No. STUDY REPORT ON THE SUPPORTING PROJECT FOR EXPANDED PROGRAM ON IMMUNIZATION (GRANT AID FOR CHILD WELFARE) IN THE REPUBLIC OF GUINEA NOVEMBER 2000 JAPAN INTERNATIONAL COOPERATION AGENCY GR2 CR（1） 00－225 STUDY REPORT ON THE SUPPORTING PROJECT FOR EXPANDED PROGRAM ON IMMUNIZATION (GRANT AID FOR CHILD WELFARE) IN THE REPUBLIC OF GUINEA NOVEMBER 2000 JAPAN INTERNATIONAL COOPERATION AGENCY PREFACE In response to a request from the Government of the Republic of Guinea, the Government of Japan decided to conduct a study on the Grant Aid for Child Welfare, the Supporting Project for Expanded Program on Immunization and entrusted the Japan International Cooperation Agency (JICA) to conduct the study with the assistance of the Japan International Cooperation System (JICS). JICA sent to the Republic of Guinea a study team from July 15 to August 6, 2000. I hope that this report will contribute to the promotion of the project and to the enhancement of friendly relations between our two countries. I wish to express my sincere appreciation to the officials concerned of the Government of the Republic of Guinea for their close cooperation extended to the team. November 2000 Kunihiko Saito President Japan International Cooperation Agency RŽpublique Koundara de GuinŽe-Bissau Mali RŽpublique du Gaoual Mali Koubia Dinguiraye Siguiri Lelouma TouguŽ BokŽ Pita TŽlimŽlŽ Dabola Dalaba Kouroussa Mandiana Fria Boffa Mamou DubrŽka Faranah Kindia Kankan RŽpublique Coyah de C™te DÕlvoire Conakry ForŽcariah Kissidougou TŽlimŽlŽ RŽpublique de Sierra Leone GuŽkŽdou Beyla Macenta NzŽrŽkorŽ Lola RŽpublique du Yomou LibŽria Location Map Abbreviations PEV ：Expanded Program on Immunization (Programme Elargi de Vaccination) SSP ：Primary Health Care (Soins de SantŽ Primaires) ME ：Essential Drugs (MŽdicaments Essentiels) OAU ：Organization of African Unity ESPFIDC ：Equipment Supply Program for Infections Disease Control WHO ：World Health Organization UNICEF ：United Nations ChildrenÕs Fund GAVI ：Global Alliance for Vaccines and Immunization Contents Preface Location Map Abbreviations Chapter 1 Outline of the Project ..........................................................................................1 Chapter 2 Contents of the Project ........................................................................................2 2-1 Basic Concept of the Project................................................................................2 2-2 Basic Design of the Requested Japanese Assistance ............................................2 2-2-1 Design Policy......................................................................................................2 2-2-2 Basic Plan (Equipment Plan).............................................................................15 2-2-3 Implementation Schedule ..................................................................................18 2-3 Obligations of Recipient Country ......................................................................18 2-4 Project Operation Plan.......................................................................................19 2-4-1 Operation and Maintenance Cost.......................................................................19 Chapter 3 Project Evaluation and Recommendations.........................................................21 3-1 Project Effect ....................................................................................................21 3-2 Recommendations.............................................................................................21 [Appendices] 1. Member List of the Study Team 2. Study Schedule 3. List of Parties Concerned in the Recipient Country 4. Minutes of Discussions 5. References 6. Kerosene and Electronic Refrigerator Distribution Plan Chapter 1 Outline of the Project The Government of the Republic of Guinea requested the Government of Japan to provide the Grant Aid for procurement of vaccines for routine vaccination, cold chain equipment for cold storage of vaccines and vehicles for vaccine transportation. The items of the request are listed in Table 1-1 below. Table1-1 Requested Items Equipment Quantity 1. BCG vaccine（20 doses/vial） 99,000 vials 2. Polio vaccine（10 doses/vial） 132,000 vials 3. Measles vaccine（10 doses/vial） 526,000 vials 4. DTP (diphtheria- tetanus - pertussis) vaccine（10 doses/vial） 394,000 vials 5. Tetanus toxoid vaccine（10 doses/vial） 1,232,000 vials 6. Yellow fever vaccine（10 doses/vial） 132,000 vials 7. Auto-disable syringe 1,500,000 pieces 8. Safety box 60,000 boxes 9. Pre-fabricated type walk-in freezer（min. capacity of about 10m3） 1 unit 10 Pre-fabricated type walk-in refrigerator（min. capacity of about 20 m3） 1 unit 11. Generator 1 unit 12. Kerosene and electronic refrigerator 50 units 13. Ice-lined refrigerator 250 units 14. Icepack freezer 150 units 15. Vaccine cold box（capacity of about 20.7 liter） 300 units 16. Vaccine cold box（capacity of about 8.7 liter） 300 units 17. Vaccine carrier 500 units 18. Icepack 800 units 19. Spare parts for cold chain 1 set 20. Vehicle for surveillance 2 units 21. Vehicle for communication 5 units 22. Motorcycle 35 units 23. Cargo truck 1 unit 24. Vehicle for maintenance work 1 unit 25. Spare parts for vehicles 1 set －1－ Chapter 2 Contents of the Project 2-1 Basic Concept of the Project In 1998, the Republic of Guinea (hereinafter referred to as "Guinea") started the Expanded Program on Immunization (PEV) as one of the ÒExpanded Program on Immunization, Primary Health Care and Essential Drugs Projects (PEV/SSP/ME)Ó. After the start of the PEV Program, Guinea improved the immunized rate of children from 1 percent in 1986 to 70 percent in 1998 under the assistance of other donor countries, and could reduce the incidence rate of diseases such as measles, polio, tetanus neonatorum, pertussis, diphtheria and BCG, which could be prevented by vaccines. However, the immunized rate of children is still insufficient in Guinea (70 percent in 1999 for the goal of 80 percent) because ① 70 percent of all the vehicles for vaccine transportation is old, ② cold chain equipment is old and ③ access to the remote areas is difficult. In addition, reflecting the special recommendation aimed at eradication of polio in African countries that was adopted in the last conference of the heads of the states of the Organization of African Unity (OAU) held in YaoundŽ, Cameroon, the Government of Guinea decided it as the highest priority issue to promptly improve the rate of vaccination in order to eradicate polio by the next OAU conference in 2000. However, the polio eradication program has not made favorable progress because of shortage of financial sources to properly enforce the governmental decision. The Project is intended to procure vaccines, syringes for the vaccination, cold chain equipment and vehicles for vaccine transportation and for surveillance under the Japanese Grant Aid, in order to ensure the following goals in Guinea to be attained: ① Prevention of infections (to improve immunized rate of infants under 1 year old and women at childbearing age to prevent them from being infected with preventable diseases); ② Improvement of the vaccination system (to improve the vaccination system for effective implementation of vaccination in Guinea through renewal of refrigerating and freezing equipment in the target areas). 2-2 Basic Design of the Requested Japanese Assistance 2-2-1 Design Policy The Government of Guinea requested the Government of Japan for provision of vaccines in the Equipment Supply Program for Infections Disease Control (ESPFIDC). Prior to application for the ESPFIDC in the year of 2001, however, the Government of Guinea made the request for procurement of vaccines for use in multiple years with replacement of large quantity of cold chain equipment under the Project. For this request, the Government of －2－ Japan planned to procure vaccines instead of the ESPFIDC under the consideration that vaccines could be procured along with replacement of cold chain equipment. As the provision of vaccines should be examined on vaccination implemented in each full year, the Project will procure the required quantities of vaccines for 2001. For the polio vaccines that will be required in 2001 and other vaccines required in and after 2002, the advice of request for the ESPFIDC and assistance from other donors was recommended to the Government of Guinea. As to the cold chain equipment, the Project intends to replace the existing deteriorated equipment in accordance with the same specifications of the existing equipment. The design policy for each of the equipment will be described below. (1) Vaccines 1) Polio vaccine (OPV): WHO-UNICEF has been developing the Global Polio Eradication Initiative throughout the world, and the supply of this vaccine is quite tight. Thus, it is expected that there will be a difficulty in procuring the necessary quantity of this vaccine under the Japanese Grant Aid. As a result, the polio vaccine was excluded from this Project. 2) Yellow fever vaccine: The WHO study shows that there is no case of incidence of yellow fever since 1987 and the Global Alliance for Vaccines and Immunization (GAVI) plans to provide yellow fever vaccine in and after 2001. Thus, this item was excluded from the program to avoid the duplicate cooperation with GAVI. 3) BCG/Measles/DTP (diphtheria-tetanus-pertussis)/Tetanus toxoid vaccines: The request for the required quantities of these vaccines for three years was initially made, but the shelf life of these vaccines is about 2 years after the