Evaluation of the CORE Group Polio Project_ 5.15.11_Perry

Evaluation of the CORE Group Polio Project

Presentation to the Global Health Council Annual Meeting

Henry Perry, MD, PhD, MPHDepartment of International Health

Johns Hopkins Bloomberg School of Public Health15 June 2011

Global Polio Eradication Initiative

Began in 1988

Project Background

Current USAID project cycle: October 2007 – September 2012

Donors:

1999 – September 2012

December 2008 - December 2013

Structure of the CGPP

CGPP Angola

CGPP Ethiopia

CGPP Uttar Pradesh, India

Southern Sudan

• Work has just commenced there with Gates Foundation support

Project Background

Increased routine vaccination rates

Increased/sustained participation in quality SIAs

Increased/sustained reporting of suspected AFP cases

OUTCOMESCommunity-based Social MobilizationDoor-to-door counseling + child trackingGroup education sessionsInfluencer involvementKey surveillance informantsOther Country-specific activities

Capacity-building for Local Health SystemsTraining opportunitiesTechnical assistance for microplanningChild tracking

Country-specific high-level contributionsCampaign quality monitoring – AngolaRegional advocacy workshops – EthiopiaSMNet partner - India

PROJECT ACTIVITIES

Community-based Human Resources

• Community-based workers are the basic “building blocks” of the CGPP

• In India they are paid full-time workers• In Angola and Ethiopia, they are volunteer

part-time workers

CORE Group Polio Project Expenses by Country, October 2007 – September 2010

(Headquarters and In-country Expenses Combined, US dollars)

Period India Angola Ethiopia Total

Total $4,842,765 $2,861,357 $1,824,276 $9,528,398Number of beneficiaries (children <15 years of age) 21.4 million 3.8 million 2.0 million 27.2 millionAverage annual cost per project beneficiary $0.08 $0.25 $0.30 $0.12

CGPP Volunteer/Worker ContactDOOR-TO-DOOR COUNSELING

*

* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.

CGPP Volunteer/Worker ContactGROUP EDUCATION SESSIONS

* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.

Immunization Coverage

• Levels of OPV coverage and coverage of routine immunizations are similar in the CGPP catchment areas to levels of coverage in lower-risk areas, and this is a major achievement considering that these areas contain the hardest-to-reach/hardly reached populations (because of their geographic isolation, mobility, or social resistance to polio immunization)

• These levels have remained the same or increased modestly since baseline

• There are still “hard core” pockets 5-10% of unreached children not participating in polio Supplemental Immunization Activities (SIAs)

Routine Immunization - Angola

* *

* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.

Routine Immunization - Ethiopia

* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.

OPV0 OPV0 OPV0OPV3 OPV3 OPV3Penta1 Penta1 Penta1 Penta3Penta3Penta3

* * ** ** ** *

Baseline n=883Midterm n=286

Baseline n=602Midterm n=281

Baseline n=593Midterm n=263

(based on card review only)

Routine Immunization - India

* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.

*

Supplementary Immunization Activities

* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.

* * * **

Acute Flaccid Paralysis Surveillance

* Represents statistically significant difference (at alpha = 5%) between baseline and midterm figures.

**

Complementary Activities Beginning in India (with Gates Foundation Support)

• Health camps• Attended by physicians, nurses and auxiliary

nurse midwives,• Provide immunizations, malaria prevention,

vitamin A supplementation, de-worming treatment .

• Demand is more for ‘routine’ primary health care, rather than such incentivized piecemeal services

Status in CORE Group Polio Project Countries

• Angola – 4 polio cases confirmed in 2011 so far (and 5 by this date in 2010, and 33 cases identified in the entire year of 2010)

• Ethiopia – No cases identified so far in 2011, in 2010, or 2009 (last case in the spring of 2008)

• India – No cases identified in Uttar Pradesh so far in 2011 (but 1 case from West Bengal), and 21 identified by this date in 2010 and 42 cases identified in the entire year of 2010

Conclusion

The CORE Group Polio Project is well-positioned to play an increasingly greater role in the Global Polio Eradication Initiative