supporting routine and supplementary immunization activities in stop
TRANSCRIPT
The Expanded Program on Immunizations – EPI
Supporting Routine AND Supplementary Immunization Activities in STOP
The “RE” –Emphasis on Routine2009 external evaluation of major
barriers to interrupting poliovirus transmission (WHO) RI is weak across re-infected countries leading to inability
to quickly control importation
Recommendations to WHO D.G. Systematic attention by the polio eradication programme
to strengthening RI systems Appropriate balance needed between SIAs and RI
services across endemic countries Coordination must be improved between partners to
ensure both RI and SIA are conducted optimally Capacity in social mobilization, planning, management
and monitoring should be strengthened
Note: routine strengthening assumes 2.5% annual improvement in routine immunization coverage until 95%
Constant routine
Strengthen routine only
Annual measles deaths
Strengthen routine + “catch-up” + “second opportunity”
“Catch-up” + Constant routine
Year
Together, Routine & Supplementary Activities Can Most Quickly Decrease Deaths
Key areas of RI + SIA overlapSocial mobilization activitiesPlanningTarget population identificationCold chainSurveillanceHuman resourcesVaccine safetyWaste managementManagement teams
Social mobilizationWhat you can do
Have campaign materials emphasize▪ Routine services protect against
other VPDs▪ Location of RI sessions▪ Routine vaccine schedule
When you can do it Training materials development Health worker training Campaign monitoring Meetings with community social mobilization
committees
Don’t forget to come back next month for
your routine immunization!
PlanningWhat you can do
Plan campaigns with minimal interruption to routine program
Ensure RI supervision checklists exist Check that microplans exist for SIA and RI Develop systems that benefit RI: update maps, …
When you can do it National level planning meetings Facility/district staff meetings Facility visits
Define targetsAreas of low coverage
High risk areas/popsAreas of continued disease transmission
Refer high risk/zero dose areas to RI for follow up
Look at this map with the high
risk areas in blue!
Target population identification
Communities
What you can do Check vaccination cards Check if health worker has given
messages on RI▪ Location of vaccination post▪ Reminder about next vaccine▪ Reminder about any missed vaccinations
When you can do it Campaign monitoring
I’ll take this opportunity to promote routine and
supplemental immunizations!
Cold chain
What you can do Check functioning of each
freezer & refrigerator Check that regular monitoring is
occurring Verify ice pack conditioning Report back to management
teamWhen you can do it
Campaign monitoring visits Health facility visits during
planning, training and surveillance visits
I’m taking note of your broken cold chain equipment. Let’s work with the district to
get this fixed!
Vaccine management
What you can do Check vaccine stock records Check condition of all vaccines
▪ VVM stage▪ Ensure HW knows how to interpret
Discuss numbers & stock with HW Report stockouts to district
When you can do it Health facility visits
Let’s talk about ways to improve stock
management to reduce vaccine wastage.
Surveillance system
What you can do Check awareness of health workers on
▪ How to handle suspected cases▪ What is reportable? Measles, AFP, …
Availability of case investigation forms/manuals
Functionality feedback loop from labs to facilities
When you can do it Health facility visits National lab visits Meetings with district officials
Health workers
Many RI health workers work in campaigns
What you can do Provide motivation in your interactions Train, supervise & discuss RI issues
Great work!
Vaccine safety and waste management
What you can do Check awareness of health workers on
▪ Proper vaccination techniques▪ Handling of AEFI
Availability of AEFI plans for all vaccines Availability and proper use of incinerators /
pits Check proper syringe disposal techniques
When you can do it Health facility visit Immunization sessions
What a brave boy you were! I need to put this used needle in the safety box.
Management teams = Decision makers for SIA + RI
In many locations District health management teams manage
SIA as well as RIConvey messages
High routine coverage lengthens the period between campaigns
Updates on weak areas which affect both activities▪ cold chain▪ target populations▪ surveillance
The maps do not include the
slum areas along the river.
We must update them!
Opportunities to emphasize RI
Social mobilization planning Emphasize routine messages
District level campaign planning Emphasize sharing of maps and action
plans
Campaign training Offer training in other aspects of EPI
Surveillance system interactions Lend support to surveillance of other
diseases
Opportunities to emphasize RI (cont)
National/District decision-maker meetings Report on problem areas Ensure emphasis on RI messages
Health facility visits Cold chain Vaccine management Health worker knowledge
Monitoring / Community visits Vaccination cards Awareness of RI
Practical reminders when giving RI messages
Ideally, EPI programmes include both RI and SIA activities
However, different partners may own different activities
Evaluate the country situation
Be in line with the in-country structure
Resources
STOP folder – 9 Opportunities to Enhance Synergy between Supplemental Immunization Activities and Routine Immunization Services
Local EPI Director & WHO office
http://www.who.int/health_topics/immunization/en
Immunization Essentials: a Practical Field Guide
STOP point of contact
Discussion Exercise: Identify ways in which STOP members can utilize SIA/Surveillance and Routine Immunization activities
1. Identify those of you with EPI experience in balancing RI & Polio/Measles
2. Quickly Match with 1 or 2 persons in the room with less/no experience
3. Spend 10 minutes discussing in group what you can do in polio/measles assignments to strengthen RI
4. We will review ideas as a group
Your Ideas for how to promote Routine EPI during your assignments