epi surveillance review tls 2015

Joint National/International Expanded
Programme on Immunization and
Vaccine-Preventable Disease
Surveillance Review
Democratic Republic of Timor-Leste, 1-13 March 2015

i

Joint National/International Expanded Programme on Immunization and Vaccine-Preventable Disease Surveillance Review, Democratic
Republic of Timor-Leste
© World Health Organization 2017
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Contents
Abbreviations and acronyms............................................................................................................................... v
1

Introduction .................................................................................................................................................... 1

2

Background ..................................................................................................................................................... 1

3

Objectives and methodology ................................................................................................................... 4
3.1 Objectives .............................................................................................................................................. 4
3.2 Methodology........................................................................................................................................ 5

4

Findings and recommendations .............................................................................................................. 5

4.1 Policies, strategies and service delivery ..................................................................................... 6
4.1.1

Major achievements and issues identified .........................................................................6

4.1.2

Recommendations.......................................................................................................................7

4.2 Immunization supply chain management................................................................................. 7
4.2.1

Major achievements and issues identified .........................................................................7

4.2.2

Recommendations.......................................................................................................................8

4.3 Programme monitoring and use of data ................................................................................... 8
4.3.1

Major achievements and issues identified .........................................................................8

4.3.2

Recommendations.................................................................................................................... 10

4.4 New vaccine introduction..............................................................................................................10
4.4.1

Major achievements and issues identified ...................................................................... 10

4.4.2

Recommendations.................................................................................................................... 10

4.5 Communication and social mobilization .................................................................................11
4.5.1

Major achievements and issues identified ...................................................................... 11

4.5.2

Recommendations.................................................................................................................... 11

4.6 VPD surveillance................................................................................................................................11
4.6.1

Major achievements and major issues identified ......................................................... 11

4.6.2

Recommendations.................................................................................................................... 14

4.7 Disease elimination and control .................................................................................................15
4.7.1

Polio eradication ....................................................................................................................... 15
4.7.1.1 Major achievements and major issues identified…………………………………………. 16
4.7.1.2 Recommendations………………………………………………………………………………………….17

4.7.2

Measles elimination and rubella/CRS control ................................................................ 17
4.7.2.1 Major achievements and major issues identified………………………….………………..18
4.7.2.2 Recommendations……………………………………………………………………….…………………19

4.7.3

Maternal and neonatal tetanus elimination ................................................................... 19
4.7.3.1 Major achievements and major issues identified…………………………………….……..19
4.7.3.2 Recommendations……………………………………………………………………….…………………21

4.8 Healthcare system

.............................................................................................22

4.8.1

Major achievements and issues identified ...................................................................... 23

4.8.2

Recommendations.................................................................................................................... 24
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5

References .....................................................................................................................................................26

6

Annexes ..........................................................................................................................................................27
6.1 Participants and team members .................................................................................................27
6.2 Team members and sites visited ................................................................................................29
6.3 List of background documents reviewed ................................................................................32
6.4 Municipal reports .............................................................................................................................34

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Abbreviations and acronyms
AEFI

adverse events following immunization

ANC

antenatal care

AFP

acute flaccid paralysis

BCG

Bacillus Calmette-Guerin (tuberculosis) vaccine

bOPV

bivalent OPV

BSP

package of basic services

CHC

community health centre

CRS

congenital rubella syndrome

cVDPV

circulating vaccine-derived poliovirus

DHIS

District Health Information Software

DHS

Demographic and Health Survey

DPHO

district public health office

DT

diphtheria tetanus toxoids, paediatric formulation

DTP

diphtheria-tetanus toxoids and pertussis vaccine

DTP1

first dose of DTP

DTP3

third dose of DTP

DHO

district health office

EPI

Expanded Programme on Immunization

EVM

effective vaccine management

FHR

family health register

GVAP

Global Vaccine Action Plan

HDI

Human Development Index

HepB

hepatitis B vaccine

HSS

Healthy System Strengthening

Hib

Haemophilus influenzae type b
v

HMIS

Health Management Information System

HP

health post

IPV

inactivated polio vaccine

India

the Republic of India

Indonesia

the Republic of Indonesia

MCV1

the first dose of measles-containing vaccine

MHO

municipal health office

MNT

maternal and neonatal tetanus

MNTE

maternal and neonatal tetanus elimination

MoH

Ministry of Health

MPHO

municipal public health office

MR

measles-rubella vaccine

MR1

first dose of MR

MR2

second dose of MR

NCCPE

National Certification Committee for Polio Eradication

NT

neonatal tetanus

OPV

oral polio vaccine

OPV2

OPV type 2

OPV3

third dose of OPV

PHC

primary healthcare

PSF

promotor saude familiar (family health promoter)

PV

poliovirus

RCCPE

Regional Certification Commission for Polio Eradication

RI

routine immunization

SEAR

South-East Asia Region

SEARO

(WHO’s) Regional Office for South-East Asia

SIA

supplementary immunization activity
vi

SOPs

standard operating procedures

Td

tetanus and diphtheria vaccine, adult/adolescent formulation

tOPV

trivalent OPV

Timor-Leste

the Democratic Republic of Timor-Leste

TT

tetanus toxoid

TT2+

second and subsequent doses of tetanus toxoid

UNICEF

United Nations Children’s Fund

VAPP

vaccine-associated paralytic polio

VPD

vaccine-preventable disease

VVM

vaccine vial monitor

WHA

World Health Assembly

WHO

World Health Organization

WPV

wild poliovirus

WPV1

WPV type 1

WPV2

WPV type 2

WPV3

WPV type 3

WRA

women of reproductive age

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Acknowledgements
We would like to express our sincere gratitude and appreciation to Mr Jose dos Reis Magno,
General Director of the Ministry of Health of the Democratic Republic of Timor-Leste (MoH);
Mr Marcelo Amaral, National Director of the Directorate of Finance and Procurement
Management, MoH; Mr Carlitos Correia Freitas, National Director of the Public Health
Directorate, MoH; Dr Inesh Teodora Almeida da Silva, Director of Services of Diseases
Control, MoH; Ms Isabel Maria Gomes, Director of Services of Community Health, MoH; and
Dr Virna Martins Sam, President of the National Certification Committee for Polio Eradication.
We would also like to thank Dr Rajesh Panav, Representative of the World Health
Organization (WHO) in the Democratic Republic of Timor-Leste; Ms Desiree M. Jongsma,
Representative of the United Nations Children’s Fund (UNICEF) in the Democratic Republic of
Timor-Leste; and Dr Teodulo Clemente de J. Ximenes of the United States Agency for
International Development.
Our special thanks go to the Maternal and Child Health and the Surveillance Departments of
the MoH, and to the WHO and UNICEF teams for their continuous contributions throughout
the review.

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1

Introduction
The Sixty-fifth World Health Assembly in May 2012 endorsed The Global Vaccine
Action Plan (GVAP) based on an extensive consultation with countries and multiple
stakeholders. In addition to articulating a global vision for immunization and outlining
key strategies, the GVAP proposes five key goals for the Decade of Vaccines (2011–
2020): (1) to achieve a world free of polio; (2) to meet vaccination coverage targets; (3)
to reduce child mortality; (4) to meet global and regional elimination targets; and (5)
to develop and introduce new vaccines. Each Regional Member State is expected to
further define specific targets and develop and implement action plans to advance
the global goals. Through the Regional strategic plan and other initiatives, the World
Health Organization’s (WHO’s) Regional Office for South-East Asia (SEARO) has
identified specific targets for its Member States. Due to the commitment of national
Expanded Programmes on Immunization (EPIs) and multiple partners, the Region has
made significant progress towards achieving these goals, as exemplified by the
certification of the Region as polio-free in March 2014 and by setting the goal to
eliminate measles and control rubella and congenital rubella syndrome (CRS) by 2020.
In addition, all countries of the South-East Asia Region (SEAR) have certified validation
of maternal and neonatal tetanus elimination (MNTE) except the Republic of
Indonesia (Indonesia) and the Republic of India in which MNTE remains to be
validated in a few provinces or states. However, as noted in the GVAP, sustaining
these achievements and meeting the current global and Regional objectives and
targets will require committed country ownership, ensuring comprehensive and
equitable vaccination coverage, sustainable health systems, and innovation to address
new challenges as they arise.
Periodically reviewing how each country is meeting these requirements not only
provides insight into the status of the national immunization programme (NIP) , but
also allows best practices to be shared with other national EPIs . A comprehensive
review becomes even more important in the context of large migration and crossborder movements. The last joint national and international review of the Democratic
Republic of Timor-Leste’s (Timor-Leste’s) EPI by the MoH and WHO was conducted in
2008 with a follow-up review in 2010. The current review was conducted from 1–13
March 2015 and provided the opportunity to objectively assess the progress and
current status of the EPI and vaccine-preventable disease (VPD) surveillance
programme as well as to provide recommendations for addressing the challenges
faced in meeting national, Regional and global immunization goals and targets.

2.

Background
Timor-Leste is a country of 15 410 km2, with an estimated total population of
1 212 110 and 40 351 children aged