March 9, 2012 Atmosphere of Success

We have now been around the block–er, world–enough times to see national vaccination systems across the spectrum of capability. Inevitably we start to compare what we see with what we have seen. I realize we have been in Benin for all of a week and our exposure has been extremely limited, but I am encouraged from what I have seen so far. Let me recount an exchange we had to support this opinion.

We were able to enjoy a relaxed workload for the first few days upon arrival. Our key contact, the WHO country manager in charge of childhood vaccinations, was stranded in Chad. As such, we were left to our own devices with the majority of our meetings pushed to the end of the week. This suited us just fine as we had a backlog of work that needed to get done. The accelerated nature of this project meant that we were still putting the finishing touches on the software translation and training materials.

Work has ramped up the past few days. We spent Thursday at the Ministry of Health providing a summary of the project to the Director General. She is already aware of the project and had already signed off. This meeting was as much to make introductions as anything else and to fine tune a couple of the project’s details. I provided a general overview of the project in French (my apologies to the Francophone world for what I did to your language). After I wrapped up, she only had two questions for me.

As background, I have sat through these meetings before. In fact, we do this in every country we visit. The results of these meetings are rarely positive. High-level policymakers are forced to sit through meetings where a couple of young Americans tell them how their vaccination systems can be improved. In most cases, these are the same policymakers who helped shepherd their health programs from coverage levels of 40% up to current levels of anywhere from 60%-90%. For the most part, they have done admirable work. So the only questions we usually get are to the tune of “Why are you here?” Which is why we were pleasantly surprised by the questions posed by the Director General in Benin.

Question the first: “When can we scale up?” For context, we are four days into a six-month project. We have not trained a single health worker. We have not scanned a single child’s fingerprints. And yet already, the Director General is thinking about how we can maximize the impact by moving from a small pilot project to a sub-national or national size. Here at VaxTrac, we probably consider ourselves big thinkers (we are out to revolutionize the international vaccine system, you know). And even we were thrown off for just a minute by the Director General’s ability to see the potential benefit and already start to move down the path of progress.

Question the second: “What assistance can we provide?” We do not ever work without government approval of our projects, which generally amounts to government officials not actively objecting to our work as long as we do not place any increased burden on their staff. Essentially, they will let us do what we need to do but that’s the extent of their involvement. To hear a high-ranking official offer us a blank check gave us pause a second time in as many minutes. We rattled off a few “would-be-nice-to-have”s and each duly got a response of “Done.”

I get the impression that the further we delve into the vaccination system of Benin, the more often we will find ourselves pleasantly surprised. Benin is still one of the poorest countries on Earth. Yet, they have one of the most admired vaccine track records among their peer nations. And even they would likely say that their vaccination system has room for improvement. It is this open-mindedness and the general willingness to collaborate and embrace innovative ideas that bodes well for further improvement.

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