Paper Outline
Introduction
Governance roles and responsibilities
Background Information
Influenza
Transmission
Diagnosis
Treatment and prevention
Epidemiology
Influenza vaccination among children
Preparing a School Based Influenza Vaccination Program
Initiating the process
Liaising with the school
Objectives
Scope, Constraints and Assumptions
Work Breakdown Structure (WBS)
Timeline
Budget
Quality plan
Risk Management-Risk Assessment and Management Table
Assessment of the programme
Introduction
Influenza has been identified as one of the most common diseases affecting children. The symptoms for the disease include headache, fever, and pain in the body. Among the children victims, they may also experience nausea and vomiting. Influenza is associated with considerable illnesses among children (Neuzil, Hohlbein and Zhu, 2002). In Australia, influenza accounts for most of hospitalization for diseases that can be prevented through vaccination. It has been established that young individuals stand a high chance of contracting influenza compared to adults. Notably, about 70 per cent of the children contact influenza whenever there is a pandemic. Having noted that influenza incidences are high among children, children account for most of the transmission of the disease within the society. It has been estimated that about 1500 children in Australia are hospitalized every year due to influenza (Newell and Scuffham, 2008).
There are numerous ways in which influenza can be controlled among children. Nonetheless, vaccination of the children has been identified as the most effective way of managing the condition (Milne et al, 2004). The other ways of reducing the risk of contracting influenza involve maintaining personal hygiene and avoiding crowded places especially during the times when influenza is prevalent. Since it is difficult for children to observe hygiene and avoid crowded areas, vaccination remains the best option in reducing influenza incidences among children (Weycker et al, 2005). This paper presents a vaccination program that will be carried out among Australia’s school going children. The focus will be on the public schools within the Northern Territory State. The programme shall be developed right from the initiation phase to completion. The vaccination program is set to be implemented within a certain timeline and budget.
Governance roles and responsibilities
This vaccination programme has been sponsored by the World Health Organisation (WHO) in collaboration with the department of health in the Northern Territory State of Australia. Therefore, it can be asserted that the project owner is the World Health Organisation. This is because they are the main sponsors of the vaccination programme. The department of health in the Northern Territory State can be termed as the project sponsors. This is because the department is charged with the responsibility of ensuring that the vaccination programme is implemented within the state in an effective manner. The department forms the senior most management team of the programme. However, it should be clear that the department is managing the vaccination programme on behalf of the World Health Organisation.
I will be the project manager whereby I will be in charge of the actual implementation of the programme. In this regard, I will responsible for developing and maintaining the plan of the vaccination programme. I will also ensure the effective management of resources during the vaccination programme. Thus, I will oversee the implementation of the influenza vaccination in the Northern Territory State. There will be no line manager for the project. In stead, I will be reporting to the state department of health officials on the progress of the programme on a daily basis. The project team members will include twenty staffs and five registered nurses. The twenty individuals that will assist in the administration of the vaccine shall be divided into groups of fours. Each group will be led by a registered nurse for effective implementation of the vaccination programme. The registered nurses will be required to report to me as the project manager regarding the progress of the vaccination programme.
Background Information
Influenza
Influenza, also known as “the flu”, can be described as a chronic disease. In most instances, this condition affects the respiratory system. This disease has various symptoms including muscle pains, fever, and headaches among others. In most instances, influenza is often self-limiting. Nonetheless, this condition can lead to severe and life threatening illnesses that may require hospitalisation. Many people have confused influenza with other respiratory complications such as a bad cold (Neuzil, Dupont, Wright and Edwards, 2001). However, the two complications are distinctly different. The table below indicates the differences between influenza and cold:
Disease
Symptoms
Influenza
Cold
Time sick
At least a week
1 to 2 days
High fever
Common
Rare, usually mild fever if any
Muscular pains
Common
Rare
Shivering
Common
Rare
Running nose
Rare, usually dry sensation initially
Common
Influenza viruses include the orthomyxoviruses that are categorised based on the antigens as A, B and C. The most common form of influenza is A. This form of influenza is closely related to the chronic forms of the disease and it occurs in large waves. On the other hand, influenza B occurs in small outbreaks. There are virus strains that have been observed in the influenza causing pathogens. There are two types of proteins found on the viruses that cause influenza. These proteins are often referred to as the haemagglutinin (H) and neuraminidase (N) antigens. The proteins get altered to form new strains through a procedure known as “antigenic drift”. When there is a significant alteration in the arrangement of the disease causing pathogen, this is called “antigenic shift”. There are two forms of influenza A that are currently in circulation around the world. These include the A(H1N1) and A(H3N2). It has been noted that those at a great risk of influenza include those who have pre-existing medical conditions like heart disease among others. Nonetheless, incidences of severe complications from influenza have been reported among healthy individuals. Pneumonia and myocarditis have been known to emanate from influenza infection (Treanor, 2010).
Transmission
Influenza is an airborne disease. In this case, sneezing and coughing are the main ways in which the disease is transmitted. It can be argued that influenza viruses are spread through droplets that can be found on surfaces. This allows the condition to be passed from one person to another. Notably, those individuals suffering from influenza are said to be infectious. This starts from a day before they show any symptom. They may also continue to be infectious for several days once the symptoms show up. However, the infectiousness of these individuals diminishes as time lapses. It has been noted that influenza is quite common among children where between 10 and 40 per cent get infected annually. Also, about one per cent of the infected children end up being hospitalised (Treanor, 2010).
Diagnosis
Diagnosis of influenza is done through collecting a nose or throat swab, or collecting blood samples for analysis. When the throat or nose approach is used, the test should be done within a span of three days after the symptoms are exhibited. These tests are normally carried out in a hospital setting on individuals who are suspected to be suffering from the condition.
Treatment and prevention
In most instances, treatment involves bed rest, high fluid intake, and use of pain relieving medicine like aspirin. The use of anti-viral medication can also be adopted. This assists in reducing the harshness and time taken for the signs of the condition to cease. However, the antiviral medication should be administered within 48 hours after the symptoms are exhibited (Treanor, 2010). Influenza can be prevented through two ways. The first one is through prevention of contact with the infected person. The other way is through vaccination. Vaccination has been identified as the best strategy to prevent influenza infection. This is especially among the children who may find it difficult to observe the stringent measures in an effort to prevent the contraction of the disease.
Epidemiology
Influenza is a seasonal illness that occurs during the cold weather conditions. In Australia, the condition is prevalent during the winter period. The condition is accountable for over eighty deaths and about four thousand hospitalisation in Australia every year. These figures are conservative as the influenza cases are likely to surpass the estimates. Historically, there have been various influenza outbreaks. These historical influenza outbreaks led to disastrous outcomes where high mortality was reported (Block, 2004).
Influenza vaccination among children
It is recommended that influenza vaccination should be carried out among individuals who are at least six months old. This is important since it leads to a reduction in the chance of these individuals contracting influenza. For children who are ≥6 months old, it is advisable for them to be vaccinated each year. This is for as long as they do not have a medical contraindication to the immunisation. For children who are ≤9 years of age, and have never received the influenza vaccine before, the immunisation should be administered in double dosage. The administration of the dosage should be done within a span of four weeks. For children who are between more than six months and three years of age, a reduced dosage of the vaccine is administered compared to that administered to grown-up children and grown-ups. The common influenza vaccines should not be used in the immunisation of children who are <6 months. These include the Fluvax and Fluvax Junior (CSL) vaccines. Notably, children should be immunised using the seasonal influenza vaccine that is suitable for their age (Leeb, et al, 2011).
Influenza vaccination should not be carried out among children who are <6 months of age. Also, vaccination should not be carried out among children who had experienced anaphylaxis when an influenza vaccine was administered in the past (Vynnycky et al, 2008). There are some vaccines that must not be administered to children who are between six months and less than five years old. Such vaccines include the 2011 Fluvax. This is because this vaccine is not appropriate for this age group. The split virion and subunit vaccines are commonly used. These vaccines are derived from embryonated hens’ eggs. The vaccines may have bits of egg proteins. Most influenza vaccines comprise some elements of antibiotics. In most instances, influenza vaccines have the various strains of the virus (Bridges, et al, 2008).
Preparing a School Based Influenza Vaccination Program
Initiating the process
This is a critical stage for any program that is to be implemented. Having realised that influenza is a very common disease among Australian children; a vaccination program should be initiated to address the issue. In this respect, there are various elements that should be observed. The first one is the clarification of the purpose and justification of the vaccination programme. Secondly, the needs of the stakeholders should be analysed. It is also important to determine the broad scope of the vaccination programme. Establishment of clear and shared project objectives is also critical. In addition, the governance structures for the vaccination program have to be established. All these aspects have to be documented as a project proposal (Thomas, 2001).
In respect to the purpose and justification of the vaccination programme, it is important for the two aspects to be clearly outlined. This is important to ensure that the time, cost and quality of the programme are not compromised. Influenza has been identified as one of the most common ailments affecting children. This is the case all over the world including Australia. Since vaccination has been identified as the most appropriate method of managing the condition, the program should be carried out in Australian schools. The reasons for carrying out the influenza vaccination programme are varied. It has been noted that influenza causes serious illnesses such as pneumonia. In some incidences, these illnesses may require hospitalisation or lead to death of the victims in worst scenarios. Although influenza is common among individuals with pre-existing medical conditions, healthy people are not immune to this condition. Therefore, vaccination stands out as the best method in protecting individuals against influenza especially among children. According to research, there are new strains of the disease that are emerging. Therefore, vaccination should be carried out frequently. This will ensure that individuals are continuously protected from influenza (Newell and Scuffham, 2008).
Influenza vaccinations are recommended for children aged between 6 months and 18 years. This includes school-aged children and the vaccination program can be essential in helping to reduce the rate of absenteeism among school-going children. It has been identified that school-based vaccination programs are the best in achieving established immunization goals and objectives. Such programmes have been identified as the most practical and effective (Cawley, Hull and Rousculp, 2010).
Liaising with the school
The principals of slightly over 150 primary schools the Northern Territory State, who will participate in the vaccination program, shall be contacted. This will be done before the start of the new academic year in order to discuss the implementation of the program in the next year. The vaccination program is set to start in the month of February after the schools open for the new academic year. The vaccination program is scheduled to run for four months. The vaccine will be administered in the evening after classes to avoid interfering with the usual school program, and will last for a quarter an hour.
Objectives
The objectives of this vaccination program include the following:
Ensure that school going children between the age of nine and fifteen are immunised against influenza.
Sensitise parents on the importance of vaccination against influenza.
Establish a close working relationship among the various stakeholders in promoting child health.
Scope, Constraints and Assumptions
PROJECT SCOPE
Within Scope
Administration of the influenza vaccine among public primary school children in the Northern Territory State of Australia.
Sensitising parents and teachers on the importance of influenza vaccination within the Northern Territory State of Australia.
Outside Scope
To ensure that all children are vaccinated against influenza in Australia.
To ensure that the whole of the Australian society is a ware of the importance of Vaccination against influenza.
Constraints
Lack of effective cooperation from disgruntled principals who saw the exercise as interfering with the school programmes.
Ignorant parents and guardians refusing to give consent for vaccination to be carried out on their children.
Lack of enough resources to traverse the whole Northern Territory State while implementing the influenza vaccination. Limited resources meant that few staffs were going to be employed in carrying out the programme.
Assumptions
The programme will be appreciated by the stakeholders involved and be spread to other parts of the country.
Work Breakdown Structure (WBS)
A work breakdown structure can be described as a chart that is critical during the brainstorming of activities that will have to be accomplished (Turner, 1999). This tool is critical in developing estimations, assigning the staffs, tracking of the programme’s progression, and showing the scope of the programme. In essence, this tool is critical in breaking the work into small tasks that can be managed effectively (Hartley, 2003). For the influenza vaccination programme, the work breakdown structure will appear as shown below:
Timeline
This vaccination program is set to take a period of four months. Therefore, the vaccination program will begin in February of 2013 and end in May 2013. In the first month, training for those who will facilitate the programme shall be conducted. This will ensure that the facilitators are a ware of the vaccination programme in a comprehensive manner. In the second month, the project manager will identify children who qualify to be vaccinated during the programme. In addition, the consent forms shall be distributed to students who are qualified for the vaccination. These forms will be required to be filled and signed by the parents or legal guardians on behalf of the children. This is because the vaccination programme will target children who are not adults to consent by themselves. Nonetheless, the vaccination programme shall be explained to the children.
In the third month, the consent forms shall be collected and children who have been approved to partake in the programme identified. In addition, the process will be explained to the children. Also, the programme will be initiated during the third month. This will see the administration of the influenza vaccination to children who are between nine and fifteen years old. In the fourth month, the evaluation of the programme shall be carried out to ascertain its effectiveness. This will include reports on health of the vaccinated children regarding influenza. The success of the programme shall be determined by the improved health condition of the children in respect to influenza. It is expected that the children will have very few incidences of influenza after vaccination.The timeline of the whole process can be summarised in the following Ganttchart:
Event
Training of facilitators
Identification of the participants
Implementation of the programme
Evaluation of the programme
February
March
April
May
Budget
This program is estimated to cost about $ 100,000. This is because of the activities involved and the incorporation of other people who will assist in carrying out the programme. Although the vaccine is going to be provided by the state department of health, the manpower required for the delivery of the vaccination programme shall be hired. There are other aspects such as transport costs that will also have to be addressed. During the training, the workforce for the project will be paid an allowance of fifty dollars per day for two weeks excluding the weekends. In this case, the allowance shall be paid for ten days. There will be twenty people who will be employed to help in the facilitation of the vaccination of the programme. They will be divided in groups of fours. Each group will be led by a registered nurse who will also be on the payroll. Therefore, the vaccination programme shall have five registered nurses for the programme. Food, accommodation, and transport costs shall also be catered for through the programme’s budget. Also, the refrigeration facilities for the vaccine shall be hired. As the programme manager, I will also be entitled to remuneration for the implementation of the project. The budget for the whole vaccination programme can be summarised as follows:
Influenza Vaccination Budget for the Northern Territory State
Item
Rate in $
Cost in $
Transport cost and refrigeration hire
—
10,000
Training allowances for 20 facilitators
500
10,000
Salary for 20 facilitators for four months
2,000
40,000
Refrigeration and storage for the vaccine
—
10,000
Salaries for 5 registered nurses for four months
3000
15,000
Food and accommodation for four months
—
8,000
Salary for the project manager for four months
—
4,000
TOTAL
97,000
Quality plan
There is a need to ensure that the vaccination programme achieves the established objectives in an effective manner. In this respect, the vaccination programme has ensured that registered nurses are recruited to head the five groups that are to participate in the implementation of the programme. The individuals who have been hired to implement the vaccination programme will need to have a clinical background. In addition, these individuals will undergo rigorous training on how to carry out the immunisation programme. In this respect, the focus will be on how to administer the vaccine to the children. Each group will be headed by a registered nurse who will facilitate the vaccination programme. The Northern Territory department officials will be consulted on matters that are beyond our comprehension regarding the influenza incidences in the area. This will be critical as it will give an indication on the gravity of the situation in the Northern Territory State.
Also, an effective vaccine management is necessary to enhance the quality plan for the programme. This vaccination programme aims at immunising five thousand children between the ages of 9 and 15 in the Northern Territory State. Therefore, enough equipment will be ordered in advance before the programme begins. The supply of the vaccine will be facilitated by the National Immunisation Programme Schedule in conjunction with the World Health Organisation. The vaccines shall be stored in respect to the guidelines outlined by the National Vaccine Storage guidelines. These guidelines call for safe temperatures while transporting and storing vaccines. The temperatures suggested are in the range between +2 and +8oc. The significant range of in the provision for temperature guidelines ensures that the vaccinations are not destroyed due to variations in temperature. These are some of the measures adopted to ensure that the influenza vaccination programme is a success story.
Risk Management – Risk Assessment and Management Table
Risks are defined as the potential setbacks that are likely to affect the implementation of the programme. These are aspects that cannot be controlled by the team working on the programme. Therefore, it is important to anticipate risks that are likely to affect the implementation of the project. This will ensure that plans are established to address the anticipated risks (Greer, 2001). In the implementation of the influenza vaccination programme within the Northern Territory State, there are several risks that were identified. The first risk that can affect the programme is the lack of cooperation from some principals and parents. To address this risk, awareness campaigns will be carried out emphasizing on the importance of influenza vaccination. The other risk is the time factor. In this respect, the implementation of the programme is likely to extend past the scheduled date. It will be necessary to stick to the strict deadlines provided in order to avoid the chances of this risk occurring.
The other risk that is likely to occur is in respect to the cost of the project. There is a likelihood of the vaccination programme exceeding the budget. This is particularly if the programme will be extended beyond the scheduled timeframe. In this respect, there is a need to ensure that strict timelines are observed to prevent the budget from blowing out. In addition, budget overflow can be necessitated by unplanned spending. Therefore, it is important to operate within the budget as planned. Another risk that is likely to affect the implementation of the programme is a delay in resource allocation. Since the programme is sponsored by the World Health Organisation, the funds are likely to be delayed due to the bureaucracy involved. This way, the whole programme will be delayed. Early planning for the vaccination programme is necessary to limit the occurrence of such a risk. Since the funds are scheduled for release in December of this year, it is necessary to provide enough time before the programmed is rolled out. This will allow for any delays in the disbursements of the funds to be addressed before the commencement of the vaccination programme.The risk management table for the implementation of the vaccination can be represented as shown below:
Risk
Level
Management Strategy
Lack of cooperation
Low
Carrying out awareness campaigns.
Time
Medium
Sticking to the strict deadline schedules.
Budget
Medium
Sticking with the deadlines.
Avoid spending on unnecessary aspects.
Resource allocation
Low
Plan in advance to allow ample time for the disbursements of funds.
Assessment of the programme
This vaccination programme is set to become a great success. The programme is expected to reach out to a substantial number of children who have been targeted. This is because the programme shall be carried out in schools that are attended by most of the children under the age bracket being targeted. The programme is expected to gain full cooperation from the stakeholders involved given that influenza incidences have been rampant in the recent past. Since the funds are being provided by the World Health Organisation (WHO), it is expected that the funds will be available on time for the implementation of this programme. This is because WHO has been greatly concerned with the spread of influenza across the world.
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