In Africa, approximately 8.3 million infants each year do not receive the most basic vaccines.

According to the World Health Organization (WHO), one major reason for low immunization coverage in many developing countries is the lack of skilled health workers.

As a founding partner in the GAVI Alliance, a historic public-private partnership committed to increasing access to immunization in lowest-income countries, Merck responded to this public health challenge by launching a multiyear philanthropic initiative designed to help strengthen the capacity of Expanded Program on Immunization (EPI) health workers in sub-Saharan Africa.

Formally endorsed by the GAVI Alliance in 2003, the Merck Vaccine Network–Africa (MVN-A) supports collaborative partnerships in the development and implementation of sustainable EPI management training programs in Kenya, Uganda, Mali and Zambia. MVN-A also supports the achievement of the UN Millennium Development Goals, including reducing by two-thirds the mortality rate among children under five by 2015.

With $4.8 million in support from The Merck Company Foundation, collaborative partnerships established MVN-A training programs in Kenya, Mali, Uganda and Zambia. These MVN-A training programs provide mid- to high-level immunization program managers in these four countries with training in vaccine management and immunization services. Each MVN-A program is managed and administered by two primary institutions that have forged a broader collaborative partnership with ministries of health and education, nongovernmental organizations, medical and nursing schools, and multilateral organizations such as WHO and UNICEF:

• MVN-A Kenya: Indiana University School of Medicine (Indianapolis, Indiana, USA) and Moi University School of Medicine (Eldoret, Kenya)
• MVN-A Mali: Center for Vaccine Development at the University of Maryland School of Medicine (Baltimore, Maryland, USA) and Centre pour le Développement des Vaccins, Mali (Bamako, Mali)
• MVN-A Uganda: Task Force for Global Health (Decatur, Georgia, USA) and Makerere University School of Public Health (Kampala, Uganda)
• MVN-A Zambia: Brighton and Sussex University Hospitals NHS Trust (Brighton, England, UK) and University Teaching Hospital of the University of Zambia School of Medicine (Lusaka, Zambia)

Each MVN-A program has developed and continues to adapt customized training curriculums and methodologies to improve the capacity of EPI health workers and address evolving national immunization management needs. These tools are based on the findings of baseline training needs assessments in all four countries, which helped to identify specific gaps in the knowledge, skills and practice of EPI health workers, as well as inadequacies in reference materials, cold chain equipment and logistical resources.

MVN-A is helping the Republic of Mali and its people address this critical issue by building a skilled cadre of immunization managers. This partnership is a testament to how the public and private sectors can come together to help strengthen healthcare capacity and ensure the health of our nation's children.

Professor Abdel Kader Traoré, Ministry of Health, Republic of Mali

Health worker training initiatives in sub-Saharan Africa face numerous operational challenges, including maintaining, adapting and continuously improving training activities to address high staff turnover; internal health worker migration from low-population rural areas to high-population urban areas; and unforeseen events, such as natural disasters and political unrest that can lead to disease outbreaks.

For this reason, each MVN-A training program is fully integrated into the existing national healthcare infrastructure, ensuring complete alignment with the immunization priorities identified by the ministry of health and also with strategic policies and initiatives endorsed by regional and international stakeholders, such as WHO, UNICEF and the GAVI Alliance.

From 2003 to 2011, MVN-A programs in Kenya, Mali, Uganda and Zambia trained more than 1,600 Expanded Program on Immunization (EPI) health workers across all four countries. Trainees in each country have demonstrated significant improvement in perceived ability, competence, knowledge and skills in most targeted areas of EPI management. In addition, MVN-A graduates have returned to their home medical facilities to disseminate their expertise and knowledge to fellow health workers.

In all four countries, “training of trainers” sessions conducted by ministry of health and WHO EPI personnel enhanced the national training capacity of the MVN-A programs. The MVN-A programs have also found that, while cascade training appears to be an efficient way to reach several management levels, it requires extensive “training of trainers” and targeted follow-up to effectively reach EPI health workers at peripheral levels. Supervisory training can enhance the distribution of information to peripheral health centers. But the MVN-A training programs have concluded that, to maintain high immunization coverage, there is a need to significantly improve supportive supervision practices in each country and make public resources available to conduct more frequent, focused training of midlevel EPI managers to support evolving national immunization priorities.

As The Merck Company Foundation prepares to conclude funding support in 2012, MVN-A collaborators have advanced efforts to sustain their training programs in close partnership with key national stakeholders. Ministries of health remain highly committed partners in all four programs, having enlisted MVN-A graduates to conduct operational- level training (Kenya, Mali, Uganda), disease outbreak responses (Kenya, Uganda), mass immunization campaigns in camps of internally displaced persons (Kenya) and new vaccine introductions (Kenya, Mali and Zambia).