strengthening routine infant immunization in emr partners for measles advocacy february, 2007...

Strengthening Routine Infant Immunization in EMRStrengthening Routine Infant Immunization in EMR

Partners for Measles AdvocacyPartners for Measles Advocacy

February, 2007February, 2007

Eastern Mediterranean Regional Office

Vaccines Preventable Diseases & Immunization

Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007

Trends in DTP3 and MCV1 Coverage in the Trends in DTP3 and MCV1 Coverage in the EMR, 1994-2003EMR, 1994-2003

20

40

60

80

100

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

Year

Per

cen

t co

vera

ge

DTP3/OPV3

Measles




Reported Routine Immunization Reported Routine Immunization Coverage, EMR0, 1994-2003Coverage, EMR0, 1994-2003

20

40

60

80

100

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Year

Per

cen

t co

vera

ge

DTP3/OPV3MeaslesHBV 3




Reported Infants Routine Immunization Coverage Reported Infants Routine Immunization Coverage (2003)(2003)

0

10

20

30

40

50

60

70

80

90

100

AFG

BAH DJ

I

EGY

IRA

IRQ

JOR

KWT

LEB

LIY

MOR

OMA

PAK

PAL

QAT

SAA

SOM

SUD

SYR

TUN

UAE

YEM

90%




Distribution of Unvaccinated Infants in EMR, 2003Distribution of Unvaccinated Infants in EMR, 2003

4.0%

50%7%

7%

9%9%

14%

PAK

IRQ

AFG

SOM

SUD

YEMOthers




• Insecurity (AFG, SOM, SUD, IRQ)• Poor management• Ongoing polio activities• Weak Health Systems

– Human resources– Logistics

• Financial resources ????

Key Constraints to Raising EPI CoverageKey Constraints to Raising EPI Coverage




REGIONAL PRIORITY 2003REGIONAL PRIORITY 2003Increase routine coverage in the 6 priority countriesIncrease routine coverage in the 6 priority countries

Capacity development• RED approach• Vaccine management• Financial sustainability planning

Targeted technical assistance • RWG-GAVI• SSAs & STPs

Monitoring– District-level coverage – Frequent country visits




Palestine

Bahrain

05/2001$7,255,000

02/2001$32,508,000

10/2001$8,968,500

05/2001$4,342,000

05/2002$3,393,500

05/2002$271,000

Immunization Services Strengthening




Reported Routine Immunization Reported Routine Immunization Coverage, EMR0, 1994-2005Coverage, EMR0, 1994-2005

20

40

60

80

100

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

Year

Perc

en

t co

vera

ge

DTP3/OPV3MeaslesHBV 3




Reported DPT3 Routine Immunization Coverage in Reported DPT3 Routine Immunization Coverage in Priority countries 2002-2005Priority countries 2002-2005

0

10

20

30

40

50

60

70

80

90

100

AFG DJI IRQ PAK SOM SUD YEM

2002 2003 2004



2005


Impact of RED on District Impact of RED on District Performance (2002-2005)Performance (2002-2005)



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2002

2005

2002

2005

2002

2005

2002

2005

2002

2005

2002

2005

2002

2005

AFG DJI IRQ PAK SUD YEM SOM

DPT3<50% 50<DPT3<79% DPT3>=80%

% o

f d

istr

icts

Program Management Reform Sudan (2001 – 2005)

1. Governance tools designed & strengthened;1. Strategic planning addressing all program components/ DC2. Effective coordination3. Knowledge & Information (strong database and M&E system)

2. Resource development;1. Capacity building (TOT training 100%, Refresher 70%, SOPs)2. Rehabilitation of the infrastructure (Cold chain,

communication & Transport > 2 million $)3. Mobilization of local resources (using GAVI money)

3. Service delivery;1. Addressing Access & Utilization issues (RED approach)2. Quality Immunization & safety issues3. Integration? (District Health System)

Components of RED in Sudan

1. Re-establishment of outreach vaccination…

2. Supportive supervision…

3. Link between community and service…

4. Monitoring for action…

5. Planning and management of resources…

Re-establishing Outreach Vaccination Services in Sudan

1153 1148

2059

31214048 3925240

205

410 828

10798650

1000

2000

3000

4000

5000

6000

7000

2002 2003 2004 2005

Fixed sites Outreaches Mobile units

Sustaining Outreach services…

– Deliver immunization services on basis of periodic contact to people with limited or no access

– Community participation is vital…

– Campaign and/or outreach depending on operational constraints like distance, population density and terrain.

Supportive supervision…

• Planned, joint activity…• On- site training…• Use DQS as a tool (2005)…• Performance was carefully

measured using quality indicators…

• Good performance was acknowledged and rewarded…

Link with community…

• Advocacy meetings to revitalize the political commitment/ ICC…

• Establishing EPI friends Associations in some states (NIDs’ volunteers)…

• Use existing community structure to trace & retrieve the defaulters…

• Use of polio campaigns to advocate for routine immunization/ IEC…

• Feedback to community (still Ad Hoc)…

Monitoring for action…Sudan

• Use maps, graphs and charts to;

– Map vaccination coverage and drop-out rates by health facility & each district…

– Follow trend of performance of each health facility & each district.

– Send regular feedback & feed forward…

Monitoring for action…2

• Conduct regular (monthly “State” and quarterly “Federal”) review meetings:

– Opportunity for on-site training…

– Problem solving…

– Feedback…

Planning and management of resources…1

Set up teams (Federal/ State/ Locality):

1. Technical support and need assessment…

2. Familiarization of participants on the RED approach and its implementation…

District planning workshops; the 5 steps were followed to develop the districts micro-plans…

Rational use of polio infrastructure/ experience…

The 5 steps:

Prioritization for implementation Prioritization for implementation

Operational considerations for implementation of RED approach:

• Effective and efficient logistics management which includes;

– Vaccine management

– Cold chain management

– Maintenance management for all equipments

Group (1): Good performing States, Group (1): Good performing States, Achievements 2002 - 2005 Achievements 2002 - 2005

8892 89 100

0102030405060708090

10081

86 86 85

0102030405060708090

10096 94 98 95

0102030405060708090

100

91 89 85 89

0102030405060708090

100

White Nile

85.7 8680

97

0102030405060708090

100

S. Kordofan

Blue NileGezira River Nile

100 98 100 97

0102030405060708090

100

Gedarif

Group (2): Medium Performing States, Group (2): Medium Performing States, Achievements 2002 – 2005…1 Achievements 2002 – 2005…1

NorthernW. Kordofan

Red SeaN. Kordofan Sennar

Kassala

54.4

9485

92

0102030405060708090

100

65

95 93 99

0

10

20

30

40

50

60

70

80

90

100

64.6

7584 84

0102030405060708090

100

41

8288

84

0102030405060708090

100

41

8288

84

0102030405060708090

100

68.173 76 81

0102030405060708090

100

Group (2): Medium Performing States, Group (2): Medium Performing States, Achievements 2002 – 2005…2 Achievements 2002 – 2005…2

N. Darfur

S. DarfurKhartoum

W. Darfur

44.5

55.463 65

0102030405060708090

100

36.3

45.451

61

0102030405060708090

100

50

8676

70

0102030405060708090

100

76

888177

0102030405060708090

100

Group (3): low performing States, Group (3): low performing States, Achievements 2002 - 2005 Achievements 2002 - 2005

Jongli

E. Equatoria

Upper Nile

Bahr Algabal

Unity

W. B. Gazal

45.5

7989

48

0102030405060708090

100

34

6768

44

0102030405060708090

100

34

726157

0102030405060708090

100

9

2721

9

0102030405060708090

10031

10080

50

0102030405060708090

100

2

54

25

3

0102030405060708090

100

0

14118

0102030405060708090

100

Upper Nile

Jongli

N. B. Gazal

EPI Performance Sudan, 2002- 2005

DTP3 in 2003DTP3 in 2002

DTP3 in 2004

> 80% 50 – 79% < 50%

DTP3 in 20050

20

40

60

80

100

2002

2003

2004

2005

OPV3 DPT3 BCG Measles

SummarySummaryStrengthening Routine EPI in the EMRStrengthening Routine EPI in the EMR

• Impact of GAVI input: – SUD, YEM & AFG ++++– PAK & DJI ++ – SOM & sSUD: ??




SummarySummaryStrengthening Routine EPI in the EMRStrengthening Routine EPI in the EMR

• Lessons learned – PAK:

• Channeling financial resources to operational level • Devolution• Rigidity in financial rules

– DJI: Human resources issue– SOM & sSUD:

• Insecurity• Poor coordination between partners

– ALL: • Health system barriers not/poorly addressed• End of 5 years ISS support +++






GIM Meeting, New York, USA, 13-15 February 2007

http://chicago.cubs.mlb.com/index.jsp?c_id=chc

strengthening routine infant immunization in emr partners for measles advocacy february, 2007...

Documents