Medecins Sans Frontieres (MSF), Organization for Economic Cooperation and Development (OECD) and the GAVI Alliance Secretariat.

Powerful examples from the three country representatives illustrated that immunization can be successfully provided even under difficult circumstances.  “During very active conflict and fighting in Afghanistan, one of the few live saving services provided to children was immunisation” said Dr Suraya Dalil, Minister of Health in Afghanistan and GAVI Alliance Board member.

Sierra Leone elaborated on factors that contributed to the country managing to re-build its immunisation system after the end of the civil war in 2002.

Key component of success were investments in human resources, construction of health facilities to increase geographical access, and abolition of user fees. Investing in human capital and establishing safety nets for the most vulnerable were highlighted as key elements which - if put in place during ‘good times’ -  can help prevent interruptions to basic health services even during prolonged fragile situations.

Scaling up routine immunisation services with limited resources despite difficult circumstances is a priority for Chad.

Measures have been taken by the government to overcome hurdles in service delivery, including progressive increases in health and immunization budgets, enhanced use of local communities for immunisation activities, and application of innovative strategies to reach nomadic populations. “Sometimes, in order to jump better, you have to take a step back” explained Dr Mamouth Nahor N’gawara, Minister of Health in Chad.

Assessments of disease epidemiology and local contexts are crucial for MSF when deciding about the most appropriate immunisation strategy in support of a country. This may lead to targeting extended age groups or - if scientifically supported, the controlled use of cold chain – as the latter is often a bottleneck to reach the most vulnerable. 

Drawing from his extensive experience in fragile states, Mukesh Kapila confirmed that “It is in the middle of most chaotic circumstances that one needs to be coolest in order to come up with realistic needs assessments and evidence-based responses

The panel discussion and interventions from the audience clearly highlighted the need for tailored approaches that take account of the country context. GAVI’s new approach to fragility and immunisation which recognises this need was therefore very welcome. 

440 million

Since 2000, 440 million additional children have been immunised through GAVI support to routine immunisation in the world's poorest countries.

WHO-UNICEF 2013

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