Reflections on REACH [resources for child health] immunization program assistance to the former Soviet Union, 1992-1993

This contractor report reviews A.I.D."s response to the immunization crisis through the REACH (Resources for Child Health) Project, which has been implemented by John Snow Inc. since 3/92 in Kyrgyzstan, Turkmenistan, Tajikistan, and Uzbekistan; the PACR is 3/94. The report concludes that REACH prevented countless deaths and permanent disabilities of children due to disease through the provision of vaccine for the primary immunization of over 1 million beneficiaries, and of almost 1 million dollars in cold chain equipment. In addition, REACH provided a TA package (covering program planning, policy reform, vaccine procurement, training, cold chain repair and maintenance, and translation and adaptation of printed materials) which prevented the collapse of health services, which were on the verge of atrophy for want of commodities. REACH"s success may be attributed to its use of field assessments to make an appropriate response to the crisis; its focus on institution building as well as the emergency mitigation with commodities; its credibility (earned through the speedy provision of commodities) which allowed it to influence immunization policy; and its ability to continually prioritize its needs in anticipation of budget limitations. In addition, REACH successfully used technical experts in the field who were backstopped with technical and administrative support from Washington; exhibited procedural flexibility (e.g., the project formed direct links outside the bureaucratic structures, to coordinate with other donors); implemented a high-profile public relations campaign in Washington which gained political support for the project; and displayed an appreciation for the agendas of all project players, particularly potential funding sources.